The distal femur fracture is a difficult injury that affects young men andelderly women. The tissue stripping that occurs with the traditional approach has been a factor in the development of complications like infection and nonunion. This study addresses the issue of minimally invasive approach. Does the LISS system really improve the results of such fracture? Fifty-two patients were included in the trial from six academic trauma centres. Twenty-eight fractures had been randomised to be fixed with the LISS device, while twenty-four had the DCS implant. Type C3 fractures were excluded as they were not amenable for fixation with DCS system. All procedures were performed via minimally invasive technique. The LISS system had the targeter that helped with plate insertion and distal diaphyseal screws placement. Radiography was utilised in the case of the DCS distal screws insertion. All fractures went onto union, except two participants in LISS group who had to be revised due to loss of reduction, in the early post-operative peroid. There were three nonunions in the same group. These required a re-operation. Further more, a LISS participant who had re-injured his distal femur (unrelated to LISS plate), was fixed with different implant. There was a single nonunion with the DCS group that needed revision surgery. There was one participant from each group who had drifted into varus. Neither required a re-operation. This translated into a 21% re-operation rate in the LISS system compared to 4% with the DCS device. Our data supports the use of the DCS system in the fixation of distal femur fractures (except Type C3} via a minimally invasive approach. The LISS implant seems to be technique dependent. In our centre, the LISS plate had been discontinued in favour of the DCP and LCP systems.
The precise indications for tibial component metal backing and modularity remain controversial in routine primary total knee arthroplasty. This is particularly true in elderly patients where the perceived benefits of metal backing such as load redistribution and the reduction of polyethylene strain may be clinically less relevant. The cost implications for choosing a metal-backed design over an all-polyethylene design may exceed USD500 per primary knee arthroplasty case. A prospective randomised clinical trial was carried out at the QEII Health Sciences Centre, Halifax, Nova Scotia, to compare modular metal-backed versus an all-polyethylene tibial component. Outcome measures included clinical range of motion, radiographs, survivorship, Knee Society Clinical Rating System, WOMAC and SF-12.Introduction
Methods
Cement pressurisation in the distal humerus is technically difficult due to the anatomy of the humeral intramedullary (IM) cavity. Conventional cement restrictors often migrate proximally or leak, reducing the effect of pressurisation during implantation. Theoretically with a better cement bone interdigitation, the longevity of the elbow replacement can be improved. The aim of this cadaveric study was to evaluate the usefulness of a novel technique for cementation. Eight paired fresh frozen cadaveric elbows were randomly allocated to conventional cementing techniques or cementing using a paediatric foley catheter as a temporary restrictor. The traditional cementing technique consisted of canal preparation using irrigation, brushing and drying prior to cementation, with no use of a cement restrictor. The new technique involved same canal preparation but prior to cementation a size 8 foley catheter was introduced and the balloon inflated to act as a temporary cement restrictor. The humeri were cut into 10mm sections. Each slice was photographed and radiographed. This dual imaging technique was used to establish the best methodology for evaluation of cement penetration. Cement penetration was calculated as a ratio of the area of intra-medullary cavity occupied by the cement.Introduction
Method
To determine, in skeletally immature children with acceptably angulated (< = 15 degrees deformity at presentation) distal radius fractures, if a pre-fabricated wrist splint is at least as effective as a cast. A randomised controlled, non-inferiority, single blinded, single-centre trial was performed. The primary outcome was physical function at six weeks. Secondary outcomes included angulation, wrist range of motion, strength, pain, and patient preferences.Purpose
Methods
