Aim

The aim of this study was to compare outcomes between patients with diabetic foot soft-tissue infection and osteomyelitis.

Neurogenic heterotopic ossification (NHO) is a disorder of aberrant bone formation affecting one in five patients sustaining a spinal cord injury or traumatic brain injury. Ectopic bone forms around joints in characteristic patterns, causing pain and limiting movement especially around the hip and elbow. Clinical sequelae of neurogenic heterotopic ossification include urinary tract infection, pressure injuries, pneumonia and poor hygiene, making early diagnosis and treatment clinically compelling. However, diagnosis remains difficult with more investigation needed. Our pathophysiological understanding stems from mechanisms of basic bone formation enhanced by evidence of systemic influences from circulating humor factors and perhaps neurological ones. This increasing understanding guides our implementation of current prophylaxis and treatment including the use of non-steroidal anti-inflammatory drugs, bisphosphonates, radiation therapy and surgery and, importantly, should direct future, more effective ones.

Background: Complex fractures of the tibial plateau can be difficult to characterize on plain radiographs and two-dimensional computed tomography scans. We tested the hypothesis that three-dimensional computed tomography reconstructions improve the reliability of tibial plateau fracture characterization and classification.

Methods: Forty-five consecutive intra-articular fractures of the tibial plateau were evaluated by six independent observers for the presence of six fracture characteristics that are not specifically included in currently used classification schemes:

posteromedial shear fracture;

In addition, fractures were classified according to the AO/OTA Comprehensive Classification of Fractures, the Schatzker classification system and the Hohl and Moore system. Two rounds of evaluation were performed and then compared. First, a combination of plain radiographs and two-dimensional computed tomography scans (2D) were evaluated, and then, four weeks later, a combination of radiographs, two-dimensional computed tomography scans, and three-dimensional reconstructions of computed tomography scans (3D) were assessed.

Results: Interobserver agreement improved for all classification systems after the addition of three-dimensional reconstructions (AO/OTA κ2D = 0.536 versus κ3D = 0.545; Schatzker κ2D = 0.545 versus κ3D = 0.596; Hohl and Moore κ2D = 0.668 versus κ3D = 0.746).

Three-dimensional computed tomography reconstructions also improved the average intraobserver reliability for all fracture characteristics, from κ2D = 0.624 (substantial agreement) to κ3D = 0.687 (substantial agreement). The addition of three-dimensional images had limited infiuence on the average interobserver reliability for the recognition of specific fracture characteristics (κ2D = 0.488 versus κ3D = 0.485, both moderate agreement). Three-dimensional computed tomography images improved interobserver reliability for the recognition of coronal plane fractures from fair (κ2D = 0.398) to moderate (κ3D = 0.418) but this difference was not statistically significant.

Conclusions: Three-dimensional computed tomography is helpful for;

individual orthopaedic surgeons for preoperative planning (improves intraobserver reliability for the recognition of fracture characteristics), and for

Purpose: Although more than half of all medical graduates are now female, orthopaedics has experienced the least growth of all primary surgical fields in attracting female residency candidates. Our purpose was to identify ways to enhance female interest in orthopaedic surgery as a career.

Method: The effect of exposure on interest in orthopaedics was studied prospectively for two years. Enrollment data regarding student demographics, interest, and exposure to orthopaedic, general, or other surgical subspecialties was obtained from two medical schools. At 6 month intervals, students were offered electronically-based orthopaedic literature, elective lectures, and were resurveyed for exposure and interest level. Univariate analysis was performed between demographics, background, exposure variables and interest levels. Change in exposure was further analyzed against change in interest with a multivariate logistic regression model constructed using significant associations along with gender.

Results: 274 females and 73 male controls enrolled. Baseline increased interest in orthopaedics was correlated in a multivariate model with personal experiences as musculoskeletal patient and/or researcher, among others (p< 0.05). Interim enhanced exposure to orthopaedic web materials was significantly associated with increased interest, intent to enroll in an elective, and intent to apply for orthopaedics or sports medicine. Interestingly, no associations with other surgical specialties were found, and gender was not a significant independent determinant of interest and intent in this model.

Conclusion: This study demonstrates that interest among female medical students can be significantly increased by enhancing exposure to orthopaedic subject matter during medical school. Early exposure may prove a critical tool in recruiting more women into orthopaedic surgery, which will be necessary to meet the anticipated demands of the growing orthopaedic patient population.

Purpose: The purpose of this study was to evaluate clinical and radiological outcomes after cementless bipolar hemiar-throplasty in elderly patients with femoral neck fractures.

Materials and Methods: Eighty hips – all in patients greater than 70 years of age – were followed for more than 2 years after undergoing cementless bipolar hemi-arthroplasty with a tapered rectangular cementless stem (Lima SPH-C2^®). The mean age was 76 years, and the mean follow-up period was 37 months. The Harris hip score and postoperative hip pain were analyzed clinically. Femoral bone types were classified according to Dorr method. The radiological results were assessed using various radiological indices.

Results: At last follow-up, the mean Harris hip score was 80.2 points. There were 5 cases of groin pain, 4 (5.0%) mild and 1 (1.3%) moderate and 7 cases of thigh pain, 6 (7.5%) mild and 1 (1.3%) moderate. Fifty-five cases (68.7%) showed no decrease in ambulation capacity postoperatively. Patients have type A bone types in 13 cases(16.2%), type B in 51 cases(63.7%) and type C in 16 cases(20.0%). Radiologically, there were 47 cases (58.7%) of bone ingrowth and 33 cases (41.3%) of stable fibrous fixation. There were no cases of osteolysis, and 30 cases (37.5%) exhibited new bone formation around the stem. All stems were stable without significant alignment change or progressive subsidence.

Conclusion: Short-term outcomes proved to be satisfactory in elderly patients undergoing cementless bipolar hemiarthroplasty for femoral neck fractures. Tapered rectangular stem showed satisfactory results with all bone morphology.

We reviewed our experience with a modified triple innominate osteotomy for hip instability and limb shortening due to poliomyelitis in 62 adolescent and adult patients, treated from 1973 to 1990. Their ages at surgery ranged from 12 years to 35 years (average 22.3). At a mean follow-up of 4 years (2 to 18) 59 of the patients (95.2%) had substantial improvement in hip stability, and all but one had radiological improvement as determined by the acetabular angle, centre-edge angle and acetabulum-head quotient. In 59 cases in which transiliac limb lengthening was attempted, the mean gain was 1.7 cm (0.6 to 3.0). When the abductor muscles had been partially paralysed, the operation produced an appreciable increase in power in 12 of the 39 hips examined.

We report 60 patients with tuberculosis of the hip treated by Charnley low friction arthroplasty and followed for eight to 13 years. Eight of them had active tuberculosis of the hip at the time of operation, and all were covered by relatively short courses of antituberculous drugs. Our study suggests that arthroplasty can be recommended for these patients provided that adequate chemotherapy is given both before and after operation.