Aim

We report the results of 60 patients who were assessed using the Oxford Hip Score following surgery for revision of ASL XL and ASR Resurfacing systems at our institution. We included preoperative metal ion levels, surgical approach, revision implant, and post op histology and complications to determine variables for improved outcomes.

Introduction

In this cohort study, the TightRope® fixation technique has been compared with the traditional screw fixation for ankle syndesmosis injuries, with respect to the accuracy of the syndesmotic reduction and their clinical correlation.

Aim: To compare the outcome of open reduction and internal fixation with MUA and k-wire stabilisation of dorsally displaced distal radial fractures

Methods: A review of patients that had ORIF or MUA and k-wire stabilisation for dorsally displaced distal radial fractures was carried out and patients with a follow period of more than 6 months were selected for this study. The patient history and the management of the injury were obtained and the wrist examined. Each patient completed a patient-rated wrist evaluation form and the range of movement and strength of the wrist was determined by the senior occupational therapist. Standard radiographs were obtained and volar tilt, radial inclination and radial length were measured.

Results: This study provides results on 24 patients, which were grouped according to the two different surgical procedures; ORIF and MUA and k-wire stabilisation. The procedure undertaken depended on consultant preferences and in the majority of cases patients were treated with MUA and k-wire stabilisation. Patients of both groups were of similar age and all sustained either a low or medium energy injury. All patients from each group received physiotherapy post operatively.

There was no significant difference between both groups for range of movement and grip strength. There was also no difference between the patient’s perception of pain and function which was assessed using the patient rated wrist evaluation (PRWE). Radiologically, the k-wire stabilisation group averaged better volar tilt compared with the ORIF group. For radial height and inclination the outcome was similar.

Conclusion: MUA and k-wire stabilisation has been the most popular surgical management for unstable dorsally displaced fractures of the distal radius. More recently ORIF with the locking compression plate has been used with good results. This study showed that the outcome of ORIF and MUA and k-wire stabilisation were similar and therefore either surgical management can be used with good results.

Introduction: Hip arthroplasty is growing in importance and relevance in the detection and treatment of various pathologies affecting the hip joint. A growing number of indications exist including the diagnosis and treatment of synovial-based disease, extraction of loose bodies within the joint, and treating chondral flaps and labral tears. Hip arthroplasty represents a minimally invasive, joint preserving, effective and reproducible tool to achieve these. The literature cites few complications arising from the procedure.

Study: Retrospective study of the outcomes of 20 patients who underwent hip arthroplasty between March 1999 and October 2002.

Methods: All the patients were first clinically assessed and then underwent Magnetic Resonance Imaging of their hips prior to undergoing arthroplasty. The indications for the MR arthrography included hip or groin pain, joint stiffness with associated impaired exercise tolerance. Arthroscopy was performed as a day case under general anaesthetic. The patients were placed supine on a fracture table and traction applied, under image control 30 and 70 degree arthoscopes were placed through an anterior and peritrochanteric portals. The patients followed up for an average of 20 months (6–44 months) and assessed for pain, mechanical symptoms, activity level, work status, sports ability and performance of activities of daily living. Data collected was retrospectively reviewed.

Results: The correlation between MR imaging and arthroscopy was approximately 80%. MR imaging detected all the labral tears present in 10 patients. This sensitivity was however reduced for the detection of small osteophytes (105), synovitis (5%), and minor labral radial fibrillation (5%). Four patients had loose bodies, which were successfully extracted. The patients whose symptoms were the result of mechanical pathology achieved complete resolution of their symptoms post operatively. No complications were seen.

Conclusion: Hip arthroplasty can be performed for a variety of conditions with reasonable expectations of success and minimal complication rate.

There have been multiple approaches described for internal fixation of acetabular fractures. We discuss the results of acetabular fractures treated in our institution via a Stoppa intrapelvic approach. Between July 1997 to October 2002, the senior author surgically treated 14 acetabular fractures using this approach. Indications for utilizing this approach include displaced anterior column fractures, transverse fractures, T shaped fractures, both column fractures and anterior column or wall fractures associated with a posterior hemi transverse component. The fractures were classified according to Letournel and Judet. There were 10 males, 4 females with a mean age of 34 years (20–57 years).

Patients were followed up for an average of 26 months (8–60 months). All fractures went on to union at an average of 12 weeks. There was one superficial wound infection, which was successfully treated with antibiotics. No patients suffered loss of fixation. There were no nerve or visceral injury in our series.

Clinical results evaluated were based on the Harris Hip Score (out of 100). Our results show 13 patients had good to excellent results (Score 80–100), whereas one patient had a fair result.

The Stoppa intrapelvic approach offers improved reduction and fixation techniques with a decrease in complications associated with extensile approaches.

Introduction: Conservative treatment of humeral diaphyseal fractures yields reliable union rates with satisfactory clinical outcome. The high incidence of shoulder complications following intramedullary fixation of humeral fractures has led clinicians to consider other less invasive treatment modalities. There is a growing body of evidence supporting the role of functional bracing in the conservative management of these fractures.

Aims: To compare the outcome of patients with humeral fractures treated non-operatively using functional bracing and those treated by internal fixation.

Methods: Retrospective clinical and radiographic study of two groups of patients with humeral diaphyseal fractures matched for age, sex and mechanism of injury. The study group consisted of 46 patients who had presented to our institution between January 1999 and July 2002 with closed diaphyseal humeral fractures. Mean follow-up was 21 months 96–42 months). Patients were assessed for pain, range of motion, return to work and sporting activities. Group 1 comprised of patients who underwent functional bracing whereas Group 2 underwent internal fixation. There were 12 males and 10 females in Group 1, with a mean age of 42 (16–75 years). Group 2 comprised 13 males and 11 females, with a mean age of 37 years (20–80 years). Fourteen patients were treated with antegrade locked intramedullary nailing, whereas 10 patients underwent plate osteosynthesis. All functional braces were specifically moulded and customised for each patient by the senior upper limb occupational therapist. Three patients were lost to follow-up (Group 2).

Results: All patients treated with functional bracing went on to union at an average of 13 weeks (10–18 weeks). There were no major complications in this group. Two patients had residual loss of shoulder range of motion. Two patients had radial nerve palsies at presentation, which recovered fully. Of the twenty-one patients treated operatively, four required further procedures. Three patients had removal of IM nails with ORIF and bone grafting. One patient went on to non-union following ORIF, and had subsequent bone grafting. Eight patients developed restricted shoulder function, four requiring manipulations under anaesthesia.

Conclusion: Functional bracing of humeral diaphyseal fractures is a safe, non-invasive treatment providing reliable outcome and high rates of union. In this retrospective study, we found the results following functional bracing to be superior to that following internal fixation. Close supervision and patient compliance with treatment and rehabilitation is empiric to a satisfactory outcome in these patients.

Introduction: Fractures of the distal radius are amongst the most commonly encountered injuries in orthopaedic trauma. Treatment options include closed manipulation, percutaneous fixing using K wires and external fixation. Restoration of the volar tilt and radial length are proven to have a positive correlation with a good functional outcome.

A randomised prospective study has been performed to compare the effectiveness of percutaneous stabilisation using K wires inserted in the traditional transcortical fashion with K wires inserted using a novel intramedullary spring loaded technique. The treatments were compared for their ability to restore normal anatomy, carpal alignment and function of the hand after unstable fractures of the distal radius.

Patients and Methods: Between October 2001 and February 2002, 46 patients with unstable fractures of the distal radius were entered into the study. There were 37 females and 9 males, mean age of 58 years (range 17–87). Fractures were classified using the AO system. Patients were randomly allocated using closed envelopes into one of two groups. All fractures were reduced, and three 1.6mm K wires were inserted using one of two techniques. Group I (24 pts) had the wires engaged into the opposite cortex and driven down the medullary canal (spring-loaded). All patients were followed up for a minimum of 6 weeks. Radiological and functional evaluation was performed.

Results: Immediate post operative radiographs showed a mean dorsal angle of –3° in Group I (ie 3 degrees volar tilt) and –7.5° in Group II. Restoration of radial length was similar in both groups. By 6 weeks, the mean dorsal angle for Group I was −1.9°, and –10.6° in Group II. The mean loss of radial length was similar in both groups (1.2mm in Group I; 1.3mm in Group II). Functional outcome was assessed using the Wrist Function Score², and was similar in both groups at 6 weeks. There were 2 early fixation failures, both in Group I, and both class C3 fractures (AO).

Conclusion: ‘Spring loaded’ percutaneous K wiring of distal radius fractures results a significantly superior restoration of volar tilt post operatively and at 6 weeks when compared against the transcortical technique. The ‘spring’ translates into a dynamic force reducing the fracture. We estimate that these radiological results will result in a superior functional outcome in the longer term.

The goal of treatment of an intra-articular fracture is anatomic restoration of normal anatomy and rigid internal fixation to allow for early motion. Weber Type ‘B’ ankle fractures (AO Type B and Lauge-Hansen supination-external rotation) are the most common ankle fractures that require internal fixation. Brunner and Weber first described the use of antiglide plate for treatment of these fractures in 1982. The aim of our study was to assess the functional and radiological outcomes of patients who underwent this procedure. This was a retrospective analysis of a consecutive series, reviewing patients over a ten year period, from 1990 to 1999, in a regional orthopaedic and trauma unit. There were 122 antiglide plate fixations performed in total over the period under review. Our group consisted of 64 patients who had an isolated closed lateral malleolor fracture, thereby excluding patients with open injuries and bimalleolar fractures. 6 patients were lost to follow-up. There were 25 males (age 19–64 years) and 31 females (age 13–62 years) with a mean age of 42 years. The patients were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Score and the average follow-up was 5.8 years. The implant used was a 3.5mm AO DCP applied along the posterior surface of the lateral malleolus. This was followed by early commencement of postoperative ankle and foot exercises, allowing toe touch weight bearing out of cast until union. Our results (AOFAS Score out of 100) show that 92% (52 patients) had good to excellent result (Score> 80) with only 8% (4 patients) had a satisfactory outcome. We recommend the use of an antiglide plate because of its biomechanical stability especially in osteoporotic bones which allows for early motion and the nearly nil incidence of implant removal.