The second wave of COVID-19 infections in 2021 resulting from the delta strain had a significantly larger impact on the state of New South Wales, Australia and with it the government implemented harsher restrictions. This retrospective cohort study aims to explore how the increased restrictions affected hand trauma presentations and their treatment. Retrospective analysis was performed on patients who underwent hand surgery from the period of June 23 – August 31 in 2020 and 2021 at a level one trauma centre in Western Sydney. During the second-wave lockdown there was an 18.9% decrease in all hand trauma presentations. Despite widespread restrictions placed on the manufacturing, wholesale, retail and construction industries, there was an insignificant difference in work injuries. Stay-at-home orders and reduced availability of professional tradespersons likely contributed to an increase in DIY injuries. Significant reductions in metacarpal and phalangeal fractures coincided with significantly curtailed sporting seasons. The findings from this study can assist in predicting the case-mix of hand trauma presentations and resource allocation in the setting of future waves of COVID-19 and other infectious diseases.
Controversy about the use of an anatomical total shoulder arthroplasty
(aTSA) in young arthritic patients relates to which is the ideal
form of fixation for the glenoid component: cemented or cementless.
This study aimed to evaluate implant survival of aTSA when used
in patients aged < 60 years with primary glenohumeral osteoarthritis (OA),
and to compare the survival of cemented all-polyethylene and cementless
metal-backed glenoid components. A total of 69 consecutive aTSAs were performed in 67 patients
aged < 60 years with primary glenohumeral OA. Their mean age
at the time of surgery was 54 years (35 to 60). Of these aTSAs,
46 were undertaken using a cemented polyethylene component and 23
were undertaken using a cementless metal-backed component. The age, gender,
preoperative function, mobility, premorbid glenoid erosion, and
length of follow-up were comparable in the two groups. The patients
were reviewed clinically and radiographically at a mean of 10.3
years (5 to 12, Aims
Materials and Methods
Patient-specific glenoid guides (PSGs) claim an improvement in
accuracy and reproducibility of the positioning of components in
total shoulder arthroplasty (TSA). The results have not yet been
confirmed in a prospective clinical trial. Our aim was to assess
whether the use of PSGs in patients with osteoarthritis of the shoulder
would allow accurate and reliable implantation of the glenoid component. A total of 17 patients (three men and 14 women) with a mean age
of 71 years (53 to 81) awaiting TSA were enrolled in the study.
Pre- and post-operative version and inclination of the glenoid were
measured on CT scans, using 3D planning automatic software. During
surgery, a congruent 3D-printed PSG was applied onto the glenoid
surface, thus determining the entry point and orientation of the
central guide wire used for reaming the glenoid and the introduction
of the component. Manual segmentation was performed on post-operative
CT scans to compare the planned and the actual position of the entry
point (mm) and orientation of the component (°).Aims
Patients and Methods
Böhler’s historical tuber-joint angle of the calcaneus has been used since 1931. Surprisingly, there is a paucity of literature on the topic. The aims of this study were to confirm the normal range for Böhler’s angle and determine the angle with the highest accuracy in the diagnosis of calcaneal fractures. A retrospective cohort study was performed. Data were obtained from The St George Hospital digital Picture Archival and Communication System (PACS) and through a review of medical records. The study cohort comprised 212 consecutive patients diagnosed with calcaneal fractures on CT scan, spanning a five-year period from April 2003 to March 2008. An additional 212 patients with normal lateral foot radiographs were used to determine the normal range. Böhler’s angle was measured by two independent observers on lateral xray using the digital angle tool from PACS. Data were analysed using Stata 8 statistical software package. This is the largest study to our knowledge that examines the diagnostic accuracy of Böhler’s angle in fractures of the calcaneus. Contrary to many texts but true to Böhler’s assertions, the mean Böhler’s angle in patients without calcaneal fracture was 29.4 degrees (95% CI, 28.9–30.0 degrees). In this group there was no difference in Böhler’s angle between male and female patients (p>
.05), left and right feet (p>
.05) or across age (ANOVA, p>
.05). In those patients with calcaneal fractures, a Böhler’s angle below 25 degrees was moderately predictive of calcaneal fracture (sensitivity = 100%, specificity = 82%, PPV = 85%, NPV = 100%, LR+ = 5), an angle below 23 degrees was highly predictive of calcaneal fracture (sensitivity = 100%, specificity = 89%, PPV = 90%, NPV = 100%, LR+ = 9) and an angle below 21 degrees was strongly suggestive of calcaneal fracture (sensitivity = 99%, specificity = 99%, PPV = 99%, NPV = 99%, LR+ = 110). A Böhler’s angle of less than or equal to 20 degrees had the highest diagnostic accuracy as there were only two false negatives and one false positive from a total of 424 patients. A Böhler’s angle of 20 degrees or less is highly accurate in determining the presence or absence of calcaneal fracture. These findings are of particular importance when fracture is uncertain as it gives the surgeon a definitive reference point when using Böhler’s angle for assessment of fracture of the calcaneus.
