Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. 105 patients aged 50 years or greater with a distal femoral fracture, presenting to four UK major trauma centres between October 2010 and September 2011 were identified. Data was collected using an adapted NHFD data collection tool via retrospective case note and radiograph review. Local ethics approval was obtained.Background
Methods
We wished to assess the feasibility of a future randomised controlled
trial of parathyroid hormone (PTH) supplements to aid healing of
trochanteric fractures of the hip, by an open label prospective
feasibility and pilot study with a nested qualitative sub study.
This aimed to inform the design of a future powered study comparing
the functional recovery after trochanteric hip fracture in patients
undergoing standard care, We undertook a pilot study comparing the functional recovery
after trochanteric hip fracture in patients 60 years or older, admitted
with a trochanteric hip fracture, and potentially eligible to be
randomised to either standard care or the administration of subcutaneous
PTH for six weeks. Our desired outcomes were functional testing
and measures to assess the feasibility and acceptability of the
study.Aims
Patients and Methods
Unstable bicondylar tibial plateau fractures
are rare and there is little guidance in the literature as to the
best form of treatment. We examined the short- to medium-term outcome
of this injury in a consecutive series of patients presenting to
two trauma centres. Between December 2005 and May 2010, a total
of 55 fractures in 54 patients were treated by fixation, 34 with
peri-articular locking plates and 21 with limited access direct
internal fixation in combination with circular external fixation
using a Taylor Spatial Frame (TSF). At a minimum of one year post-operatively,
patient-reported outcome measures including the WOMAC index and
SF-36 scores showed functional deficits, although there was no significant
difference between the two forms of treatment. Despite low outcome scores,
patients were generally satisfied with the outcome. We achieved
good clinical and radiological outcomes, with low rates of complication.
In total, only three patients (5%) had collapse of the joint of
>
4 mm, and metaphysis to diaphysis angulation of greater than 5º,
and five patients (9%) with displacement of >
4 mm. All patients
in our study went on to achieve full union. This study highlights the serious nature of this injury and generally
poor patient-reported outcome measures following surgery, despite
treatment by experienced surgeons using modern surgical techniques.
Our findings suggest that treatment of complex bicondylar tibial
plateau fractures with either a locking plate or a TSF gives similar
clinical and radiological outcomes. Cite this article:
Separation of the ACL into anteromedial (AM) and posterolateral (PL) fibre bundles has been widely accepted. The bundles act synergistically to restrain anterior laxity throughout knee flexion, with the PL bundle providing the more important restraint near extension and its obliquity better restraining tibial rotational laxity. 10% of ACL injuries involve isolated rupture to one of these bundles causing patients to present with instability symptoms or pain. As knowledge about the influence of the ACL bundles on knee kinematics has increased, isolated reconstruction of either PL or AM bundle has been advocated. However only one cohort study of 17 patients has been presented in the clinical literature. KOOS (Knee Injury and Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee Form) scores at 1yr post op were obtained for 12 patients who had undergone isolated ACL augmentation between 2007 and 2009. These were compared with previously published outcome scores for standard ACL reconstruction procedures. In addition examination under anaesthesia (EUA) assessments were analysed to see if a pattern of laxity for isolated AM and PL rupture could be determined. There were 5 patients with isolated AM bundle rupture and 7 with isolated PL bundle rupture. EUA analysis demonstrated that patients with isolated PL bundle rupture had increased pivot shift and Lachman test laxity, whereas the AM bundle rupture group had increased laxity with the anterior drawer test. Compared to previously published IKDC scores, there were no difference between isolated bundle augmentation and standard ACL reconstruction. However the KOOS scores showed significantly increased Sports function scores which was significantly better in the isolated bundle augmentations (93/100 v's 74/100). Differences between isolated AM and PL bundle reconstructions were not distinguishable. Isolated ACL bundle tears make up a significant proportion ACL injuries. Although technically more difficult than standard ACL reconstruction, isolated bundle augmentation appears to result in improved sports function when compared to standard ACL reconstruction.
