Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in-hospital mortality, in-hospital post-operative complications, length of stay and non-routine discharges. The purpose of this study was to retrospectively compare the complications associated with operatively treated ankle fractures in a group of patients with uncomplicated diabetes versus a group of patients with complicated diabetes. Complicated diabetes was defined as diabetes associated with end organ damage such as peripheral neuropathy, nephropathy and/or PAD. Uncomplicated diabetes was defined as diabetes without any of these associated conditions. Our hypothesis was that patients with uncomplicated diabetes would experience fewer complications than those patients with complicated diabetes.Background
Aim
Every trainee in Trauma and Orthopaedics (T&O) in the UK and Ireland records their operative experience via the Faculty of Health Informatics eLogbook. Since August 2009, all doctors were subject to the full European Working Time Directive (EWTD) restrictions of 48 hours of work per week. We have previously shown that the implementation of shift working patterns in some units in preparation for these restrictions reduced training opportunities by 50% (elective surgical exposure). We have now analysed the national data to establish whether operative experience has fallen since August 2009. All operative data recorded nationally by trainees (all years, all supervision levels) between the 3 months of August to October 2007, 2008 and 2009 were compared. Data were available for 1091 ‘validated’ training grade surgeons (ST3-8 or equivalent) in 2007, 1103 in 2008 and 767 in 2009. Mean operative figures were calculated per trainee for each of the 3-month time periods.Background
Methods
The UKITE was started nationally as a yearly, online, curriculum-based, self-assessment examination in 2007 for the orthopaedic trainees. It remains free if trainees contribute questions. The examination has matured, expanded its services and established over 3 years. The UKITE is funded by DePuy. The data for the last 3 years of UKITE examinations were collected and analysed using Microsoft Excel.Background
Methods
Despite evidence of long term survival of cemented femoral stem prostheses, studies have shown concerns in the longevity of the cemented sockets. This has led to a rise in the use of uncemented and hybrid implants (with uncemented cup and cemented stem) without long term studies to determine evidence for their use. We aimed to assess whether there is any difference in clinical outcome between cemented and non-cemented acetabular fixation in elderly patients. Between February 2001 and August 2006 186 patients over 72 years of age were prospectively randomised to receive either a cemented Exeter cup or a HA coated press fit cementless cup. Both groups received a cemented Exeter stem. The patients were assessed pre-operatively and reviewed at 6 weeks, 6 months and yearly in a research clinic, by an independent observer. Outcome measures were the Merle D'Aubigné, Postel, Oxford Hip and Visual analogue pain scores. The implants were also assessed radiographically and all complications were recorded.Introduction
Patients and Methods
Statement of clinical significance: Gait Analysis (GA) is a valuable technique for investigating functional limitations in children with gait abnormalities. Because GA generates such a large quantity of data, it could be more useful to have a single parameter derived from kinematic and kinetic GA data. For this reason, Schutte proposed the use of a global index (Normalcy Index – NI) that is derived from 16 selected gait variables and measures the distance between the patient’s gait data and that of a control population with no pathology. The first aim of this study is the classification of children with gait abnormalities such as “clumsy” children, idiopathic Toe-walkers and children affected by Cerebral Palsy using NI and the second aim is to verify the usefulness of the NI in the characterisation of these subjects’ gait. Material and methods: The GA trials were carried out at the “Gait Analysis Lab”, Children Hospital “V.Buzzi”, Milan, Italy by using an ELITE system (8 TVC working at 100 Hz) and two force platforms (Kistler, CH). 25 subjects with no known gait pathology (mean age 14, range: 7– 28 years) underwent GA and formed the group needed in order to define the parameters of normal gait. The subjects with gait abnormalities were 7 clumsy children (mean age: 7 years, range: 5-10 years), 17 idiopathic Toe-walkers (mean age: 6 years, range: 5-8 years) and 166 subjects affected by Cerebral Palsy (mean age: 10 years, range: 3-24 years) divided in two groups: Independent Walkers (33 hemiplegics, 106 diplegics and 7 quadriplegics) and Dependent Walkers (13 diplegics and 7 quadriplegics). The mean NI over the available trials was calculated for each subject. For all the subjects the left and right side NI values were pooled. Group means and standard errors were then calculated. Results: For clumsy children and for idiopathic Toe-walkers we obtained mean NI values higher than mean NI value found for healthy subjects, but they are smaller than the mean NI values calculated for subjects affected by Cerebral Palsy. Moreover for children affected by Cerebral palsy, we found that higher degrees of severity of CP induced impairment were associated with higher NI values, in accordance with the findings of Schutte et al. The division of the Cerebral Palsy subjects into Independent and Dependent Walkers shows that the use of aids results in a locomotor pattern that is totally incomparable with that of “normal gait”. Conclusions: The NI is easy to understand and to apply in order to summarize GA data. It is a useful element in the classification of the locomotor pattern of subjects with motor abnormalities. The NI is able to distinguish normal subjects from clumsy children and idiopathic Toe-walkers, patients with only minor abnormalities and by using NI it’s possible to classify different levels of functional impairments in group of subjects affected by Cerebral Palsy.
Results are given of a study of four cases of osteogenesis imperfecta using biophysical methods comprising microradiography, microscopy using polarised light, and x-ray diffraction. Rebuilding of bone tissue was infrequent in the material studied and has been shown to occur in an abnormal manner. The mineralisation of the bone is more uniform than is found in normal bone. The collagen has an abnormal organisation and is sparse. The ultrastructure of bone salts and their orientation are as in normal bone.
