Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality.Aims
Methods
Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade.Aims
Methods
Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era. A multicentre observational study was carried out at 19 NHS Trusts in England. The study period for the data collection was 1 February 2021 until 28 February 2022, with mortality tracing until 28 March 2022. Data collection included demographic details, data points to calculate the Nottingham Hip Fracture Score, COVID-19 status, 30-day mortality, and vaccination status.Aims
Methods
It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site. The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian.Aims
Methods
Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined. This multicentre observational study included 1,633 patients who sustained a hip fracture across nine hospital trusts in North West England. Data were collected for three months from March 2020 and for the same period in 2019. Patients were matched by Nottingham Hip Fracture Score (NHFS), hospital, and fracture type. We looked at the mortality outcomes of COVID-19 positive and COVID-19 negative patients sustaining a hip fracture. We also looked to see if vitamin D levels had an impact on mortality.Aims
Methods
The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group. We prospectively studied 270 patients with primary hip osteo-arthritis who underwent a straight forward THR between February 2012 and September 2013. The first 70 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray before closure and the last 100 patients received 1g TA on induction. Demographic data, comorbidities, surgical time, surgeon grade, anaesthetic type, haemoglobin drop post-operative and transfusion requirements were analysed using one-way ANOVA. The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the 3 groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 & 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0% vs 10%, p = 0.05). The LOS was significantly shorter in the tranexamic acid group than fibrin sealant group and in the fibrin sealant group compared with control group. There was no significant difference between the groups with regards to proportion of patients with wound leaking problems. No other complications (e.g. VTE) were encountered Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.
To determine whether the amount of fibula resection in fibula osteotomy influences outcome in deformity correction surgery. Retrospective case note and imaging review was performed on a cohort of 45 patients from November 2005 to July 2009 treated with lengthening and/or correction for leg deformity in either an adult or paediatric limb reconstruction centre. Method, extent and level of original fibular resection was recorded, as well as type of fixator, distraction regime and total gap at osteotomy site after distraction. Outcome was measured as premature, expected or non-union and subsequent need for reintervention.Statement of purpose
Methods
Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.Background
Methods
The purpose of the study was to evaluate the results of Expert tibial nailing for distal tibial fractures. All patients who had a distal third or distal end fracture of the tibia treated with the Expert tibial nail over a three year period at our institution were included in the study. A total of 44 distal tibial fractures in the same number of patients were treated with the nailing system. One patient died in the immediate post operative period from complications not directly related to the procedure and 3 were lost to follow up leaving a cohort of 40 patients for evaluation. 31 of the fractures were closed while the remaining 9 were open. The average age group of the cohort was 46.8 years with 26 males and 14 females.Aim
Methods
Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.Background
Methods
A single centre, prospective study of 196 closed tibial diaphyseal fractures treated by monolateral external fixation. Surgical management of all patients followed a protocol of the senior author (PBMT), with regard to technique and fracture reduction. Operations were performed by several different surgeons including the senior author. A definitive fixator was used as a reduction tool in 34 cases, and a separate fracture reduction device was used in 162 patients. Follow-up was in a dedicated external fixator clinic by the senior author until one year post-fracture healing. Fracture healing was determined by fracture stiffness measurements. 196 tibial fractures in 196 patients, average age 29 (range 12-80). 111 right sided and 85 left sided. 166 male and 30 female. 116 fractures due to low energy and 80 due to high energy. football 75, fall 52, RTA 49, others 20. 33 patients had an additional 74 injuries: 38 fractures/dislocations (3 open), 7 compartment syndromes, 7 head injuries, 16 chest injuries, 9 soft tissue injuries. According to AO classification system: 33 A1, 47 A2, 42 A3, 15 B1, 46 B2, 7 B3. Time to fracture healing was 19 weeks on average (range 9-87). 15 patients had coronal deformity >5 degrees and 1 also had saggital deformity >10 degrees. One osteotomy for correction of malunion. 279 pin site infections requiring antibiotics in 35 patients. 7 fixators removed early due to pin site infection. One established osteomyelitis-lautenbach. 7 refractures, all healed (5 with pop, 2 with further fixator). Non-union: 5 hypertrophic, 2 atrophic-all healed with further external fixation. Our results show that external fixation of closed tibial fracture is a viable alternative to other treatment methods with regard to healing time and angular deformity. Our study also uses a well validated end point to define fracture healing and does not rely on the difficulty of defining union on clinical and radiological grounds.Mechanism of injury
Inter-phalangeal (IP) joint fusion of lesser toes has been quite a commonly done procedure using Kirchner wires (K-wire). Infection from the K-wire site has been significant complication. We present a retrospective study of 21 toes of arthrodesis of IP joints of lesser toes using a cannulated screw. The indications were either claw toe or a hammer toe. All the cases that were done from February 2006 to June 2008 were included. There were 21 toes in 15 patients at an average age of 69 years (range 54 – 80). There were 20 females and only one male. The distribution of second, third and fourth toes were 12, 6 and 3 respectively. Nine toes were right sided and 12 were left sided. They were followed for an average of 14 months (range 2–30). There was one case of superficial cellulitis (4.8%) which has responded well to antibiotic therapy. There were two cases where the prominent screws had to be removed at 4 and 5 months post-operative period. Good arthrodesis has been achieved by this time. Clinical arthrodesis was achieved at 4.5 months (range 3–7) and radiological arthrodesis was achieved at 5.2 months (range 4 – 9). All have been discharged at the time of this study. Good correction of deformities with well healed arthrodesis was achieved. Most patients reported pain free toes. We have found this technique to be very useful alternative with good results and less complications.
The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at Macclesfield District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month gap between the two procedures. The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthrosopies performed by two upper limb surgeons. Patients undergoing both procedures were identified. The arthrogram reports and operation notes were examined for correlation. Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunatotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had a 92.3% sensitivity and 54.6% specificity. The lunatotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 50% sensitivity and 77.8% specificity. Wrist arthrogram and arthroscopy are both invasive techniques and equally time consuming. In cost terms the arthrogram remains cheaper but is superseded by arthroscopy as it is both diagnostic and therapeutic.
Single centre prospective study of 196 closed tibial diaphyseal fractures treated by monolateral external fixation.
Operations performed by several different surgeons including senior author. Definitive fixator used as a reduction tool in 34 cases, fracture reduction device used in 162 patients – ST.O.R.M Followed up in a dedicated external fixator clinic by the senior author until one year post fracture healing. Fracture healing was determined by fracture stiffness measurements.
111 right sided and 85 left sided. 166 male and 30 female. 116 fractures due to low energy and 80 due to high energy. Mechanism of injury: football 75, fall 52, RTA 49, direct blow 7, assault 4, rugby 3, crush 2, dancing 2, bowling 1, roller skating 1. 33 patients had an additional 74 injuries: 35 fractures (3 open), 7 compartment syndromes, 3 dislocations, 7 head injuries, 16 chest injuries, 9 soft tissue injuries. According to AO classification system: 33 A1, 47 A2, 42 A3, 15 B1, 46 B2, 7 B3. Time to # healing was 19 weeks on average (range 9–87) X ray data: 15 patients had deformity >
5 degrees in the coronal plane and 1 of these also had deformity >
10 degrees in the saggital plane. One patient underwent osteotomy for correction of malunion. 85 patients had a total of 279 pin site infections requiring Abx (6 with 14 pin infections requiring iv abx), and 33 pins were removed due to persistent infection. 15 patients had 32 ring sequestra which settled with debridement under GA. 7 fixators removed early due to pin site infection. 1 established osteomyelitis-lautenbach. 7 refractures, all healed(5 with pop, 2 with further fixator) Non-union: 5 hypertrophic, 2 atrophic-all healed with further external fixation. Malunion: 1
Our study also uses a well validated end point to define fracture healing and does not rely on the difficulty of defining healing on clinical or radiological grounds which is known to be unreliable. This is the first time this highly repeatable methodology has been used for such fractures.
A prospective study of 196 closed tibial diaphyseal fractures treated by a monolateral external fixator is presented. The patients were managed by a group of Surgeons including the senior author (PBMT), a definitive fixator being used in 34 patients, and a fracture reduction device in 162 patients. All the patients were followed up in an external fixator clinic by the senior author, and follow up continued for 1 year after the fractures had healed. Fracture healing was determined clinically. There were 196 tibial fractures, with an average age of 29 years (range 12–80 years). 111 Fractures involved the right tibia, and 85 the left. There were 166 males and 30 females. 116 Fractures were deemed due to a low energy accident, and 80 due to a high energy injury. The most common mechanism of injury was football (75), a fall (52), a road vehicle accident (49), direct trauma (7), assault (4), and rugby (3). According to the AO classification system 33 were A1 fractures, 47 A2, 42 A3, 15 B1, 46 B2, and 7 B3. Time to fracture healing was 19 weeks on average (with a range from 9–87 weeks). 15 Fractures united with a deformity of more than 50 in the coronal plane. One patient required a corrective osteotomy for a mal-united fracture. There were 279 pin track infections that required antibiotic treatment in 85 patients. 33 Pins had to be removed due to persistent infection. Of these patients 15 developed 32 ring sequestrae, but infection was settled by debridement under GA. 7 External fixators had to be removed early because of pin site infection. One patient developed a full blown osteomyelitis, which was treated with the Lautenbach irrigation and settled. There were 7 re-fractures, but all healed after further treatment. 5 Were treated in a POP cast and 2 were re-treated with another external fixator. There were 7 non-unions, but all eventually healed with further treatment with an external fixator. The authors conclude that treating a closed tibial fracture with an external fixator is a viable alternative method of treatment.
