Aims

Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty.

We present a consecutive case cohort of the first 100 Birmingham Hip Resurfacing (BHR)'s in 90 patients with a minimum follow up of 20 years. All procedures were performed by a single surgeon having commenced the study in 1998.

The original cohort included 68 males with 75 hips (7 bilateral) and 22 females with 25 hips (3 bilateral). The mean age at index procedure was 52. Patients were recalled to review in clinic as per Medicines and Healthcare products Regulatory Agency guidelines with x-rays, metal ions and Harris Hip Scores recorded.

After a minimum of 20 year follow-up review the known overall revision rate is 11%. 11 have died and 7 have been lost to review. In males the known revision rate is 4/75 (5%), 3 of which were due to early fractures and 1 revision for infection at 5 years. The known revision rate in females is 7/25 (28%) of which 6 were due to adverse reactions to metal debris; 3 at 7–8 yrs, 1 at 15 yrs, 2 at 18 years, and 1 at 2 months for avascular necrosis. The mean 20 year metal ions results were cobalt 36.6 nmol/l (range 7.4–232.1) and chromium 32.1 nmol/l (range 6–120.8). The mean Harris hip score was 88.5 (range 38.6–99.8).

This case series with 20 years follow-up demonstrates excellent long term survival of the BHRs further to registry BHR data and similar to THR for same age recipients. Applying today's strict criteria for patient selection would likely improve survival rate further. BHR has not demonstrated the catastrophic revision rates associated with some metal-on-metal resurfacing and remains a safe option for those who meet the criteria.

Aim

This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture.

Aim

The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile.

The management of displaced forearm diaphyseal fractures in adults is predominantly operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement.

We aimed to assess the value of this technique, but intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination.

A single cadaveric arm was prepared and pronation/supination was examined according to American Academy of Orthopaedic Surgeons guidance. A Henry approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A volar locking plate was used to hold the radius in progressive amounts of translation and rotation, with pronosupaintion measured with a goniometer.

The radius could be grossly malreduced with no effect on pronation and supination until the extremes of deformity. The forearm showed more tolerance with rotational malreduction than translation. Passive pronation was more sensitive for malreduction than supination.

The use of passive pronosupination to assess quality of reduction is misleading.

Introduction: Infection with Neisseria Meningitidis remains one of the most devastating illnesses in paediatrics. Affected patients can progress from a mild viral-like illness to septicaemia and death within a matter of hours. We present our clinical experience in identifying and managing the orthopaedic complications associated with meningococcal septicaemia and highlight the long-term problems of physeal growth arrest especially after limb amputation.

Methods: Between August 1997 and June 2005, 88 consecutive children aged from 1 month to 17 years were admitted to the paediatric intensive care unit with meningococcal septicaemia. These patients were retrospectively assessed for orthopaedic manifestations.

Results: During the acute phase of the disease, there were six deaths and 22 patients suffered tissue loss from amputations. Twenty digits were allowed to demarcate and were subsequently amputated. Ten Limb amputations were performed in 6 patients, all of which developed physeal growth arrests proximal to the level of amputation. Four patients had a substantial rise in lower leg compartmental pressures but only two patients underwent fasciotomies, one of which required bilateral below knee amputations.

Conclusions: Meningococcal septicaemia is a potentially lethal paediatric disease. In the acute phase, 22 patients needed orthopaedic input to address complications related to tissue loss, vascular and ischemic problems. Limb amputations due to meningococcal septicaemia will invariably result in physeal damage and our recommendation is that patients should always be screened for this late sequela after index admission. Additionally, early compartment decompression does not appear to improve limb survival.

Introduction: Infection with Neisseria Meningitidis remains one of the most devastating illnesses in paediatrics. Affected patients can progress from a mild viral-like illness to septicaemia and death within a matter of hours. We present our clinical experience in identifying and managing the orthopaedic complications associated with meningococcal septicaemia and highlight the long-term problems of physeal growth arrest especially after limb amputation.

Methods: Between August 1997 and June 2005, 88 consecutive children aged from 1 month to 17 years were admitted to the paediatric intensive care unit with meningococcal septicaemia. These patients were retrospectively assessed for orthopaedic manifestations.

Results: During the acute phase of the disease, there were six deaths and 22 patients suffered tissue loss from amputations. Twenty digits were allowed to demarcate and were subsequently amputated. Ten lower limb amputations were performed in 6 patients, all of which developed physeal growth arrests proximal to the level of amputation. Four patients had a substantial rise in lower leg compartmental pressures but only two patients underwent fasciotomies, one of which required bilateral below knee amputations.

Conclusions: Meningococcal septicaemia is a potentially lethal paediatric disease. In the acute phase, 22 patients needed orthopaedic input to address complications related to tissue loss, vascular and ischemic problems. Limb amputations due to meningococcal septicaemia will invariably result in physeal damage and our recommendation is that patients should always be screened for this late sequela after index admission. Additionally, early compartment decompression does not appear to improve limb survival.