A number of studies have described the epidemiological characteristics of clavicle fractures, including two previous reports from our institution. The Robinson classification system was described in 1998, after the analysis of 1,000 clavicle fractures. We aim to provide a contemporary analysis and compare current clavicle fracture patterns of our adult population with historical reports. A retrospective analysis of a prospectively collected fracture database from an institution serving 598,000 was conducted. Demographic data were recorded prospectively for each patient with an acute clavicle fractures including age, gender, mode of injury, fracture classification, and the presence of associated skeletal injuries. Fractures were classified according to the Robinson system. A total of 312 clavicle fractures were identified, occurring with an incidence of 55.9/100,000/yr (CI 49.8–62.5) and following a bimodal male and unimodal older female distribution. Sporting activity and a simple fall from standing caused the majority of injuries. More than half of simple fall fractures affected the lateral clavicle. The incidence of clavicle fractures has risen over a twenty year period, and a greater proportion of older adults are now affected. Overall, type II midshaft fractures remain the most common, but comparison of this series with historical data reveals that the epidemiology of clavicle fractures is changing. We have identified an increase in the average patient age and overall incidence of clavicle fractures in our adult population. The incidence, relative frequency, and average patient age of type III lateral one-fifth fractures have increased. This epidemiological trend has implications for the future management of clavicle fractures in our region.
There are limited recent epidemiological data pertaining to the patterns of skeletal injury around the knee joint in adult patients. Data on fractures of the distal femur, proximal tibia and patella have been individually reported. We aimed to describe the collective epidemiological characteristics of all fractures around the knee. We conducted a retrospective analysis of a prospectively collected fracture database from an institution serving 545,000 adults. The demographic and injury details for all patients suffering fractures of the distal femur, proximal tibia and patella were analysed. Fractures were classified according to the AO (distal femur, patella) and Schatzker (proximal tibia) systems. A total of 173 fractures occurred in 170 patients (60% women), representing 6.7% of all lower limb fractures. There were 36 distal femoral fractures, 82 proximal tibial fractures (metaphyseal, plateau or bony avulsions) and 55 patella fractures. Each fracture type displayed distinct epidemiological characteristics. Injuries of the distal femur occurred in older women. A proportion of tibial plateau fractures occurred in young men following high-energy trauma, but a greater number were encountered by older men and women following low-energy injury. The majority of fractures around the knee were caused by a simple fall from standing, followed by road traffic accidents, and falls from height. When compared with historical data from our unit, the incidence of fractures around the knee has increased. The median age of affected patients has also risen, and this is particularly true for fractures of the distal femur and tibial plateau. The epidemiological characteristics of fractures around the knee joint in our adult population are presented. Low-energy trauma in the elderly is likely to constitute an increasing proportion of knee injuries in the future, and this has implications for the provision of trauma services in our region.
Techniques for fixation of the lateral malleolus have remained essentially unchanged since the 1960s, but are associated with complication rates of up to 30%. The fibular nail is an alternative method of fixation requiring a minimal incision and tissue dissection, and has the potential to reduce complications. We reviewed the results of 105 patients with unstable fractures of the ankle that were fixed between 2002 and 2010 using the Acumed fibular nail. The mean age of the patients was 64.8 years (22 to 95), and 80 (76%) had significant systemic medical comorbidities. Various different configurations of locking screw were assessed over the study period as experience was gained with the device. Nailing without the use of locking screws gave satisfactory stability in only 66% of cases (4 of 6). Initial locking screw constructs rendered between 91% (10 of 11) and 96% (23 of 24) of ankles stable. Overall, seven patients had loss of fixation of the fracture and there were five post-operative wound infections related to the distal fibula. This lead to the development of the current technique with a screw across the syndesmosis in addition to a distal locking screw. In 21 patients treated with this technique there have been no significant complications and only one superficial wound infection. Good fracture reduction was achieved in all of these patients. The mean physical component Short-Form 12, Olerud and Molander score, and AAOS Foot and Ankle outcome scores at a mean of six years post-injury were 46 (28 to 61), 65 (35 to 100) and 83 (52 to 99), respectively. There have been no cases of fibular nonunion. Nailing of the fibula using our current technique gives good radiological and functional outcomes with minimal complications, and should be considered in the management of patients with an unstable ankle fracture.
Distal radius fractures are common, yet the long-term functional outcome of these patients is unknown. This study investigated the long-term functional outcomes after distal radius fracture (DRF) in adult patients 16–23 years following injury. Secondary aims were to establish morbidity, mortality and function related to pattern of injury and patient demographics. 622 consented adult patients with a DRF were enrolled in the study. Prospective data was recorded; patient age, mechanism of injury and fracture pattern. Patients were assessed 16–23 years post-injury. 275 patients were deceased. 194 patients were able to complete a Quick Dash (QD) validated upper limb pain and function Patient-Reported Outcome Measure (PROM). Five patients declined follow-up. Socioeconomic status was assessed using the Scottish Index of Multiple Deprivation (SIMD) 2009. The mean age at injury was 41 years for men and 64 for women in the initial cohort. 146 women and 48 men completed final follow-up. The mean age at QD assessment was 57 years for men and 76 for women; mean and median SIMD deciles were 6.7 and 7, respectively, for both genders. The mean QD score was 10.35 for all patients, with no significant gender difference (p=0.63). 85.6% (n=166) reported no or at most, mild limitation. High socioeconomic status, absence of other injuries at DRF and age under 85 years old at follow-up was associated with better long-term function. Early function and pain predicted long-term function; comminution pattern, treatment modality as chosen by surgeon, and early complications did not. Mortality data was analysed for the deceased (n=275). The mean patient survival from DRF to death was 11 years 5 months, with no significant gender difference (p=0.43); survival was predicted by age at injury, post-treatment dorsal angulation and early function. Respiratory, cardiovascular causes and malignancy were the three most common primary causes of death.Methods
Results
A number of studies have described the epidemiological characteristics of clavicle fractures, including two previous reports from our institution. The Robinson classification system was described in 1998, after the analysis of 1,000 clavicle fractures. We aim to provide a contemporary analysis and compare current clavicle fracture patterns of our adult population with historical reports.Background
Aims
