Introduction

Distal femur fracture fixation in elderly presents significant challenges due to osteoporosis and associated comorbidities. There has been an evolution in the management of these fractures with a description of various surgical techniques and fixation methods; however, currently, there is no consensus on the standard of care. Non-union rates of up to 19% and mortality rates of up to 26 % at one year have been reported in the literature. Delay in surgery and delay in mobilisation post-operatively have been identified as two main factors for high rate of mortality. As biomechanical studies have proved better stability with dual plating or nail-plate combination, a trend has been shifting for past few years towards rigid fixation to allow early mobilisation. Our study aims to compare outcomes of distal femur fractures managed with either single plate (SP), dual plating (DP) or nail-plate construct (NP).

The recruitment drive, investment and collaboration within Betsi Cadwaladr University Health Board (BCUHB) sites providing specialist lower limb arthroplasty and trauma service has evolved over last few years with aims to improve patient care and reduce reliance on tertiary referral centres. Through our service-evaluation project, we reviewed the results of treatment provided for periprosthetic femur fractures (PPFFs) presenting to BCUHB sites over last 4 years.

We retrospectively reviewed consecutive PPFFs admitted at three BCUHB sites from January’20 to June’23 with mean follow-up of 20.8 ± 13.2 (8–49) months [n=161; Mean age: 82.2 ± 8.5 (59–101) years, Females:107]. Over the review period we noted a 23% increase in service demand for care of PPFFs. Majority were managed surgically [132/161] [38 revision arthroplasties; 94 ORIFs] at BCUHB sites and two patients were referred to tertiary centre. Average time to surgery was 3.5 days. 90% of the PPFFs were managed successfully with 10% (16/159) having orthopaedic complications needing further intervention. 6.3 (10/159) had medical complications and did not need orthopaedic re-intervention. In our series, 12-month re-operation rate was 6.1% (8/132) and 1-month, 3-month and 1-year mortality rate was 6.3%, 11.3% and 21.4% respectively. These results are comparable to the published results of PPFF management at tertiary centres. Potential cost savings compared to transfer to tertiary centre for PPFF management was £2.31 million. Thus, it is possible to successfully provide adequate care for PPFFs at DGHs and efforts should be made to appropriately equip and adequately staff DGHs, to provide service for local PPFF care.

Abnormal patella height has been found to be one of the main reasons for abnormal contact between patella and trochlear groove leading to patellar instability in children. Many methods have been described to diagnose patellar instability but most of them are justified only in adults. The reason being incomplete ossification in the paediatric population. These methods have been divided into direct and indirect methods. We analysed the MRI scan of knee of 57 children between 12–14 years of age with no previous diagnosis of patellar instability. Patients with a diagnosis of patellar instability, previous surgery on the knee or trauma and poor MRI scan were excluded from the study. We used Insall -Salvati Index (ISI), Caton-Deschamp Index (CDI) and Patella-Trochlear Index (PTI) and compared the results. We found that 40% of measurements by CDI and 41% by ISI showed patella alta in patients with normal patella height. 10% of patients in PTI readings had value suggestive of abnormal patella height.

We concluded that PTI is a more reliable index to be used in children as it uses the length of articular surface and does not rely on bony landmarks. Studies done show PTI is a more reliable and accurate method of measuring patella height.