Aims

This study investigated the effects of transcatheter arterial embolization (TAE) on pain, function, and quality of life in people with early-stage symptomatic knee osteoarthritis (OA) compared to a sham procedure.

Australian Football (AF) is a popular sport in Australia, with females now representing one-third of participants. Despite this, the injury profiles of females versus males in largely unknown. The current study investigated fractures, dislocations and tendon ruptures in females versus males presenting to emergency departments (ED) with an AF injury.

All patients, regardless of age, presenting to one of 10 EDs in Victoria, Australia, with an AF injury were included. Data were prospectively collected over a 10-month period, coinciding with a complete AF season. Data were extracted from patient medical records regarding injury-type, body-part injured and treatments required. Female and male data were compared with chi-squared tests.

Of the 1635 patients presenting with an AF injury, 595 (36.0%) had a fracture, dislocation or tendon rupture, of whom 85 (14.3%) were female and the average age was 20.5 years (SD 8.0). Fractures accounted for most injuries (n=478, 80.3% of patients had a fracture), followed by dislocations (n=118, 19.8%) and tendon ruptures (n=14, 2.4%). Upper limb fractures were more common than lower limb fractures (71.1% v 11.5% of fractures). Females were more likely to fracture their hands or fingers than males (45.7% v 34.3%). Males were more likely to fracture ribs (5.4% v 0%). Most fractures (91.2%) were managed in the ED, with the remainder being admitted for surgery (GAMP/ORIF). Males were more likely to be admitted for surgery than females (11.2% v 5.9%). Regarding dislocations (n=118), females were more likely to dislocate the patella (36.8% v 8.1% of dislocations). Only males sustained a tendon rupture (n=14): finger extensor or flexor (57.1%), achilles tendon (28.6%) and patella tendon (14.3%).

Orthopaedic AF injuries are common presentations to EDs in Victoria, though few require specialist orthopaedic intervention. Injury profiles differed between genders suggesting that gender specific injury prevention and management might be required.

There is an increased risk of fracture following osteoplasty of the femoral neck for cam-type femoroacetabular impingement (FAI). Resection of up to 30% of the anterolateral head–neck junction has previously been considered to be safe, however, iatrogenic fractures have been reported with resections within these limits. We re-evaluated the amount of safe resection at the anterolateral femoral head–neck junction using a biomechanically consistent model.

In total, 28 composite bones were studied in four groups: control, 10% resection, 20% resection and 30% resection. An axial load was applied to the adducted and flexed femur. Peak load, deflection at time of fracture and energy to fracture were assessed using comparison groups.

There was a marked difference in the mean peak load to fracture between the control group and the 10% resection group (p < 0.001). The control group also tolerated significantly more deflection before failure (p < 0.04). The mean peak load (p = 0.172), deflection (p = 0.547), and energy to fracture (p = 0.306) did not differ significantly between the 10%, 20%, and 30% resection groups.

Any resection of the anterolateral quadrant of the femoral head–neck junction for FAI significantly reduces the load-bearing capacity of the proximal femur. After initial resection of cortical bone, there is no further relevant loss of stability regardless of the amount of trabecular bone resected.

Based on our findings we recommend any patients who undergo anterolateral femoral head–neck junction osteoplasty should be advised to modify their post-operative routine until cortical remodelling occurs to minimise the subsequent fracture risk.

Cite this article: Bone Joint J 2015;97-B:1214–19.

Aim of Study To assess the efficacy of commonly used sutures materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

Methods The investigation was carried out in three phases. Initially the ultimate strength of the suture material was tested. Materials compared were 1PDS, 2 Ethibond, 1 Panacryl The suture was then tested to failure by two surgeons comparing five different knotting techniques. Knots tested were Tennessee slider, Duncan loop, SMC, Tautline hitch, and Surgeons knot. Finally the test was repeated after soaking the suture with normal saline.

Results As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in > 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

Conclusions Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength.

Aims:There is little published on the clinical impact of radial styloidectomy, although resultant instability has been studied in cadaveric models. Methods: Over a ten-year period 31 patients had a radial styloidectomy performed within the Upper Limb Unit. The surgery was performed arthroscopically in 22 patients and via an open approach in 9 cases. A retrospective review of the arthroscopically managed patients is presented. There were 4 females and 18 males with an average follow up of 13.1 months (range 6–53 months) and an average age of 35.4 years (range 18–64). The underlying condition treated was scaphoid non-union in 11 cases, scapholunate collapse in 7, primary osteoarthritis in 3, and one each of scaphoid avascular necrosis and Keinbochñs disease with a SLAC wrist.

Patients were independently clinically reviewed or completed a wrist assessment questionnaire. The outcome was good or satisfactory in 75% of cases and unsatisfactory in the other 25%. Surgery had been carried out in 13.4% (3 patients) previously and all these patients had a satisfactory outcome. In those patients with a poor outcome, the average time to failure or further surgery was 9 months. Conclusions:Arthroscopic radial styloidectomy is a simple procedure with low morbidity. In patients with localised radial styloid impingement it can reliably provide lasting symptomatic relief in the majority of patients.

The study assesses the efficacy of commonly used suture materials with commonly described arthroscopic knotting techniques in as close a physiological pattern as possible.

The investigation was carried out in three phases. Initially the suture material strength was tested. The suture was then tested to failure using the different knotting techniques. Finally the test was repeated after soaking the suture with normal saline.

A Hounsfield tensometer was utilised with a load cell of 1000N, strain rate of 25mm/min, bar separation of 7.5mm and standard temperature and pressure. Suture material tested was 2 ethibond, 1 PDS and 1 Panacryl. Knotting techniques compared were the Tennessee slider, Tautline hitch, Duncan Loop, SMC knot and Surgeon’s knot. Two surgeons tied each knot 10 times after first becoming practiced with each technique. Each knot was tested to failure on 10 sequential experiments.

Ultimate strength of the suture material and of the knotting techniques was assessed. In addition the mode of failure, whether the knot slipped or suture material fractured was investigated.

As expected, 2 ethibond has a higher ultimate strength than either 1 PDS or 1 Panacryl. The Tautline hitch and Surgeon’s knot had a significantly lower slippage rate when compared to the other knotting techniques. (P value < 0.002). The Tennessee slider, Duncan Loop and SMC knots slipped in more than 50% of experiments. No difference was observed when the suture material had been soaked in normal saline. The number of half hitches required to provide maximum knot holding capacity was 3, confirming previous experimental findings by other investigators.

The Tautline hitch is recommended for use with all suture materials due to low slippage rates, ease of tying, ease of sliding and overall high knot strength