The Nottingham Hip Fracture Score (NHFS) is validated to predict mortality after fragility neck of femur fractures (NOF). Risk stratification supports informed consent, peri-operative optimisation and case prioritisation.

With the inclusion of fragility distal femur fractures (DFF) in the BPT, increasing attention is being placed on the outcome of these injuries. Developing on the lessons learnt over the past decades in NOF management is key.

This study assesses the validity of the NHFS in predicting mortality after fragility DFFs.

A multi-centre study of 3 high volume fragility fracture units was performed via a retrospective analysis of prospectively collected databases.

Patients aged 60 years-of-age who presented with AO 33.A/B/C native DFF, or V.3.A/B periprosthetic DFF over an 86-month period between September 2014 and December 2021 and underwent surgical treatment were eligible for inclusion. Open and/or polytrauma (ISS >15) were excluded.

All operations were performed or supervised by Consultant Orthopaedic Surgeons and were reviewed peri-operatively by a 7-day MDT.

Patients with a NHFS of gt;=5 were stratified into a high-risk of 30-day mortality cohort, with all others being œlow-risk.

285 patients were eligible for inclusion with 92 considered to be low-risk of 30-day mortality, these tended to be younger female patients admitted from their own homes.

30-day mortality was 0% in the low-risk cohort and 6.2% (12/193) in the high-risk group. 1-year mortality was 8.7% (8/92) and 35.7% (69/193) in the low and high-risk groups respectively.

Area Under the Curve (AUC) analyses of Receiver Operator Characteristic (ROC) curves demonstrated the greatest ability to predict mortality at 30-days for the high-risk cohort (0.714).

The NHFS demonstrates a good ability to predict 30-day mortality in those patients with a NHFS =5 after a surgically managed fragility DFF. With comparable mortality outcomes to those documented from fragility NOF.

Purpose: Uncertain position of the acetabular implant has been the cause of dysfunction in certain cases of total hip arthroplasty (THA). Classical computed tomographic analysis of anteversion has certain limitations. Integrated reconstruction of positions at risk allows a better diagnostic approach.

Material and methods: We studied 46 THA because of posterior malposition (n=17, anterior subluxation in the standing position in twelve, and true dislocation in five) and anterior malposition (n=29, posterior subluxation in sixteen and true dislocation in thirteen). Two groups of 70 naïve hips and a group of 56 THA with no functional problem served as controls. The position of the acetabulum was studied on optimised computed tomography slices reconstructing the planes of analysis for the standing, sitting and reclining positions. The reference planes for the slices was given by the sacral tilt angle measured on the lateral views of the patient in the corresponding positions. The optimised computed tomographic measurements of anteversion were compared with the classical measures. None of the patients had abnormal femoral anteversion and/or an oblique pelvis and/or leg length discrepancy greater than 10 mm. The frontal inclination of the acetabular implants was 40°–50°.

Results: In the naïve hips, acetabular anteversion varied: 19.2 with the conventional method, 15.7 in the standing position and 31 in the sitting position. In the THA controls, anteversion measurements differed: 21.3 with the conventional method, 21.4 in the standing position and 35.8 in the sitting position. In the THA with a posterior malposition, 18/29 could not be explained by the conventional measurement, but the optimised measurement enabled an understanding in 17 hips (defective anteversion in the sitting position).

Discussion: Changes in pelvis orientation between the sitting and standing positions modifies real anteversion of the cup. In particular, subjects with THA tend to have a spontaneous posterior tilt of the pelvis related to trunk ageing. This element should be taken into account for the analysis of both major and minor THA dysfunction.

Thirty-two operations on the common peroneal nerve for leprous neuritis are reported. A combined medical and surgical approach to treatment is recommended, and the technique of operation is described. Recovery of motor power was satisfactory but depended on many factors, including the duration of the neuritis, the extent of the compression, the immunopathological status of the patient and the efficacy of medical treatment. The main indication for neurolysis is hyperalgesic neuritis. The only contraindication is painless long-standing paralysis; in this condition the degree of neural fibrosis prevents any hope of improvement.