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.

Aims

The extended wait that most patients are now experiencing for hip and knee arthroplasty has raised questions about whether reliance on waiting time as the primary driver for prioritization is ethical, and if other additional factors should be included in determining surgical priority. Our Prioritization of THose aWaiting hip and knee ArthroplastY (PATHWAY) project will explore which perioperative factors are important to consider when prioritizing those on the waiting list for hip and knee arthroplasty, and how these factors should be weighted. The final product will include a weighted benefit score that can be used to aid in surgical prioritization for those awaiting elective primary hip and knee arthroplasty.

Introduction

Subject-specific finite element models (FEMs) allow for a variety of biomechanical conditions to be tested in a highly repeatable manner. Accuracy of FEMs is improved by mapping density using quantitative computed tomography (QCT) and choosing a constitutive relationship relating density and mechanical properties of bone. Although QCT-derived FEMs have become common practice in contemporary computational studies of whole bones, many density-modulus relationships used at the whole bone level were derived using mechanical loading of small trabecular or cortical bone cores. These cores were mechanically loaded to derive an apparent modulus, which is related to each core's mean apparent or ash density. This study used these relationships and either elemental or nodal material mapping strategies to elucidate optimal methods for scapular QCT-FEMs.

Purpose

In revision hip surgery, Type IIIB femurs have presented the greatest historical challenge to achieving stable fixation and osseous integration. This study evaluated the intermediate term outcome of a modular, tapered, distal fixation revision femoral component used in a consecutive revision hip series with special attention to its performance in the defective Type IIIB femur.

Bertolotti’s syndrome, first described in 1917, is characterised by the presence of an anomaly of unilateral or bilateral enlargement of the transverse process of the most caudal vertebra that may articulate or fuse with the sacrum or ilium. This gives rise to low back pain. Although described, relevant literature is sparse and in particular, no evidence exists as to its incidence specifically in young people.

This study analysed all MRI scans of the lumbosacral spine performed on patients between July 2003 and November 2004 inclusive. MRI scans for all indications were included in the study.

Out of a total of 818 MRI scans of the lumbosacral spine, 627 showed disc disease. Of these, 35 had radiological signs of Bertolotti’s syndrome (7 bilateral, 28 unilateral). There were 22 males and 17 females in this group. The average age of the Bertolotti group was 31.8+/−12.0 years (range: 15–60). This was less than those with multiple disc disease whose average age was 44.0+/−15.6 years (p< 0.0002, ANOVA), those with isolated disc disease (41.1+/−16.0 years, p=0.013, ANOVA) and those with isolated disc disease at the L4/5 level (46.0+/−11.3 years, p=0.003, ANOVA). The overall incidence of Bertolotti’s syndrome in this study was 5.6%. However, 18 of the patients in the Bertolotti group were under 30 years of age giving an overall incidence in this age group of 8.9%.

Bertolotti’s syndrome is a frequently occurring pathology in the lumbosacral spine. It occurs in significantly younger patients than either multi-level disc disease or isolated disc disease including at the L4/5 level. In the under 30 group its incidence of 8.9% mandates that it must form part of a differential list in the investigation of low back pain in young people.

Introduction: The Ganz periacetabular osteotomy aims to improve femoral head coverage in dysplastic hips. It is joint preserving procedure and therefore is ideally preformed before significant articular cartilage degeneration. One proposed advantage of this procedure is that it partially preserves the posterior column and does not disrupt the vascular supply of the main fragment. This study aims to 1) assess the role of MR imaging in the perioperative evaluation of articular cartilage and labrial tissues prior to Ganz osteotomies and 2) to document any alteration in the vascularity of the acetabular fragment post operatively.

Patient and Methods: Twenty patients (all female, average age 18.2 years) under consideration for peracetabular osteotomy for hip dysplasia and MR Studies of the pelvis as part of the perioperative assessment. Sixteen patients had follow-up imaging at 4, 12 and 26 weeks post surgery, at which time evidence of healing, oedema, vascularity and femoral head coverage were assessed.

Discussion: MR imaging has proven to be a reliable method of assessing articular cartilage health before considering pelvic osteotomy. Hopefully this will allow more appropriate selection of patients likely to benefit from this procedure. In addition MRI scanning allows clearer assessment of other articular elements, such as labium and ligamentum teres, that are difficult to visualize with plain radiographs and CT scans. A further benefit of MR scanning is that, as this study has shown the vast majority of patients who are potential candidates are female of childbearing age and it voids the use of ionizing radiation in this sensitive group of patients. This study has shown that despite some early alterations in osteotomy fragment vascularity the ultimate outcome is that vascularity is substantively unharmed by periacetabular osteotomy.

Conclusion: MR imaging is extremely useful in the perioperative workup and postoperative follow-up in patients undergoing Ganz periacetabular osteotomies.

We report three patients with neurological deterioration after the reduction of cervical spine dislocation. In each case compression of the spinal cord by disc material was demonstrated by magnetic resonance imaging and recovery occurred following removal of the compressing disc. A separate radiological study suggested that disproportionate narrowing of the disc space implies disc extrusion; reduction of a dislocation showing this sign may produce or exacerbate neurological deterioration.

Intramedullary rods manufactured from polyacetal were used to fix diaphyseal fractures in osteoporotic bone. They are pliable and can be introduced without further damage to such bone. Their low elastic modulus induces abundant callus. They can be locked with cortical bone screws without the need of jigs or radiographic control. Nine femoral and five tibial fractures were fixed in 10 patients, all with osteoporosis; 13 united primarily; one required bone grafting. No implant broke; however, no ambulant patient weighed more than 75 kg. The rods offer a promising treatment for diaphyseal fractures in osteoporotic bone.

A Salter innominate osteotomy is used to treat acetabular dysplasia, but reports of its effects on the position of the femoral head are few and conflicting. Lateral shift would increase the resultant forces acting on the joint and be detrimental. We studied 15 Salter innominate osteotomies and demonstrated that a correctly performed osteotomy does not significantly alter the distance from the centre of the femoral head to the midline of the body. Stereophotogrammetry was used in three patients to delineate the axis of rotation of the distal acetabular fragment and determine the locus of movement of the centre of the femoral head about it. Our results explain why the Salter osteotomy does not lateralise the femoral head.

Distraction fractures of the upper lumbar spine are most often associated with the wearing of seat-belts. Twenty patients with this spinal fracture were reviewed and half of them had intra-abdominal injuries. Eight patients required an exploratory laparotomy. Three distinct patterns of distraction fractures have been identified. Open reduction, local spinal fusion and Harrington instrumentation are recommended for unstable fractures and for those with neurological involvement. Four cases of non-union are included ln the series. Legislation for the compulsory wearing of seat-belts should encompass improvements in design and stricter criteria for installation.

Acute myelopathy is a rare complication of Scheuermann's disease. Three patients are reported where spinal cord compression occurred at the apex of a kyphos. All were male, aged 14, 18 and 20 years, and each had a profound neurological defect associated with a short, sharp kyphos in the low thoracic region. Each patient underwent anterior decompression and all made an almost full recovery. It is deduced that factors which may influence the onset of cord compression include the angle of kyphosis, the number of segments involved, the rate of change of the angle, local anatomical variations, trauma, and possible secondary impairment of the vasculature of the cord.

Twenty-three adults with fractures of the odontoid process are reviewed. Te possible reasons for the high rate of non-union in reported series are considered: these include the type of fracture, its displacement, the presence of a gap at the fracture site, imperfect reduction and inadequate immobilisation. Type 2 fractures (at the base of the odontoid process) are the commonest and also the most liable to nonunion. In their treatment, reduction is important; as seen in the lateral radiograph at least two-thirds of the fracture surfaces should be in contact. Skull traction is not advised and halo-cast fixation is the treatment of choice; with this method 87.5 per cent of recent odontoid fractures united.