Aims

This study aimed to compare the outcomes of two different postoperative management approaches following surgical fixation of ankle fractures: traditional cast immobilization versus the Early Motion and Directed Exercise (EMADE) programme.

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Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy.

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To determine mortality risk after first revision total hip arthroplasty (THA) for periprosthetic femoral fracture (PFF), and to compare this to mortality risk after primary and first revision THA for other common indications.

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Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery.

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The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI).

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The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.

This study compares the cost-effectiveness of treating dorsally displaced distal radial fractures with a volar locking plate and percutaneous fixation. It was performed from the perspective of the National Health Service (NHS) using data from a single-centre randomised controlled trial. In total 130 patients (18 to 73 years of age) with a dorsally displaced distal radial fracture were randomised to treatment with either a volar locking plate (n = 66) or percutaneous fixation (n = 64). The methodology was according to National Institute for Health and Care Excellence guidance for technology appraisals. .

There were no significant differences in quality of life scores between groups at any time point in the study. Both groups returned to baseline one year post-operatively.

NHS costs for the plate group were significantly higher (p < 0.001, 95% confidence interval 497 to 930). For an additional £713, fixation with a volar locking plate offered 0.0178 additional quality-adjusted life years in the year after surgery. The incremental cost-effectiveness ratio (ICER) for plate fixation relative to percutaneous fixation at list price was £40 068. When adjusting the prices of the implants for a 20% hospital discount, the ICER was £31 898. Patients who underwent plate fixation did not return to work earlier.

We found no evidence to support the cost-effectiveness, from the perspective of the NHS, of fixation using a volar locking plate over percutaneous fixation for the operative treatment of a dorsally displaced radial fracture.

Cite this article: Bone Joint J 2015;97-B:1264–70.

We reviewed 59 bone graft substitutes marketed by 17 companies currently available for implantation in the United Kingdom, with the aim of assessing the peer-reviewed literature to facilitate informed decision-making regarding their use in clinical practice. After critical analysis of the literature, only 22 products (37%) had any clinical data. Norian SRS (Synthes), Vitoss (Orthovita), Cortoss (Orthovita) and Alpha-BSM (Etex) had Level I evidence. We question the need for so many different products, especially with limited published clinical evidence for their efficacy, and conclude that there is a considerable need for further prospective randomised trials to facilitate informed decision-making with regard to the use of current and future bone graft substitutes in clinical practice.

Cite this article: Bone Joint J 2013;95-B:583–97.

We examined prospectively collected data from 6782 consecutive hip fractures and identified 327 fractures in 315 women aged ≤65 years. We report on their demographic characteristics, treatment and outcome and compare them with a cohort of 4810 hip fractures in 4542 women aged > 65 years.

The first significant increase in age-related incidence of hip fracture was at 45, rather than 50, which is when screening by the osteoporosis service starts in most health areas. Hip fractures in younger women are sustained by a population at risk as a result of underlying disease. Mortality of younger women with hip fracture was 46 times the background mortality of the female population. Smoking had a strong influence on the relative risk of ‘early’ (≤ 65 years of age) fracture.

Lag screw fixation was the most common method of operative treatment. General complication rates were low, as were re-operation rates for cemented prostheses. Kaplan-Meier implant survivorship of displaced intracapsular fractures treated by reduction and lag screw fixation was 71% (95% confidence interval 56 to 81) at five years. The best form of treatment remains controversial.

This paper outlines the recent development of an exchange Travelling Fellowship scheme between the British and American Orthopaedic Research Societies.

Introduction: The mini C-arm is a compact, user-friendly device with the advantage of reducing exposure to ionising radiation compared to the conventional C-arm. Optimising radiation exposure is not only desirable, but also a legal requirement and protocols should be in place to achieve this. The purpose of this paper is to review our use of the mini C-arm for elective foot surgery and to suggest guidelines for optimising its use.

Materials and Methods: Between 2004 and 2006, all elective foot surgery requiring intraoperative imaging were performed using the mini C-arm unit. Procedures performed included ankle, midfoot and hindfoot arthrodeses and joint injections or aspirations. Screening times and radiation doses were recorded for each procedure.

Results: Following an initial learning curve, the screening times stabilised around the median value for the individual procedures. For a subtalar or triple arthrodesis this was less than 60 seconds, for ankle arthrodesis, less than 90 seconds and for hindfoot arthrodesis using a nail, less than 100 seconds. Other single joint arthrodeses had a screening time under 30 seconds and injections or aspirations, under 12 seconds.

Discussion: As screening time is the main variable that can be controlled by the surgeon, assuming that all other precautions are followed, screening time can be used as a useful audit tool to measure optimum use of the mini C-arm. A protocol is presented which includes completion of an audit form for every operation where the mini C-arm is used. The above times can be used as a guide to enable hospital trusts to formulate their own protocols to regulate radiation exposure.

Conclusion: The mini C-arm is well suited for foot and ankle surgery. Having a protocol in place and periodic audit is essential to optimise its use. Apart from being good clinical practice, this is now a legal requirement.

Results: In males CA was significantly larger in all regions of the foot than in females. There were no significant between sex differences in PP, CT and PTI. FTI was significantly greater in males than females for most regions in the foot. IPP was earlier in females. MaxF was also significantly higher in males in all the regions except the 2nd toe. MeanF was also higher in males.

Conclusion: There were no PP differences; however the plantar surface area of the male foot was larger than females.

Introduction: Hypermobility is a common finding, however, it lacks diagnostic parameters and is poorly understood, especially in the foot.

Aim: To quantify medial column/first ray mobility in patients with midfoot arthritis and planovalgus feet.

Methods: We compared first ray mobility in patients with radiologically defined midfoot tarsometatarsal osteoarthritis, a radiologically normal first ray and planovalgus feet, with control subjects who had normal feet and first rays. An all female group of 20 patients (mean age of 70) and 20 controls (mean age of 53) met the criteria. Analysis of patients’ x-rays identified the site of their arthritis and allowed angular measurements of their flat foot deformity. Patient and control subjects underwent identical examinations, recording hindfoot correctability, medial longitudinal arch appearance, hindfoot prontion and supination, forefoot supination and degrees of flexion/extension and abduction/adduction with an electronic goniometer. Each subject was graded by the AOFAS and SF-36 outcome scores.

Results: There was a significant difference in first ray mobility between the patient and control subjects for all positions adopted (P=< 0.001), except when dorsiflexed and weight bearing (P=0.052). Patients with a neutral non-weight bearing ankle exhibited greatest mobility of 16.8 +/− 4.7 degrees compared to 9.4 +/− 2.6 degrees in controls. This was a significant difference, P=< 0.001, as was the difference between patients adopting the NWB plantarflexed, dorsiflexed and WB neutral positions. P=0.002, P=0.014, P=0.001 respectively. Patients’ median score for 5 out of 8 SF36 domains were considerably less than controls, as were patients’ AOFAS. Reduced physical and social functioning were shown to be linked to poor foot scores.

Conclusion: Patients with planovalgus feet and tarsometatarsal OA have greater first ray mobility than controls with normal feet. Recognising this may help plan orthotic or surgical treatment.

The patho-anatomy and aetiology of hallux valgus will be described. History, physical examination, radiographic evaluation, surgical evaluation and decision making will be discussed, as well as the management of common complications.

Throughout the symposium the authors’ preferred treatment and rationale will be illustrated using clinical cases.

Infection of orthopaedic implants is a significant problem, with increased antibiotic resistance of adherent ‘biofilm’ bacteria causing difficulties in treatment. We have investigated the in vitro effect of a pulsed electromagnetic field (PEMF) on the efficacy of antibiotics in the treatment of infection of implants.

Five-day biofilms of Staphylococcus epidermidis were grown on the tips of stainless-steel pegs. They were exposed for 12 hours to varying concentrations of gentamicin or vancomycin in microtitre trays at 37°C and 5% CO₂. The test group were exposed to a PEMF. The control tray was not exposed to a PEMF. After exposure to antibiotic the pegs were incubated overnight, before standard plating onto blood agar for colony counting.

Exposure to a PEMF increased the effectiveness of gentamicin against the five-day biofilms of Staphylococcus epidermidis. In three of five experiments there was reduction of at least 50% in the minimum biofilm inhibitory concentration. In a fourth experiment there was a two-log difference in colony count at 160 mg/l of gentamicin. Analysis of variance (ANOVA) confirmed an effect by a PEMF on the efficacy of gentamicin which was significant at p < 0.05. There was no significant effect with vancomycin.