Background

The aim of the study was to analyze effectiveness and safety of packing the medullary canal of the tibia and femur with Herafill (Heraeus Medical GmbH, Wehrheim, Germany), a void filler and antibiotic carrier, during second stage revision total knee arthroplasty(TKA) for periprosthetic joint infection (PJI). We used hybrid cementation technique for the fixation of TKA components with antibiotic-loaded bone cement for femoral and tibial component and cementless stem extensions.

The aim of the study was to assess the results of treating knee osteoarthrosis with total knee arthroplasty (TKA) after previous tibia and/or femur fractures resulting in axial limb deformities. Thirty-six knees (34 patients) were operated on. At the most recent follow-up, 4.8 years after surgery, all but one patient demonstrated an improvement in both clinical and functional KSS. This male patient required revision after 2 years due to tibial component aseptic loosening. Improved range of motion was generally noted, especially extension, however, two patients with both tibia and femur fractures had worse results. TKA is an effective method of treatment for patients with arthrosis after a previous femur or tibia fractures. When deformity is severe semi-constrained or constrained, implants with extensions may be necessary.

The use of passive stretching of the elbow after arthrolysis is controversial. We report the results of open arthrolysis in 81 patients. Prospectively collected outcome data with a minimum follow-up of one year were analysed. All patients had sustained an intra-articular fracture initially and all procedures were performed by the same surgeon under continuous brachial plexus block anaesthesia and with continuous passive movement (CPM) used post-operatively for two to three days. CPM was used to maintain the movement achieved during surgery and passive stretching was not used at any time. A senior physiotherapist assessed all the patients at regular intervals. The mean range of movement (ROM) improved from 69° to 109° and the function and pain of the upper limb improved from 32 to 16 and from 20 to 10, as assessed by the Disabilities of the Arm Shoulder and Hand score and a visual analogue scale, respectively. The greatest improvement was obtained in the stiffest elbows: nine patients with a pre-operative ROM < 30° achieved a mean post-operative ROM of 92° (55° to 125°). This study demonstrates that in patients with a stiff elbow after injury, good results may be obtained after open elbow arthrolysis without using passive stretching during rehabilitation.

Aim

Over the last 15 years there has been a series of publications reporting the beneficial effects of elbow arthrolysis, with considerable variation in operative technique and post-operative management. Many advocate the use of passive stretching techniques in the early post-operative period if range of motion fails to improve satisfactorily. The purpose of this study was to assess our results of open elbow arthrolysis in patients who did not receive any passive stretching after discharge from hospital.

Over the last 15 years there have been a series of publications reporting the beneficial effects of elbow arthrolysis, with considerable variation in operative technique and post-operative management.

Aim. To assess the results of open elbow arthrolysis in patients who did not receive any physiotherapy after discharge from hospital, although this is routinely prescribed by many surgeons.

Patients and Methods. Prospectively collected data of 34 patients with a minimum follow-up of 1 year after arthrolysis was analysed. All the procedures were performed by the same surgeon, achieving as much improvement in elbow motion as possible at operation. All the patients had continuous brachial plexus blocks and continual passive motion for 2–3 days postoperatively but none received any physiotherapy after discharge. At review, a senior physiotherapist formally assessed all the patients, including measuring elbow motion with a goniometer.

Results. All patients’ arc of movement improved from, with mean elbow flexion increasing by 16 degrees and extension 20 degress at the last follow-up. Upper limb function, assessed with a Disabilities of the Arm, Shoulder and Hand score (DASH), had improved 30%. Pain had decreased from 4.8 to 3.1 using the Visual Analogue Score. The greatest improvement in motion was obtained in the stiffest elbows – 5 patients with an arc of 30 degrees or less pre-operatively achieved an arc of 96 degrees by the time of the last review. Only early complications occurred – ulnar neuritis and significant pain – but these symptoms had largely settled by the time of the last review.

Conclusions. Good results of open arthrolysis for post-traumatic elbow stiffness can be achieved with continuous brachial plexus blocks and continual passive motion for 2–3 days post-operatively. There appears to be little evidence to support formal treatment with physiotherapy after discharge from hospital, as our results are similar to other reported series.

Introduction: There is paucity of literature describing complex lateral condylar mass (LCM) fractures of the elbow in children, which we define as a LCM fracture occurring concurrently with another fracture or dislocation in the same elbow. The aim of this study was to evaluate the management, outcome and complication rate of 26 complex LCM fractures and to analyse difference in the outcome between the isolated and complex LCM fractures.

Materials and methods: Between 1990 and 2005, we identified 26 complex LCM fractures in the departmental database (1% of 2502 elbow/humeral injuries). Information was collected from theatre-charts, casenotes and radiographs. The mean follow-up was 5.9 months (range, 6 weeks to 4 years).

Results: These were complex because of their association with elbow dislocation (n=12; mean age 8.2 years), olecranon fracture (n=8; mean age 4.1 years) and medial condylar fracture (n=6; mean age 8 years). Nine were treated conservatively. The remaining 17 were fixed with K-wires (9), a screw (7) or both (1). A concomitant elbow dislocation was managed by closed reduction followed by open K-wiring or screw fixation of the LCM fracture. An associated olecranon fracture was treated non-operatively for minimally displaced fractures, although one needed internal fixation. All displaced T-condylar fractures required open reduction and internal fixation. There were no complications of non-union, mal-union, avascular necrosis, cubitus valgus or tardy ulnar palsy. Healing and return of normal function occurred in all, although six patients had minor loss of extension.

Conclusion: We found no obvious difference in the outcome between the isolated displaced LCM fractures described in the literature and our complex LCM group. However the importance of careful assessment of the preoperative radiographs and testing of elbow stability by examination under anaesthesia is stressed.

Introduction: The aim of this paper was to test the hypothesis that for hips affected with Legg-Calve-Perthes’ (LCP) disease under the age of 8 years, surgery does not affect the outcome.

Methods: We performed a retrospective paired study of patients, who were diagnosed with LCP disease before the age of 8 years, to compare the radiological results after treatment between conservatively and surgicallytreated groups. One patient was selected from each group to create the pairs for this study. Each pair was strictly matched for gender, body mass index, age at onset, and stage at the first visit, Catterall and Herring grading and radiological at-risk signs. Each pair was assessed by comparing the values of five radiological measurements.

Results: From a cohort of 345 hips diagnosed with LCP disease 14 pairs (28 hips) fitted the criteria. The radiological measurements, which showed a statistically better result in the surgical groups, were Mose’s method (p = 0.019), the Acetabular-Head Index (p = 0.034). There were no statistical differences in the Slope of the Acetabular Roof (p = 0.37), Articulotrochanteric distance (p = 0.17) and Stulberg grading (p = 0.2). 5 pairs had a better Stulberg result in the operative group. Three of these 5 pairs were less than 6.5 years at the time of their surgical procedure. Three pairs had a better Stulberg result in the conservative group. Six pairs had no difference between the groups.

Discussion: We conclude that surgical treatment can improve the sphericity of the femoral head and provide greater acetabular cover than conservative treatment in hips of patients less than 8 years at the onset of LCP disease. However, the Stulberg grading was not affected. Our study supports the hypothesis that for hips affected with LCP disease under the age of 8 years, surgery does not affect the outcome.

Introduction: The aim of this paper was to present a profile of Legg-Calve-Perthes’ (LCP) disease and test the hypothesis of an association between LCP disease and poverty.

Methods: We examined demographic data on a group of 240 children (263 hips) presenting with LCP disease in Greater Glasgow, where the mean deprivation scores are substantially greater than in the rest of Scotland, to see if this association applies or whether other clues to the aetiology of LCP could be divined.

Results: There were 197 males and 43 females. The majority presented in the sclerosis phase with much smaller numbers in the other phases. 70 % (184 cases of LCP) were Catterall grades 3 or 4. 16.25% had a family history of LCP. Bone age in our series is heavily skewed towards the lower centiles. The number of siblings in the family averaged 1.9, with 13 % being an only child. The maternal age at birth of the index child showed no preponderance to older age. Maternal smoking during and after pregnancy was noted in 55 %, which compares with 52% reported in the population of Greater Glasgow in general. Bone age in our series was heavily skewed towards the lower centiles. Birth weight showed a definite shift to the left, height a weaker shift to the left. 25 % of the children in our series are in social class IV and V, although this accounts for more than 50 % of the population of the Greater Glasgow.

Discussion: There is no significant evidence of a preponderance of LCP disease in the most deprived groups (p=0.9). The aetiology of LCP disease is likely to be multifactorial and may include a genetic or deprivation influence causing low bone age, hyperactivity and a high pain threshold.

We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later.

There were 77 children with type-3 supracondylar fractures. Of these, in 43 the fracture was reduced and pinned within 12 hours and in 34 more than 12 hours after injury. Both groups were similar in regard to gender, age and length of follow-up. Bivariate and logistical regression analysis showed no statistical difference between the groups. The number of peri-operative complications was low and did not affect the outcome regardless of the timing of treatment.

Our study confirmed that the treatment of uncomplicated displaced supracondylar fractures of the humerus can be early or delayed. In these circumstances operations at night can be avoided.

It has been reported that there is an association between Perthes’ disease and poverty. We examined the demographic data of a group of 240 children (263 hips) who presented with Perthes’ disease in Greater Glasgow, where the mean deprivation scores are substantially greater than in the rest of Scotland, to see if this association applied and whether other clues to the aetiology of Perthes’ disease could be found. There were 197 boys and 43 girls; 39 (16.25%) had a family history of Perthes’ disease. Bone age in this series was heavily skewed towards the lower percentiles. The mean number of siblings was 1.9, with 31 (12.9%) being an only child. Maternal age at the birth of the first child showed no preponderance of older mothers. Maternal smoking during and after pregnancy was noted in 132 (55%), which compared with the 52% reported in the population of Greater Glasgow in general. Of the children in our series, 60 (25%) were in social class IV and V. However, this applies to more than half of the population of Greater Glasgow. There was no significant evidence of a preponderance of Perthes’ disease in the most deprived groups. The aetiology of Perthes’ disease is likely to be multifactorial and may include a genetic or deprivation influence resulting in delayed bone age.

Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip.

The purpose of the study was to evaluate a number of clinical and radiological risk factors for AVN after non-operative treatment of DDH.

Clinical data and radiographs of 77 patients with103 abnormal hips treated because of developmental dysplasia of the hip by closed reduction followed by cast immobilization were reviewed retrospectively. The average age of patients at the time of reduction was 16 months (ranged, 4 to 28) and the average final follow up was 22,4 years (ranged from 13 to 47 years). Kalamchi and MacEwen classification system was used for evaluation of the AVN. Avascular necrosis was found in 35,9% of the treated hips. We established the influence of several radiological and clinical data on the incidence and severity of AVN.

Conclusion: In our analysis the degree of initial dislocation according to Tönnis classification is an important risk factor for AVN. Age at the onset of treatment, presence and size of ossific nucleus, the use and period of preliminary traction, previous treatment with Frejka pillow or Pavlik splint, sex and side were not associated with the incidence and severity of ischemic necrosis. The results have been analysed statistically.