The primary aim of this study was to identify the rate of osteoarthritis in scaphoid fracture non-union. We also aimed to investigate whether the incidence of osteoarthritis correlates with the duration of non-union(interval), and to identify the variables that influence the outcome. We retrospectively reviewed 273 scaphoid fracture non-union presented between 2007 and 2016. Data included patient demographics, interval, fracture morphology, grade of osteoarthritis (Kellgren-Lawrence) and scaphoid non-union advanced collapse (SNAC), and overall health-related quality of life. Patients were divided into two groups (SNAC and Non-SNAC). Group differences were analysed using Mann-Whitney U test and association with Pearson's correlations. A two-sided p-value of <0.05 was considered significant. The scaphoid fracture non-union were confirmed on CT scans (n=243) and plain radiographs (n=35). The subjects were 32 females and 260 males with the mean age of 33.8 years (SD, 13.2). The average interval was 3.1 years (range, 0–45 years). Osteoarthritis occurred in 58% (n=161) of non-unions, and 42% (n=117) had no osteoarthritis. In overall, 38.5% (n=107) had SNAC-1, 9% (n=25) with SNAC-2, and 10.4% (n=29) presented with SNAC-3. The mean interval in the non-SNAC group was 1.2 years, and in SNAC 1,2, and 3 were 2.6, 6.8, and 11.1 years, respectively. The average summary index in SNAC and non- SNAC groups was 0.803 and 0.819, respectively. Our results also showed a significant correlation between advanced osteoarthritis and proximal fracture non-unions(P<0.05). We concluded that there is no clear correlation between the interval and the progression of osteoarthritis. SNAC was more likely to occur in fractures aged 2 years or older.
Treatment of a partial laceration in zone two of a flexor tendon remains controversial. The intact part of the tendon can sustain forces of normal un-resisted motion, and repaired partially treated tendons can actually be weaker than un-repaired ones. Trimming these lacerations has been shown to be beneficial in partially lacerated tendons with triggering or entrapment. The purpose of this study is to observe the behaviour of a partially lacerated and subsequently trimmed tendon under strain, and measure their friction coefficient at different flexion angle and load. Ten long flexor tendons from long digit of turkey foot, along with the equivalent of A2 pulley were used. All experiments were carried out for intact, lacerated (50%) and trimmed tendon at 10, 30, 50 and 70 degrees of flexion and two load settings of 200 and 400g. The friction forces were measured by the difference between the two load transducers and the friction coefficient was measured using this formula, μ = Ln[(F2/F1)]/Ø. Friction coefficient (μ), Tension forces (F2 and F1), arc of tendon and pulley contact (Ø). Results: Friction coefficient increased significantly by three folds (0.3) after laceration compare with intact tendon (0.12) at both loads. This was reduced significantly after trimming the tendon but the friction coefficient was still approximately twice the value of the intact tendon (0.2). Triggering was noticed in all tendon lacerations. Triggering was reduced after trimming in 10 and 30 degrees of flexion but increased markedly at 50 and 70 degrees of flexion associated with tendon fragmentation at the trimmed area. Trimming partially lacerated flexor tendons will reduce the gliding resistance of the tendon through the pulley but this can lead to further fragmentation and triggering at higher flexion degrees and loads.
The Trent Arthroplasty Audit Group (TAAG) is an arthroplasty register set up over ten years ago to record data on all hip and knee arthroplasties performed in the Trent region. This currently serves a population of 5.16 million with an average of 10,000 arthroplasties recorded each year. Patients are sent a postal questionnaire at one year post surgery to record satisfaction with surgery amongst some of its parameters. We analysed the questionnaires returned on patients having undergone primary knee arthroplasties during the years 97/98. Those recording a poor satisfaction score were then analysed to see if any trends emerged and thus achieve our aim of improving overall satisfaction scores within Trent. In 1997/98, 3219 primary knee replacements were perfomed in Trent, of which 241(12%) recorded a poor satisfaction rating. Analysing this group, 30% of patients had no clinically identifiable cause for their dissatisfaction. No correlation between type of implant used could be suggested. In 28% of patients the surgeons were unaware of their patients’ dissatisfaction in clinic. Bilateral arthroplasties had been performed in 25% of the dissatisfied group. Re-evaluating this group 4 years post-op, improved their dissatisfaction to 7%. Our study indicates that a high proportion of patients (12%), undergoing knee replacement surgery record a poor satisfaction score at one year post-op. The respective consultants were unaware of any problem in 30% of cases, despite follow up. This rating improved to 7% without intervention in many cases. We suggest that this may be due to high expectations and appropriate pre-operative counselling needs to be undertaken before such surgery.
All knee arthroplasty patients are sent a questionnaire one year post surgery to assess satisfaction and detect any complications. In 1997/98 828 total knee replacements were performed in Leicester. 60% of patients returned their questionnaire and analysis of these indicated that 8% were dissatisfied and 9% unsure whether their TKR was successful. In a significant proportion of dissatisfied or unsure patients (30%) no clinically identifiable cause could be found. In another 30% of patients a clinical cause could be speculated for their dissatisfaction. Within this group 34% were unhappy with the final flexion achieved, despite an acceptable range of movement after manipulation. When comparing these figures with total hip arthroplasty questionnaires performed during the same period a significantly higher proportion of knee arthroplasty patients expressed dissatisfaction. The consultants were unaware of patient dissatisfaction in 11 % of the total within this group due to their current follow up regimes. We were unable to detect any preventable causes within the dissatisfied/unsure group.
Not all problems detected presented initially to the respective consultants due to current follow-up regimes.
