Although infrequent, a fracture of the cuboid can lead to significant
disruption of the integrity of the midfoot and its function. The
purpose of this study was to classify the pattern of fractures of
the cuboid, relate them to the mechanism of injury and suggest methods
of managing them. We performed a retrospective review of patients with radiologically
reported cuboid fractures. Fractures were grouped according to commonly
occurring patterns of injury. A total of 192 fractures in 188 patients
were included. They were classified into five patterns of injury.Aims
Patients and Methods
We wished to assess the feasibility of a future randomised controlled
trial of parathyroid hormone (PTH) supplements to aid healing of
trochanteric fractures of the hip, by an open label prospective
feasibility and pilot study with a nested qualitative sub study.
This aimed to inform the design of a future powered study comparing
the functional recovery after trochanteric hip fracture in patients
undergoing standard care, We undertook a pilot study comparing the functional recovery
after trochanteric hip fracture in patients 60 years or older, admitted
with a trochanteric hip fracture, and potentially eligible to be
randomised to either standard care or the administration of subcutaneous
PTH for six weeks. Our desired outcomes were functional testing
and measures to assess the feasibility and acceptability of the
study.Aims
Patients and Methods
We aimed to identify the pattern of nerve injury associated with
paediatric supracondylar fractures of the humerus. Over a 17 year period, between 1996 and 2012, 166 children were
referred to our specialist peripheral nerve injury unit. From examination
of the medical records and radiographs were recorded the nature
of the fracture, associated vascular and neurological injury, treatment
provided and clinical course.Aims
Patients and Methods
Fractures of the distal femur are an important cause of morbidity.
Their optimal management remains controversial. Contemporary implants
include angular-stable anatomical locking plates and locked intramedullary
nails (IMNs). We compared the long-term patient-reported functional
outcome of fixation of fractures of the distal femur using these
two methods of treatment. A total of 297 patients were retrospectively identified from
a State-wide trauma registry in Australia: 195 had been treated
with a locking plate and 102 with an IMN. Baseline characteristics
of the patients and their fractures were recorded. Health-related
quality-of-life, functional and radiographic outcomes were compared
using mixed effects regression models at six months and one year.Aims
Patients and Methods
We compared the accuracy, operating time and radiation exposure
of the introduction of iliosacral screws using O-arm/Stealth Navigation
and standard fluoroscopy. Iliosacral screws were introduced percutaneously into the first
sacral body (S1) of ten human cadavers, four men and six women.
The mean age was 77 years (58 to 85). Screws were introduced using
a standard technique into the left side of S1 using C-Arm fluoroscopy
and then into the right side using O-Arm/Stealth Navigation. The
radiation was measured on the surgeon by dosimeters placed under
a lead thyroid shield and apron, on a finger, a hat and on the cadavers.Aims
Materials and Methods
We performed a systematic review of the literature
pertaining to the functional outcomes of the surgical management
of acetabular fractures. A total of 69 articles met our inclusion
criteria, revealing that eight generic outcome instruments were
used, along with five specific instruments. The majority of studies
reported outcomes using a version of the d’Aubigne and Postel score,
which has not been validated for use in acetabular fracture. Few validated
outcome measures were reported. No psychometric testing of outcome
instruments was performed. The current assessment of outcomes in
surgery for acetabular fractures lacks scientific rigour, and does
not give reliable outcome data for either scientific comparison
or patient counselling. Take home message: The use of non-validated functional outcome
measures is a major limitation of the current literature pertaining
to surgical management of acetabular fractures; future studies should
use validated outcome measures to ensure the legitimacy of the reported
results. Cite this article:
The aim of this study was to inform a definitive trial which
could determine the clinical effectiveness of the X-Bolt Dynamic
Hip Plating System compared with the sliding hip screw for patients
with complex pertrochanteric fragility fractures of the femur. This was a single centre, participant blinded, randomised, standard-of-care
controlled pilot trial. Patients aged 60 years and over with AO/ASIF
A2 and A3 type femoral pertrochanteric fractures were eligible.Aims
Patients and Methods
Hemiarthroplasty of the hip is usually carried out through either
a direct lateral or posterior approach. The aim of this prospective
observational study was to determine any differences in patient-reported
outcomes between the two surgical approaches. From the Swedish Hip Arthroplasty Register we identified patients
of 70 years and above who were recorded as having had a hemiarthroplasty
during 2009. Only patients who had been treated with modern prostheses
were included. A questionnaire was posted to those who remained
alive one year after surgery. A total of 2118 patients (78% of those
available) with a mean age of 85 years (70 to 102) returned the
questionnaire. Aims
Patients and Methods
The aim of this study was to identify risk factors for the failure
of exchange nailing in nonunion of tibial diaphyseal fractures. A cohort of 102 tibial diaphyseal nonunions in 101 patients with
a mean age of 36.9 years (15 to 74) were treated between January
1992 and December 2012 by exchange nailing. Of which 33 (32%) were
initially open injuries. The median time from primary fixation to
exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to
9.8 months). The main outcome measures were union, number of secondary fixation
procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify
risk factors for failure to achieve union. Aims
Patients and Methods
Amputation in intractable cases of complex regional pain syndrome
(CRPS) remains controversial. The likelihood of recurrent Complex Regional Pain Syndrome (CRPS),
residual and phantom limb pain and persistent disability after amputation
is poorly described in the literature. The aims of this study were
to compare pain, function, depression and quality of life between
patients with intractable CRPS who underwent amputation and those
in whom amputation was considered but not performed. There were 19 patients in each group, with comparable demographic
details. The amputated group included 14 men and five women with
a mean age of 31 years ( All participants completed the following questionnaires: Short-Form
(SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability
Index (PDI), the Beck Depression Inventory (BDI) and a clinical
demographic questionnaire. Aims
Patients and Methods
The management of open lower limb fractures in the United Kingdom
has evolved over the last ten years with the introduction of major
trauma networks (MTNs), the publication of standards of care and
the wide acceptance of a combined orthopaedic and plastic surgical approach
to management. The aims of this study were to report recent changes
in outcome of open tibial fractures following the implementation
of these changes. Data on all patients with an open tibial fracture presenting
to a major trauma centre between 2011 and 2012 were collected prospectively.
The treatment and outcomes of the 65 Gustilo Anderson Grade III
B tibial fractures were compared with historical data from the same
unit. Aims
Patients and Methods
Our aim, using English Hospital Episode Statistics data before
during and after the Distal Radius Acute Fracture Fixation Trial
(DRAFFT), was to assess whether the results of the trial affected
clinical practice. Data were grouped into six month intervals from July 2005 to
December 2014. All patient episodes in the National Health Service
involving emergency surgery for an isolated distal radial fracture
were included.Aims
Patients and Methods
In this study, we aimed to determine whether designation as a
major trauma centre (MTC) affects the quality of care for patients
with a fracture of the hip. All patients in the United Kingdom National Hip Fracture Database,
between April 2010 and December 2013, were included. The indicators
of quality that were recorded included the time to arrival on an
orthopaedic ward, to review by a geriatrician, and to operation.
The clinical outcomes were the development of a pressure sore, discharge
home, length of stay, in-hospital mortality, and re-operation within
30 days. Aims
Patients and Methods
While use of large national clinical databases for orthopaedic
trauma research has increased dramatically, there has been little
study of the differences in populations contained therein. In this
study we aimed to compare populations of patients with femoral shaft
fractures across three commonly used national databases, specifically
with regard to age and comorbidities. Patients were identified in the Nationwide Inpatient Sample (NIS),
National Surgical Quality Improvement Program (NSQIP) and National
Trauma Data Bank (NTDB). Aims
Patients and Methods
A pragmatic multicentre randomised controlled trial (PROFHER)
was conducted in United Kingdom National Health Service (NHS) hospitals
to evaluate the clinical effectiveness and cost effectiveness of
surgery compared with non-surgical treatment for displaced fractures
of the proximal humerus involving the surgical neck in adults. A cost utility analysis from the NHS perspective was performed.
Differences between surgical and non-surgical treatment groups in
costs and quality adjusted life years (QALYs) at two years were
used to derive an estimate of the cost effectiveness of surgery
using regression methods. Aims
Methods
The aims of this study were to estimate the cost of surgical
treatment of fractures of the proximal humerus using a micro-costing
methodology, contrast this cost with the national reimbursement
tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using
semi-structured interviews with 32 members of hospital staff. Its
content validity was established through a Delphi panel evaluation.
Costs were calculated using time-driven activity-based costing (TDABC)
and sensitivity analysis was performed to evaluate the determinants
of costAims
Methods
The treatment of late presenting fractures of the lateral humeral
condyle in children remains controversial. We report on the outcome for 16 children who presented with a
fracture of the lateral humeral epicondyle at a mean of 7.4 weeks
(3 to 15.6) after injury and were treated surgically.Aims
Methods
This study identifies early risk factors for symptomatic nonunion
of displaced midshaft fractures of the clavicle that aid identification
of an at risk group who may benefit from surgery. We performed a retrospective study of 88 patients aged between
16 and 60 years that were managed non-operatively. Aims
Methods
This study aimed to determine the long-term functional,
clinical and radiological outcomes in patients with Schatzker IV
to VI fractures of the tibial plateau treated with an Ilizarov frame.
Clinical, functional and radiological assessment was carried out
at a minimum of one year post-operatively. A cohort of 105 patients
(62 men, 43 women) with a mean age of 49 years (15 to 87) and a
mean follow-up of 7.8 years (1 to 19) were reviewed. There were
18 type IV, 10 type V and 77 type VI fractures. All fractures united
with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient
developed a deep infection. The median range of movement (ROM) of
the knee was 110o and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with
no deep infection; spanning the knee had no detrimental effect on
the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively
with a fine wire Ilizarov fixator. Cite this article:
