We report on the use of the Ilizarov method to
treat 40 consecutive fractures of the
Hindfoot (subtalar) movement and disability after fracture of the
One hundred patients who had sustained a fracture of the
We performed a prospective randomised trial on matched groups of patients with displaced
One hundred consecutive closed fractures of the adult
1. One hundred and eighty-one fractures of the
1. A study of the late results of 343 soundly united
We analysed the results of 93
1 . A series of 343
All
1. Eighty consecutive open fractures of the
We measured pressures in the anterior and deep posterior compartments continuously for up to 72 hours in 20 patients with closed fractures of the
The stability of union following the conservative treatment of
A prospective study of 141 patients with 143
We have reviewed our recent results with functional bracing of
1. A series of 705 fractures of the tibia is reviewed, 674 of which were treated conservatively. 2. The factors most conducive to delayed or non-union are initial displacement, comminution, associated soft-tissue wound and infection. The extent to which these are combined in any fracture determines its "personality" and its inherent propensity for union. 3. Eight fracture types are differentiated based on the above "personality rating." The incidence of delayed union or non-union varies from 9 per cent in the most favourable type to 39 per cent in the least favourable. Infection raises the incidence to 60 per cent. Comparative statistics which fail to recognise these differences can be entirely misleading. 4. Continuous traction does not retard union. 5. The results of conservative treatment are analysed with regard to union, deformity, stiff joints and contractures and the conclusion is reached that no case has yet been made out for internal fixation as the method of choice in the treatment of this fracture.
1. The probable greatest bending moment applied to a plated or nailed fracture of the tibia during restricted weight-bearing is estimated to be, in men, up to about 79 Newton metres (58 poundsforce feet). The maximum twisting moment is estimated to be about 29 Newton metres (22 poundsforce feet). 2. Twenty-two human tibiae were loaded in three-point bending and broke at bending moments of from 57·9 to 294 Newton metres (42·7 to 216 poundsforce feet) if they had not previously been drilled; tibiae which had holes made through both cortices with a c. 3-millimetre (⅛-inch) drill broke at from 32·4 to 144 Newton metres (23·8 to 106 poundsforce feet). Tibiae loaded in torsion broke at twisting moments of from 27·5 to 892 Newton metres (20·2 to 65·8 poundsforce feet) when not drilled, 23·6 to 77·5 Newton metres (l7·3 to 57·1 poundsforce feet) when drilled. 3. When bent so as to open the fracture site, the 14-centimetre Stamm was the strongest of all the single plates tested (reaching its elastic limit at a bending moment of 17·6 Newton metres (13 poundsforce feet) and 5 degrees total angulation at 22·6 Newton metres (16·6 poundsforce feet)), while the Venable was the weakest (elastic limit 4·9 Newton metres (3·6 poundsforce feet) and 5 degrees at 7·9 Newton metres (5·8 poundsforce feet)). A 13-millimetre Küntscher nail reached its elastic limit at 42·2 Newton metres (31·1 poundsforce feet) and 5 degrees total angulation at 49 Newton metres (36 poundsforce feet). 4. In torsion the 15-centimetre Hicks was the strongest ofthe plates (elastic limit 27·5 Newton metres (20·2 poundsforce feet) and 5 degrees rotation at 16·7 Newton metres (l2·3 poundsforce feet)). 5. Küntscher nails in bones provided no dependable strength in torsion. 6. In both bending and torsion, a preparation of one Venable plate on each of the two anterior surfaces was stronger than any single plate, and was as strong as the weaker drilled tibiae. 7. The three currently available metallic materials (stainless steel, cobalt-chrome and titanium) have static mechanical properties so similar that the choice between them can be made on other grounds. 8. The highest load applied to a screw during bending tests was about half that needed to pull a screw out of even a thin-walled tibia. 9. Screws beyond four for one plate are mechanically redundant at the moment of implantation but may be necessary as an insurance against subsequent deterioration in strength. 10. Countersinks in plates are a source of significant weakness, and should preferably be as shallow as possible. 11. An unoccupied screw hole in the centre of a plate is a source of serious weakness. 12. Only the strongest implants tested were strong enough to withstand the bending or twisting moments to be expected in restricted weight-bearing. In two-plate preparations a danger is introduced by the fact that these moments are similar to those required to Ireak a drilled tibia.
1. The thesis is advanced that in the treatment of fractures of the adult tibia rigid fixation is desirable. 2. The mechanical factors are discussed and a technique is described which provides a high degree of fixation without exposing more than one surface of the bone. 3. The process of healing of such fractures is described and the results in thirty-three unselected patients are given.
We examined the placement of the stem in relation to the medial tibial cortex when using total knee replacements (TKRs) with medially-offset tibial stems in Korean patients. Measurements were performed on the pre- and post-operative radiographs of 246 osteoarthritic knees replaced between January 2005 and May 2006 using the Genesis II or E-motion TKR with a medially-offset stem. Pre-operatively, we measured the distance between the mechanical axis and that of the
Aims. Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open
There is no absolute method of evaluating healing
of a fracture of the
Fractures of the
It seems right to draw the following conclusions from this study of the relative merits of early and delayed fixation for fractures of the femoral and
We present the results of ankle fusion using the Ilizarov technique for bone loss around the ankle in 20 patients. All except one had sustained post-traumatic bone loss. Infection was present in 17. The mean age was 33.1 years (7 to 71). The mean size of the defect was 3.98 cm (1.5 to 12) and associated limb shortening before the index procedure varied from 1 cm to 5 cm. The mean time in the external fixator was 335 days (42 to 870). Tibiotalar fusion was performed in 19 patients and tibiocalcaneal fusion in one. Associated problems included diabetes in one patient, pelvic and urethral injury in one, visual injury in one patient and ipsilateral tibial fracture in five. At the final mean follow-up of 51.55 months (24 to 121) fusion had been achieved in 19 of 20 patients. A total of 16 patients were able to return to work. The results were graded as good in 11 patients, fair in six and poor in three. The mean external fixation index was 8.8 days/mm (0 to 30). One patient with diabetes developed severe infection which required early removal of the fixator. Refractures occurred in three patients, two of which were at the site of fusion and one at a previous
The aim of this study was to describe the incidence of refractures among children, following fractures of all long bones, and to identify when the risk of refracture decreases. All patients aged under 16 years with a fracture that had occurred in a bone with ongoing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the primary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones.Aims
Methods
Ensuring correct rotation of the femoral component
is a challenging aspect of patellofemoral replacement surgery. Rotation
equal to the epicondylar axis or marginally more external rotation
is acceptable. Internal rotation is associated with poor outcomes.
This paper comprises two studies evaluating the use of the medial
malleolus as a landmark to guide rotation. We used 100 lower-leg anteroposterior radiographs to evaluate
the reliability of the medial malleolus as a landmark. Assessment
was made of the angle between the
The use of autograft bone is the best option
when undertaking a procedure that requires bone graft because it
is osteogenic, osteoconductive and osseo-inductive. Pain, morbidity
and complications associated with harvesting iliac or non-iliac
sites occur in between 6% and 30% of cases. An alternative source
of graft with possibly a lower morbidity is the intramedullary canal.
In this study, 28 patients undergoing 30 arthrodesis procedures
on the hindfoot had a mean of 48 cm. 3 . (43 to 50) of bone
harvested locally from the hindfoot or the
Aims. This 501-patient, multi-centre, randomised controlled trial sought
to establish the effect of low-intensity, pulsed, ultrasound (LIPUS)
on
Tibial tubercle osteotomy (TTO) facilitates surgical exposure and protects the extensor mechanism during revision total knee arthroplasty (rTKA). The purpose of this study was to determine the rates of bony union, complications, and reoperations following TTO during rTKA, to assess the functional outcomes of rTKA with TTO at two years’ minimum follow-up, and to identify the risk factors of failure. Between January 2010 and September 2020, 695 rTKAs were performed and data were entered into a prospective database. Inclusion criteria were rTKAs with concomitant TTO, without extensor mechanism allograft, and a minimum of two years’ follow-up. A total of 135 rTKAs were included, with a mean age of 65 years (SD 9.0) and a mean BMI of 29.8 kg/m2 (SD 5.7). The most frequent indications for revision were infection (50%; 68/135), aseptic loosening (25%; 34/135), and stiffness (13%; 18/135). Patients had standardized follow-up at six weeks, three months, six months, and annually thereafter. Complications and revisions were evaluated at the last follow-up. Functional outcomes were assessed using the Knee Society Score (KSS) and range of motion.Aims
Methods
The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI). This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared.Aims
Methods
Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity. Patients who underwent TKA from September 2020 to September 2021 were prospectively included. Inclusion criteria were primary end-stage osteoarthritis (Kellgren-Lawrence stage IV) of the knee. Exclusion criteria were missed follow-up visit, post-traumatic pathologies of the foot, and neurological disorders. Radiological angles measured included the mTFA, hindfoot alignment view angle, and TT. The Foot Function Index (FFI) score was assessed. Gait analyses were conducted to measure mediolateral changes of the gait line and ankle laxity was tested using an ankle arthrometer. All parameters were acquired one week pre- and three months postoperatively.Aims
Methods
A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups.Aims
Methods
Although it is widely accepted that grade IIIB open tibial fractures require combined specialised orthopaedic and plastic surgery, the majority of patients in the UK initially present to local hospitals without access to specialised trauma facilities. The aim of this study was to compare the outcome of patients presenting directly to a specialist centre (primary group) with that of patients initially managed at local centres (tertiary group). We reviewed 73 consecutive grade IIIB open
Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions. We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded.Aims
Methods
The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler ultrasound (DUS), to assess the incidence of pulmonary embolism (PE) using CT angiography, and to identify the factors that predict postoperative DVT in patients with a pelvic and/or acetabular fracture. All patients treated surgically for a pelvic and/or acetabular fracture between October 2016 and January 2020 were enrolled into this prospective single-centre study. The demographic, medical, and surgical details of the patients were recorded. DVT screening of the lower limbs was routinely performed using DUS before and at six to ten days after surgery. CT angiography was used in patients who were suspected of having PE. Age-adjusted univariate and stepwise multiple logistic regression analysis were used to determine the association between explanatory variables and postoperative DVT.Aims
Methods
We report four patients who sustained secondary fractures of the posterior wall of the
We present two children with massive defects of the tibia and an associated active infection who were treated by medial transport of the fibula using the Ilizarov device. The first child had chronic discharging osteomyelitis which affected the whole
We treated 24 patients with nonunion of
1. The frequency of variable degrees of ischaemia of soft tissue in closed tibial and fibular shaft fractures is emphasised. 2. Two cases with ischaemia of calf musculature are described. 3. A follow-up study of 100 cases of closed
The results of immediate plate fixation of 97 open fractures of the
We report the operative technique and results of a new method of central grafting for persistent nonunion of the
1. The results of internal fixation are described in 470
We made a prospective study of the incidence and natural history of algodystrophy and associated changes in bone mineral density in the ankles and feet of 60 consecutive patients who had suffered unilateral fractures of the
We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the
We have analysed the initial displacement and the retention of position after reduction of 192 spiral fractures of the
The management of twenty-one children with a defect of the
Forty failed hinged arthroplasties of the knee were revised by the insertion of another hinged implant. In 14 cases the prosthesis used at the revision operation was similar to the primary implant; in 26, a hinge with an elongated femoral stem was used, usually replacing part of the femoral shaft. In seven of these knees an elongated tibial stem was also required, though the