The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and step-off values in the weightbearing dome were digitally measured by two trauma surgeons. Native hip survival was reported using Kaplan-Meier curves. Predictors for conversion to THA were determined using Cox regression analysis.Aims
Methods
Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality.Aims
Methods
Hip hemiarthroplasty is a standard treatment for intracapsular
proximal femoral fractures in the frail elderly. In this study we
have explored the implications of early return to theatre, within
30 days, on patient outcome following hip hemiarthroplasty. We retrospectively reviewed the hospital records of all hip hemiarthroplasties
performed in our unit between January 2010 and January 2015. Demographic
details, medical backround, details of the primary procedure, complications,
subsequent procedures requiring return to theatre, re-admissions,
discharge destination and death were collected.Aims
Patients and Methods
The aim of this double-blind prospective randomised controlled
trial was to assess whether low intensity pulsed ultrasound (LIPUS)
accelerated or enhanced the rate of bone healing in adult patients
undergoing distraction osteogenesis. A total of 62 adult patients undergoing limb lengthening or bone
transport by distraction osteogenesis were randomised to treatment
with either an active (n = 32) or a placebo (n = 30) ultrasound
device. A standardised corticotomy was performed in the proximal
tibial metaphysis and a circular Ilizarov frame was used in all
patients. The rate of distraction was also standardised. The primary
outcome measure was the time to removal of the frame after adjusting
for the length of distraction in days/cm for both the per protocol
(PP) and the intention-to-treat (ITT) groups. The assessor was blinded
to the form of treatment. A secondary outcome was to identify covariates affecting
the time to removal of the frame.Aims
Patients and Methods
As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was ≥ 3 mm.
The spiral blade modification of the Dynamic
Hip Screw (DHS) was designed for superior biomechanical fixation
in the osteoporotic femoral head. Our objective was to compare clinical
outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients over the age of 50 years
treated with DHS-blades (blades) and 242 patients treated with conventional
DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were
identified from a prospectively compiled database in a level 1 trauma
centre. Using propensity score matching, two groups comprising 177
matched patients were compiled and radiological and clinical outcomes
compared. In each group there were 66 males and 111 females. Mean
age was 83.6 (54 to 100) for the conventional DHS group and 83.8
(52 to 101) for the blade group. Loss of fixation occurred in two blades and 13 DHSs. None of
the blades had observable migration while nine DHSs had gross migration
within the femoral head before the fracture healed. There were two
versus four implant cut-outs respectively and one side plate pull-out
in the DHS group. There was no significant difference in mortality
and eventual walking ability between the groups. Multiple logistic
regression suggested that poor reduction (odds ratio (OR) 11.49,
95% confidence intervals (CI) 1.45 to 90.9, p = 0.021) and fixation
by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent
predictors of loss of fixation. The spiral blade design may decrease the risk of implant migration
in the femoral head but does not reduce the incidence of cut-out
and reoperation. Reduction of the fracture is of paramount importance
since poor reduction was an independent predictor for loss of fixation
regardless of the implant being used. Cite this article:
