The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years’ follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded.Aims
Methods
In this retrospective observational cohort study,
we describe 17 patients out of 1775 treated for various fractures who
developed mycobacterium tuberculosis (MTB) infection after surgery.
The cohort comprised 15 men and two women with a mean age of 40
years (24 to 70). A total of ten fractures were open and seven were
closed. Of these, seven patients underwent intramedullary nailing
of a fracture of the long bone, seven had fractures fixed with plates,
two with Kirschner-wires and screws, and one had a hemiarthroplasty
of the hip with an Austin Moore prosthesis. All patients were followed-up
for two years. In all patients, the infection resolved, and in 14
the fractures united. Nonunion was seen in two patients one of whom
underwent two-stage total hip arthroplasty (THA) and the other patient
was treated using excision arthoplasty. Another patient was treated
using two-stage THA. With only sporadic case reports in the literature,
MTB infection is rarely clinically suspected, even in underdeveloped
and developing countries, where pulmonary and other forms of TB
are endemic. In developed countries there is also an increased incidence
among immunocompromised patients. In this paper we discuss the pathogenesis
and incidence of MTB infection after surgical management of fractures
and suggest protocols for early diagnosis and management. Cite this article:
The best method of managing a fracture of the
distal humerus in a frail low-demand patient with osteoporotic bone remains
controversial. Total elbow arthroplasty (TEA) has been recommended
for patients in whom open reduction and internal fixation (ORIF)
is not possible. Conservative methods of treatment, including the
‘bag of bones’ technique (acceptance of displacement of the bony
fragments and early mobilisation), are now rarely considered as
they are believed to give a poor functional result. We reviewed 40 elderly and low-demand patients (aged 50 to 93
years, 72% women) with a fracture of the distal humerus who had
been treated conservatively at our hospital between March 2008 and
December 2013, and assessed their short- and medium-term functional
outcome. In the short-term, the mean Broberg and Morrey score improved
from 42 points (poor; 23 to 80) at six weeks after injury to 67
points (fair; 40 to 88) by three months. In the medium-term, surviving patients (n = 20) had a mean Oxford
elbow score of 30 points (7 to 48) at four years and a mean Disabilities
of the Arm, Shoulder and Hand score of 38 points (0 to 75): 95%
reported a functional range of elbow flexion. The cumulative rate
of fracture union at one year was 53%. The mortality at five years approached
40%. Conservative management of a fracture of the distal humerus in
a low-demand patient only gives a modest functional result, but
avoids the substantial surgical risks associated with primary ORIF
or TEA. Cite this article:
The aim of this study was to report the incidence
of arthrofibrosis of the knee and identify risk factors for its development
following a fracture of the tibial plateau. We carried out a retrospective
review of 186 patients (114 male, 72 female) with a fracture of
the tibial plateau who underwent open reduction and internal fixation.
Their mean age was 46.4 years (19 to 83) and the mean follow-up
was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring
a further intervention. Using multivariate regression analysis,
the use of a provisional external fixator (odds ratio (OR) 4.63,
95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly
associated with the development of arthrofibrosis. Similarly, the
use of a continuous passive movement (CPM) machine was associated
with significantly less development of arthrofibrosis (OR = 0.32,
95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external
fixator was found to be significant, with each extra day of external
fixation increasing the odds of requiring manipulation under anaesthesia
(MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy
fracture, surgical approach, infection and use of tobacco were not
associated with the development of arthrofibrosis. Patients with
a successful MUA had significantly less time to MUA (mean 2.9 months; Based our results, CPM following operative fixation for a fracture
of the tibial plateau may reduce the risk of the development of
arthrofibrosis, particularly in patients who also undergo prolonged
provisional external fixation. Cite this article:
We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities. We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D). There was a significant reduction in level of activity, frequency of participation in sport (both p <
0.001) and EQ-5D scores in patients of all age groups compared to a normal English population (p = 0.001). A total of 22 (42%) were able to return to their previous level of activities: 35 (67%) were able to take part in sport at some level. Of all the parameters analysed, the Matta radiological follow-up criteria were the single best predictor for resumption of sporting activity and frequency of participation.
We reviewed 78 femoral and tibial nonunions treated between January 1992 and December 2003. Of these, we classified 41 in 40 patients as complex cases because of infection (22), bone loss (6) or failed previous surgery (13). The complex cases were all treated with Ilizarov frames. At a mean time of 14.1 months (4 to 38), 39 had healed successfully. Using the Association for the Study and Application of the Methods of Ilizarov scoring system we obtained 17 excellent, 14 good, four fair and six poor bone results. The functional results were excellent in 14 patients, good in 14, fair in two and poor in two. A total of six patients were lost to follow-up and two had amputations so were not evaluated for final functional assessment. All but two patients were very satisfied with the results. The average cost of treatment to the treating hospital was approximately £30 000 per patient. We suggest that early referral to a tertiary centre could reduce the morbidity and prolonged time off work for these patients. The results justify the expense, but the National Health Service needs to make financial provision for the reconstruction of this type of complex nonunion.
