External fixators are the traditional fixation method of choice for contaminated open fractures. However, patient acceptance is low due to the high profile and therefore physical burden of the constructs. An externalised locking compression plate is a low profile alternative. However, the biomechanical differences have not been assessed. The objective of this study was to evaluate the axial and torsional stiffness of the externalised titanium locking compression plate (ET-LCP), the externalised stainless steel locking compression plate (ESS-LCP) and the unilateral external fixator (UEF). A fracture gap model was created to simulate comminuted mid-shaft tibia fractures using synthetic composite bones. Fifteen constructs were stabilised with ET-LCP, ESS-LCP or UEF (five constructs each). The constructs were loaded under both axial and torsional directions to determine construct stiffness.Objectives
Methods
The PROximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial has recently demonstrated that surgery is non-superior to non-operative treatment in the management of displaced proximal humeral fractures. The objective of this study was to assess current surgical practice in the context of the PROFHER trial in terms of patient demographics, injury characteristics and the nature of the surgical treatment. A total of ten consecutive patients undergoing surgery for the treatment of a proximal humeral fracture from each of 11 United Kingdom hospitals were retrospectively identified over a 15 month period between January 2014 and March 2015. Data gathered for the 110 patients included patient demographics, injury characteristics, mode of surgical fixation, the grade of operating surgeon and the cost of the surgical implants.Objectives
Methods
The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison. A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison.Objectives
Methods
The biomembrane (induced membrane) formed around polymethylmethacrylate (PMMA) spacers has value in clinical applications for bone defect reconstruction. Few studies have evaluated its cellular, molecular or stem cell features. Our objective was to characterise induced membrane morphology, molecular features and osteogenic stem cell characteristics. Following Institutional Review Board approval, biomembrane specimens were obtained from 12 patient surgeries for management of segmental bony defects (mean patient age 40.7 years, standard deviation 14.4). Biomembranes from nine tibias and three femurs were processed for morphologic, molecular or stem cell analyses. Gene expression was determined using the Affymetrix GeneChip Operating Software (GCOS). Molecular analyses compared biomembrane gene expression patterns with a mineralising osteoblast culture, and gene expression in specimens with longer spacer duration (> 12 weeks) with specimens with shorter durations. Statistical analyses used the unpaired student Objectives
Methods
Current studies on the additional benefit of using computed tomography
(CT) in order to evaluate the surgeons’ agreement on treatment plans
for fracture are inconsistent. This inconsistency can be explained
by a methodological phenomenon called ‘spectrum bias’, defined as
the bias inherent when investigators choose a population lacking
therapeutic uncertainty for evaluation. The aim of the study is
to determine the influence of spectrum bias on the intra-observer
agreement of treatment plans for fractures of the distal radius. Four surgeons evaluated 51 patients with displaced fractures
of the distal radius at four time points: T1 and T2: conventional
radiographs; T3 and T4: radiographs and additional CT scan (radiograph
and CT). Choice of treatment plan (operative or non-operative) and
therapeutic certainty (five-point scale: very uncertain to very
certain) were rated. To determine the influence of spectrum bias,
the intra-observer agreement was analysed, using Kappa statistics,
for each degree of therapeutic certainty. Objectives
Methods
The purpose of this study was to refine an accepted contaminated
rat femur defect model to result in an infection rate of approximately
50%. This threshold will allow examination of treatments aimed at
reducing infection in open fractures with less risk of type II error. Defects were created in the stablised femurs of anaethetised
rats, contaminated with Objectives
Methods
To study the measurement properties of a joint specific patient
reported outcome measure, a measure of capability and a general
health-related quality of life (HRQOL) tool in a large cohort of
patients with a hip fracture. Responsiveness and associations between the Oxford Hip Score
(a hip specific measure: OHS), ICEpop CAPability (a measure of capability
in older people: ICECAP-O) and EuroQol EQ-5D (general health-related
quality of life measure: EQ-5D) were assessed using data available
from two large prospective studies. The three outcome measures were assessed
concurrently at a number of fixed follow-up time-points in a consecutive
sequence of patients, allowing direct assessment of change from
baseline, inter-measure associations and validity using a range
of statistical methods.Objectives
Methods
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. Controversy exists regarding
the optimal treatment for independent patients with displaced intracapsular fractures
of the proximal femur. The recognised alternatives are hemiarthroplasty
and total hip replacement. At present there is no established standard
of care, with both types of arthroplasty being used in many centres.
The principal advantages of total hip replacement are a functional
benefit over hemiarthroplasty and a reduced risk of revision surgery.
The principal criticism is the increased risk of dislocation. We
believe that an alternative acetabular component may reduce the
risk of dislocation but still provide the functional benefit of
total hip replacement in these patients. We therefore propose to
investigate the dislocation risk of a dual-mobility acetabular component
compared with standard polyethylene component in total hip replacement
for independent patients with displaced intracapsular fractures
of the proximal femur within the framework of the larger WHiTE (Warwick
Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article:
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. Controversy exists regarding
the optimal treatment for patients with unstable trochanteric proximal
femoral fractures. The recognised treatment alternatives are extramedullary
fixation usually with a sliding hip screw and intramedullary fixation
with a cephalomedullary nail. Current evidence suggests that best
results and lowest complication rates occur using a sliding hip screw.
Complications in these difficult fractures are relatively common
regardless of type of treatment. We believe that a novel device,
the X-Bolt dynamic plating system, may offer superior fixation over
a sliding hip screw with lower reoperation risk and better function.
We therefore propose to investigate the clinical effectiveness of
the X-bolt dynamic plating system compared with standard sliding
hip screw fixation within the framework of a the larger WHiTE (Warwick
Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article:
One commonly used rat fracture model for bone and mineral research
is a closed mid-shaft femur fracture as described by Bonnarens in
1984. Initially, this model was believed to create very reproducible
fractures. However, there have been frequent reports of comminution
and varying rates of complication. Given the importance of precise
anticipation of those characteristics in laboratory research, we
aimed to precisely estimate the rate of comminution, its importance and
its effect on the amount of soft callus created. Furthermore, we
aimed to precisely report the rate of complications such as death
and infection. We tested a rat model of femoral fracture on 84 rats based on
Bonnarens’ original description. We used a proximal approach with
trochanterotomy to insert the pin, a drop tower to create the fracture
and a high-resolution fluoroscopic imager to detect the comminution.
We weighed the soft callus on day seven and compared the soft callus
parameters with the comminution status.Objectives
Methods
Nonunion is one of the most troublesome complications to treat
in orthopaedics. Former authors believed that atrophic nonunion
occurred as a result of lack of mesenchymal stem cells (MSCs). We
evaluated the number and viability of MSCs in site of atrophic nonunion compared
with those in iliac crest. We enrolled five patients with neglected atrophic nonunions of
long bones confirmed by clinical examinations and plain radiographs
into this study. As much as 10 ml bone marrow aspirate was obtained
from both the nonunion site and the iliac crest and cultured for
three weeks. Cell numbers were counted using a haemocytometer and
vitality of the cells was determined by trypan blue staining. The
cells were confirmed as MSCs by evaluating their expression marker
(CD 105, CD 73, HLA-DR, CD 34, CD 45, CD 14, and CD 19). Cells number and
viability were compared between the nonunion and iliac creat sites.Objectives
Methods
To determine the morbidity and mortality outcomes of patients
presenting with a fractured neck of femur in an Australian context.
Peri-operative variables related to unfavourable outcomes were identified
to allow planning of intervention strategies for improving peri-operative
care. We performed a retrospective observational study of 185 consecutive
adult patients admitted to an Australian metropolitan teaching hospital
with fractured neck of femur between 2009 and 2010. The main outcome
measures were 30-day and one-year mortality rates, major complications
and factors influencing mortality. Objectives
Methods
Osteochondral injuries, if not treated adequately, often lead
to severe osteoarthritis. Possible treatment options include refixation
of the fragment or replacement therapies such as Pridie drilling,
microfracture or osteochondral grafts, all of which have certain
disadvantages. Only refixation of the fragment can produce a smooth
and resilient joint surface. The aim of this study was the evaluation
of an ultrasound-activated bioresorbable pin for the refixation of
osteochondral fragments under physiological conditions. In 16 Merino sheep, specific osteochondral fragments of the medial
femoral condyle were produced and refixed with one of conventional
bioresorbable pins, titanium screws or ultrasound-activated pins.
Macro- and microscopic scoring was undertaken after three months. Objectives
Methods
The use of two implants to manage concomitant ipsilateral femoral
shaft and proximal femoral fractures has been indicated, but no
studies address the relationship of dynamic hip screw (DHS) side
plate screws and the intramedullary nail where failure might occur
after union. This study compares different implant configurations
in order to investigate bridging the gap between the distal DHS
and tip of the intramedullary nail. A total of 29 left synthetic femora were tested in three groups:
1) gapped short nail (GSN); 2) unicortical short nail (USN), differing
from GSN by the use of two unicortical bridging screws; and 3) bicortical
long nail (BLN), with two angled bicortical and one unicortical bridging
screws. With these findings, five matched-pairs of cadaveric femora
were tested in two groups: 1) unicortical long nail (ULN), with
a longer nail than USN and three bridging unicortical screws; and
2) BLN. Specimens were axially loaded to 22.7 kg (50 lb), and internally
rotated 90°/sec until failure.Objectives
Methods
We aimed to further evaluate the biomechanical characteristics
of two locking screws Synthetic tubular bone models representing normal bone density
and osteoporotic bone density were used. Artificial fracture gaps
of 1 cm were created in each specimen before fixation with one of
two constructs: 1) two locking screws using a five-hole locking
compression plate (LCP) plate; or 2) three non-locking screws with
a seven-hole LCP plate across each side of the fracture gap. The
stiffness, maximum displacement, mode of failure and number of cycles
to failure were recorded under progressive cyclic torsional and
eccentric axial loading.Objectives
Methods
To investigate the differences of open reduction and internal
fixation (ORIF) of complex AO Type C distal radius fractures between
two different models of a single implant type. A total of 136 patients who received either a 2.4 mm (n = 61)
or 3.5 mm (n = 75) distal radius locking compression plate (LCP
DR) using a volar approach were followed over two years. The main
outcome measurements included motion, grip strength, pain, and the
scores of Gartland and Werley, the Short-Form 36 (SF-36) and the
Disabilities of the Arm, Shoulder, and Hand (DASH). Differences
between the treatment groups were evaluated using regression analysis
and the likelihood ratio test with significance based on the Bonferroni
corrected p-value of <
0.003.Objectives
Methods
Negative pressure wound therapy (NPWT) and vessel loop assisted
closure are two common methods used to assist with the closure of
fasciotomy wounds. This retrospective review compares these two
methods using a primary outcome measurement of skin graft requirement. A retrospective search was performed to identify patients who
underwent fasciotomy at our institution. Patient demographics, location
of the fasciotomy, type of assisted closure, injury characteristics,
need for skin graft, length of stay and evidence of infection within
90 days were recorded.Introduction
Methods
