Musculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections. Between January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30).Aims
Methods
To investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients. We undertook a retrospective, case-control study of 67 patients at mean 3.5 years (SD 1.3; 1.3 to 6.1) after TPF (47 patients underwent fixation, and 20 nonoperative management). Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a 1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF.Aims
Methods
Using human cadaver specimens, we investigated
the role of supplementary fibular plating in the treatment of distal
tibial fractures using an intramedullary nail. Fibular plating is
thought to improve stability in these situations, but has been reported
to have increased soft-tissue complications and to impair union
of the fracture. We proposed that multidirectional locking screws
provide adequate stability, making additional fibular plating unnecessary.
A distal tibiofibular osteotomy model performed on matched fresh-frozen
lower limb specimens was stabilised with reamed nails using conventional
biplanar distal locking (CDL) or multidirectional distal locking
(MDL) options with and without fibular plating. Rotational stiffness
was assessed under a constant axial force of 150 N and a superimposed
torque of ± 5 Nm. Total movement, and neutral zone and fracture
gap movement were analysed. In the CDL group, fibular plating improved stiffness at the tibial
fracture site, albeit to a small degree (p = 0.013). In the MDL
group additional fibular plating did not increase the stiffness.
The MDL nail without fibular plating was significantly more stable
than the CDL nail with an additional fibular plate (p = 0.008). These findings suggest that additional fibular plating does not
improve stability if a multidirectional distal locking intramedullary
nail is used, and is therefore unnecessary if not needed to aid
reduction. Cite this article:
Fractures in patients aged ≥ 65 years constitute
an increasing burden on health and social care and are associated with
a high morbidity and mortality. There is little accurate information
about the epidemiology of fractures in the elderly. We have analysed
prospectively collected data on 4786 in- and out-patients who presented
with a fracture over two one-year periods. Analysis shows that there
are six patterns of the incidence of fractures in patients aged ≥ 65
years. In males six types of fracture increase in incidence after
the age of 65 years and 11 types increase in females aged over 65
years. Five types of fracture decrease in incidence after the age
of 65 years. Multiple fractures increase in incidence in both males
and females aged ≥ 65 years, as do fractures related to falls. Analysis of the incidence of fractures, together with life expectancy,
shows that the probability of males and females aged ≥ 65 years
having a fracture during the rest of their life is 18.5% and 52.0%,
respectively. The equivalent figures for males and females aged ≥ 80
years are 13.3% and 34.8%, respectively. Cite this article:
Bicondylar tibial plateau fractures result from
high-energy injuries. Fractures of the tibial plateau can involve
the tibial tubercle, which represents a disruption to the extensor
mechanism and logically must be stabilised. The purpose of this
study was to identify the incidence of an independent tibial tubercle
fracture in bicondylar tibial plateau fractures, and to report management
strategies and potential complications. We retrospectively reviewed
a prospectively collected orthopaedic trauma database for the period
January 2003 to December 2008, and identified 392 bicondylar fractures
of the tibial plateau, in which 85 tibial tubercle fractures (21.6%)
were identified in 84 patients. There were 60 men and 24 women in
our study group, with a mean age of 45.4 years (18 to 71). In 84 fractures
open reduction and internal fixation was undertaken, either with
screws alone (23 patients) or with a plate and screws (61 patients).
The remaining patient was treated non-operatively. In all, 52 fractures
were available for clinical and radiological assessment at a mean
follow-up of 58.5 weeks (24 to 94). All fractures of the tibial
tubercle united, but 24 of 54 fractures (46%) required a secondary
procedure for their tibial plateau fracture. Four patients reported
pain arising from prominent tubercle plates and screws, which in
one patient required removal. Tibial tubercle fractures occurred
in over one-fifth of the bicondylar tibial plateau fractures in
our series. Fixation is necessary and can be reliably performed
with screws alone or with a screw and plate, which restores the
extensor mechanism and facilitates early knee flexion. Cite this article:
