The aim of this retrospective multicentre study was to evaluate
mid-term results of the operative treatment of Monteggia-like lesions
and to determine the prognostic factors that influence the clinical
and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age
of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion
were followed up clinically and radiologically after surgical treatment.
The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score
(MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder
and Hand (DASH) score were used for evaluation at a mean of 65 months
(27 to 111) postoperatively. All ulnar fractures were stabilized
using a proximally contoured or precontoured locking compression
plate. Mason type I fractures of the radial head were treated conservatively, type
II fractures were treated with reconstruction, and type III fractures
with arthroplasty. All Morrey type II and III fractures of the coronoid
process was stabilized using lag screws.Aims
Patients and Methods
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only. The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period.Objectives
Methods
To compare the early management and mortality of older patients
sustaining major orthopaedic trauma with that of a younger population
with similar injuries. The Trauma Audit Research Network database was reviewed to identify
eligible patients admitted between April 2012 and June 2015. Distribution
and severity of injury, interventions, comorbidity, critical care
episodes and mortality were recorded. The population was divided
into young (64 years or younger) and older (65 years and older) patients.Aims
Patients and Methods
Taper junctions between modular hip arthroplasty femoral heads and stems fail by wear or corrosion which can be caused by relative motion at their interface. Increasing the assembly force can reduce relative motion and corrosion but may also damage surrounding tissues. The purpose of this study was to determine the effects of increasing the impaction energy and the stiffness of the impactor tool on the stability of the taper junction and on the forces transmitted through the patient’s surrounding tissues. A commercially available impaction tool was modified to assemble components in the laboratory using impactor tips with varying stiffness at different applied energy levels. Springs were mounted below the modular components to represent the patient. The pull-off force of the head from the stem was measured to assess stability, and the displacement of the springs was measured to assess the force transmitted to the patient’s tissues.Objectives
Methods
A failed total ankle arthroplasty (TAA) is often associated with
much bone loss. As an alternative to arthrodesis, the surgeon may
consider a custom-made talar component to compensate for the bone
loss. Our aim in this study was to assess the functional and radiological
outcome after the use of such a component at mid- to long-term follow-up. A total of 12 patients (five women and seven men, mean age 53
years; 36 to77) with a failed TAA and a large talar defect underwent
a revision procedure using a custom-made talar component. The design
of the custom-made components was based on CT scans and standard
radiographs, when compared with the contralateral ankle. After the
anterior talocalcaneal joint was fused, the talar component was
introduced and fixed to the body of the calcaneum.Aims
Patients and Methods
The number of patients undergoing arthroscopic surgery of the
hip has increased significantly during the past decade. It has now
become an established technique for the treatment of many intra-
and extra-articular conditions affecting the hip. However, it has
a steep learning curve and is not without the risk of complications.
The purpose of this systematic review was to determine the prevalence
of complications during and following this procedure. Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines were used in designing this study. Two reviewers systematically
searched the literature for complications related to arthroscopy
of the hip. The research question and eligibility criteria were
established Aims
Materials and Methods
Limb salvage for diabetic foot infections often require multiple
procedures. Some patients will eventually end up with below knee
amputation (BKA) when all limb salvage attempts fail. We seek to
study the patients’ ability to return to normal life, functional
status, prosthesis usage and perspectives on multiple limb salvage
procedures that culminated in BKA to review if they would undertake
a similar path if their situation was repeated. A total of 41 patients who underwent BKA between July 2011 and
June 2013 were reviewed. They were divided into primary and creeping
(prior multiple salvage procedures) amputations. The Barthel’s Index
(BI) and the Reintegration to Normal Living Index (RNLI) were used.
A questionnaire was used to identify whether the patient would undergo
the same multiple attempts at limb salvage again if faced with the
same problem.Aims
Patients and Methods
Patellar instability most frequently presents
during adolescence. Congenital and infantile dislocation of the
patella is a distinct entity from adolescent instability and measurable
abnormalities may be present at birth. In the normal patellofemoral
joint an increase in quadriceps angle and patellar height are matched
by an increase in trochlear depth as the joint matures. Adolescent
instability may herald a lifelong condition leading to chronic disability
and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer
or medial patellofemoral ligament (MPFL) reconstruction in the young
adult prevents further instability. Although these techniques are
proven in the young adult, they may cause growth arrest and deformity
where the physis is open. A vigorous non-operative strategy may
permit delay of surgery until growth is complete. Where non-operative
treatment has failed a modified MPFL reconstruction may be performed
to maintain stability until physeal closure permits anatomical reconstruction.
If significant growth remains an extraosseous reconstruction of
the MPFL may impart the lowest risk to the physis. If minor growth
remains image intensifier guided placement of femoral intraosseous
fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to
adolescent instability and provides a framework for management of
these patients. Cite this article:
Radial head arthroplasty (RHA) may be used in the treatment of
non-reconstructable radial head fractures. The aim of this study
was to evaluate the mid-term clinical and radiographic results of
RHA. Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23
women with either acute injuries (54) or with traumatic sequelae
(23) of a fracture of the radial head. Four designs of RHA were
used, including the Guepar (Small Bone Innovations (SBi)/Stryker;
36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten)
or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up
was 74.0 months (standard deviation (Aims
Patients and Methods
This is a prospective randomised controlled trial comparing the
functional outcomes of plate fixation and elastic stable intramedullary
nailing (ESIN) of completely displaced mid-shaft fractures of the
clavicle in the active adult population. We prospectively recruited 123 patients and randomised them to
either plate fixation or ESIN. Patients completed the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) score at one to six weeks post-operatively.
They were followed up at six weeks, three and six months and one
year with radiographs, and their clinical outcome was assessed using
both the DASH and the Constant Score.Aims
Patients and Methods
The purpose of the present study was to evaluate the impact of
intravenous tranexamic acid on the reduction of blood loss, transfusion
rate, and early post-operative clinical outcome in total shoulder
arthroplasty. A randomised, placebo-controlled trial which included 54 patients
undergoing unilateral primary stemless anatomical or stemmed reverse
total shoulder arthroplasty was undertaken. Patients received either
100 ml saline (placebo, n = 27), or 100 ml saline together with
1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to
skin incision and during wound closure. Peri-operative blood loss
via an intra-articular drain was recorded and total blood loss was
calculated. The post-operative transfusion rate was documented.
Assessment of early clinical parameters included the visual analogue
scale for pain (VAS), documentation of haematoma formation and adverse events.Aims
Patients and Methods
Hip and groin injuries are common in athletes
who take part in high level sports. Adductor muscle tendon injuries represent
a small but important number of these injuries. Avulsion of the
tendons attached to the symphysis pubis has previously been described:
these can be managed both operatively and non-operatively. We describe
an uncommon variant of this injury, namely complete avulsion of
the adductor sleeve complex: this includes adductor longus, pectineus
and rectus abdominis. We go on to describe a surgical technique
which promotes a full return to the pre-injury level of sporting
activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed
acute adductor complex avulsion injury (six to 34 days old) underwent
surgical repair. The operative procedure consisted of anatomical
re-attachment of the avulsed tissues in each case and mesh reinforcement
of the posterior inguinal wall in seven patients. All underwent a
standardised rehabilitation programme, which was then individualised
to be sport-specific. One patient developed a superficial wound infection, which was
successfully treated with antibiotics. Of the 15 patients, four
complained of transient local numbness which resolved in all cases.
All patients (including seven elite athletes) returned to their
previous level of participation in sport. Cite this article:
A variety of operative techniques have been described as under
the term ‘Bristow-Latarjet’ procedure. This review aims to define
the original procedure, and compare the variation in techniques
described in the literature, assessing any effect on clinical outcomes. A systematic review of 24 studies was performed to compare specific
steps of the technique (coracoid osteotomy site, subscapularis approach,
orientation and position of coracoid graft fixation and fixation
method, additional labral and capsular repair) and detect any effect
this variability had on outcomes.Objectives
Materials and Methods
We present the results of correcting a double or triple curve
adolescent idiopathic scoliosis using a convex segmental pedicle
screw technique. We reviewed 191 patients with a mean age at surgery of 15 years
(11 to 23.3). Pedicle screws were placed at the convexity of each
curve. Concave screws were inserted at one or two cephalad levels
and two caudal levels. The mean operating time was 183 minutes (132
to 276) and the mean blood loss 0.22% of the total blood volume
(0.08% to 0.4%). Multimodal monitoring remained stable throughout
the operation. The mean hospital stay was 6.8 days (5 to 15).Aims
Patients and Methods
The MAGnetic Expansion Control (MAGEC) system
is used increasingly in the management of early-onset scoliosis.
Good results have been published, but there have been recent reports
identifying implant failures that may be associated with significant
metallosis surrounding the implants. This article aims to present
the current knowledge regarding the performance of this implant,
and the potential implications and strategies that may be employed
to identify and limit any problems. We urge surgeons to apply caution to patient and construct selection;
engage in prospective patient registration using a spine registry;
ensure close clinical monitoring until growth has ceased; and send
all explanted MAGEC rods for independent analysis. The MAGEC system may be a good instrumentation system for the
treatment of early-onset scoliosis. However, it is innovative and
like all new technology, especially when deployed in a paediatric
population, robust systems to assess long-term outcome are required
to ensure that patient safety is maintained. Cite this article:
Radiostereometric analysis (RSA) allows an extremely accurate
measurement of early micromotion of components following arthroplasty. In this study, RSA was used to measure the migration of 11 partially
cemented fluted pegged glenoid components in patients with osteoarthritis
who underwent total shoulder arthroplasty using an improved surgical
technique (seven men, four women, mean age 68). Patients were evaluated
clinically using the American Shoulder and Elbow Surgeons (ASES)
and Constant-Murley scores and by CT scans two years post-operatively. Aims
Patients and Methods
Osteoarthritis (OA) is the most common form of arthritis, affecting approximately 15% of the human population. Recently, increased concentration of nitric oxide in serum and synovial fluid in patients with OA has been observed. However, the exact role of nitric oxide in the initiation of OA has not been elucidated. The aim of the present study was to investigate the role of nitric oxide in innate immune regulation during OA initiation in rats. Rat OA was induced by performing meniscectomy surgery while cartilage samples were collected 0, 7, and 14 days after surgery. Cartilage cytokine levels were determined by using enzyme-linked immunosorbent assay, while other proteins were assessed by using Western blotObjectives
Methods
