The best time for definitive orthopaedic care is often unclear
in patients with multiple injuries. The objective of this study
was make a prospective assessment of the safety of our early appropriate
care (EAC) strategy and to evaluate the potential benefit of additional
laboratory data to determine readiness for surgery. A cohort of 335 patients with fractures of the pelvis, acetabulum,
femur, or spine were included. Patients underwent definitive fixation
within 36 hours if one of the following three parameters were met:
lactate <
4.0 mmol/L; pH ≥ 7.25; or base excess (BE) ≥ -5.5 mmol/L.
If all three parameters were met, resuscitation was designated full
protocol resuscitation (FPR). If less than all three parameters
were met, it was designated an incomplete protocol resuscitation
(IPR). Complications were assessed by an independent adjudication
committee and included infection; sepsis; PE/DVT; organ failure;
pneumonia, and acute respiratory distress syndrome (ARDS). Aims
Patients and Methods
The aim of this paper is to review the evidence relating to the
anatomy of the proximal femur, the geometry of the fracture and
the characteristics of implants and methods of fixation of intertrochanteric
fractures of the hip. Relevant papers were identified from appropriate clinical databases
and a narrative review was undertaken.Aims
Materials and Methods
To evaluate whether an ultra-low-dose CT protocol can diagnose
selected limb fractures as well as conventional CT (C-CT). We prospectively studied 40 consecutive patients with a limb
fracture in whom a CT scan was indicated. These were scanned using
an ultra-low-dose CT Reduced Effective Dose Using Computed Tomography
In Orthopaedic Injury (REDUCTION) protocol. Studies from 16 selected
cases were compared with 16 C-CT scans matched for age, gender and
type of fracture. Studies were assessed for diagnosis and image
quality. Descriptive and reliability statistics were calculated.
The total effective radiation dose for each scanned site was compared.Aims
Patients and Methods
Fractures of the hip are common, often occurring
in frail elderly patients, but also in younger fit healthy patients following
trauma. They have a significant associated mortality and major social
and financial implications to patients and health care providers.
Many guidelines are available for the management of these patients,
mostly recommending early surgery for the best outcomes. As a result,
healthcare authorities now put pressure on surgical teams to ‘fast
track’ patients with a fracture of the hip, often misquoting the
available literature, which in itself can be confusing and even
conflicting. This paper has been written following an extensive review of
the available literature. An attempt is made to clarify what is
meant by early surgery (expeditious Cite this article:
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods
We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. Aims
Patients and Methods
A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed.Objectives
Methods
Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons.Objectives
Methods
This is a prospective randomised study which compares the radiological
and functional outcomes of ring and rail fixators in patients with
an infected gap (>
3 cm) nonunion of the tibia. Between May 2008 and February 2013, 70 patients were treated
at our Institute for a posttraumatic osseocutaneous defect of the
tibia measuring at least 3 cm. These were randomised into two groups
of 35 patients using the lottery method. Group I patients were treated
with a ring fixator and group II patients with a rail fixator. The
mean age was 33.2 years (18 to 64) in group I and 29.3 years (18
to 65) in group II. The mean bone gap was 5.84 cm in group I and 5.78
cm in group II. The mean followup was 33.8 months in group I and 32.6 months
in group II. Bone and functional results were assessed using the
classification of the Association for the Study and Application
of the Method of Ilizarov (ASAMI). Functional results were also
assessed at six months using the short musculoskeletal functional
assessment (SMFA) score.Aims
Patients and Methods
We aimed to determine whether there is evidence of improved patient
outcomes in Major Trauma Centres following the regionalisation of
trauma care in England. An observational study was undertaken using the Trauma Audit
and Research Network (TARN), Hospital Episode Statistics (HES) and
national death registrations. The outcome measures were indicators
of the quality of trauma care, such as treatment by a senior doctor
and clinical outcomes, such as mortality in hospital.Aims
Patients and Methods
Deep bone and joint infections (DBJI) are directly intertwined with health, demographic change towards an elderly population, and wellbeing. The elderly human population is more prone to acquire infections, and the consequences such as pain, reduced quality of life, morbidity, absence from work and premature retirement due to disability place significant burdens on already strained healthcare systems and societal budgets. DBJIs are less responsive to systemic antibiotics because of poor vascular perfusion in necrotic bone, large bone defects and persistent biofilm-based infection. Emerging bacterial resistance poses a major threat and new innovative treatment modalities are urgently needed to curb its current trajectory. We present a new biphasic ceramic bone substitute consisting of hydroxyapatite and calcium sulphate for local antibiotic delivery in combination with bone regeneration. Gentamicin release was measured in four setups: 1) Objectives
Materials and Methods
The fundamental concept of open reduction and internal fixation
(ORIF) of ankle fractures has not changed appreciably since the
1960s and, whilst widely used, is associated with complications
including wound dehiscence and infection, prominent hardware and
failure. Closed reduction and intramedullary fixation (CRIF) using
a fibular nail, wires or screws is biomechanically stronger, requires
minimal incisions, and has low-profile hardware. We hypothesised
that fibular nailing in the elderly would have similar functional
outcomes to standard fixation, with a reduced rate of wound and
hardware problems. A total of 100 patients (25 men, 75 women) over the age of 65
years with unstable ankle fractures were randomised to undergo standard
ORIF or fibular nailing (11 men and 39 women in the ORIF group,
14 men and 36 women in the fibular nail group). The mean age was
74 years (65 to 93) and all patients had at least one medical comorbidity. Complications,
patient related outcome measures and cost-effectiveness were assessed
over 12 months.Aims
Patients and Methods
To determine whether there is any difference in infection rate
at 90 days between trauma operations performed in laminar flow and
plenum ventilation, and whether infection risk is altered following
the installation of laminar flow (LF). We assessed the impact of plenum ventilation (PV) and LF on the
rate of infection for patients undergoing orthopaedic trauma operations.
All NHS hospitals in England with a trauma theatre(s) were contacted
to identify the ventilation system which was used between April
2008 and March 2013 in the following categories: always LF, never
LF, installed LF during study period (subdivided: before, during
and after installation) and unknown. For each operation, age, gender,
comorbidity, socio-economic deprivation, number of previous trauma
operations and surgical site infection within 90 days (SSI90) were
extracted from England’s national hospital administrative Hospital
Episode Statistics database. Crude and adjusted odds ratios (OR)
were used to compare ventilation groups using hierarchical logistic
regression. Subanalysis was performed for hip hemiarthroplasties.Aims
Patients and Methods
We examined risk of developing acute renal failure and the associated
mortality among patients aged >
65 years undergoing surgery for
a fracture of the hip. We used medical databases to identify patients who underwent
surgical treatment for a fracture of the hip in Northern Denmark
between 2005 and 2011. Acute renal failure was classified as stage
1, 2 and 3 according to the Kidney Disease Improving Global Outcome
criteria. We computed the risk of developing acute renal failure
within five days after surgery with death as a competing risk, and
the short-term (six to 30 days post-operatively) and long-term mortality
(31 days to 365 days post-operatively). We calculated adjusted hazard
ratios (HRs) for death with 95% confidence intervals (CIs).Aims
Patients and Methods
Flail chest from a blunt injury to the thorax is associated with
significant morbidity and mortality. Its management globally is
predominantly non-operative; however, there are an increasing number
of centres which undertake surgical stabilisation. The aim of this
meta-analysis was to compare the efficacy of this approach with
that of non-operative management. A systematic search of the literature was carried out to identify
randomised controlled trials (RCTs) which compared the clinical
outcome of patients with a traumatic flail chest treated by surgical
stabilisation of any kind with that of non-operative management.Aims
Patients and Methods
Demineralised bone matrix (DBM) is rarely used for the local
delivery of prophylactic antibiotics. Our aim, in this study, was
to show that a graft with a bioactive glass and DBM combination,
which is currently available for clinical use, can be loaded with
tobramycin and release levels of antibiotic greater than the minimum
inhibitory concentration for Antibiotic was loaded into a graft and subsequently evaluated
for drug elution kinetics and the inhibition of bacterial growth.
A rat femoral condylar plug model was used to determine the effect
of the graft, loaded with antibiotic, on bone healing.Aims
Materials and Methods
The aim of this study was to report the outcome following primary
fixation or a staged protocol for type C fractures of the tibial
plafond. We studied all patients who sustained a complex intra-articular
fracture (AO type C) of the distal tibia over an 11-year period.
The primary short-term outcome was infection. The primary long-term
outcome was the Foot and Ankle Outcome Score (FAOS).Aims
Patients and Methods
Compartment syndrome results from increased intra-compartmental
pressure (ICP) causing local tissue ischaemia and cell death, but
the systemic effects are not well described. We hypothesised that
compartment syndrome would have a profound effect not only on the affected
limb, but also on remote organs. Using a rat model of compartment syndrome, its systemic effects
on the viability of hepatocytes and on inflammation and circulation
were directly visualised using intravital video microscopy.Aims
Methods
This article presents a unified clinical theory
that links established facts about the physiology of bone and homeostasis,
with those involved in the healing of fractures and the development
of nonunion. The key to this theory is the concept that the tissue
that forms in and around a fracture should be considered a specific
functional entity. This ‘bone-healing unit’ produces a physiological
response to its biological and mechanical environment, which leads
to the normal healing of bone. This tissue responds to mechanical
forces and functions according to Wolff’s law, Perren’s strain theory
and Frost’s concept of the “mechanostat”. In response to the local
mechanical environment, the bone-healing unit normally changes with
time, producing different tissues that can tolerate various levels
of strain. The normal result is the formation of bone that bridges
the fracture – healing by callus. Nonunion occurs when the bone-healing
unit fails either due to mechanical or biological problems or a
combination of both. In clinical practice, the majority of nonunions
are due to mechanical problems with instability, resulting in too
much strain at the fracture site. In most nonunions, there is an
intact bone-healing unit. We suggest that this maintains its biological
potential to heal, but fails to function due to the mechanical conditions.
The theory predicts the healing pattern of multifragmentary fractures
and the observed morphological characteristics of different nonunions.
It suggests that the majority of nonunions will heal if the correct
mechanical environment is produced by surgery, without the need
for biological adjuncts such as autologous bone graft. Cite this article:
Although infrequent, a fracture of the cuboid can lead to significant
disruption of the integrity of the midfoot and its function. The
purpose of this study was to classify the pattern of fractures of
the cuboid, relate them to the mechanism of injury and suggest methods
of managing them. We performed a retrospective review of patients with radiologically
reported cuboid fractures. Fractures were grouped according to commonly
occurring patterns of injury. A total of 192 fractures in 188 patients
were included. They were classified into five patterns of injury.Aims
Patients and Methods
