The Ankle Injury Management (AIM) trial was a pragmatic equivalence randomized controlled trial conducted at 24 hospitals in the United Kingdom that recruited 620 patients aged more than 60 years with an unstable ankle fracture. The trial compared the usual care pathway of early management with open reduction and internal fixation with initially attempting non-surgical management using close contact casting (CCC). CCC is a minimally padded cast applied by an orthopaedic surgeon after closed reduction in the operating theatre. The intervention groups had equivalent functional outcomes at six months and longer-term follow-up. However, potential barriers to using CCC as an initial form of treatment for these patients have been identified. In this report, the results of the AIM trial are summarized and the key issues are discussed in order to further the debate about the role of CCC. Evidence from the AIM trial supports surgeons considering conservative management by CCC as a treatment option for these patients. The longer-term follow-up emphasized that patients treated with CCC need careful monitoring in the weeks after its application to monitor maintenance of reduction. Cite this article:
Aims. The aim of this study was to determine whether the sequential
application of povidone iodine-alcohol (PVI) followed by chlorhexidine
gluconate-alcohol (CHG) would reduce surgical wound contamination
to a greater extent than PVI applied twice in patients undergoing
spinal surgery. Patients and Methods. A single-centre, interventional, two arm, parallel group randomised
controlled trial was undertaken, involving 407 patients who underwent
elective spinal surgery. For 203 patients, the skin was disinfected before surgery using
PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured
alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and
for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine
gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint).
The primary
Aims. Reconstruction of the acetabulum after failed total hip arthroplasty
(THA) can be a surgical challenge in the presence of severe bone
loss. We report the long-term survival of a porous tantalum revision
acetabular component, its radiological appearance and quality of
life
Aims. The aim of this study was to inform a definitive trial which
could determine the clinical effectiveness of the X-Bolt Dynamic
Hip Plating System compared with the sliding hip screw for patients
with complex pertrochanteric fragility fractures of the femur. Patients and Methods. This was a single centre, participant blinded, randomised, standard-of-care
controlled pilot trial. Patients aged 60 years and over with AO/ASIF
A2 and A3 type femoral pertrochanteric fractures were eligible. Results. The primary
Aims. Fractures of the distal femur are an important cause of morbidity.
Their optimal management remains controversial. Contemporary implants
include angular-stable anatomical locking plates and locked intramedullary
nails (IMNs). We compared the long-term patient-reported functional
outcome of fixation of fractures of the distal femur using these
two methods of treatment. Patients and Methods. A total of 297 patients were retrospectively identified from
a State-wide trauma registry in Australia: 195 had been treated
with a locking plate and 102 with an IMN. Baseline characteristics
of the patients and their fractures were recorded. Health-related
quality-of-life, functional and radiographic
Aims. In order to evaluate the effectiveness of the Mobi-C implant
in cervical disc degeneration, a randomised study was conducted,
comparing the Mobi-C prosthesis arthroplasty with anterior cervical
disc fusion (ACDF) in patients with single level cervical spondylosis. Patients and Methods. From January 2008 to July 2009, 99 patients were enrolled and
randomly divided into two groups, those having a Mobi-C implant
(n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28
men, 20 women).The patients were followed up for five years, with
the primary
Aims. The optimal management of intracapsular fractures of the femoral
neck in independently mobile patients remains open to debate. Successful
fixation obviates the limitations of arthroplasty for this group
of patients. However, with fixation failure rates as high as 30%,
the
Aims. We aimed to characterise the effect of expeditious hip fracture
surgery in elderly patients within 24 hours of admission on short-term
post-operative
Aims. This prospective randomised controlled trial was designed to
evaluate the
Aims. Positive cultures are not uncommon in cases of revision total
knee and hip arthroplasty (TKA and THA) for presumed aseptic causes.
The purpose of this study was to assess the incidence of positive
intra-operative cultures in presumed aseptic revision of TKA and
THA, and to determine whether the presence of intra-operative positive cultures
results in inferior survival in such cases. Patients and Methods. A retrospective cohort study was assembled with 679 patients
undergoing revision knee (340 cases) or hip arthroplasty (339 cases)
for presumed aseptic causes. For all patients three or more separate
intra-operative cultures were obtained. Patients were diagnosed
with a previously unsuspected prosthetic joint infection (PJI) if two
or more cultures were positive with the same organism. Records were
reviewed for demographic details, pre-operative laboratory results
and culture results. The primary
The repair of chondral lesions associated with
femoroacetabular impingement requires specific treatment in addition
to that of the impingement. In this single-centre retrospective
analysis of a consecutive series of patients we compared treatment
with microfracture (MFx) with a technique of enhanced microfracture
autologous matrix-induced chondrogenesis (AMIC). Acetabular grade III and IV chondral lesions measuring between
2 cm. 2. and 8 cm. 2. in 147 patients were treated
by MFx in 77 and AMIC in 70. The
Aims. We reviewed all patients who sustained a fracture of the hip
and were treated in Northern Ireland over a period of 15 years to
identify trends in incidence, the demographics of the patients,
the rates of mortality, the configuration of the fracture and the
choice of implant. Patients and Methods. Since 01 January 2001 data about every fracture of the hip sustained
in an adult have been collected centrally in Northern Ireland. All
adults with such a fracture between 2000 and 2015 were included
in the study. Temporal changes in their demographics, the mode of
treatment, and