Despite the expansion of arthroscopic surgery of the shoulder,
the open deltopectoral approach is increasingly used for the fixation
of fractures and arthroplasty of the shoulder. The anatomy of the
terminal branches of the posterior circumflex humeral artery (PCHA)
has not been described before. We undertook an investigation to
correct this omission. The vascular anatomy encountered during 100 consecutive elective
deltopectoral approaches was recorded, and the common variants of
the terminal branches of the PCHA are described.Aims
Patients and Methods
The goals of this study were to define the risk factors, nature,
chronology, and treatment strategies adopted for periprosthetic
femoral fractures in 32 644 primary total hip arthroplasties (THAs). There were 564 intra-operative fractures (1.7%); 529 during uncemented
stem placement (3.0%) and 35 during cemented stem placement (0.23%).
Intra-operative fractures were more common in females and patients
over 65 years (p <
0.001). The majority occurred during placement
of the femoral component (60%), and involved the calcar (69%). There
were 557 post-operative fractures (20-year probability: 3.5%; 95%
confidence interval (CI) 3.2 to 3.9); 335 fractures after placement
of an uncemented stem (20-year probability: 7.7%; 95% CI 6.2 to
9.1) and 222 after placement of a cemented stem (20-year probability:
2.1%; 95% CI 1.8 to 2.5). The probability of a post-operative fracture
within 30 days after an uncemented stem was ten times higher than
a cemented stem. The most common post-operative fracture type was
a Vancouver AG (32%; n = 135), with 67% occurring after
a fall. In all, 36% (n = 152) were treated with revision arthroplasty. Aim and Methods
Results
To assess the structure and extracellular matrix molecule expression of osteogenic cell sheets created via culture in medium with both dexamethasone (Dex) and ascorbic acid phosphate (AscP) compared either Dex or AscP alone. Osteogenic cell sheets were prepared by culturing rat bone marrow stromal cells in a minimal essential medium (MEM), MEM with AscP, MEM with Dex, and MEM with Dex and AscP (Dex/AscP). The cell number and messenger (m)RNA expression were assessed Objectives
Methods
This study aimed to determine the long-term functional,
clinical and radiological outcomes in patients with Schatzker IV
to VI fractures of the tibial plateau treated with an Ilizarov frame.
Clinical, functional and radiological assessment was carried out
at a minimum of one year post-operatively. A cohort of 105 patients
(62 men, 43 women) with a mean age of 49 years (15 to 87) and a
mean follow-up of 7.8 years (1 to 19) were reviewed. There were
18 type IV, 10 type V and 77 type VI fractures. All fractures united
with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient
developed a deep infection. The median range of movement (ROM) of
the knee was 110o and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with
no deep infection; spanning the knee had no detrimental effect on
the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively
with a fine wire Ilizarov fixator. Cite this article:
Slipped capital femoral epiphysis (SCFE) may
lead to symptomatic femoroacetabular impingement (FAI). We report our
experience of arthroscopic treatment, including osteochondroplasty,
for the sequelae of SCFE. Data were prospectively collected on patients undergoing arthroscopy
of the hip for the sequelae of SCFE between March 2007 and February
2013, including demographic data, radiological assessment of the
deformity and other factors that may influence outcome, such as
the presence of established avascular necrosis. Patients completed
the modified Harris hip score (mHHS) and the non-arthritic hip score
(NAHS) before and after surgery. In total, 18 patients with a mean age of 19 years (13 to 42),
were included in the study. All patients presented with pain in
the hip and mechanical symptoms, and had evidence of FAI (cam or
mixed impingement) on plain radiographs. The patients underwent arthroscopic osteoplasty of the femoral
neck. The mean follow-up was 29 months (23 to 56). The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1)
and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p
= 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively.
Linear regression analysis demonstrated a significant association
between poorer outcome scores and increased time to surgery following SCFE
(p <
0.05 for all parameters except baseline MHHS). Symptomatic FAI following (SCFE) may be addressed using arthroscopic
techniques, and should be treated promptly to minimise progressive
functional impairment and chondrolabral degeneration. Take home message: Arthroscopy of the hip can be used to treat
femoroacetabular impingement successfully following SCFE. However,
this should be performed promptly after presentation in order to
prevent irreversible progression and poorer clinical outcomes. Cite this article:
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods
This study aimed to evaluate the histological and mechanical features of tendon healing in a rabbit model with second-harmonic-generation (SHG) imaging and tensile testing. A total of eight male Japanese white rabbits were used for this study. The flexor digitorum tendons in their right leg were sharply transected, and then were repaired by intratendinous stitching. At four weeks post-operatively, the rabbits were killed and the flexor digitorum tendons in both right and left legs were excised and used as specimens for tendon healing (n = 8) and control (n = 8), respectively. Each specimen was examined by SHG imaging, followed by tensile testing, and the results of the two testing modalities were assessed for correlation.Objectives
Materials and Methods
The aim of this consensus was to develop a definition of post-operative
fibrosis of the knee. An international panel of experts took part in a formal consensus
process composed of a discussion phase and three Delphi rounds.Aims
Patients and Methods
While use of large national clinical databases for orthopaedic
trauma research has increased dramatically, there has been little
study of the differences in populations contained therein. In this
study we aimed to compare populations of patients with femoral shaft
fractures across three commonly used national databases, specifically
with regard to age and comorbidities. Patients were identified in the Nationwide Inpatient Sample (NIS),
National Surgical Quality Improvement Program (NSQIP) and National
Trauma Data Bank (NTDB). Aims
Patients and Methods
We wished to assess the feasibility of a future randomised controlled
trial of parathyroid hormone (PTH) supplements to aid healing of
trochanteric fractures of the hip, by an open label prospective
feasibility and pilot study with a nested qualitative sub study.
This aimed to inform the design of a future powered study comparing
the functional recovery after trochanteric hip fracture in patients
undergoing standard care, We undertook a pilot study comparing the functional recovery
after trochanteric hip fracture in patients 60 years or older, admitted
with a trochanteric hip fracture, and potentially eligible to be
randomised to either standard care or the administration of subcutaneous
PTH for six weeks. Our desired outcomes were functional testing
and measures to assess the feasibility and acceptability of the
study.Aims
Patients and Methods
The aim of this study was to evaluate the time course of changes
in parameters of diffusion tensor imaging (DTI) such as fractional
anisotropy (FA) and apparent diffusion coefficient (ADC) in patients
with symptomatic lumbar disc herniation. We also investigated the
correlation between the severity of neurological symptoms and these parameters. A total of 13 patients with unilateral radiculopathy due to herniation
of a lumbar disc were investigated with DTI on a 1.5T MR scanner
and underwent micro discectomy. There were nine men and four women,
with a median age of 55.5 years (19 to 79). The changes in the mean
FA and ADC values and the correlation between these changes and the
severity of the neurological symptoms were investigated before and
at six months after surgery. Aims
Patients and Methods
As residency training programmes around the globe
move towards competency-based medical education (CBME), there is
a need to review current teaching and assessment practices as they
relate to education in orthopaedic trauma. Assessment is the cornerstone
of CBME, as it not only helps to determine when a trainee is fit
to practice independently, but it also provides feedback on performance
and guides the development of competence. Although a standardised
core knowledge base for trauma care has been developed by the leading
national accreditation bodies and international agencies that teach
and perform research in orthopaedic trauma, educators have not yet established
optimal methods for assessing trainees’ performance in managing
orthopaedic trauma patients. This review describes the existing knowledge from the literature
on assessment in orthopaedic trauma and highlights initiatives that
have recently been undertaken towards CBME in the United Kingdom,
Canada and the United States. In order to support a CBME approach, programmes need to improve
the frequency and quality of assessments and improve on current
formative and summative feedback techniques in order to enhance
resident education in orthopaedic trauma. Cite this article:
Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1’s effects on experimental OA. Collagenase (type II) was injected twice into both knees of three-month-old rabbits to induce OA, combined with two intra–articular injections of Torin 1 (400 nM). Degeneration of articular cartilage was evaluated by histology using the Mankin scoring system at eight weeks after injection. Chondrocyte degeneration and autophagosomes were observed by transmission electron microscopy. Matrix metallopeptidase-13 (MMP-13) and vascular endothelial growth factor (VEGF) expression were analysed by quantitative RT-PCR (qPCR).Beclin-1 and light chain 3 (LC3) expression were examined by Western blotting.Objectives
Methods
Osteoarthritis (OA) is characterised by articular cartilage degradation. MicroRNAs (miRNAs) have been identified in the development of OA. The purpose of our study was to explore the functional role and underlying mechanism of miR-138-5p in interleukin-1 beta (IL-1β)-induced extracellular matrix (ECM) degradation of OA cartilage. Human articular cartilage was obtained from patients with and without OA, and chondrocytes were isolated and stimulated by IL-1β. The expression levels of miR-138-5p in cartilage and chondrocytes were both determined. After transfection with miR-138-5p mimics, allele-specific oligonucleotide (ASO)-miR-138-5p, or their negative controls, the messenger RNA (mRNA) levels of aggrecan (ACAN), collagen type II and alpha 1 (COL2A1), the protein levels of glycosaminoglycans (GAGs), and both the mRNA and protein levels of matrix metalloproteinase (MMP)-13 were evaluated. Luciferase reporter assay, quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot were performed to explore whether Forkhead Box C1 (FOCX1) was a target of miR-138-5p. Further, we co-transfected OA chondrocytes with miR-138-5p mimics and pcDNA3.1 (+)-FOXC1 and then stimulated with IL-1β to determine whether miR-138-5p-mediated IL-1β-induced cartilage matrix degradation resulted from targeting FOXC1.Objectives
Materials and Methods
Approved by the Food and Drug Administration in 2004, the Phase
III Oxford Medial Partial Knee is used to treat anteromedial osteoarthritis
(AMOA) in patients with an intact anterior cruciate ligament. This
unicompartmental knee arthroplasty (UKA) is relatively new in the
United States, and therefore long-term American results are lacking. This is a single surgeon, retrospective study based on prospectively
collected data, analysing a consecutive series of primary UKAs using
the Phase III mobile-bearing Oxford Knee and Phase III instrumentation. Between July 2004 and December 2006, the senior author (RHE)
carried out a medial UKA in 173 patients (213 knees) for anteromedial
osteoarthritis or avascular necrosis (AVN). A total of 95 patients were men and 78 were women. Their mean
age at surgery was 67 years (38 to 89) and mean body mass index
29.87 kg/m2 (17 to 62). The mean follow-up was ten years (4 to 11).Aims
Patients and Methods
1. Practical experience has shown that subcapital fractures of the femur unite freely if reduction is stable and fixation is secure. 2. Stable reduction is obtained when the muscular and gravitational forces tending to redisplace the fracture are opposed by equal and opposite counterforces, and inherent stability is believed to depend upon the integrity of the flared cortical buttress at the postero-inferior junction of the femoral neck and head. 3. In the stable subcapital fracture a state of equilibrium is reached when the forward and upward thrust of the fixation appliance in the femoral head is opposed by the counterthrust of the closely applied and cleanly broken fragments at the postero-inferior aspect of the fracture. When the postero-inferior cortical buttress is comminuted, inherent stability is lost, lateral rotation deformity recurs and the fixation device is avulsed from the cancellous bone of the head. 4. Stability may be restored by reduction in the "valgus" position, by various forms of osteotomy, by refashioning the fracture fragments or by a postero-inferiorly positioned bone graft. Theoretically, stability may also be obtained by a double lever system of fixation in which an obliquely placed fixation device or bone graft is combined with a horizontally disposed wire, pin, nail or screw crossing it anteriorly. Multilever fixation by three or more threaded wires or pins inserted at different angles and lying in contact at their point of crossing may likewise provide stability. 5. Fixation by two crossed screws has been chosen for clinical trial in 100 displaced subcapital fractures. Imperfect positioning of the screws in seven patients has been followed by early breakdown of reduction and non-union, but satisfactory positioning has been associated with radiological union in fifty patients who have been observed for twelve months or more. 6. Ultimate breakdown in some of these fractures is certain to follow avascular necrosis, and this complication has already been seen in a few patients treated by cross screw fixation more than two years ago. It is also expected that non-union will occur in some of those patients still under observation for less than a year. Even so, these preliminary findings indicate a percentage of union far greater than that obtained by previous methods of treatment, and, although statistically inadequate, they are presented in support of the belief that it should no longer be considered impossible to achieve the same percentage of union in subcapital fractures of the femur as we are accustomed to expect in the treatment of fractures elsewhere. It is not implied, however, that this ideal will be reached merely by the adoption of some form of double or multilever fixation, and much will continue to depend upon the quality of the radiographic services, the precision of reduction and the perfection of operative technique. 7. Every advance in our understanding of what is meant by "perfection of operative technique" lends increasing support to the ultimate truth of Watson-Jones's (1941) dictum: "A perfect result may be expected from a technically perfect operation; an imperfect result is due to imperfect technique." But the simple and foolproof method of fixation which will end the search for technical perfection in the treatment of the displaced subcapital fracture has yet to be evolved, and many questions remain to be answered about this
