Advertisement for orthosearch.org.uk
Results 261 - 280 of 556
Results per page:
The Journal of Bone & Joint Surgery British Volume
Vol. 71-B, Issue 5 | Pages 777 - 781
1 Nov 1989
Nilsson L Stromqvist B Thorngren K

We report a series of 640 consecutive cervical hip fractures which were followed prospectively for two years after primary internal fixation with two hook-pins. Secondary arthroplasties were performed as salvage procedures in 75 cases and the early outcome of these was studied retrospectively. The mean time in hospital was 25 days for prosthetic replacement, though 60% of the patients had other medical conditions considered as risk factors. Mortality was 5% after six months and 8% after one year. Dislocation was seen in 11% and additional surgery was required in 4%. There was one case of deep infection and one supracondylar femoral fracture. In some cases there was considerable delay between the primary and secondary operation due to lack of awareness of functional deterioration, but although many patients had poor mobility before the secondary operation this was greatly improved within six weeks of the arthroplasty. We conclude that elective secondary hip arthroplasty for failure of fracture fixation is a safe and successful procedure. Once the decision to perform an arthroplasty is taken, this should be done without delay to avoid deterioration of function


Bone & Joint 360
Vol. 8, Issue 3 | Pages 37 - 40
1 Jun 2019


Bone & Joint Research
Vol. 8, Issue 10 | Pages 472 - 480
1 Oct 2019
Hjorthaug GA Søreide E Nordsletten L Madsen JE Reinholt FP Niratisairak S Dimmen S

Objectives

Experimental studies indicate that non-steroidal anti-inflammatory drugs (NSAIDs) may have negative effects on fracture healing. This study aimed to assess the effect of immediate and delayed short-term administration of clinically relevant parecoxib doses and timing on fracture healing using an established animal fracture model.

Methods

A standardized closed tibia shaft fracture was induced and stabilized by reamed intramedullary nailing in 66 Wistar rats. A ‘parecoxib immediate’ (Pi) group received parecoxib (3.2 mg/kg bodyweight twice per day) on days 0, 1, and 2. A ‘parecoxib delayed’ (Pd) group received the same dose of parecoxib on days 3, 4, and 5. A control group received saline only. Fracture healing was evaluated by biomechanical tests, histomorphometry, and dual-energy x-ray absorptiometry (DXA) at four weeks.


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 5 | Pages 778 - 788
1 Sep 1994
de la Caffiniere J Pelisse F de la Caffiniere M

We report the use of a new method of locked intramedullary flexible osteosynthesis (LIFO) in the treatment of 118 unstable fractures of the femur and tibia. The implant utilises a set of flexible pins with a separate locking device for their proximal ends. The LIFO system proved capable of stabilising unstable fractures, and most of the complications occurred during the early testing. At follow-up, 19 of 21 femoral fractures had healed; one become infected and one showed defective callus. Of the 78 tibial shaft fractures, five failed to consolidate and five had inadequate callus. Reaming of the tibial medullary canal was never necessary. Of 28 open fractures only one became infected. The system was most difficult to use in comminuted distal fractures of the tibia, with five failures of healing in 19 cases; these cases require considerable technical proficiency. The flexibility of the system appears to promote earlier consolidation of open fractures, and normal consolidation times for fractures with interfragmentary gaps of up to 10 to 12 mm. A comparative study of callus density in tibial fractures showed a mean improvement of 50 days in cases treated by the LIFO system compared with similar cases treated by rigid nailing


Bone & Joint 360
Vol. 9, Issue 1 | Pages 10 - 14
1 Feb 2020
Ibrahim M Reito A Pidgaiska O


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 491 - 496
1 Apr 2019
Li NY Kalagara S Hersey A Eltorai AEM Daniels AH Cruz Jr AI

Aims

The aim of this study was to utilize a national paediatric inpatient database to determine whether obesity influences the operative management and inpatient outcomes of paediatric limb fractures.

Patients and Methods

The Kids’ Inpatient Database (KID) was used to evaluate children between birth and 17 years of age, from 1997 and 2012, who had undergone open and closed treatment of humeral, radial and ulna, femoral, tibial, and ankle fractures. Demographics, hospital charges, lengths of stay (LOS), and complications were analyzed.


Bone & Joint Research
Vol. 9, Issue 4 | Pages 182 - 191
1 Apr 2020
D’Ambrosio A Peduzzi L Roche O Bothorel H Saffarini M Bonnomet F

Aims

The diversity of femoral morphology renders femoral component sizing in total hip arthroplasty (THA) challenging. We aimed to determine whether femoral morphology and femoral component filling influence early clinical and radiological outcomes following THA using fully hydroxyapatite (HA)-coated femoral components.

Methods

We retrospectively reviewed records of 183 primary uncemented THAs. Femoral morphology, including Dorr classification, canal bone ratio (CBR), canal flare index (CFI), and canal-calcar ratio (CCR), were calculated on preoperative radiographs. The canal fill ratio (CFR) was calculated at different levels relative to the lesser trochanter (LT) using immediate postoperative radiographs: P1, 2 cm above LT; P2, at LT; P3, 2 cm below LT; and D1, 7 cm below LT. At two years, radiological femoral component osseointegration was evaluated using the Engh score, and hip function using the Postel Merle d’Aubigné (PMA) and Oxford Hip Score (OHS).


The Journal of Bone & Joint Surgery British Volume
Vol. 77-B, Issue 2 | Pages 277 - 283
1 Mar 1995
Choueka J Koval K Kummer F Crawford G Zuckerman J

We studied the biomechanical behaviour of three sliding fixation devices for trochanteric femoral fractures. These were a titanium alloy sideplate and lag screw, a titanium alloy sideplate and dome plunger with cement augmentation, and a stainless-steel sideplate and lag screw. We used 18 mildly osteoporotic cadaver femora, randomly assigned to one of the three fixation groups. Four displacement and two strain gauges were fixed to each specimen, and each femur was first tested intact (control), then as a two-part fracture and then as a four-part intertrochanteric fracture. A range of physiological loads was applied to determine load-bearing, load-sharing and head displacement. The four-part-fracture specimens were subsequently tested to failure to determine maximum fixation strengths and modes of failure. The dome-plunger group failed at a load 50% higher than that of the stainless-steel lag-screw group (p < 0.05) and at a load 20% higher than that of the titanium-alloy lag-screw group (NS). All 12 lag-screw specimens failed by cut-out through the femoral head or neck, but none of the dome-plunger group showed movement within the femoral head when tested to failure. Strain-gauge analysis showed that the dome plunger produced considerably less strain in the inferior neck and calcar region than either of the lag screws. Inferior displacement of the femoral head was greatest for the dome-plunger group, and was due to sliding of the plunger. The dome plunger with cement augmentation was able to support higher loads and did not fail by cut-out through the femoral head.(ABSTRACT TRUNCATED AT 250 WORDS)


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 4 | Pages 544 - 549
1 May 2002
Piccaluga F Valle AD Fernández JCE Pusso R

Impacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis. The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further revision. The latest follow-up radiographs in 56 reconstructions showed a well fixed stem and radiological healing of the graft in 52 (93%), and definite loosening in four (7%). Of these four, two were revised again and two were asymptomatic after a follow-up of 120 months each. The mean subsidence in the 52 successful revisions was 0.38 mm (0 to 4). Impaction allografting with a Charnley stem restored bone stock and provided adequate fixation of the stem in 93% of the hips. There was a low rate of rerevision (3.5%) and a low incidence of intraoperative and postoperative complications


The Journal of Bone & Joint Surgery British Volume
Vol. 32-B, Issue 4 | Pages 694 - 729
1 Nov 1950
Watson-Jones R Adams JC Bonnin JG Burrows HJ King T Nicoll EA Palmer I vom Saal F Smith H Trevor D Vaughan-Jackson OJ Le Vay AD

One hundred and sixty-four cases of intramedullary nailing of the long bones have been studied with special reference to the difficulties and complications encountered. There was one death not attributable to the method. Two cases of pulmonal fat embolism and one case of thrombosis occurred, all in fractures of the femur. The lessons we have learned from our mistakes can be summarised as follows:. 1 . The method requires technical experience and knowledge and is not suited to inexperienced surgeons or surgeons with little fracture material at their disposal. 2. Intramedullary nailing should only be used in fractures to which the method is suited. In general, comminuted fractures or fractures near a joint are unsuitable. 3. Open reduction is preferable to closed methods. 4. The nail should never be driven in with violence. It should be removed and replaced with a new one if difficulty is encountered when inserting it. 5. In fractures of the femur the nail should be driven in from the tip of the trochanter after careful determination of the direction. 6. The nail should be introduced only to the level of the fracture before exploring and reducing the fracture. 7. Distraction of the fragments must be avoided. 8. If the nail bends it should be replaced by a new one, at least in femoral fractures. 9. If union is delayed, the fracture should be explored and chip grafts of cancellous bone placed around it. 10. Improvised nails or nails which are not made of absolutely reliable material should never be used. 11 . Make sure that the nail is equipped with an extraction hole for removal


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 7 | Pages 967 - 971
1 Sep 2000
Patton JT Cook RE Adams CI Robinson CM

In a consecutive series of 498 patients with 528 fractures of the femur treated by conventional interlocking intramedullary nailing, 14 fractures of the femoral neck (2.7%) occurred in 13 patients. The fracture of the hip was not apparent either before operation or on the immediate postoperative radiographs. It was diagnosed in the first two weeks after operation in three patients and after three months in the remainder. Age over 60 years at the time of the femoral fracture and female gender were significantly predictive of hip fracture on bivariate logistic regression analysis, but on multivariate analysis only the location of the original fracture in the proximal third of the femur (p = 0.0022, odds ratio = 6.96, 95% CI 2.01 to 24.14), low-energy transfer (p = 0.0264, odds ratio = 15.56, 95% CI 1.38 to 75.48) and the severity of osteopenia on radiographs (p = 0.0128, odds ratio = 7.55, 95% CI 1.54 to 37.07) were significant independent predictors of later fracture. Five of the 19 women aged over 60 years, who sustained an osteoporotic proximal diaphyseal fracture of the femur during a simple fall, subsequently developed a fracture of the neck. Eleven of the hip fractures were displaced and intracapsular and, in view of the advanced age of most of these patients, were usually treated by replacement arthroplasty. Reduction and internal fixation was used to treat the remaining three intertrochanteric fractures. Three patients developed complications requiring further surgery; five died within two years of their fracture


The Bone & Joint Journal
Vol. 101-B, Issue 7 | Pages 779 - 786
1 Jul 2019
Lamb JN Baetz J Messer-Hannemann P Adekanmbi I van Duren BH Redmond A West RM Morlock MM Pandit HG

Aims

The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical in vitro model.

Materials and Methods

A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an in vitro model using paired fresh frozen cadaveric femora.


The Bone & Joint Journal
Vol. 101-B, Issue 6_Supple_B | Pages 91 - 96
1 Jun 2019
Smith A Denehy K Ong KL Lau E Hagan D Malkani A

Aims

Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN.

Patients and Methods

Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors.


The Bone & Joint Journal
Vol. 100-B, Issue 12 | Pages 1559 - 1564
1 Dec 2018
McConnell JS Saunders PRJ Young SK

Aims

Cementless femoral stems must be correctly sized and well-seated to obtain satisfactory biological fixation. The change in sound that occurs during impaction of the femoral broach is said to indicate good fit, but this has not been widely studied. We set out to find whether the presence or absence of these sound changes could predict correct sizing.

Patients and Methods

We recorded the sound generated during femoral broaching for 105 cementless total hip arthroplasties using the Corail stem. Four cases were excluded, leaving 101 recordings for analysis. There were 36 male patients and 65 female patients, with a mean age of 69.9 years (sd 12.3) and median body mass index (BMI) of 29 kg/m2 (interquartile range (IQR) 26 to 32). The recordings were analyzed to identify the frequencies of the sounds produced during impaction of the femoral broach.


Bone & Joint 360
Vol. 8, Issue 2 | Pages 33 - 35
1 Apr 2019


Bone & Joint 360
Vol. 8, Issue 5 | Pages 33 - 35
1 Oct 2019


Bone & Joint Research
Vol. 8, Issue 10 | Pages 502 - 508
1 Oct 2019
Mao W Ni H Li L He Y Chen X Tang H Dong Y

Objectives

Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC.

Methods

A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis.


Bone & Joint Research
Vol. 8, Issue 10 | Pages 481 - 488
1 Oct 2019
Nathan K Lu LY Lin T Pajarinen J Jämsen E Huang J Romero-Lopez M Maruyama M Kohno Y Yao Z Goodman SB

Objectives

Up to 10% of fractures result in undesirable outcomes, for which female sex is a risk factor. Cellular sex differences have been implicated in these different healing processes. Better understanding of the mechanisms underlying bone healing and sex differences in this process is key to improved clinical outcomes. This study utilized a macrophage–mesenchymal stem cell (MSC) coculture system to determine: 1) the precise timing of proinflammatory (M1) to anti-inflammatory (M2) macrophage transition for optimal bone formation; and 2) how such immunomodulation was affected by male versus female cocultures.

Methods

A primary murine macrophage-MSC coculture system was used to demonstrate the optimal transition time from M1 to M2 (polarized from M1 with interleukin (IL)-4) macrophages to maximize matrix mineralization in male and female MSCs. Outcome variables included Alizarin Red staining, alkaline phosphatase (ALP) activity, and osteocalcin protein secretion.


Bone & Joint 360
Vol. 8, Issue 1 | Pages 10 - 12
1 Feb 2019


Bone & Joint 360
Vol. 8, Issue 1 | Pages 31 - 33
1 Feb 2019