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Bone & Joint 360
Vol. 8, Issue 3 | Pages 11 - 13
1 Jun 2019


The Bone & Joint Journal
Vol. 100-B, Issue 3 | Pages 387 - 395
1 Mar 2018
Ganeshalingam R Donnan A Evans O Hoq M Camp M Donnan L

Aims

Displaced fractures of the lateral condyle of the humerus are frequently managed surgically with the aim of avoiding nonunion, malunion, disturbances of growth and later arthritis. The ideal method of fixation is however not known, and treatment varies between surgeons and hospitals. The aim of this study was to compare the outcome of two well-established forms of surgical treatment, Kirschner wire (K-wire) and screw fixation.

Patients and Methods

A retrospective cohort study of children who underwent surgical treatment for a fracture of the lateral condyle of the humerus between January 2005 and December 2014 at two centres was undertaken. Pre, intraoperative and postoperative characteristics were evaluated.

A total of 336 children were included in the study. Their mean age at the time of injury was 5.8 years (0 to 15) with a male:female patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture and the fracture was displaced by > 2 mm in 228 (68%). In all, 235 patients underwent K-wire fixation and 101 had screw fixation.


Bone & Joint 360
Vol. 8, Issue 3 | Pages 23 - 26
1 Jun 2019


The Bone & Joint Journal
Vol. 100-B, Issue 11 | Pages 1499 - 1505
1 Nov 2018
Mazhar FN Ebrahimi H Jafari D Mirzaei A

Aims

The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury.

Patients and Methods

The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded.


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


The Bone & Joint Journal
Vol. 101-B, Issue 5 | Pages 512 - 521
1 May 2019
Carter TH Duckworth AD White TO

Abstract

The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants.

Cite this article: Bone Joint J 2019;101-B:512–521.


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 396 - 402
1 Apr 2019
Ji B Wahafu T Li G Zhang X Wang Y Momin M Cao L

Aims

Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants.

Patients and Methods

Between 2010 and 2016, 126 patients underwent routine single-stage revision with cementless reconstruction with powdered vancomycin or imipenem poured into the medullary cavity and re-implantation of cementless components. For patients with a culture-negative hip, fungal infections, and multidrug-resistant organisms, a direct intra-articular infusion of pathogen-sensitive antibiotics was performed postoperatively. Recurrence of infection and clinical outcomes were evaluated. Three patients died and 12 patients (none with known recurrent infection) were lost to follow-up. There were 111 remaining patients (60 male, 51 female) with a mean age of 58.7 (sd 12.7; 20 to 79).


Bone & Joint 360
Vol. 7, Issue 3 | Pages 18 - 21
1 Jun 2018


The Bone & Joint Journal
Vol. 101-B, Issue 2 | Pages 198 - 206
1 Feb 2019
Salib CG Reina N Perry KI Taunton MJ Berry DJ Abdel MP

Aims

Concurrent hip and spine pathologies can alter the biomechanics of spinopelvic mobility in primary total hip arthroplasty (THA). This study examines how differences in pelvic orientation of patients with spine fusions can increase the risk of dislocation risk after THA.

Patients and Methods

We identified 84 patients (97 THAs) between 1998 and 2015 who had undergone spinal fusion prior to primary THA. Patients were stratified into three groups depending on the length of lumbar fusion and whether or not the sacrum was involved. Mean age was 71 years (40 to 87) and 54 patients (56%) were female. The mean body mass index (BMI) was 30 kg/m2 (19 to 45). Mean follow-up was six years (2 to 17). Patients were 1:2 matched to patients with primary THAs without spine fusion. Hazard ratios (HR) were calculated.


The Bone & Joint Journal
Vol. 101-B, Issue 2 | Pages 124 - 131
1 Feb 2019
Isaacs J Cochran AR

Abstract

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.


The Bone & Joint Journal
Vol. 100-B, Issue 3 | Pages 361 - 369
1 Mar 2018
Sprague S Bhandari M Heetveld MJ Liew S Scott T Bzovsky S Heels-Ansdell D Zhou Q Swiontkowski M Schemitsch EH

Aims

The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility.

Patients and Methods

Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL.


Bone & Joint 360
Vol. 7, Issue 4 | Pages 28 - 31
1 Aug 2018


Bone & Joint 360
Vol. 7, Issue 6 | Pages 12 - 15
1 Dec 2018


The Bone & Joint Journal
Vol. 100-B, Issue 12 | Pages 1535 - 1541
1 Dec 2018
Farrow L Ablett AD Mills L Barker S

Aims

We set out to determine if there is a difference in perioperative outcomes between early and delayed surgery in paediatric supracondylar humeral fractures in the absence of vascular compromise through a systematic review and meta-analysis.

Materials and Methods

A literature search was performed, with search outputs screened for studies meeting the inclusion criteria. The groups of early surgery (ES) and delayed surgery (DS) were classified by study authors. The primary outcome measure was open reduction requirement. Meta-analysis was performed in the presence of sufficient study homogeneity. Individual study risk of bias was assessed using the Risk of Bias in Non-Randomised Studies – of Interventions (ROBINS-I) criteria, with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria used to evaluate outcomes independently.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 973 - 983
1 Jul 2018
Schmal H Froberg L S. Larsen M Südkamp NP Pohlemann T Aghayev E Goodwin Burri K

Aims

The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization.

Patients and Methods

The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality.


The Bone & Joint Journal
Vol. 100-B, Issue 11 | Pages 1442 - 1448
1 Nov 2018
Hipfl C Janz V Löchel J Perka C Wassilew GI

Aims

Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems.

Patients and Methods

We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).


Bone & Joint 360
Vol. 6, Issue 1 | Pages 32 - 34
1 Feb 2017


The Bone & Joint Journal
Vol. 100-B, Issue 9 | Pages 1220 - 1226
1 Sep 2018
Chiu H Chen C Su T Chen C Hsieh H Hsieh C Shen D

Aims

We aimed to determine the effect of dementia and Parkinson’s disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population.

Patients and Methods

Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson’s disease or both, adjusting for demographic, clinical, treatment, and provider factors.


The Bone & Joint Journal
Vol. 99-B, Issue 8 | Pages 1115 - 1120
1 Aug 2017
Tsukagoshi Y Kamegaya M Kamada H Saisu T Morita M Kakizaki J Tomaru Y Yamazaki M

Aims

The aim of this study was to evaluate the correlation between Salter’s criteria and Kalamchi’s classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH).

Patients and Methods

The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter’s criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis).

The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis.


The Bone & Joint Journal
Vol. 100-B, Issue 1_Supple_A | Pages 17 - 21
1 Jan 2018
Konan S Duncan CP

Patients with neuromuscular imbalance who require total hip arthroplasty (THA) present particular technical problems due to altered anatomy, abnormal bone stock, muscular imbalance and problems of rehabilitation.

In this systematic review, we studied articles dealing with THA in patients with neuromuscular imbalance, published before April 2017. We recorded the demographics of the patients and the type of neuromuscular pathology, the indication for surgery, surgical approach, concomitant soft-tissue releases, the type of implant and bearing, pain and functional outcome as well as complications and survival.

Recent advances in THA technology allow for successful outcomes in these patients. Our review suggests excellent benefits for pain relief and good functional outcome might be expected with a modest risk of complication.

Cite this article: Bone Joint J 2018;100-B(1 Supple A):17–21.