The intermittent administration of parathyroid hormone (PTH) increases the formation of bone by stimulating osteoblastic activity. Our study evaluates the possibility that intermittent
1. A method of
We present data relating to the Bryan disc arthroplasty for the
1. The clinical features in nineteen patients with structural defects of the pars interarticularis are compared with the findings in twenty-two patients with degenerative changes in the lumbar spine, and are shown to be essentially the same. 2. It is suggested that both structural defects and degenerative changes give rise to mechanical instability of the lumbar spine. This puts an increased load on the posterior vertebral soft tissues and gives rise to a characteristic picture, the features of which are described. 3. The signs and symptoms of root compression may be superimposed on this picture, and when this is the case, decompression of the nerve roots should be undertaken in addition to spinal fusion, which is suggested as the logical
One hundred and sixteen patients with 129 ununited fractures were treated either by rigid internal fixation and bone grafting or, in 14 tibial non-unions, by posterolateral bone grafting. In 37 actively infected cases this was combined with sequestrectomy and appropriate antibiotics. The final success rate was 98.4%. Technical errors or inadequate immobilisation after operation in patients with severe osteoporosis led to some early failures. No patient had a discharge or evidence of osteomyelitis after removal of metal. Rigid internal fixation with or without bone grafting is the
Twenty-three of 46 patients, aged 56 to 95 years, with fracture of the femoral neck (FNF) completed the first trial of 10 months
Recent publication of reports showing high revision rates for hip and knee replacements carried out in Independent Sector
We examined differences in the rate of open reduction, operating time, length of hospital stay and outcome between two groups of children with displaced supracondylar fractures of the humerus who underwent surgery either within 12 hours of the injury or later. There were 77 children with type-3 supracondylar fractures. Of these, in 43 the fracture was reduced and pinned within 12 hours and in 34 more than 12 hours after injury. Both groups were similar in regard to gender, age and length of follow-up. Bivariate and logistical regression analysis showed no statistical difference between the groups. The number of peri-operative complications was low and did not affect the outcome regardless of the timing of
Between June 1988 and December 1997, we treated 332 babies with 546 dysplastic hips in a Pavlik harness for primary developmental dysplasia of the hip as detected by the selective screening programme in Southampton. Each was managed by a strict protocol including ultrasonic monitoring of
We investigated the clinical outcome of a reconstructive procedure of the medial patellofemoral ligament for the
1. Trochanteric fractures are classified, with special emphasis on the stability or instability of the fracture. The importance of the cortical buttress of bone on the inner side of the femoral neck and shaft is stressed. 2. Three series of cases are presented: a) one hundred and one cases treated conservatively in hospital; b) twenty-five cases sent home by reason of lack of hospital beds; c) twenty-two cases treated by fixation with a Capener-Neufeld nail-plate. 3. From consideration of these three series, and from study of similar series of cases reported in the literature, it is suggested that routine operative
We present an economic evaluation using data
from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare
the relative cost effectiveness of percutaneous Kirschner wire (K-wire)
fixation and volar locking-plate fixation for patients with dorsally-displaced
fractures of the distal radius. . The cost effectiveness analysis (cost per quality-adjusted life
year; QALY) was derived from a multi-centre, two-arm, parallel group,
assessor-blind, randomised controlled trial which took place in
18 trauma centres in the United Kingdom. Data from 460 patients
were available for analysis, which includes both a National Health
Service cost perspective including costs of surgery, implants and
healthcare resource use over a 12-month period after surgery, and
a societal perspective, which includes the cost of time off work
and the need for additional private care. . There was only a small difference in QALYs gained for patients
treated with locking-plate fixation over those treated with K-wires.
At a mean additional cost of £714 (95% confidence interval 588 to
865) per patient, locking-plate fixation presented an incremental
cost effectiveness ratio (ICER) of £89 322 per QALY within the first
12 months of
This review summarises the evidence for the treatment
of displaced fractures of the femoral neck in elderly patients.
Results from randomised clinical trials and national register studies are
presented when available. The advantages of arthroplasty compared with internal fixation
are supported by several studies. A number of studies contribute
to the discussions of total hip arthroplasty (THA) The direct lateral approach reduces the risk of dislocation compared
with the posterior approach. Cemented implants lower the risk of
periprosthetic fracture and its subsequent morbidity and mortality.
As the risk of peri-operative death related to bone cement can be reduced
by adequate measures, cemented implants are recommended in fracture
cases. Take home message: There remains a great variation in the surgical
management of patients with a hip fracture, and an evidence-based
approach should improve the outcomes for this vulnerable patient
group. Cite this article:
A high rate of complications is associated with open reduction and internal fixation of Sanders type 4 fractures of the calcaneum. We assessed the long-term outcome of 83 Sanders type 4 comminuted intra-articular fractures of the calcaneum in 64 patients who underwent non-operative
As part of the government’s initiative to reduce waiting times for major joint surgery in Wales, the Cardiff and Vale NHS Trust sent 224 patients (258 knees) to the NHS
We have previously described the short-term outcome of the use of reverse shoulder arthroplasty in the
Stiffness is an uncommon but potentially debilitating complication following total knee replacement (TKR). The
Our aim was to determine the outcome of the
We report our initial experience of using the Ponseti method for the
1. A retrospective clinical and radiological study has been undertaken of forty-six cases of closed Dupuytren fracture-dislocation of the ankle joint in adults. 2. The final results are analysed with reference to the methods of