Few studies dealing with chondrosarcoma of the pelvis are currently
available. Different data about the overall survival and prognostic
factors have been published but without a detailed analysis of surgery-related complications.
We aimed to analyse the outcome of a series of pelvic chondrosarcomas
treated at a single institution, with particular attention to the
prognostic factors. Based on a competing risk model, our objective
was to identify risk factors for the development of complications. In a retrospective single-centre study, 58 chondrosarcomas (26
patients alive, 32 patients dead) of the pelvis were reviewed. The
mean follow-up was 13 years (one week to 23.1 years).Aims
Patients and Methods
Following the introduction of national standards in 2009, most
major paediatric trauma is now triaged to specialist units offering
combined orthopaedic and plastic surgical expertise. We investigated
the management of open tibia fractures at a paediatric trauma centre,
primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between
2007 and 2015 presented with an open tibia fracture. Their mean
age was nine years (2 to 16) and the median follow-up was ten months
(interquartile range 5 to 18). Management involved IV antibiotics,
early debridement and combined treatment of the skeletal and soft-tissue injuries
in line with standards proposed by the British Orthopaedic Association.Aims
Patients and Methods
We describe our experience in the reduction of
dislocation of the hip secondary to developmental dysplasia using ultrasound-guided
gradual reduction using flexion and abduction continuous traction
(FACT-R). During a period of 13 years we treated 208 Suzuki type
B or C complete dislocations of the hip in 202 children with a mean
age of four months (0 to 11). The mean follow-up was 9.1 years (five
to 16). The rate of reduction was 99.0%. There were no recurrent
dislocations, and the rate of avascular necrosis of the femoral
head was 1.0%. The rate of secondary surgery for residual acetabular
dysplasia was 19.2%, and this was significantly higher in those
children in whom the initial treatment was delayed or if other previous
treatments had failed (p = 0.00045). The duration of FACT-R was significantly
longer in severe dislocations (p = 0.001) or if previous treatments
had failed (p = 0.018). This new method of treatment is effective and safe in these difficult
cases and offers outcomes comparable to or better than those of
standard methods. Cite this article:
Several studies have reported the safety and efficacy of subcapital
re-alignment for patients with slipped capital femoral epiphysis
(SCFE) using surgical dislocation of the hip and an extended retinacular
flap. Instability of the hip and dislocation as a consequence of
this surgery has only recently gained attention. We discuss this
problem with some illustrative cases. We explored the literature on the possible pathophysiological
causes and surgical steps associated with the risk of post-operative
instability and articular damage. In addition, we describe supplementary
steps that could be used to avoid these problems.Aims
Materials and Methods
Given the increasing number of total hip arthroplasty
procedures being performed annually, it is imperative that orthopaedic
surgeons understand factors responsible for instability. In order
to treat this potentially complex problem, we recommend correctly
classifying the type of instability present based on component position, abductor
function, impingement, and polyethylene wear. Correct classification
allows the treating surgeon to choose the appropriate revision option
that ultimately will allow for the best potential outcome. Cite this article:
The aim of this paper is to review the evidence relating to the
anatomy of the proximal femur, the geometry of the fracture and
the characteristics of implants and methods of fixation of intertrochanteric
fractures of the hip. Relevant papers were identified from appropriate clinical databases
and a narrative review was undertaken.Aims
Materials and Methods
The optimal treatment for independent patients with a displaced
intracapsular fracture of the hip remains controversial. The recognised
alternatives are hemiarthroplasty and total hip arthroplasty. At
present there is no established standard of care, with both types
of arthroplasty being used in many centres. We conducted a feasibility study comparing the clinical effectiveness
of a dual mobility acetabular component compared with standard polyethylene
component in total hip arthroplasty for independent patients with
a displaced intracapsular fracture of the hip, for a 12-month period
beginning in June 2013. The primary outcome was the risk of dislocation
one year post-operatively. Secondary outcome measures were EuroQol
5 Dimensions, ICEpop CAPability measure for Older people, Oxford
hip score, mortality and re-operation.Aims
Patients and Methods
The April 2015 Children’s orthopaedics Roundup360 looks at: Reducing the incidence of DDH – is ‘back carrying’ the answer?; Surgical approach and AVN may not be linked in DDH; First year routine radiographic follow up for scoliosis not necessary; Diagnosis of osteochondritis dessicans; Telemedicine in paediatrics; Regional anesthesia in supracondylar fractures?
Current studies on the additional benefit of using computed tomography
(CT) in order to evaluate the surgeons’ agreement on treatment plans
for fracture are inconsistent. This inconsistency can be explained
by a methodological phenomenon called ‘spectrum bias’, defined as
the bias inherent when investigators choose a population lacking
therapeutic uncertainty for evaluation. The aim of the study is
to determine the influence of spectrum bias on the intra-observer
agreement of treatment plans for fractures of the distal radius. Four surgeons evaluated 51 patients with displaced fractures
of the distal radius at four time points: T1 and T2: conventional
radiographs; T3 and T4: radiographs and additional CT scan (radiograph
and CT). Choice of treatment plan (operative or non-operative) and
therapeutic certainty (five-point scale: very uncertain to very
certain) were rated. To determine the influence of spectrum bias,
the intra-observer agreement was analysed, using Kappa statistics,
for each degree of therapeutic certainty. Objectives
Methods
The October 2015 Children’s orthopaedics Roundup360 looks at: Radiographic follow-up of DDH; When the supracondylar goes wrong; Apophyseal avulsion fractures; The ‘pulled elbow’; Surgical treatment of active or aggressive aneurysmal bone cysts in children; Improving stability in supracondylar fractures; Biological reconstruction may be preferable in children’s osteosarcoma; The paediatric hip fracture
There are various pin-in-plaster methods for treating fractures
of the distal radius. The purpose of this study is to introduce
a modified technique of ‘pin in plaster’. Fifty-four patients with fractures of the distal radius were
followed for one year post-operatively. Patients were excluded if
they had type B fractures according to AO classification, multiple
injuries or pathological fractures, and were treated more than seven
days after injury. Range of movement and functional results were
evaluated at three and six months and one and two years post-operatively.
Radiographic parameters including radial inclination, tilt, and
height, were measured pre- and post-operatively.Objectives
Methods
A possible solution for the management of proximal femoral bone
loss is a modular femoral endoprosthesis (EPR). Although the outcome
of EPRs in tumour surgery has been well described, the outcome of
their use in revision hip surgery has received less attention. The
aim of this study was to describe the outcome of using EPR for non-neoplastic
indications. A retrospective review of 79 patients who underwent 80 EPRs for
non-neoplastic indications was performed, including the rates of
complication and survival and the mean Oxford Hip Scores (OHS),
at a mean of five years post-operatively. The mean age at the time
of surgery was 69 years (28 to 93) and the mean number of previous operations
on the hip was 2.4 (0 to 17). The most common indications for EPR
implantation were periprosthetic joint infection (PJI) (n = 40),
periprosthetic fracture (n = 12) and failed osteosynthesis of a
proximal femoral fracture or complex trauma (n = 11).Objectives
Methods
The influence of identifiable pre-operative factors on the outcome
of eccentric rotational acetabular osteotomy (ERAO) is unknown.
We aimed to determine the factors that might influence the outcome,
in order to develop a scoring system for predicting the prognosis
for patients undergoing this procedure. We reviewed 700 consecutive ERAOs in 54 men and 646 women with
symptomatic acetabular dysplasia or early onset osteoarthritis (OA)
of the hip, which were undertaken between September 1989 and March
2013. The patients’ pre-operative background, clinical and radiological
findings were examined retrospectively. Multivariate Cox regression
analysis was performed using the time from the day of surgery to
a conversion to total hip arthroplasty (THA) as an endpoint. A risk
score was calculated to predict the prognosis for conversion to
THA, and its predictive capacity was investigated.Aims
Patients and Methods
We evaluated the outcome of treatment of nonunion
of an intracapsular fracture of the femoral neck in young patients
using two cannulated screws and a vascularised bone graft. A total
of 32 patients (15 women and 17 men, with a mean age of 36.5 years;
20 to 50) with failed internal fixation of an intracapsular fracture
were included in the study. Following removal of the primary fixation,
two cannulated compression screws were inserted with a vascularised
iliac crest bone graft based on the ascending branch of the lateral
femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved
in 27 hips (84%). A total of five patients with a mean age of 40.5
years (35 to 50) had a persistent nonunion and underwent total hip
arthroplasty as also did two patients whose fracture united but
who developed osteonecrosis of the femoral head two years post-operatively. Statistical
analysis showed that younger patients achieved earlier and more
reliable union (p <
0.001). The functional outcome, as assessed
by the Harris Hip score, was better in patients aged <
45 years
compared with those aged >
45 years (p <
0.001). These findings suggest that further fixation using two cannulated
compression screws and a vascularised iliac crest bone graft is
an effective salvage treatment in patients aged <
45 years, in
whom osteosynthesis of a displaced intracapsular fractures of the
femoral neck has failed. Cite this article:
Posterior tilt of the pelvis with sitting provides biological
acetabular opening. Our goal was to study the post-operative interaction
of skeletal mobility and sagittal acetabular component position. This was a radiographic study of 160 hips (151 patients) who
prospectively had lateral spinopelvic hip radiographs for skeletal
and implant measurements. Intra-operative acetabular component position
was determined according to the pre-operative spinal mobility. Sagittal
implant measurements of ante-inclination and sacral acetabular angle were
used as surrogate measurements for the risk of impingement, and
intra-operative acetabular component angles were compared with these.Aims
Materials and Methods
This article is a systematic review of the published
literature about the biomechanics, functional outcome and complications
of intramedullary nailing of fractures of the distal radius. We searched the Medline and EMBASE databases and included all
studies which reported the outcome of intramedullary (IM) nailing
of fractures of the distal radius. Data about functional outcome,
range of movement (ROM), strength and complications, were extracted.
The studies included were appraised independently by both authors
using a validated quality assessment scale for non-controlled studies
and the CONSORT statement for randomised controlled trials (RCTs). The search strategy revealed 785 studies, of which 16 were included
for full paper review. These included three biomechanical studies,
eight case series and five randomised controlled trials (RCTs). The biomechanical studies concluded that IM nails were at least
as strong as locking plates. The clinical studies reported that
IM nailing gave a comparable ROM, functional outcome and grip strength
to other fixation techniques. However, the mean complication rate of intramedullary nailing
was 17.6% (0% to 50%). This is higher than the rates reported in
contemporary studies for volar plating. It raises concerns about
the role of intramedullary nailing, particularly when comparative
studies have failed to show that it has any major advantage over
other techniques. Further adequately powered RCTs comparing the
technique to both volar plating and percutaneous wire fixation are needed. Cite this article:
