We conducted a study to determine whether radiological parameters
correlate with patient reported functional outcome, health-related
quality of life and physical measures of function in patients with
a fracture of the distal radius. The post-operative palmar tilt and ulnar variance at six weeks
and 12 months were correlated with the Patient Rated Wrist Evaluation,
Disabilities of the Arm, Shoulder and Hand, and EuroQol scores,
grip strength, pinch strength and range of movement at three, six
and 12 months for 50 patients (mean age 57 years; 26 to 85) having surgical
fixation, with either percutaneous pinning or reconstruction with
a volar plate, for a fracture of the distal radius.Aims
Patients and Methods
Bisphosphonates are widely used as first-line treatment for primary and secondary prevention of fragility fractures. Whilst they have proved effective in this role, there is growing concern over their long-term use, with much evidence linking bisphosphonate-related suppression of bone remodelling to an increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this article is to review this evidence, while presenting the current available strategies for the management of AFFs. We present an evaluation of current literature relating to the pathogenesis and treatment of AFFs in the context of bisphosphonate use.Objectives
Methods
The appropriate management for patients with a degenerative tear
of the rotator cuff remains controversial, but operative treatment,
particularly arthroscopic surgery, is increasingly being used. Our
aim in this paper was to compare the effectiveness of arthroscopic
with open repair of the rotator cuff. A total of 273 patients were recruited to a randomised comparison
trial (136 to arthroscopic surgery and 137 to open surgery) from
19 teaching and general hospitals in the United Kingdom. The surgeons
used their usual preferred method of repair. The Oxford Shoulder
Score (OSS), two years post-operatively, was the primary outcome
measure. Imaging of the shoulder was performed at one year after
surgery. The trial is registered with Current Controlled Trials,
ISRCTN97804283.Aims
Patients and Methods
Our aim was to describe the atypical pattern of increased fatty
degeneration in the infraspinatus muscle compared with the supraspinatus
in patients with a massive rotator cuff tear. We also wished to
describe the nerve conduction and electromyography findings in these
patients. A cohort of patients undergoing surgery for a massive rotator
cuff tear was identified and their clinical records obtained. Their
MRI images were reviewed to ascertain the degree of retraction of
the torn infraspinatus and supraspinatus muscles, and the degree
of fatty degeneration in both muscles was recorded. Nerve conduction studies
were also performed in those patients who showed more degeneration
in the infraspinatus than in the supraspinatus.Aims
Patients and Methods
Chronic osteomyelitis may recur if dead space management, after
excision of infected bone, is inadequate. This study describes the
results of a strategy for the management of deep bone infection
and evaluates a new antibiotic-loaded biocomposite in the eradication
of infection from bone defects. We report a prospective study of 100 patients with chronic osteomyelitis,
in 105 bones. Osteomyelitis followed injury or surgery in 81 patients.
Nine had concomitant septic arthritis. 80 patients had comorbidities
(Cierny-Mader (C-M) Class B hosts). Ten had infected nonunions. All patients were treated by a multidisciplinary team with a
single-stage protocol including debridement, multiple sampling,
culture-specific systemic antibiotics, stabilisation, dead space
filling with the biocomposite and primary skin closure. Aims
Patients and Methods
Our aim was to investigate the outcomes of patients with a displaced
fracture of the glenoid fossa who are treated conservatively. There
is little information in the literature about the treatment of these
rare injuries non-operatively. We reviewed 24 patients with a mean age of 52 years (19 to 81)
at a mean of 5.6 years (11 months to 18 years) after the injury.Aims
Patients and Methods
Flail chest from a blunt injury to the thorax is associated with
significant morbidity and mortality. Its management globally is
predominantly non-operative; however, there are an increasing number
of centres which undertake surgical stabilisation. The aim of this
meta-analysis was to compare the efficacy of this approach with
that of non-operative management. A systematic search of the literature was carried out to identify
randomised controlled trials (RCTs) which compared the clinical
outcome of patients with a traumatic flail chest treated by surgical
stabilisation of any kind with that of non-operative management.Aims
Patients and Methods
Deep bone and joint infections (DBJI) are directly intertwined with health, demographic change towards an elderly population, and wellbeing. The elderly human population is more prone to acquire infections, and the consequences such as pain, reduced quality of life, morbidity, absence from work and premature retirement due to disability place significant burdens on already strained healthcare systems and societal budgets. DBJIs are less responsive to systemic antibiotics because of poor vascular perfusion in necrotic bone, large bone defects and persistent biofilm-based infection. Emerging bacterial resistance poses a major threat and new innovative treatment modalities are urgently needed to curb its current trajectory. We present a new biphasic ceramic bone substitute consisting of hydroxyapatite and calcium sulphate for local antibiotic delivery in combination with bone regeneration. Gentamicin release was measured in four setups: 1) Objectives
Materials and Methods
Although infrequent, a fracture of the cuboid can lead to significant
disruption of the integrity of the midfoot and its function. The
purpose of this study was to classify the pattern of fractures of
the cuboid, relate them to the mechanism of injury and suggest methods
of managing them. We performed a retrospective review of patients with radiologically
reported cuboid fractures. Fractures were grouped according to commonly
occurring patterns of injury. A total of 192 fractures in 188 patients
were included. They were classified into five patterns of injury.Aims
Patients and Methods
Hip and groin injuries are common in athletes
who take part in high level sports. Adductor muscle tendon injuries represent
a small but important number of these injuries. Avulsion of the
tendons attached to the symphysis pubis has previously been described:
these can be managed both operatively and non-operatively. We describe
an uncommon variant of this injury, namely complete avulsion of
the adductor sleeve complex: this includes adductor longus, pectineus
and rectus abdominis. We go on to describe a surgical technique
which promotes a full return to the pre-injury level of sporting
activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed
acute adductor complex avulsion injury (six to 34 days old) underwent
surgical repair. The operative procedure consisted of anatomical
re-attachment of the avulsed tissues in each case and mesh reinforcement
of the posterior inguinal wall in seven patients. All underwent a
standardised rehabilitation programme, which was then individualised
to be sport-specific. One patient developed a superficial wound infection, which was
successfully treated with antibiotics. Of the 15 patients, four
complained of transient local numbness which resolved in all cases.
All patients (including seven elite athletes) returned to their
previous level of participation in sport. Cite this article:
“Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign.Objectives
Methods
The treatment of bone loss in revision total
knee arthroplasty has evolved over the past decade. While the management
of small to moderate sized defects has demonstrated good results
with a variety of traditional techniques (cement and screws, small
metal augments, impaction bone grafting or modular stems), the treatment of
severe defects continues to be problematic. The use of a structural
allograft has declined in recent years due to an increased failure
rate with long-term follow-up and with the introduction of highly
porous metal augments that emphasise biological metaphyseal fixation.
Recently published mid-term results on the use of tantalum cones
in patients with severe bone loss has reaffirmed the success of
this treatment strategy. Cite this article:
This study identifies early risk factors for symptomatic nonunion
of displaced midshaft fractures of the clavicle that aid identification
of an at risk group who may benefit from surgery. We performed a retrospective study of 88 patients aged between
16 and 60 years that were managed non-operatively. Aims
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:
Macrodactyly of the foot is a rare but disabling
condition. We present the results of surgery on 18 feet of 16 patients, who
underwent ray amputation and were followed-up for more than two
years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot
area pre-operatively and at six weeks and two years after surgery.
We also evaluated the clinical results using the Oxford Ankle Foot
Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot
Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly
decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57)
pre-operatively, improving to 47 (5 to 60) at two years post-operatively
(p = 0.021). The mean questionnaire for Foot Macrodactyly score
two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with
excellent functional results. For patients with metatarsal involvement,
a motionless toe, or involvement of multiple digits, ray amputation
is a clinically effective option which is acceptable to patients. Cite this article:
We present the results of 62 consecutive acetabular
revisions using impaction bone grafting and a cemented polyethylene
acetabular component in 58 patients (13 men and 45 women) after
a mean follow-up of 27 years (25 to 30). All patients were prospectively
followed. The mean age at revision was 59.2 years (23 to 82). We performed Kaplan–Meier (KM) analysis and also a Competing
Risk (CR) analysis because with long-term follow-up, the presence
of a competing event (i.e. death) prevents the occurrence of the
endpoint of re-revision. A total of 48 patients (52 hips) had died or had been re-revised
at final review in March 2011. None of the deaths were related to
the surgery. The mean Harris hip score of the ten surviving hips
in ten patients was 76 points (45 to 99). The KM survivorship at 25 years for the endpoint ‘re-revision
for any reason’ was 58.0% (95% confidence interval (CI) 38 to 73)
and for ‘re-revision for aseptic loosening’ 72.1% (95% CI 51 to
85). With the CR analysis we calculated the KM analysis overestimates
the failure rate with respectively 74% and 93% for these endpoints.
The current study shows that acetabular impaction bone grafting
revisions provide good clinical results at over 25 years. Cite this article:
Extracorporeal irradiation of an excised tumour-bearing
segment of bone followed by its re-implantation is a technique used
in bone sarcoma surgery for limb salvage when the bone is of reasonable
quality. There is no agreement among previous studies about the
dose of irradiation to be given: up to 300 Gy have been used. We investigated the influence of extracorporeal irradiation on
the elastic and viscoelastic properties of bone. Bone was harvested
from mature cattle and subdivided into 13 groups: 12 were exposed
to increasing levels of irradiation: one was not and was used as
a control. The specimens, once irradiated, underwent mechanical
testing in saline at 37°C. The mechanical properties of each group, including Young’s modulus,
storage modulus and loss modulus, were determined experimentally
and compared with the control group. There were insignificant changes in all of these mechanical properties
with an increasing level of irradiation. We conclude that the overall mechanical effect of high levels
of extracorporeal irradiation (300 Gy) on bone is negligible. Consequently
the dose can be maximised to reduce the risk of local tumour recurrence. Cite this article:
