Aims

Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes.

The effect of storage at sub-zero temperatures and subsequent thawing was investigated in dissected muscles, tendons, limbs and spines. Freezing caused a noticeable shortening of muscles which when thawed could easily be elongated; the same effects, though less pronounced, were observed with tendons. During freezing, myotomy or tenotomy led to the development of a striking deformity owing to unopposed shortening of the opposing muscles. After thawing, all frozen specimens containing muscles and joints showed an increased range of passive movements, easily demonstrable by mild tensile forces

Limb alignment in total knee arthroplasty (TKA) influences periarticular soft-tissue tension, biomechanics through knee flexion, and implant survival. Despite this, there is no uniform consensus on the optimal alignment technique for TKA. Neutral mechanical alignment facilitates knee flexion and symmetrical component wear but forces the limb into an unnatural position that alters native knee kinematics through the arc of knee flexion. Kinematic alignment aims to restore native limb alignment, but the safe ranges with this technique remain uncertain and the effects of this alignment technique on component survivorship remain unknown. Anatomical alignment aims to restore predisease limb alignment and knee geometry, but existing studies using this technique are based on cadaveric specimens or clinical trials with limited follow-up times. Functional alignment aims to restore the native plane and obliquity of the joint by manipulating implant positioning while limiting soft tissue releases, but the results of high-quality studies with long-term outcomes are still awaited. The drawbacks of existing studies on alignment include the use of surgical techniques with limited accuracy and reproducibility of achieving the planned alignment, poor correlation of intraoperative data to long-term functional outcomes and implant survivorship, and a paucity of studies on the safe ranges of limb alignment. Further studies on alignment in TKA should use surgical adjuncts (e.g. robotic technology) to help execute the planned alignment with improved accuracy, include intraoperative assessments of knee biomechanics and periarticular soft-tissue tension, and correlate alignment to long-term functional outcomes and survivorship.

Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer

Aims

The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures.

1. The prognosis of paralytic scoliosis has been studied by defining curve patterns and establishing the natural development as seen in fully grown patients who have not had surgical correction. 2. The prognosis, unlike that in idiopathic scoliosis, is related to the age of onset of the curvature and the degree of muscle imbalance rather than the site of the primary curve. 3. Paralysis of limb muscles is shown to be unrelated to the development of scoliosis. The intercostal muscles and the lateral abdominal flexors produce scoliosis when weaker on the convex side of the curve. Gravity and the other trunk muscles certainly play a part in the development of lumbar curves but their importance is difficult to assess

A new method of replacement for the paralysed anterior deltoid is described. The latissimus dorsi with its neurovascular pedicle is freed and rotated, and then placed over the anterior part of the paralysed muscle. The lever arm of the transposed muscle is as long as that of the deltoid, and the muscle volume is enough to restore the natural contour of the shoulder. We report operations on 10 patients with shoulder palsy, eight caused by brachial plexus injury and two by resection of a neurilemmoma of the plexus. In six cases, active flexion to over 90 degrees was achieved. At least one of the rotator cuff muscles or the long head of biceps should have some active function if good results are to be obtained

Aims

It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs.

Aims

The purpose is to determine the non-inferiority of a smartphone-based exercise educational care management system after primary knee arthroplasty compared with a traditional in-person physiotherapy rehabilitation model.

Aims

The primary aim of this study was to compare the postoperative systemic inflammatory response in conventional jig-based total knee arthroplasty (conventional TKA) versus robotic-arm assisted total knee arthroplasty (robotic TKA). Secondary aims were to compare the macroscopic soft tissue injury, femoral and tibial bone trauma, localized thermal response, and the accuracy of component positioning between the two treatment groups.

The use of tourniquets in lower limb trauma surgery to control bleeding and improve the surgical field is a long established practice. In this article, we review the evidence relating to harms and benefits of tourniquet use in lower limb fracture fixation surgery and report the results of a survey on current tourniquet practice among trauma surgeons in the UK.

Aims

Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care.

Clinical assessment of equinus in children before and after operation was made over a twenty-year period (1958-1978), and three groups were defined. Forty-three muscles (Group I) had abnormal shortening without spasticity and the deformity progressed steadily despite immediate improvement after operation; this was considered to be the result of a lack of muscle growth during bone growth. Forty-one muscles (Group II) had both shortening and spasticity with an imbalance which might be unchanged after operation, or reversed or improved. Fourteen muscles (Group III) had spasticity only and progression was unpredictable and could not be defined. Improvement in gait was regularly observed in Group I in the early years after operation. In Groups II and III the results were variable. These results did not depend on surgical technique but on differences in pathophysiology

1. Evidence is given of successful direct implantation of a motor branch of the ulnar nerve to the denervated flexor carpi radialis muscle in the dog with the formation of new motor end-plates. 2. A method is described of measuring four muscle parameters-volume, myoneural delay, rate of contraction and greatest developed tension-which allows a quantitative comparison of the muscle in its original state with that after it has been changed experimentally. 3. By use of this method it was found that the direct implantation of a new motor nerve restored the denervated muscle volume in twenty weeks and that at least 50 per cent of its original strength was recovered. 4. The success of motor nerve transplantation is likely to be influenced by the length of time lapsing between denervation and implantation, by the number of functioning motor fibres in the transplanted nerve, and by the amount of recovery achieved in the afferent and spindle efferent systems

1 . Voluntary activity of any given muscle in the hand is not an absolute indication of the state of the nerve which usually supplies it. 2. Significant variations in the standard pattern of innervation have been found in 20 per cent of 226 cases studied. 3. The pattern of innervation described in standard text-books occurred in only 33 per cent. of cases. 4. A striking variation is the supply of every thenar muscle by the ulnar nerve. In other cases the first dorsal interosseous muscle may be supplied by the median nerve. 5. In order to arrive at an accurate diagnosis when anomalous innervation is suspected, nerve blocks at appropriate levels are required. 6. Great care must be taken during operations to avoid damage to connections between the ulnar and the median nerves, especially in patients with anomalous innervation of the hand muscles

Aims

Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function.

Aims

The purpose of this study was to compare the clinical, radiological, and patient-reported outcome measures (PROMs) in the first 100 consecutive patients undergoing total hip arthroplasty (THA) via a direct superior approach (DSA) with a matched group of patients undergoing THA by the same surgeon, using a posterolateral approach (PLA).

1. Volkmann’s ischaemia is a real and threatening complication of fracture of the femur, and it is more common than reports in the literature would suggest. 2. The early signs and symptoms in the calf are ominous whereas the early vascular signs of a good tibial pulse, colour and temperature are often misleading. 3. Muscle decompression with or without arterial exploration has proved to be of no value. 4. Early recognition and radical treatment are imperative. Temporary paralysis of the lumbar sympathetic outflow has been shown to be an effective measure. 5. Transfixion of the calcaneum with a Kirschner wire for traction has the advantage of eliminating all bandages, suspending the tender calf and preventing an equinovarus deformity. 6. The only essential difference between the histological appearance of muscle which recovers and that which does not appears to be degeneration of muscle nuclei. The significance of engorged blood vessels remains in doubt. 7. Histological studies suggest that despite the typical gross appearance of an infarct some regeneration of muscle may occur

Aims

This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH).