We examined risk of developing acute renal failure and the associated
mortality among patients aged >
65 years undergoing surgery for
a fracture of the hip. We used medical databases to identify patients who underwent
surgical treatment for a fracture of the hip in Northern Denmark
between 2005 and 2011. Acute renal failure was classified as stage
1, 2 and 3 according to the Kidney Disease Improving Global Outcome
criteria. We computed the risk of developing acute renal failure
within five days after surgery with death as a competing risk, and
the short-term (six to 30 days post-operatively) and long-term mortality
(31 days to 365 days post-operatively). We calculated adjusted hazard
ratios (HRs) for death with 95% confidence intervals (CIs).Aims
Patients and Methods
This prospective randomised controlled trial was designed to
evaluate the outcome of both the MRI- and CT-based patient-specific
matched guides (PSG) from the same manufacturer. A total of 137 knees in 137 patients (50 men, 87 women) were
included, 67 in the MRI- and 70 in the CT-based PSG group. Their
mean age was 68.4 years (47.0 to 88.9). Outcome was expressed as
the biomechanical limb alignment (centre hip-knee-ankle: HKA-axis)
achieved post-operatively, the position of the individual components
within 3° of the pre-operatively planned alignment, correct planned
implant size and operative data (e.g. operating time and blood loss).Aims
Patients and Methods
In this study we quantified and characterised
the return of functional mobility following open tibial fracture
using the Hamlyn Mobility Score. A total of 20 patients who had
undergone reconstruction following this fracture were reviewed at
three-month intervals for one year. An ear-worn movement sensor
was used to assess their mobility and gait. The Hamlyn Mobility
Score and its constituent kinematic features were calculated longitudinally,
allowing analysis of mobility during recovery and between patients
with varying grades of fracture. The mean score improved throughout
the study period. Patients with more severe fractures recovered
at a slower rate; those with a grade I Gustilo-Anderson fracture
completing most of their recovery within three months, those with
a grade II fracture within six months and those with a grade III
fracture within nine months. Analysis of gait showed that the quality of walking continued
to improve up to 12 months post-operatively, whereas the capacity
to walk, as measured by the six-minute walking test, plateaued after
six months. Late complications occurred in two patients, in whom the trajectory
of recovery deviated by >
0.5 standard deviations below that of
the remaining patients. This is the first objective, longitudinal
assessment of functional recovery in patients with an open tibial
fracture, providing some clarification of the differences in prognosis
and recovery associated with different grades of fracture. Cite this article:
To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone. Ten patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm3 (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm3 HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment.Objectives
Methods
The monitoring of fracture healing is a complex process. Typically, successive radiographs are performed and an emerging calcification of the fracture area is evaluated. The aim of this study was to investigate whether different bone healing patterns can be distinguished using a telemetric instrumented femoral internal plate fixator. An electronic telemetric system was developed to assess bone healing mechanically. The system consists of a telemetry module which is applied to an internal locking plate fixator, an external reader device, a sensor for measuring externally applied load and a laptop computer with processing software. By correlation between externally applied load and load measured in the implant, the elasticity of the osteosynthesis is calculated. The elasticity decreases with ongoing consolidation of a fracture or nonunion and is an appropriate parameter for the course of bone healing. At our centre, clinical application has been performed in 56 patients suffering nonunion or fracture of the femur.Objectives
Materials and Methods
We chose unstable extra-capsular hip fractures as our study group
because these types of fractures suffer the largest blood loss.
We hypothesised that tranexamic acid (TXA) would reduce total blood
loss (TBL) in extra-capsular fractures of the hip. A single-centre placebo-controlled double-blinded randomised
clinical trial was performed to test the hypothesis on patients
undergoing surgery for extra-capsular hip fractures. For reasons
outside the control of the investigators, the trial was stopped
before reaching the 120 included patients as planned in the protocol. Aims
Patients and Methods
The aim of this study was to investigate the
epidemiology of fractures of the distal radius in the Swedish population and
to review the methods used to treat them between 2005 and 2010. The study population consisted of every patient in Sweden who
was diagnosed with a fracture of the wrist between 1 January 2005
and 31 December 2010. There were 177 893 fractures of the distal
radius. The incidence rate in the total population was 32 per 10
000 person-years. The mean age of the patients was 44 years (0 to
104). The proportion of fractures treated operatively increased
from 16% in 2005 to 20% in 2010. The incidence rate for plate fixation
in the adult population increased 3.61 fold. The incidence rate
for external fixation decreased by 67%. The change was greatest
in the 50 years to 74 years age group. In Sweden, there is an increasing tendency to operate on fractures
of the distal radius. The previously reported increase in the use
of plating is confirmed: it has increased more than threefold over
a five-year period. Cite this article:
The results of the DRAFFT (distal radius acute
fracture fixation trial) study, which compared volar plating with
Kirschner (K-) wire fixation for dorsally displaced fractures of
the distal radius, were published in August 2014. The use of K-wires
to treat these fractures is now increasing, with a concomitant decline
in the use of volar locking plates. We provide a critical appraisal of the DRAFFT study and question
whether surgeons have been unduly influenced by its headline conclusions. Cite this article:
The Oxford Hip and Knee Scores (OHS, OKS) have been demonstrated
to vary according to age and gender, making it difficult to compare
results in cohorts with different demographics. The aim of this
paper was to calculate reference values for different patient groups
and highlight the concept of normative reference data to contextualise an
individual’s outcome. We accessed prospectively collected OHS and OKS data for patients
undergoing lower limb joint arthroplasty at a single orthopaedic
teaching hospital during a five-year period.
T-scores were calculated based on the OHS and OKS distributions. Objectives
Methods
Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples Objectives
Methods
The aim of this study was to report a single surgeon series of
consecutive patients with moderate hallux valgus managed with a
percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35
women and three men. The mean age of the patients was 48 years (17
to 69). An additional percutaneous Akin osteotomy was performed
in 37 feet and percutaneous lateral capsular release was performed
in 22 feet. Clinical and radiological assessments included the type
of forefoot, range of movement, the American Orthopedic Foot and
Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients
were lost to follow-up.Aims
Patients and Methods
The purpose of this study was to validate the diagnosis of periprosthetic
joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). We identified a cohort of patients from the DHR who had undergone
primary total hip arthroplasty (THA) since 1 January 2005 and followed
them until first-time revision, death, emigration or until 31 December
2012. Revision for PJI, as registered in the DHR, was validated against
a benchmark which included information from microbiology databases,
prescription registers, clinical biochemistry registers and clinical
records. We estimated the sensitivity, specificity, positive predictive
value (PPV) and negative predictive value (NPV) for PJI in the DHR
alone and in the DHR when combined with microbiology databases.Aims
Patients 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 objective of this study was to determine if combining variations in mixing technique of antibiotic-impregnated polymethylmethacrylate (PMMA) cement with low frequency ultrasound (LFUS) improves antibiotic elution during the initial high phase (Phase I) and subsequent low phase (Phase II) while not diminishing mechanical strength. Three batches of vancomycin-loaded PMMA were prepared with different mixing techniques: a standard technique; a delayed technique; and a control without antibiotic. Daily elution samples were analysed using flow injection analysis (FIA). Beginning in Phase II, samples from each mix group were selected randomly to undergo either five, 15, 45, or 0 minutes of LFUS treatment. Elution amounts between LFUS treatments were analysed. Following Phase II, compression testing was done to quantify strength. Objectives
Methods
The December 2015 Wrist &
Hand Roundup
Total knee arthroplasty (TKA) is an established
and successful procedure. However, the design of prostheses continues
to be modified in an attempt to optimise the functional outcome
of the patient. The aim of this study was to determine if patient outcome after
TKA was influenced by the design of the prosthesis used. A total of 212 patients (mean age 69; 43 to 92; 131 female (62%),
81 male (32%)) were enrolled in a single centre double-blind trial
and randomised to receive either a Kinemax (group 1) or a Triathlon
(group 2) TKA. Patients were assessed pre-operatively, at six weeks, six months,
one year and three years after surgery. The outcome assessments
used were the Oxford Knee Score; range of movement; pain numerical
rating scales; lower limb power output; timed functional assessment
battery and a satisfaction survey. Data were assessed incorporating
change over all assessment time points, using repeated measures
analysis of variance longitudinal mixed models. Implant group 2
showed a significantly greater range of movement (p = 0.009), greater
lower limb power output (p = 0.026) and reduced report of ‘worst
daily pain’ (p = 0.003) over the three years of follow-up. Differences
in Oxford Knee Score (p = 0.09), report of ‘average daily pain’
(p = 0.57) and timed functional performance tasks (p = 0.23) did
not reach statistical significance. Satisfaction with outcome was
significantly better in group 2 (p = 0.001). These results suggest that patient outcome after TKA can be influenced
by the prosthesis used. Cite this article:
The number of clinical negligence claims in the UK is constantly increasing. As a specialty, trauma and orthopaedic surgery has one of the highest numbers of negligence claims. A formal request was made to the NHSLA under the Freedom of Information Act in order to obtain all data related to claims against orthopaedic surgery. It was found that the number of claims, and percentage of successful claims, has been constantly increasing over this period, with compensation paid of over £349 million.* Errors in clinical management accounted for the highest number of closed claims (2933 claims), costing over £119 million.* The level of compensation paid out has a significant financial impact on the NHS. Reforms need to be made in order to tackle the high cost of legal fees generated by these claims, which further drain the limited resources available to the NHS.
