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The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 5 | Pages 636 - 642
1 Jul 2000
Wainwright AM Williams JR Carr AJ

We assessed the inter- and intraobserver variation in classification systems for fractures of the distal humerus. Three orthopaedic trauma consultants, three trauma registrars and three consultant musculoskeletal radiologists independently classified 33 sets of radiographs of such fractures on two occasions, each using three separate systems.

For interobserver variation, the Riseborough and Radin system produced ‘moderate’ agreement (kappa = 0.513), but half of the fractures were not classifiable by this system. For the complete AO system, agreement was ‘fair’ (kappa = 0.343), but if only AO type and group or AO type alone was used, agreement improved to ‘moderate’ and ‘substantial’, respectively (kappa = 0.52 and 0.66). Agreement for the system of Jupiter and Mehne was ‘fair’ (kappa = 0.295). Similar levels of intraobserver variation were found.

Systems of classification are useful in decision-making and evaluation of outcome only if there is agreement and consistency among observers. Our study casts doubt on these aspects of the systems currently available for fractures of the distal humerus.


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 5 | Pages 702 - 704
1 Jul 2000
Cole AS Hill GA Abela M Carr AJ

We present three cases of recurrent instability of the elbow in association with the Ehlers-Danlos syndrome. The pattern of instability has not previously been reported. We describe our procedure for achieving stability using a bone graft to the olecranon fossa which gave a functional range of movement.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 6 | Pages 918 - 923
1 Nov 1997
Gendi NST Axon JMC Carr AJ Pile KD Burge PD Mowat AG

We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were revision surgery (performed or desired) and/or the presence of significant or severe pain.

The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per year. The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compared. A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04).

At review, there was a mean gain of 50° in supination-pronation and 11° in flexion-extension; both correlated with success. Failure correlated with recurrence of synovitis, elbow instability, ulnar neuropathy, poor general mobility and poor upper-limb function. The last was independently affected by the severity of RA in the ipsilateral shoulder.

Our findings show that although the short-term result of ES and RHE in rheumatoid arthritis is good, the long-term outcome is poor except in a subgroup with more than 50% limitation of forearm rotation.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 660 - 664
1 Jul 1997
Chitnavis J Sinsheimer JS Clipsham K Loughlin J Sykes B Burge PD Carr AJ

From a prospective, cross-sectional survey of 402 patients who had a total hip (THR) or a total knee (TKR) replacement for idiopathic osteoarthritis (OA) at a major centre, we determined the prevalence of these replacements for idiopathic OA in their 1171 siblings and 376 spouses. Using spouses as controls, the relative risk of THR in siblings was 1.86 (95% CI 0.93 to 3.69). The relative risk for TKR in siblings v spouses was 4.8 (95% CI 0.64 to 36.4) whereas the risk for the combined outcome measure of THR or TKR was 2.32 (95% CI 1.22 to 4.43) when siblings and spouses over 64 years of age were compared. Using a threshold liability model (Falconer), the heritability of end-stage OA of the hip was estimated at 27%.

The increased risks of joint replacement for severe, idiopathic OA which we found in siblings suggest that genetic influences are important in end-stage OA of the hip and knee.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 696 - 696
1 Jul 1997
CARR AJ


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 696 - 696
1 Jul 1997
CARR AJ


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 2 | Pages 229 - 232
1 Mar 1996
Conboy VB Morris RW Kiss J Carr AJ

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter- and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients.

We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.