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The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1385 - 1391
1 Oct 2018
Qvist AH Væsel MT Jensen CM Jensen SL

Aims

Recent studies of nonoperatively treated displaced midshaft clavicular fractures have shown a high incidence of nonunion and unsatisfactory functional outcome. Some studies have shown superior functional results and higher rates of healing following operative treatment. The aim of this study was to compare the outcome in these patients after nonoperative management with those treated with fixation.

Patients and Methods

In a multicentre, parallel randomized controlled trial, 146 adult patients with an acute displaced fracture of the midthird of the clavicle were randomized to either nonoperative treatment with a sling (71, 55 men and 16 women with a mean age of 39 years, 18 to 60) or fixation with a pre-contoured plate and locking screws (75, 64 men and 11 women with a mean age of 40 years, 18 to 60). Outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Constant Score, and radiographical evidence of union. Patients were followed for one year.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 973 - 983
1 Jul 2018
Schmal H Froberg L S. Larsen M Südkamp NP Pohlemann T Aghayev E Goodwin Burri K

Aims

The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization.

Patients and Methods

The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality.


The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 436 - 442
1 Apr 2018
Choi HG Lee YB Rhyu SH Kwon BC Lee JK

Aims

The aim of this study was to compare the rate of mortality and causes of death in Korean patients who undergo surgery for a fracture of the hip, up to 11 years after the injury, with a control group from the general population.

Materials and Methods

National cohort data from Korean Health Insurance Review and Assessment Service – National Sample Cohort were used. A ratio of 1:4 matched patients with a fracture who underwent surgery (3383, fracture group) between 2003 and 2012, and controls (13 532) were included. The matches were processed for age, gender, income, and region of residence. We also undertook analyses of subgroups according to age and gender. The mean follow-up was 4.45 years (1 to 11).


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1336 - 1344
1 Oct 2018
Powell AJ Crua E Chong BC Gordon R McAuslan A Pitto RP Clatworthy MG

Aims

This study compares the PFC total knee arthroplasty (TKA) system in a prospective randomized control trial (RCT) of the mobile-bearing rotating-platform (RP) TKA against the fixed-bearing (FB) TKA. This is the largest RCT with the longest follow-up where cruciate-retaining PFC total knee arthroplasties are compared in a non-bilateral TKA study.

Patients and Methods

A total of 167 patients (190 knees with 23 bilateral cases), were recruited prospectively and randomly assigned, with 91 knees receiving the RP and 99 knees receiving FB. The mean age was 65.5 years (48 to 82), the mean body mass index (BMI) was 29.7 kg/m2 (20 to 52) and 73 patients were female. The Knee Society Score (KSS), Knee Society Functional Score (KSFS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short-Form Health Survey Physical and Mental Component Scores (SF-12 PCS, SF-12 MCS) were gathered and recorded preoperatively, at five-years’ follow-up, and at ten years’ follow-up. Additionally, Knee Injury and Osteoarthritis Outcome Scores (KOOS) were collected at five- and ten-year follow-ups. The prevalence of radiolucent lines (RL) on radiographs and implant survival were recorded at five- and ten-year follow-ups.


The Bone & Joint Journal
Vol. 100-B, Issue 9 | Pages 1220 - 1226
1 Sep 2018
Chiu H Chen C Su T Chen C Hsieh H Hsieh C Shen D

Aims

We aimed to determine the effect of dementia and Parkinson’s disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population.

Patients and Methods

Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson’s disease or both, adjusting for demographic, clinical, treatment, and provider factors.


Bone & Joint 360
Vol. 7, Issue 1 | Pages 22 - 24
1 Feb 2018


Bone & Joint 360
Vol. 7, Issue 4 | Pages 28 - 31
1 Aug 2018


The Bone & Joint Journal
Vol. 99-B, Issue 8 | Pages 1115 - 1120
1 Aug 2017
Tsukagoshi Y Kamegaya M Kamada H Saisu T Morita M Kakizaki J Tomaru Y Yamazaki M

Aims

The aim of this study was to evaluate the correlation between Salter’s criteria and Kalamchi’s classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH).

Patients and Methods

The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter’s criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis).

The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis.


The Bone & Joint Journal
Vol. 100-B, Issue 8 | Pages 1054 - 1059
1 Aug 2018
Kelly C Harwood PJ Loughenbury PR Clancy JA Britten S

Aims

Anatomical atlases document classical safe corridors for the placement of transosseous fine wires through the calcaneum during circular frame external fixation. During this process, the posterior tibial neurovascular bundle (PTNVB) is placed at risk, though this has not been previously quantified. We describe a cadaveric study to investigate a safe technique for posterolateral to anteromedial fine wire insertion through the body of the calcaneum.

Materials and Methods

A total of 20 embalmed cadaveric lower limbs were divided into two groups. Wires were inserted using two possible insertion points and at varying angles. In Group A, wires were inserted one-third along a line between the point of the heel and the tip of the lateral malleolus while in Group B, wires were inserted halfway along this line. Standard dissection techniques identified the structures at risk and the distance of wires from neurovascular structures was measured. The results from 19 limbs were subject to analysis.


The Bone & Joint Journal
Vol. 100-B, Issue 2 | Pages 176 - 182
1 Feb 2018
Petrie MJ Blakey CM Chadwick C Davies HG Blundell CM Davies MB

Aims

Fractures of the navicular can occur in isolation but, owing to the intimate anatomical and biomechanical relationships, are often associated with other injuries to the neighbouring bones and joints in the foot. As a result, they can lead to long-term morbidity and poor function. Our aim in this study was to identify patterns of injury in a new classification system of traumatic fractures of the navicular, with consideration being given to the commonly associated injuries to the midfoot.

Patients and Methods

We undertook a retrospective review of 285 consecutive patients presenting over an eight- year period with a fracture of the navicular. Five common patterns of injury were identified and classified according to the radiological features. Type 1 fractures are dorsal avulsion injuries related to the capsule of the talonavicular joint. Type 2 fractures are isolated avulsion injuries to the tuberosity of the navicular. Type 3 fractures are a variant of tarsometatarsal fracture/dislocations creating instability of the medial ray. Type 4 fractures involve the body of the navicular with no associated injury to the lateral column and type 5 fractures occur in conjunction with disruption of the midtarsal joint with crushing of the medial or lateral, or both, columns of the foot.


The Bone & Joint Journal
Vol. 100-B, Issue 8 | Pages 1002 - 1009
1 Aug 2018
Westerman RW Whitehouse SL Hubble MJW Timperley AJ Howell JR Wilson MJ

Aims

The aim of this study was to report the initial results of the Exeter V40 stem, which became available in 2000.

Patients and Methods

A total of 540 total hip arthroplasties (THAs) were performed in our unit using this stem between December 2000 and May 2002. Our routine protocol is to review patients postoperatively and at one, five, and ten years following surgery.


The Bone & Joint Journal
Vol. 100-B, Issue 1 | Pages 95 - 100
1 Jan 2018
Evers J Fischer M Zderic I Wähnert D Richards RG Gueorguiev B Raschke MJ Ochman S

Aims

The aim of this study was to investigate the effect of a posterior malleolar fragment (PMF), with < 25% ankle joint surface, on pressure distribution and joint-stability. There is still little scientific evidence available to advise on the size of PMF, which is essential to provide treatment. To date, studies show inconsistent results and recommendations for surgical treatment date from 1940.

Materials and Methods

A total of 12 cadaveric ankles were assigned to two study groups. A trimalleolar fracture was created, followed by open reduction and internal fixation. PMF was fixed in Group I, but not in Group II. Intra-articular pressure was measured and cyclic loading was performed.


Bone & Joint 360
Vol. 7, Issue 3 | Pages 16 - 18
1 Jun 2018


Bone & Joint 360
Vol. 7, Issue 3 | Pages 21 - 24
1 Jun 2018


Bone & Joint 360
Vol. 6, Issue 6 | Pages 25 - 28
1 Dec 2017


The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1533 - 1536
1 Nov 2017
Nie K Rymaruk S Paton RW

Aims

A clicky hip is a common referral for clinical and sonographic screening for developmental dysplasia of the hip (DDH). There is controversy regarding whether it represents a true risk factor for pathological DDH. Therefore a 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological DDH.

Patients and Methods

A total of 362 infants from 1997 to 2016 were referred with clicky hips to our ‘one-stop’ paediatric hip screening clinic. Hips were assessed clinically for instability and by ultrasound imaging using a simplified Graf/Harcke classification. Dislocated or dislocatable hips were classified as Graf Type IV hips.


The Bone & Joint Journal
Vol. 100-B, Issue 6 | Pages 733 - 739
1 Jun 2018
DeDeugd CM Perry KI Trousdale WH Taunton MJ Lewallen DG Abdel MP

Aims

The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population.

Patients and Methods

A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded.


The Bone & Joint Journal
Vol. 99-B, Issue 4_Supple_B | Pages 17 - 25
1 Apr 2017
Khan T Grindlay D Ollivere BJ Scammell BE Manktelow ARJ Pearson RG

Aims

The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.

Materials and Methods

A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.


The Bone & Joint Journal
Vol. 100-B, Issue 6 | Pages 798 - 805
1 Jun 2018
Zhang Y Guo W Tang X Yang R Ji T Yang Y Wang Y Wei R

Aims

The sacrum is frequently invaded by a pelvic tumour. The aim of this study was to review our experience of treating this group of patients and to identify the feasibility of a new surgical classification in the management of these tumours.

Patients and Methods

We reviewed 141 patients who, between 2005 and 2014, had undergone surgical excision of a pelvic tumour with invasion of the sacrum.

In a new classification, pelvisacral (Ps) I, II, and III resections refer to a sagittal osteotomy through the ipsilateral wing of the sacrum, through the sacral midline, or lateral to the contralateral sacral foramina, respectively. A Ps a resection describes a pelvic osteotomy through the ilium and a Ps b resection describes a concurrent resection of the acetabulum with osteotomies performed through the pubis and ischium or the pubic symphysis. Within each type, surgical approaches were standardized to guide resection of the tumour.


Bone & Joint 360
Vol. 6, Issue 5 | Pages 21 - 24
1 Oct 2017