The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.Objectives
Methods
To evaluate the outcomes of cemented total hip arthroplasty (THA)
following a fracture of the acetabulum, with evaluation of risk
factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of
57 years (25 to 87) underwent cemented THA at a mean of 6.5 years
(0.1 to 25) following acetabular fracture. A total of 38 had undergone
surgical fixation and 11 had been treated non-operatively; 13 patients
died at a mean of 10.2 years after THA (0.6 to 19). Patients were
assessed pre-operatively, at one year and at final follow-up (mean
9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant
survivorship was assessed. An age and gender-matched cohort of THAs
performed for non-traumatic osteoarthritis (OA) or avascular necrosis
(AVN) (n = 98) were used to compare complications and patient-reported outcome
measures (PROMs).Aims
Patients and Methods
Periprosthetic fracture is a significant complication of total
hip and knee arthroplasty. This study aimed to describe the survival
of patients sustaining periprosthetic femoral fractures and compare
this with that of the general population, as well as to identify
the factors that influence survival. A total of 151 patients (women: men 116:35, mean age 74.6 years,
standard deviation 11.5) that sustained a periprosthetic fracture
between January 2005 and October 2012 were retrospectively analysed.
Epidemiological data, comorbidities, type of surgical management,
type of implant, and mortality data were studied.Aims
Patients and Methods
The objective of this study was to assess all evidence comparing the Thompson monoblock hemiarthroplasty with modular unipolar implants for patients requiring hemiarthroplasty of the hip with respect to mortality and complications. A literature search was performed to identify all relevant literature. The population consisted of patients undergoing hemiarthroplasty of the hip for fracture. The intervention was hemiarthroplasty of the hip with a comparison between Thompson and modular unipolar prostheses. Pubmed, Embase, CINAHL, Web of Science, PROSPERO and the Cochrane Central Register of Controlled Trials. The study designs included were randomised controlled trials (RCTs), well designed case control studies and retrospective or prospective cohort studies. Studies available in any language, published at any time until September 2015 were considered. Studies were included if they contained mortality or complications.Objectives
Methods
Our aim was to report survivorship data and lessons learned with
the Corail/Pinnacle cementless total hip arthroplasty (THA) system. Between August 2005 and March 2015, a total of 4802 primary cementless
Corail/Pinnacle THAs were performed in 4309 patients. In March 2016,
we reviewed these hips from a prospectively maintained database.Aims
Patients and Methods
We review our experience of Coonrad-Morrey total elbow arthroplasty
(TEA) for fractures of the distal humerus in non-rheumatoid patients
with a minimum of ten years follow-up. TEA through a triceps splitting approach was peformed in 37 non-rheumatoid
patients for a fracture of the distal humerus between 1996 and 2004.
One patient could not be traced and 17 had died before the tenth
anniversary of their surgery. This left 19 patients with a minimum
follow-up of ten years to form the study group. Of these, 13 patients
were alive at the time of final review. The other six had died,
but after the tenth anniversary of their elbow arthroplasty. Their
clinical and radiological data were included in the study. Aims
Patients and Methods
This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P). Using standard suture loops pulled in-line with the rotator cuff (approximately 60°), anchors were tested in cadaveric bone and foam blocks representing normal to osteopenic bone. Mechanical testing included preloading to 10 N and cyclic loading for 500 cycles from 10 N to 60 N at 60 mm/min. The parameters evaluated were initial displacement, cyclic displacement and number of cycles and load at 3 mm displacement relative to preload. Video recording throughout testing documented the predominant source of suture displacement and the distance of ‘suture cutting through bone’.Objectives
Methods
Patients with diabetes are at increased risk of wound complications
after open reduction and internal fixation of unstable ankle fractures.
A fibular nail avoids large surgical incisions and allows anatomical
reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided
reduction and percutaneous fibular nail fixation for unstable Weber
type B or C fractures in 24 adult patients with type 1 or type 2
diabetes. The re-operation rate for wound dehiscence or other indications
such as amputation, mortality and functional outcomes was determined.Aims
Patients and Methods
The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis was evaluated using the joint space width and Kellgren-Lawrence (KL) radiographic classification. The Objectives
Methods
Cellular movement and relocalisation are important for many physiologic properties. Local mesenchymal stem cells (MSCs) from injured tissues and circulating MSCs aid in fracture healing. Cytokines and chemokines such as Stromal cell-derived factor 1(SDF-1) and its receptor chemokine receptor type 4 (CXCR4) play important roles in maintaining mobilisation, trafficking and homing of stem cells from bone marrow to the site of injury. We investigated the differences in migration of MSCs from the femurs of young, adult and ovariectomised (OVX) rats and the effect of CXCR4 over-expression on their migration. MSCs from young, adult and OVX rats were put in a Boyden chamber to establish their migration towards SDF-1. This was compared with MSCs transfected with CXCR4, as well as MSCs differentiated to osteoblasts.Objectives
Methods
Fractures of the proximal femur are a common clinical problem, and a number of orthopaedic devices are available for the treatment of such fractures. The objective of this study was to assess the rotational stability, a common failure predictor, of three different rotational control design philosophies: a screw, a helical blade and a deployable crucifix. Devices were compared in terms of the mechanical work (W) required to rotate the implant by 6° in a bone substitute material. The substitute material used was Sawbones polyurethane foam of three different densities (0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3). Each torsion test comprised a steady ramp of 1°/minute up to an angular displacement of 10°.Objectives
Methods
Modular or custom-made femoral components have been preferred
for total hip arthroplasty (THA) in patients with a history of Perthes’
disease because of the distortion in the anatomy of the proximal
femur. However, it has not been established whether a monobloc cementless
stem will fit the distorted proximal femur or whether the results
of the procedure are satisfactory in this group of patients. We reviewed 68 consecutive patients who had undergone THA for
childhood Perthes’ disease between June 2003 and December 2008.
There were 35 men and 33 women with a mean age of 48 years (16 to
73) at the time of index arthroplasty. Their mean body mass index
was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg
class III and 36 as class IV. The mean pre-operative shortening
of the affected leg was 17.2 mm (5 to 34). The minimum follow-up
was five years (mean 8.5 years; 5.2 to 10).Aims
Patients and Methods
Compared with primary total hip arthroplasty (THA), revision
surgery can be challenging. The cement-in-cement femoral revision
technique involves removing a femoral component from a well-fixed
femoral cement mantle and cementing a new stem into the original
mantle. This technique is widely used and when carried out for the
correct indications, is fast, relatively inexpensive and carries
a reduced short-term risk for the patient compared with the alternative
of removing well-fixed cement. We report the outcomes of this procedure
when two commonly used femoral stems are used. We identified 1179 cement-in-cement stem revisions involving
an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty
Register (SHAR) between January 1999 and December 2015. Kaplan-Meier
survival analysis was performed.Aims
Patients and Methods
In this study, we aimed to determine whether designation as a
major trauma centre (MTC) affects the quality of care for patients
with a fracture of the hip. All patients in the United Kingdom National Hip Fracture Database,
between April 2010 and December 2013, were included. The indicators
of quality that were recorded included the time to arrival on an
orthopaedic ward, to review by a geriatrician, and to operation.
The clinical outcomes were the development of a pressure sore, discharge
home, length of stay, in-hospital mortality, and re-operation within
30 days. Aims
Patients and Methods