This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries. In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined.Aims
Patients and Methods
Dual plating of distal femoral fractures with medial and lateral implants has been performed to improve construct mechanics and alignment, in cases where isolated lateral plating would be insufficient. This may potentially compromise vascularity, paradoxically impairing healing. This study investigates effects of single versus dual plating on distal femoral vascularity. A total of eight cadaveric lower limb pairs were arbitrarily assigned to either 1) isolated lateral plating, or 2) lateral and medial plating of the distal femur, with four specimens per group. Contralateral limbs served as matched controls. Pre- and post-contrast MRI was performed to quantify signal intensity enhancement in the distal femur. Further evaluation of intraosseous vascularity was done with barium sulphate infusion with CT scan imaging. Specimens were then injected with latex medium and dissection was completed to assess extraosseous vasculature.Aims
Methods
The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Abstract
The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery. We conducted a systematic review of MEDLINE and the CEA Registry to identify CEAs that were conducted on or after 1 January 1997, that studied a procedure pertaining to the field of hand and upper extremity surgery, that were clinical studies, and that reported outcomes in terms of quality-adjusted life-years. We identified a total of 33 studies that met our inclusion criteria. The quality of these studies was assessed using the Quality of Health Economic Analysis (QHES) scale.Aims
Materials and Methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
High-quality clinical research in children’s orthopaedic surgery
has lagged behind other surgical subspecialties. This study used
a consensus-based approach to identify research priorities for clinical
trials in children’s orthopaedics. A modified Delphi technique was used, which involved an initial
scoping survey, a two-round Delphi process and an expert panel formed
of members of the British Society of Children’s Orthopaedic Surgery.
The survey was conducted amongst orthopaedic surgeons treating children
in the United Kingdom and Ireland.Aims
Methods
The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included.Aims
Materials and Methods
Displaced fractures of the lateral condyle of the humerus are
frequently managed surgically with the aim of avoiding nonunion,
malunion, disturbances of growth and later arthritis. The ideal
method of fixation is however not known, and treatment varies between
surgeons and hospitals. The aim of this study was to compare the
outcome of two well-established forms of surgical treatment, Kirschner
wire (K-wire) and screw fixation. A retrospective cohort study of children who underwent surgical
treatment for a fracture of the lateral condyle of the humerus between
January 2005 and December 2014 at two centres was undertaken. Pre,
intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean
age at the time of injury was 5.8 years (0 to 15) with a male:female
patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture
and the fracture was displaced by > 2 mm in 228 (68%). In all, 235
patients underwent K-wire fixation and 101 had screw fixation. Aims
Patients and Methods
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. 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.Aims
Patients and Methods
The aims of this study were to characterize the frequency of
missing data in the National Surgical Quality Improvement Program
(NSQIP) database and to determine how missing data can influence
the results of studies dealing with elderly patients with a fracture
of the hip. Patients who underwent surgery for a fracture of the hip between
2005 and 2013 were identified from the NSQIP database and the percentage
of missing data was noted for demographics, comorbidities and laboratory
values. These variables were tested for association with ‘any adverse
event’ using multivariate regressions based on common ways of handling
missing data.Aims
Patients and Methods
Involvement of the posterior malleolus in fractures of the ankle
probably adversely affects the functional outcome and may be associated
with the development of post-traumatic osteoarthritis. Anatomical
reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term
outcome of patients with trimalleolar fractures, who were treated
surgically using a posterolateral approach in our hospital between
2010 and 2014. The study involved 52 patients. Their mean age was 49 years (22
to 79). There were 41 (79%) AO 44B-type and 11 (21%) 44C-type fractures.
The mean size of the posterior fragment was 27% (10% to 52%) of
the tibiotalar joint surface.Aims
Patients and Methods
The aim of this study was to report the clinical, functional
and radiological outcomes of children and adolescents with tibial
fractures treated using the Ilizarov method. Between 2013 and 2016 a total of 74 children with 75 tibial fractures
underwent treatment at our major trauma centre using an Ilizarov
frame. Demographic and clinical information from a prospective database
was supplemented by routine functional and psychological assessment
and a retrospective review of the notes and radiographs.Aims
Patients and Methods
