Wrist block has been used to provide pain relief
for many procedures on the hand and wrist but its role in arthroscopy
of the wrist remains unexplored. Chondrotoxicity has been a concern
with the intra-articular infiltration of local anaesthetic. We aimed
to evaluate and compare the analgesic effect of portal and wrist
joint infiltration with a wrist block on the pain experienced by
patients after arthroscopy of the wrist. A prospective, randomised, double-blind trial was designed and
patients undergoing arthroscopy of the wrist under general anaesthesia
as a day case were recruited for the study. Levo-bupivacaine was
used for both techniques. The effects were evaluated using a ten-point
visual analogue scale, and the use of analgesic agents was also
compared. The primary outcomes for statistical analyses were the
mean pain scores and the use of analgesia post-operatively. A total of 34 patients (63% females) were recruited to the portal
and joint infiltration group and 32 patients (59% males) to the
wrist block group. Mean age was 40.8 years in the first group and
39.7 years in the second group (p >
0.05). Both techniques provided
effective pain relief in the first hour and 24 hours post-operatively
but wrist block gave better pain scores at bedtime on the day of
surgery (p = 0.007) and at 24 hours post-operatively (p = 0.006). Wrist block provides better and more reliable analgesia in patients
undergoing arthroscopy of the wrist without exposing patients to
the risk of chondrotoxicity. Cite this article:
Although vertebroplasty is very effective for relieving acute pain from an osteoporotic vertebral compression fracture, not all patients who undergo vertebroplasty receive the same degree of benefit from the procedure. In order to identify the ideal candidate for vertebroplasty, pre-operative prognostic demographic or clinico-radiological factors need to be identified. The objective of this study was to identify the pre-operative prognostic factors related to the effect of vertebroplasty on acute pain control using a cohort of surgically and non-surgically managed patients. Patients with single-level acute osteoporotic vertebral compression fracture at thoracolumbar junction (T10 to L2) were followed. If the patients were not satisfied with acute pain reduction after a three-week conservative treatment, vertebroplasty was recommended. Pain assessment was carried out at the time of diagnosis, as well as three, four, six, and 12 weeks after the diagnosis. The effect of vertebroplasty, compared with conservative treatment, on back pain (visual analogue score, VAS) was analysed with the use of analysis-of-covariance models that adjusted for pre-operative VAS scores.Objectives
Patients and Methods
To compare the structural durability of hydroxyapatite-tricalcium
phosphate (HATCP) to autologous iliac crest bone graft in calcaneal
lengthening osteotomy (CLO) for pes planovalgus in childhood. We present the interim results of ten patients (HATCP, n = 6
and autograft, n = 5) with a mean age of 11.5 years (8.2 to 14.2)
from a randomised controlled non-inferiority trial with six months
follow-up. The primary outcome was the stability of the osteotomy
as measured by radiostereometric analysis. A non-inferiority margin
of ≤ 2 mm osteotomy compression was set.Aims
Patients and Methods
To elucidate the effects of age on the expression levels of the receptor activator of the nuclear factor-κB ligand (RANKL) and osteoclasts in the periodontal ligament during orthodontic mechanical loading and post-orthodontic retention. The study included 20 male Sprague-Dawley rats, ten in the young group (aged four to five weeks) and ten in the adult group (aged 18 to 20 weeks). In each rat, the upper-left first molar was subjected to a seven-day orthodontic force loading followed by a seven-day retention period. The upper-right first molar served as a control. The amount of orthodontic tooth movement was measured after seven-day force application and seven-day post-orthodontic retention. The expression levels of RANKL and the tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts were evaluated on day 7 (end of mechanical force loading) and day 14 (after seven days of post-orthodontic retention). Statistical analysis was performed using the Objectives
Materials and Methods
Patients undergoing femoral lengthening by external fixation
tolerate treatment less well when compared to tibial lengthening.
Lengthening of the femur with an intramedullary device may have
advantages. We reviewed all cases of simple femoral lengthening performed
at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities,
congenital limb deficiencies and lengthening with an unstable hip
were excluded, leaving 33 cases (in 22 patients; 11 patients had
bilateral procedures) for review. Healing index, implant tolerance
and complications were compared.Aims
Patients and 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 aim of this study was to present data on 11 459 patients
who underwent total hip (THA), total knee (TKA) or unicompartmental
knee arthroplasty (UKA) between November 2002 and April 2014 with
aspirin as the primary agent for pharmacological thromboprophylaxis. We analysed the incidence of deep vein thrombosis (DVT) and pulmonary
embolism (PE) then compared the 90-day all-cause mortality with
the corresponding data in the National Joint Registry for England
and Wales (NJR). Aims
Patients and Methods
Compartment syndrome results from increased intra-compartmental
pressure (ICP) causing local tissue ischaemia and cell death, but
the systemic effects are not well described. We hypothesised that
compartment syndrome would have a profound effect not only on the affected
limb, but also on remote organs. Using a rat model of compartment syndrome, its systemic effects
on the viability of hepatocytes and on inflammation and circulation
were directly visualised using intravital video microscopy.Aims
Methods
We sought to determine if a durable bilayer implant composed of trabecular metal with autologous periosteum on top would be suitable to reconstitute large osteochondral defects. This design would allow for secure implant fixation, subsequent integration and remodeling. Adult sheep were randomly assigned to one of three groups (n = 8/group): 1. trabecular metal/periosteal graft (TMPG), 2. trabecular metal (TM), 3. empty defect (ED). Cartilage and bone healing were assessed macroscopically, biochemically (type II collagen, sulfated glycosaminoglycan (sGAG) and double-stranded DNA (dsDNA) content) and histologically.Objectives
Materials and Methods
Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons.Objectives
Methods
This study aimed to determine the long-term functional,
clinical and radiological outcomes in patients with Schatzker IV
to VI fractures of the tibial plateau treated with an Ilizarov frame.
Clinical, functional and radiological assessment was carried out
at a minimum of one year post-operatively. A cohort of 105 patients
(62 men, 43 women) with a mean age of 49 years (15 to 87) and a
mean follow-up of 7.8 years (1 to 19) were reviewed. There were
18 type IV, 10 type V and 77 type VI fractures. All fractures united
with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient
developed a deep infection. The median range of movement (ROM) of
the knee was 110o and the median Iowa score was 85. Our study demonstrates good long-term functional outcome with
no deep infection; spanning the knee had no detrimental effect on
the ROM or functional outcome. High-energy fractures of the tibial plateau may be treated effectively
with a fine wire Ilizarov fixator. Cite this article:
In order to evaluate the effectiveness of the Mobi-C implant
in cervical disc degeneration, a randomised study was conducted,
comparing the Mobi-C prosthesis arthroplasty with anterior cervical
disc fusion (ACDF) in patients with single level cervical spondylosis. From January 2008 to July 2009, 99 patients were enrolled and
randomly divided into two groups, those having a Mobi-C implant
(n = 51; 30 men, 21 women) and those undergoing ACDF (n = 48; 28
men, 20 women).The patients were followed up for five years, with
the primary outcomes being the Japanese Orthopaedic Association
score, visual analogue scale for pain and the incidence of further
surgery. The secondary outcomes were the Neck Disability Index and
range of movement (ROM) of the treated segment.Aims
Patients and Methods
The place of thromboprophylaxis in arthroplasty surgery remains
controversial, with a challenging requirement to balance prevention
of potentially fatal venous thrombo-embolism with minimising wound-related
complications leading to deep infection. We compared the incidence
of fatal pulmonary embolism in patients undergoing elective primary
total hip arthroplasty (THA) between those receiving aspirin, warfarin
and low molecular weight heparin (LMWH) for the chemical component
of a multi-modal thromboprophylaxis regime. A prospective audit database was used to identify patients who
had died within 42 and 90 days of surgery respectively between April
2000 and December 2012. A case note review was performed to ascertain
the causes of death.Aims
Patients and Methods
A retrospective study was performed in 18 patients
with achondroplasia, who underwent bilateral humeral lengthening
between 2001 and 2013, using monorail external fixators. The mean
age was ten years (six to 15) and the mean follow-up was 40 months
(12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score
fell from 32.3 (20 to 40)
pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A
mean lengthening of 60% (40% to 95%) was required to reach the goal
of independent perineal hygiene. One patient developed early consolidation,
and fractures occurred in the regenerate bone of four humeri in
three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with
achondroplasia and is not just a cosmetic procedure. Cite this article:
Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (Objectives
Methods
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
Only limited data are available regarding the
infiltration of local anaesthetic for total hip arthroplasty (THA),
and no studies were performed for THA using the anterior approach. In this prospective, randomised placebo-controlled study we investigated
the effect of both standard and reverse infiltration of local anaesthetic
in combination with the anterior approach for THA. The primary endpoint
was the mean numeric rating score for pain four hours post-operatively.
In addition, we recorded the length of hospital stay, the operating
time, the destination of the patient at discharge, the use of pain
medication, the occurrence of side effects and pain scores at various
times post-operatively. Between November 2012 and January 2014, 75 patients were included
in the study. They were randomised into three groups: standard infiltration
of local anaesthetic, reversed infiltration of local anaesthetic,
and placebo. There was no difference in mean numeric rating score
for pain four hours post-operatively (p = 0.87). There were significantly
more side effects at one and eight hours post-operatively in the
placebo group (p = 0.02; p = 0.03), but this did not influence the
mobilisation of the patients. There were no differences in all other
outcomes between the groups. We found no clinically relevant effect when the infiltration
of local anaesthetic with ropivacaine and epinephrine was used in
a multimodal pain protocol for THA using the anterior approach. Cite this article:
Although atlantoaxial rotatory fixation (AARF) is a common cause
of torticollis in children, the diagnosis may be delayed. The condition
is characterised by a lack of rotation at the atlantoaxial joint
which becomes fixed in a rotated and subluxed position. The management of
children with a delayed presentation of this condition is controversial.
This is a retrospective study of a group of such children. Children who were admitted to two institutions between 1988 and
2014 with a diagnosis of AARF were included. We identified 12 children
(four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4),
in whom the duration of symptoms on presentation was at least four weeks
(four to 39). All were treated with halo traction followed by a
period of cervical immobilisation in a halo vest or a Minerva jacket.
We describe a simple modification to the halo traction that allows
the child to move their head whilst maintaining traction. The mean follow-up
was 59.6 weeks (24 to 156).Aims
Patients and Methods
