We hypothesised that the synovial white blood cell (WBC) count
in patients with a late periprosthetic joint infection (PJI) of
the hip would depend on the duration of a patient’s symptoms, and
that the optimal diagnostic threshold would also depend on this
period of time. The synovial WBC count and percentage of polymorphonuclear cells
(%PMN), and the serum CRP and ESR levels obtained >
six weeks after
primary THA were compared between 50 infected and 88 non-infected
THAs, and in patients with symptoms for more than or less than two
weeks. Diagnostic thresholds for the synovial WBC count were calculated
using area under the curve calculation.Aims
Patients and Methods
The aims of this study were to describe the course of non-operatively
managed, bilateral Perthes’ disease, and to determine specific prognostic
factors for the radiographic and clinical outcome. We identified 40 children with a mean age of 5.9 years (1.8 to
13.5), who were managed non-operatively for bilateral Perthes’ disease
from our prospective, multicentre study of this condition, which
included all children in Norway who were diagnosed with Perthes’
disease in the five-year period between 1996 and 2000. All children
were followed up for five years. The hips were classified according to the Catterall classification.
A modified three-group Stulberg classification was used as an outcome
measure, with a spherical femoral head being defined as a good outcome,
an oval head as fair, and a flat femoral head as a poor outcome. Aims
Patients and Methods
As residency training programmes around the globe
move towards competency-based medical education (CBME), there is
a need to review current teaching and assessment practices as they
relate to education in orthopaedic trauma. Assessment is the cornerstone
of CBME, as it not only helps to determine when a trainee is fit
to practice independently, but it also provides feedback on performance
and guides the development of competence. Although a standardised
core knowledge base for trauma care has been developed by the leading
national accreditation bodies and international agencies that teach
and perform research in orthopaedic trauma, educators have not yet established
optimal methods for assessing trainees’ performance in managing
orthopaedic trauma patients. This review describes the existing knowledge from the literature
on assessment in orthopaedic trauma and highlights initiatives that
have recently been undertaken towards CBME in the United Kingdom,
Canada and the United States. In order to support a CBME approach, programmes need to improve
the frequency and quality of assessments and improve on current
formative and summative feedback techniques in order to enhance
resident education in orthopaedic trauma. Cite this article:
Rib fracture fixation by orthopaedic and cardiothoracic surgeons has become increasingly popular for the treatment of chest injuries in trauma. The literature, though mainly limited to Level II and III evidence, shows favourable results for operative fixation. In this paper we review the literature and discuss the indications for rib fracture fixation, surgical approaches, choice of implants and the future direction for management. With the advent of NICE guidance and new British Orthopaedic Association Standards for Trauma (BOAST) guidelines in production, the management of rib fractures is going to become more and more commonplace.
Neuropathic changes in the foot are common with
a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy
is often delayed in diabetic patients with harmful consequences
including amputation. The appropriate diagnosis and treatment can
avoid an extensive programme of treatment with significant morbidity
for the patient, high costs and delayed surgery. The pathogenesis
of a Charcot foot involves repetitive micro-trauma in a foot with impaired
sensation and neurovascular changes caused by pathological innervation
of the blood vessels. In most cases, changes are due to a combination
of both pathophysiological factors. The Charcot foot is triggered
by a combination of mechanical, vascular and biological factors
which can lead to late diagnosis and incorrect treatment and eventually
to destruction of the foot. This review aims to raise awareness of the diagnosis of the Charcot
foot (diabetic neuropathic osteoarthropathy and the differential
diagnosis, erysipelas, peripheral arterial occlusive disease) and
describe the ways in which the diagnosis may be made. The clinical
diagnostic pathways based on different classifications are presented. Cite this article:
Surgical intervention in patients with bone metastases from breast
cancer is dependent on the estimated survival of the patient. The
purpose of this paper was to identify factors that would predict
survival so that specific decisions could be made in terms of surgical
(or non-surgical) management. The records of 113 consecutive patients (112 women) with metastatic
breast cancer were analysed for clinical, radiological, serological
and surgical outcomes. Their median age was 61 years (interquartile
range 29 to 90) and the median duration of follow-up was 1.6 years
(standard deviation (Aims
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
Single-event multilevel surgery (SEMLS) has been used as an effective
intervention in children with bilateral spastic cerebral palsy (BSCP)
for 30 years. To date there is no evidence for SEMLS in adults with
BSCP and the intervention remains focus of debate. This study analysed the short-term outcome (mean 1.7 years, standard
deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional
gait analysis before and after SEMLS at one institution. Aims
Methods
Our aim was to compare kinematic with mechanical alignment in
total knee arthroplasty (TKA). We performed a prospective blinded randomised controlled trial
to compare the functional outcome of patients undergoing TKA in
mechanical alignment (MA) with those in kinematic alignment (KA).
A total of 71 patients undergoing TKA were randomised to either
kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative
hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis
outcome score (KOOS), American Knee Society Score, Short Form-36,
Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed
up and go tests were assessed pre-operatively and at six weeks,
three and six months and one year post-operatively.Aims
Patients and Methods
We present the clinical and radiographic outcome of 81 children
with Gartland type I to III supracondylar humeral fractures at a
minimum follow-up of ten years (mean 12.1 years; 10.3 to 16.1) following
injury. The clinical and functional outcomes are compared with normal
age- and gender-matched individuals. The population-based study
setting was first identified from the institutional registries;
the rate of participation was 76%. Controls were randomly selected
from Finnish National Population Registry.Aims
Patients and Methods
The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients.Objectives
Methods
The diagnosis of surgical site infection following endoprosthetic reconstruction for bone tumours is frequently a subjective diagnosis. Large clinical trials use blinded Central Adjudication Committees (CACs) to minimise the variability and bias associated with assessing a clinical outcome. The aim of this study was to determine the level of inter-rater and intra-rater agreement in the diagnosis of surgical site infection in the context of a clinical trial. The Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial CAC adjudicated 29 non-PARITY cases of lower extremity endoprosthetic reconstruction. The CAC members classified each case according to the Centers for Disease Control (CDC) criteria for surgical site infection (superficial, deep, or organ space). Combinatorial analysis was used to calculate the smallest CAC panel size required to maximise agreement. A final meeting was held to establish a consensus.Objectives
Materials and Methods
