The December 2015 Trauma Roundup360 looks at: Delay to surgery in hip fracture; Hexapod fixators in the management of hypertrophic tibial nonunions; Thromboembolism after nailing pathological fractures; Tibial plateau fracture patterns under the spotlight; The health economic effects of long bone nonunion; Adverse outcomes in trauma; The sacral screw in children; Treating the contralateral SUFE
The December 2015 Spine Roundup360 looks at: Ketamine in scoliosis surgery; Teriparatide in osteoporotic spinal fractures; Trabecular metal in the spine?; Revision surgery a SPORTing chance?; The course of degenerative lumbar spondylolisthesis; Hip or lumbar spine: a common conundrum
Hip fracture is a common injury associated with
high mortality, long-term disability and huge socio-economic burden.
Yet there has been relatively little research into best treatment,
and evidence that has been generated has often been criticised for
its poor quality. Here, we discuss the advances made towards overcoming
these criticisms and the future directions for hip fracture research:
how co-ordinating existing national infrastructures and use of now
established clinical research networks will likely go some way towards
overcoming the practical and financial challenges of conducting
large trials. We highlight the importance of large collaborative
pragmatic trials to inform decision/policy makers and the progress
made towards reaching a consensus on a core outcome set to facilitate data
pooling for evidence synthesis and meta-analysis. These advances and future directions are a priority in order
to establish the high-quality evidence base required for this important
group of patients. Cite this article:
Advances in arthroscopic techniques for rotator cuff repair have
made the mini-open approach less popular. However, the mini-open
approach remains an important technique for repair for many surgeons.
The aims of this study were to compare the integrity of the repair,
the function of the shoulder and satisfaction post-operatively using
these two techniques in patients aged >
50 years. We identified 22 patients treated with mini-open and 128 patients
treated with arthroscopic rotator cuff repair of July 2007 and June
2011. The mean follow-up was two years (1 to 5). Outcome was assessed
using the American Shoulder and Elbow Surgeons (ASES) and Simple
Shoulder Test (SST) scores, and satisfaction. The integrity of the repair
was assessed using ultrasonography. A power analysis ensured sufficient
enrolment.Aims
Patients and Methods
The February 2015 Spine Roundup360 looks at: Paracetamol use for lower back pain; En-bloc resection of vertebra reported for the first time; Spinopelvic disassociation under the spotlight; Hope for back pain; Disc replacement and ACDF equivalent in randomised study; Interspinous process devices ineffective
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK. What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.
The Bereiter trochleoplasty has been used in our unit for 12
years to manage recurrent patellar instability in patients with
severe trochlea dysplasia. The aim of this study was to document
the outcome of a large consecutive cohort of patients who have undergone
this operation. Between June 2002 and August 2013, 214 consecutive trochleoplasties
were carried out in 185 patients. There were 133 women and 52 men
with a mean age of 21.3 years (14 to 38). All patients were offered
yearly clinical and radiological follow-up. They completed the following
patient reported outcome scores (PROMs): International Knee Documentation
Committee subjective scale, the Kujala score, the Western Ontario
and McMaster Universities Arthritis Index score and the short-form
(SF)-12. Aims
Patients and Methods
Hip resurfacing arthroplasty (HRA) is an alternative to conventional
total hip arthroplasty for patients with osteonecrosis (ON) of the
femoral head. Our aim was to report the long-term outcome of HRA,
which is not currently known. Long-term survivorship, clinical scores and radiographic results
for 82 patients (99 hips) treated with HRA for ON over a period
of 18 years were reviewed retrospectively. The mean age of the 67
men and 15 women at the time of surgery was 40.8 years (14 to 64).
Patients were resurfaced regardless of the size of the osteonecrotic
lesion.Aims
Patients and Methods
The aim of this systematic review was to report the rate of dislocation
following the use of dual mobility (DM) acetabular components in
primary and revision total hip arthroplasty (THA). A systematic review of the literature according to the Preferred
Reporting Items for Systematic Reviews and Meta-analyses guidelines
was performed. A comprehensive search of Pubmed/Medline, Cochrane
Library and Embase (Scopus) was conducted for English articles between
January 1974 and March 2016 using various combinations of the keywords “dual
mobility”, “dual-mobility”, “tripolar”, “double-mobility”, “double
mobility”, “hip”, “cup”, “socket”. The following data were extracted
by two investigators independently: demographics, whether the operation
was a primary or revision THA, length of follow-up, the design of
the components, diameter of the femoral head, and type of fixation
of the acetabular component.Aims
Materials and Methods
Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset.Background
Design
We present a case series of five patients who had revision surgery
following magnetic controlled growing rods (MGCR) for early onset
scoliosis. Metallosis was found during revision in four out of five
patients and we postulated a mechanism for rod failure based on
retrieval analysis. Retrieval analysis was performed on the seven explanted rods.
The mean duration of MCGR from implantation to revision was 35 months
(17 to 46). The mean age at revision was 12 years (7 to 15; four
boys, one girl).Aims
Patients and Methods
Lumbar disc herniation (LDH) is uncommon in youth
and few cases are treated surgically. Very few outcome studies exist
for LDH surgery in this age group. Our aim was to explore differences
in gender in pre-operative level of disability and outcome of surgery
for LDH in patients aged ≤ 20 years using prospectively collected
data. From the national Swedish SweSpine register we identified 180
patients with one-year and 108 with two-year follow-up data ≤ 20
years of age, who between the years 2000 and 2010 had a primary
operation for LDH. Both male and female patients reported pronounced impairment
before the operation in all patient reported outcome measures, with
female patients experiencing significantly greater back pain, having
greater analgesic requirements and reporting significantly inferior
scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects
of Short Form-36 and Oswestry Disabilities Index, when compared
with male patients. Surgery conferred a statistically significant
improvement in all registered parameters, with few gender discrepancies.
Quality of life at one year following surgery normalised in both
males and females and only eight patients (4.5%) were dissatisfied with
the outcome. Virtually all parameters were stable between the one-
and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in
both male and female patients aged 20 years or younger, who failed
to recover after non-operative management. Cite this article:
Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a brachial plexus injury and
were included in this retrospective study. The mean follow-up after
nerve transfer was 56 months (28 to 101, standard deviation (Aims
Methods
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
The appropriate management for patients with a degenerative tear
of the rotator cuff remains controversial, but operative treatment,
particularly arthroscopic surgery, is increasingly being used. Our
aim in this paper was to compare the effectiveness of arthroscopic
with open repair of the rotator cuff. A total of 273 patients were recruited to a randomised comparison
trial (136 to arthroscopic surgery and 137 to open surgery) from
19 teaching and general hospitals in the United Kingdom. The surgeons
used their usual preferred method of repair. The Oxford Shoulder
Score (OSS), two years post-operatively, was the primary outcome
measure. Imaging of the shoulder was performed at one year after
surgery. The trial is registered with Current Controlled Trials,
ISRCTN97804283.Aims
Patients and Methods
Health economic evaluations potentially provide
valuable information to clinicians, health care administrators,
and policy makers regarding the financial implications of decisions
about the care of patients. The highest quality research should
be used to inform decisions that have direct impact on the access
to care and the outcome of treatment. However, economic analyses
are often complex and use research methods which are relatively unfamiliar
to clinicians. Furthermore, health economic data have substantial
national, regional, and institutional variability, which can limit
the external validity of the results of a study. Therefore, minimum
guidelines that aim to standardise the quality and transparency
of reporting health economic research have been developed, and instruments
are available to assist in the assessment of its quality and the
interpretation of results. The purpose of this editorial is to discuss the principal types
of health economic studies, to review the most common instruments
for judging the quality of these studies and to describe current
reporting guidelines. Recommendations for the submission of these
types of studies to Cite this article:
