We describe the results of conservative treatment for complete midsubstance tears of the anterior cruciate ligament (ACL) in 18 skeletally immature patients, followed for a minimum of 36 months. Six patients had an ACL reconstruction during the follow-up period and were assessed immediately before their operation. The average time from initial injury to evaluation was 51 months. All patients had symptoms when reviewed. The modified Lysholm knee score showed one excellent result, one good, eight fair, and eight poor with a mean score of 64.3. Only one patient had returned to her preinjury level of athletics. Secondary meniscal tears were confirmed in six patients, and three more had the clinical signs of a tear at follow-up. Radiological evidence of degenerative changes was found in 11 of the 18 patients. We conclude that the results of
We describe 24 fractures of the tuberosity of the calcaneus in 22 patients. Three were similar to the type of avulsion fracture which has been well-defined but the remainder represent a group which has been unrecognised previously. Using CT and operative findings we have defined the different patterns of fracture of the calcaneal tuberosity. Ten fractures extended into the subtalar joint, but did not fit the pattern of the common intra-articular fracture as described classically. We have defined a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane.
1. Sixty-eight crush fractures of the articular surface of the lateral tibial condyle have been analysed. 2. Follow-up examination at a minimum of three years after injury was carried out in all cases. 3. The only factors which appeared to influence the results were the extent of the original depression, and if this was severe, the degree of restoration obtained by the treatment. Prolonged plaster fixation was avoided. 4. At review, no patient complained of symptoms which were attributable to damage to ligaments or menisci and no patient had symptoms of late onset. 5. The results suggest that there is nothing to be gained by open reduction if the lateral condyle is depressed by less than 10 millimetres, as conservative treatment gives good results. If the depression is more severe, however, a good result can only be assured if the articular surface is successfully reconstituted, but this is sometimes difficult to achieve. It is not possible to reconstitute the surface by
To determine the relative risk of complications in treating ankle fractures in patients with diabetes, we compared the results of the management of displaced malleolar fractures in 26 patients with those of a matched group of non-diabetic patients, using a case-controlled study. The groups were matched for patient age, fracture type and treating surgeon. The incidence of significant complications in diabetic patients was 42.3%. By contrast, there were no complications in the matched group of non-diabetic patients. Of 19 diabetic patients treated surgically, six developed major complications including one case of malunion, one of necrosis of the wound edge requiring a flap, and two of deep sepsis. Two patients required amputation and both died. Diabetic patients with displaced ankle fractures treated non-operatively had a high incidence of loss of reduction and malunion but these caused few symptoms. In these patients,
The incidence and long-term outcome of undisplaced fatigue fractures of the femoral neck treated conservatively were examined in Finnish military conscripts between 1970 and 1990. From 106 cases identified, 66 patients with 70 fractures were followed for a mean of 18.3 years (11 to 32). The original medical records and radiographs were studied and physical and radiological follow-up data analysed for evidence of risk factors for this injury. The development of avascular necrosis and osteoarthritis was determined from the follow-up radiographs and MR scans. The impact of new military instructions on the management of hip-related pain was assessed following their introduction in 1986. The preventive regimen (1986) improved awareness and increased the detected incidence from 13.2 per 100 000 service-years (1970 to 1986) to 53.2 per 100 000 (1987 to 1990). No patient developed displacement of the fracture or avascular necrosis of the femoral head, or suffered from adverse complications. No differences were found in MRI-measured hip joint spaces at final follow-up. The mean Harris Hip Score was 97 (70 to 100) and the Visual Analogue Scale 5.85 mm (0 to 44).
Our aim in this retrospective study was to analyse the value of serial corrective casts in the management of toe-walking in children aged less than six years with cerebral palsy. A total of 20 children (10 hemiplegic and 10 diplegic) had elongation of the triceps surae by serial casting at a mean age of four years and one month. The mean passive dorsiflexion of the foot with the knee in extension was 3° (−10 to +5) and 12° (0 to +15) with the knee in flexion. After removal of the cast passive dorsiflexion was 20° (+10 to +30) with the knee in extension, and 28° (+10 to +35) with the knee in flexion. At a mean follow-up of 3.08 years (2.08 to 4.92), passive dorsiflexion was 9° (−10 to +20) with the knee in extension and 18° (0 to +30) with the knee in flexion. Serial corrective casts are useful for the treatment of equinus in young children as the procedure is simple and the results are at least equal to those of other
The results of treating 148 hips in 135 children (aged 7 to 16 at the onset of management) for Perthes' disease are analysed. Cases are classified according to the amount of epiphysial containment and the results assessed according to the degree of preserved sphericity. It is concluded that to obtain satisfactory results in this age group treatment should be prolonged until the restitution of the epiphysis so as to maintain the initially achieved containment throughout the reparative process. Containment should be secured initially as follows: by
To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. Retrospective analysis of prospectively collected data was performed for a five-week period from 20 March 2020 and the same time period in 2019. The primary outcome was mortality at 30 days. Secondary outcomes were COVID-19 infection, perioperative pulmonary complications, time to theatre, type of anaesthesia, operation, grade of surgeon, fracture type, postoperative intensive care admission, venous thromboembolism, dislocation, infection rates, and length of stay.Aims
Methods
Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019.Aims
Methods
To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes. Overall, 32 adolescents with coccydynia were treated at our institution during a seven-year period; 28 responded to final follow-up questionnaires after a minimum of one year, 14 had been treated with only injection therapy, and 14 had been operated with coccygectomy. We collected data with regards to pain while sitting, leaning forward, rising from a sitting position, during defecation, while walking or jogging, and while travelling in trains, planes, or automobiles. Pain at follow-up was registered on a numeric pain scale. Each adolescent was then matched to adult patients, and results compared in a case control fashion. The treatment was considered successful if respondents were either completely well or much better at final follow-up after one to seven years.Aims
Methods
The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019.Aims
Methods
1. A series of 196 fractures of the patella has been reviewed. 2. The treatment adopted was excision of the whole boneâl0l; excision of part of the boneâ33; open reduction and sutureâ18; suture with later excisionâ14; no operationâ30. 3. The average time of post-operative disability varied from 3·6 to 5·3 months. The time was appreciably less when operation was carried out before the fourteenth day than when it was done later. 4. An attempt was made to follow up, two to five years after injury, those patients in whom the result was not influenced by other major injuries of the limbs or by unexpected complications. Replies to questionnaires were received from 116 patients. 5. Of these, all regained a good range of movement, varying from 90 degrees of flexion to full movement, whether treatment was by excision of part or all the bone, or by open reduction and suture. 6. The late results of excision of the patella, as estimated by the patients themselves two to five years after treatment, showed that there was considerable residual disability. 7. After total excision of the bone only 5 per cent. of patients considered that the knee was normal; 90 per cent. complained of aching; 60 per cent. complained of "giving way." After excision of one fragment, about half the patients regarded the knee as normal and half complained of aching and stiffness. 8. The number of fractures in this series treated by accurate internal fixation was too small to make justifiable comparisons. 9. The indications for
Bilateral interlocking of the articular facets of the cervical spinal column results from excessive flexion. Unilateral interlocking (hemiluxation) results from simultaneous excessive flexion and rotation. Patients with hemiluxation of the cervical spine often have only mild complaints and the clinical signs may be slight. The diagnosis is made radiologically, but it is often overlooked. Various forms of treatment may give good results. In recent hemiluxation, reduction is advisable to promote recovery of radicular symptoms. The effect of reduction on spinal cord symptoms is uncertain. Manual reduction under general anaesthesia is usually successful, with the possible exception of some cases of interlocking at C.6-C.7, or C.7-T.1. Skull traction with weights of 5 to 10 kilograms even when prolonged is hardly ever successful; with weights of 10 kilograms or more there is a chance of success. Surgical reduction is not always necessary. A hemiluxation of more than two weeks' standing may still be reduced but