Asphericity of the femoral head-neck junction is common in cam-type
femoroacetabular impingement (FAI) and usually quantified using
the alpha angle on radiographs or MRI. The aim of this study was
to determine the natural alpha angle in a large cohort of patients
by continuous circumferential analysis with CT. CT scans of 1312 femurs of 656 patients were analyzed in this
cross-sectional study. There were 362 men and 294 women. Their mean
age was 61.2 years (18 to 93). All scans had been performed for
reasons other than hip disease. Digital circumferential analysis
allowed continuous determination of the alpha angle around the entire
head-neck junction. All statistical tests were conducted two-sided;
a p-value < 0.05 was considered statistically significant.Aims
Methods
An attempt has been made to describe some of the ways in which the element of rotation, which is so important a part of the function of the normal forearm, has a bearing upon the mechanism and treatment of forearm injuries. In particular, distinction is drawn between those injuries in which the shaft of the radius remains in continuity, and those in which there is a complete fracture of the bone. In the former, rotation of the hand in the reduction will be transmitted to the upper end of the radius, and extremes of rotational
Recently, the field of tissue engineering has made numerous advances towards achieving artificial tendon substitutes with excellent mechanical and histological properties, and has had some promising experimental results. The purpose of this systematic review is to assess the efficacy of tissue engineering in the treatment of tendon injuries. We searched MEDLINE, Embase, and the Cochrane Library for the time period 1999 to 2016 for trials investigating tissue engineering used to improve tendon healing in animal models. The studies were screened for inclusion based on randomization, controls, and reported measurable outcomes. The RevMan software package was used for the meta-analysis.Objectives
Methods
Our aim was to evaluate the radiographic characteristics of patients
undergoing total hip arthroplasty (THA) for the potential of posterior
bony impingement using CT simulations. Virtual CT data from 112 patients who underwent THA were analysed.
There were 40 men and 72 women. Their mean age was 59.1 years (41
to 76). Associations between radiographic characteristics and posterior
bony impingement and the range of external rotation of the hip were
evaluated. In addition, we investigated the effects of pelvic tilt
and the neck/shaft angle and femoral offset on posterior bony impingement.Aims
Patients and Methods
Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the posterior cruciate ligament (PCL), patellar tendon and quadriceps muscles under the deep knee-bend loading conditions.Objectives
Methods
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
Preserving growth following limb-salvage surgery of the upper
limb in children remains a challenge. Vascularized autografts may
provide rapid biological incorporation with the potential for growth
and longevity. In this study, we aimed to describe the outcomes
following proximal humeral reconstruction with a vascularized fibular
epiphyseal transfer in children with a primary sarcoma of bone.
We also aimed to quantify the hypertrophy of the graft and the annual
growth, and to determine the functional outcomes of the neoglenofibular
joint. We retrospectively analyzed 11 patients who underwent this procedure
for a primary bone tumour of the proximal humerus between 2004 and
2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean
age at the time of surgery was five years (two to eight). The mean
follow-up was 5.2 years (1 to 12.2).Aims
Patients and Methods
The aim of this study was to evaluate improvements in the quality
and safety of paediatric spinal surgery following the implementation
of a specialist Paediatric Spinal Surgical Team (PSST) in the operating
theatre. A retrospective consecutive case study of paediatric spinal operations
before (between January 2008 and December 2009), and after (between
January 2012 and December 2013) the implementation of PSST, was
performed. A comparative analysis of outcome variables including
surgical site infection (SSI), operating time (ORT), blood loss (BL),
length of stay (LOS), unplanned staged procedures (USP) and transfusion
rates (allogenic and cell-saver) was performed between the two groups.
The rate of complications during the first two postoperative years
was also compared between the groups.Aims
Patients and Methods
The aims of this study were to investigate any possible relationship
between a preoperative sensitivity to pain and the degree of pain
at rest and on exertion with postoperative function in patients
who underwent stemless total shoulder arthroplasty (TSA). In this prospective study, we included 63 patients who underwent
stemless TSA and were available for evaluation one year postoperatively.
There were 31 women and 32 men; their mean age was 71 years (53
to 89). The pain threshold, which was measured using a Pain Matcher
(PM) unit, the degree of pain (visual analogue scale at rest and
on exertion, and function using the short version of the Disabilities
of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded
preoperatively, as well as three and 12 months postoperatively.Aims
Patients and Methods
Controversy about the use of an anatomical total shoulder arthroplasty
(aTSA) in young arthritic patients relates to which is the ideal
form of fixation for the glenoid component: cemented or cementless.
This study aimed to evaluate implant survival of aTSA when used
in patients aged < 60 years with primary glenohumeral osteoarthritis (OA),
and to compare the survival of cemented all-polyethylene and cementless
metal-backed glenoid components. A total of 69 consecutive aTSAs were performed in 67 patients
aged < 60 years with primary glenohumeral OA. Their mean age
at the time of surgery was 54 years (35 to 60). Of these aTSAs,
46 were undertaken using a cemented polyethylene component and 23
were undertaken using a cementless metal-backed component. The age, gender,
preoperative function, mobility, premorbid glenoid erosion, and
length of follow-up were comparable in the two groups. The patients
were reviewed clinically and radiographically at a mean of 10.3
years (5 to 12, Aims
Materials and Methods
Supracondylar fractures are the most frequently occurring paediatric
fractures about the elbow and may be associated with a neurovascular
injury. The British Orthopaedic Association Standards for Trauma
11 (BOAST 11) guidelines describe best practice for supracondylar
fracture management. This study aimed to assess whether emergency
departments in the United Kingdom adhere to BOAST 11 standard 1:
a documented assessment, performed on presentation, must include
the status of the radial pulse, digital capillary refill time, and
the individual function of the radial, median (including the anterior
interosseous), and ulnar nerves. Stage 1: We conducted a multicentre, retrospective audit of adherence
to BOAST 11 standard 1. Data were collected from eight hospitals
in the United Kingdom. A total of 433 children with Gartland type
2 or 3 supracondylar fractures were eligible for inclusion. A centrally
created data collection sheet was used to guide objective analysis
of whether BOAST 11 standard 1 was adhered to. Stage 2: We created
a quality improvement proforma for use in emergency departments.
This was piloted in one of the hospitals used in the primary audit
and was re-audited using equivalent methodology. In all, 102 patients
presenting between January 2016 and July 2017 were eligible for inclusion
in the re-audit.Aims
Materials and Methods
The aim of this prospective randomised controlled trial was to
compare non-operative and operative management for acute isolated
displaced fractures of the olecranon in patients aged ≥ 75 years. Patients were randomised to either non-operative management or
operative management with either tension-band wiring or fixation
with a plate. They were reviewed at six weeks, three and six months
and one year after the injury. The primary outcome measure was the
Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.Aims
Patients and Methods
Little is known about the relative outcomes of revision of unicompartmental
knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total
knee arthroplasty (TKA). The aim of this study is to compare the
outcomes of revision surgery for the two procedures in terms of
complications, re-revision and patient-reported outcome measures (PROMs)
at a minimum of two years follow-up. This study was a retrospective review of data from an institutional
arthroplasty registry for cases performed between 2001 and 2014.
A total of 292 patients were identified, of which 217 had a revision
of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up
was longer for the HTO group compared with the UKA group, patient
demographics (age, body mass index and Charlson co-morbidity index)
and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score,
both objective and functional) were similar in the two groups prior
to revision surgery. Outcomes included the rate of complications
and
re-operation, PROMS and patient-reported satisfaction at six months
and two years post-operatively. We also compared the duration of
surgery and the need for revision implants in the two groups. Aims
Patients and Methods
We conducted a study to identify factors that are prognostic
of the outcome of extracorporeal shockwave therapy (ESWT) for calcific
tendinitis of the shoulder. Since 1998, patients with symptomatic calcific tendinitis of
the rotator cuff have been treated with ESWT using an electrohydraulic
mode shockwave device. One year after ESWT, patients were grouped
according to the level of resorption of calcification.Aims
Patients and Methods
Radiostereometric analysis (RSA) allows an extremely accurate
measurement of early micromotion of components following arthroplasty. In this study, RSA was used to measure the migration of 11 partially
cemented fluted pegged glenoid components in patients with osteoarthritis
who underwent total shoulder arthroplasty using an improved surgical
technique (seven men, four women, mean age 68). Patients were evaluated
clinically using the American Shoulder and Elbow Surgeons (ASES)
and Constant-Murley scores and by CT scans two years post-operatively. Aims
Patients and Methods
We assessed the long-term (more than ten-year) outcomes of the
Kudo type-5 elbow prosthesis in patients with rheumatoid arthritis
(RA). We reviewed 41 elbows (Larsen Grade IV, n = 21; Grade V, n =
20) in 31 patients with RA who had undergone a Kudo type-5 total
elbow arthroplasty (TEA) between 1994 and 2003, and had been followed
up for more than ten years. The humeral component was cementless
and the all-polyethylene ulnar component cemented in every patient. Clinical
outcome was assessed using the Mayo elbow performance score. We
calculated the revision rate and evaluated potential risk factors
for revision. The duration of follow-up was a mean 141 months (120
to 203).Aims
Materials and Methods
The factors that predispose to recurrent instability and revision
stabilization procedures after arthroscopic Bankart repair for anterior
glenohumeral instability remain unclear. We sought to determine
the rate and risk factors associated with ongoing instability in
patients undergoing arthroscopic Bankart repair for instability
of the shoulder. We used the Statewide Planning and Research Cooperative System
(SPARCS) database to identify patients with a diagnosis of anterior
instability of the shoulder undergoing arthroscopic Bankart repair
between 2003 and 2011. Patients were followed for a minimum of three
years. Baseline demographics and subsequent further surgery to the ipsilateral
shoulder were analyzed. Multivariate analysis was used to identify
independent risk factors for recurrent instability.Aims
Materials and Methods
