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
The aims of this study were to evaluate the clinical and radiological
outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients
with rheumatoid arthritis. This was a retrospective review of all 95 Universal-2 TWAs which
were performed in our institution between 2003 to 2012 in patients
with rheumatoid arthritis. A total of six patients were lost to
follow-up and two died of unrelated causes. A total of ten patients
had bilateral procedures. Accordingly, 75 patients (85 TWAs) were
included in the study. There were 59 women and 16 men with a mean
age of 59 years (26 to 86). The mean follow-up was 53 months (24
to 120). Clinical assessment involved recording pain on a visual
analogue score, range of movement, grip strength, the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores.
Any adverse effects were documented with particular emphasis on
residual pain, limitation of movement, infection, dislocation and
the need for revision surgery. Radiographic assessment was performed pre-operatively and at
three, six and 12 months post-operatively, and annually thereafter.
Arthroplasties were assessed for distal row intercarpal fusion and
loosening. Radiolucent zones around the components were documented
according to a system developed at our institution.Aims
Patients and Methods
Rotator cuff tendinopathy has a multifactorial origin. Rejecting
the mechanistic theory has also led to abandoning operative treatment
at initial presentation in the first line. Physiotherapy exercise
programmes are the accepted first line treatment. The aim of this
study was to assess the long-term additional benefits of subacromial decompression
in the treatment of rotator cuff tendinopathy. This randomised controlled trial of 140 patients (52 men, 88
women, mean age 47.1 years; 18 to 60) with rotator cuff tendinopathy
extended previous work up to a maximum of 13 years. The patients
were randomised into two treatment groups: arthroscopic acromioplasty
and a supervised exercise treatment and a similar supervised exercise
treatment alone. Self-reported pain on a visual analogue scale (VAS)
was the primary outcome measure. Secondary measures were disability,
working ability, pain at night, Shoulder Disability Questionnaire
score and the number of painful days during the three months preceding
the final assessment.Aims
Patients and Methods
Myxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically
presenting as painless slowly growing masses in the extremities.
Locally infiltrative growth means that the risk of local recurrence
is high. We reviewed our experience to make recommendations about
resection strategies and the role of the multidisciplinary team
in the management of these tumours. Patients with a primary or recurrent MFS who were treated surgically
in our unit between 1997 and 2012 were included in the study. Clinical
records and imaging were reviewed. A total of 50 patients with a
median age of 68.4 years (interquartile range 61.6 to 81.8) were
included. There were 35 men; 49 underwent surgery in our unit.Aims
Patients and Methods
Our aim was to investigate the outcomes of patients with a displaced
fracture of the glenoid fossa who are treated conservatively. There
is little information in the literature about the treatment of these
rare injuries non-operatively. We reviewed 24 patients with a mean age of 52 years (19 to 81)
at a mean of 5.6 years (11 months to 18 years) after the injury.Aims
Patients and Methods
Injuries to the foot in athletes are often subtle
and can lead to a substantial loss of function if not diagnosed
and treated appropriately. For these injuries in general, even after
a diagnosis is made, treatment options are controversial and become
even more so in high level athletes where limiting the time away
from training and competition is a significant consideration. In this review, we cover some of the common and important sporting
injuries affecting the foot including updates on their management
and outcomes. Cite this article:
Lumbar fusion is known to reduce the variation in pelvic tilt
between standing and sitting. A flexible lumbo-pelvic unit increases
the stability of total hip arthroplasty (THA) when seated by increasing
anterior clearance and acetabular anteversion, thereby preventing
impingement of the prosthesis. Lumbar fusion may eliminate this protective
pelvic movement. The effect of lumbar fusion on the stability of
total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone
THA and spinal fusion between 2005 and 2012. PearlDiver software
was used to query the database by the International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural
code for primary THA and lumbar spinal fusion. Patients who had
undergone both lumbar fusion and THA were then divided into three
groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The
rate of dislocation in each group was established using ICD-9-CM codes.
Patients who underwent THA without spinal fusion were used as a
control group. Statistical significant difference between groups
was tested using the chi-squared test, and significance set at p
<
0.05.Aims
Patients and Methods
Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.Objectives
Materials and Methods
To compare radiographic failure and re-operation rates of anatomical
coracoclavicular (CC) ligament reconstructional techniques with
non-anatomical techniques after chronic high grade acromioclavicular
(AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide
healthcare system to identify surgical technique, complications,
radiographic failure and re-operations. Procedures fell into four
categories: Aims
Patients and Methods
The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months.Objectives
Patients and Methods
The purposes of this study were to clarify first, the incidence
of peroneal tendon dislocation in patients with a fracture of the
talus and second the factors associated with peroneal tendon dislocation. We retrospectively examined 30 patients (30 ankles) with a mean
age of 37.5 years, who had undergone internal fixation for a fracture
of the talus. Independent examiners assessed for peroneal tendon
dislocation using the pre-operative CT images. The medical records
were also reviewed for the presence of peroneal tendon dislocation.
The associations between the presence of dislocation with the patient
characteristics or radiological findings, including age, mechanism
of injury, severity of fracture, and fleck sign, were assessed using Fisher’s
exact tests.Aims
Patients and Methods
We assessed the difference in hospital based and early clinical
outcomes between the direct anterior approach and the posterior
approach in patients who undergo total hip arthroplasty (THA). The outcome was assessed in 448 (203 males, 245 females) consecutive
patients undergoing unilateral primary THA after the implementation
of an ‘Enhanced Recovery’ pathway. In all, 265 patients (mean age:
71 years (49 to 89); 117 males and 148 females) had surgery using
the direct anterior approach (DAA) and 183 patients (mean age: 70
years (26 to 100); 86 males and 97 females) using a posterior approach.
The groups were compared for age, gender, American Society of Anesthesiologists
grade, body mass index, the side of the operation, pre-operative
Oxford Hip Score (OHS) and attendance at ‘Joint school’. Mean follow-up
was 18.1 months (one to 50).Aims
Patients and Methods
Many studies have investigated the kinematics of the lumbar spine and the morphological features of the lumbar discs. However, the segment-dependent immediate changes of the lumbar intervertebral space height during flexion-extension motion are still unclear. This study examined the changes of intervertebral space height during flexion-extension motion of lumbar specimens. First, we validated the accuracy and repeatability of a custom-made mechanical loading equipment set-up. Eight lumbar specimens underwent CT scanning in flexion, neural, and extension positions by using the equipment set-up. The changes in the disc height and distance between adjacent two pedicle screw entry points (DASEP) of the posterior approach at different lumbar levels (L3/4, L4/5 and L5/S1) were examined on three-dimensional lumbar models, which were reconstructed from the CT images.Objectives
Methods