We performed an audit of 71 children with consecutive displaced, extension-type supracondylar fractures of the humerus over a period of 30 months. The fractures were classified according to the Wilkins modification of the Gartland system. There were 29 type IIA, 22 type IIB and 20 type III. We assessed the effectiveness of guidelines proposed after a previous four-year review of 83 supracondylar fractures. These recommended that: 1) an experienced surgeon should be responsible for the initial management; 2) closed or open reduction of type-IIB and type-III fractures must be supplemented by stabilisation with Kirschner (K-) wires; and 3) K-wires of adequate thickness (1.6 mm) must be used in a crossed configuration. The guidelines were followed in 52 of the 71 cases. When they were observed there were no
During a six-year period (January 1996 to January 2002 ), we re-explored 60 interspaces (49 patients, 49 feet) for recurrence or persistent symptoms after one or more previous procedures for excision of an interdigital neuroma. Ten patients underwent concomitant excision of a primary neuroma from an adjacent interspace, and 19 underwent concomitant forefoot surgery. The mean follow-up was 39.7 months (6 to 79). Evaluation included review of records and radiographs, clinical assessment, and a questionnaire regarding satisfaction, pain, restriction of footwear and activity. In total, 15 patients (30.7%) were completely satisfied, 13 (26.5%) were satisfied with minor reservations, ten (20.4%) were satisfied with major reservations and 11 (22.4%) were dissatisfied with the outcome. Of the 49 patients, 28 (57.2%) had no or mild pain, 29 (59.2%) had moderate or severe restriction of footwear and eight (16.3%) had moderate restriction of activity. Intra-operative findings, simultaneous surgery to adjacent interspaces, concomitant forefoot surgery and previous re-explorations did not significantly influence the outcome. Persistent or recurrent symptoms after transection of a nerve present a challenging problem for both the surgeon and patient. It is essential that there is a thorough pre-operative discussion with the patient, providing the rates of failure and the increased likelihood of restriction of footwear and activity after
We reviewed 50 capitellocondylar elbow replacements performed by the lateral approach in 42 rheumatoid patients, at a median follow-up of three years. There were two major and 17 minor complications; 18 were early and one was late. Eight elbows required
The direction of wear in the acetabular socket has implications for the amount of debris that is generated during movement, for the magnitude of eccentric loading and for the incidence of impingement of the neck. We observed the direction of penetration with respect to a global co-ordinate system in 84 acetabular components retrieved at
The torsion of both femora was evaluated in 110 patients who had been treated by intramedullary nailing for unilateral femoral shaft fractures. The anteversion (AV) angle was measured by ultrasound, using a tilted-transducer technique. True torsional deformity, defined as an AV difference of 15 degrees or more between sides was found in 21 patients, but only eight had complaints related to the deformity. Three patients had
Although it is widely accepted that grade IIIB open tibial fractures require combined specialised orthopaedic and plastic surgery, the majority of patients in the UK initially present to local hospitals without access to specialised trauma facilities. The aim of this study was to compare the outcome of patients presenting directly to a specialist centre (primary group) with that of patients initially managed at local centres (tertiary group). We reviewed 73 consecutive grade IIIB open tibial shaft fractures with a mean follow-up of 14 months (8 to 48). There were 26 fractures in the primary and 47 in the tertiary group. The initial skeletal fixation required revision in 22 (47%) of the tertiary patients. Although there was no statistically-significant relationship between flap timing and flap failure, all the failures (6 of 63; 9.5%) occurred in the tertiary group. The overall mean time to union of 28 weeks was not influenced by the type of skeletal fixation. Deep infection occurred in 8.5% of patients, but there were no persistently infected fractures. The infection rate was not increased in those patients debrided more than six hours after injury. The limb salvage rate was 93%. The mean limb functional score was 74% of that of the normal limb. At review, 67% of patients had returned to employment, with a further 10% considering a return after rehabilitation. The times to union, infection rates and Enneking limb reconstruction scores were not statistically different between the primary and tertiary groups. The increased complications and
We investigated the lymphocyte-mediated immune response to polymethylmethacrylate bone cement in 26 patients who had
We used a trochanteric slide osteotomy (TSO) in 94 consecutive revision total hip arthroplasties (90 with replacement of both the cup and stem). This technique proved to be adequate for removing the components, with few complications (two minor fractures), and for implanting acetabular allografts (18%) and reinforcement devices (23%). Trochanteric union was obtained in most patients (96%), even in those with septic loosening (18/19), major femoral osteolysis (32/32), or previous trochanteric osteotomy (17/18). TSO is versatile, since it can be extended by a femoral flap (four cases) or a distal femoral window (eight cases). Despite significant bone loss, in 24% of the femora and 57% of the acetabula, favourable midterm results were achieved and only six
We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were
The present study aimed to investigate the long-term functional
results of scapulothoracic fusion using multifilament cables in
patients with facioscapulohumeral dystrophy (FSHD) to identify if
the early improvement from this intervention is maintained. We retrospectively investigated the long-term outcomes of 13
patients with FSHD (18 shoulders) in whom scapulothoracic fusion
using multifilament cables was performed between 2004 and 2007.
These patients have previously been reported at a mean of 35.5 months
(24 to 87). There were eight men and five women with a mean age
of 26 years. Their mean length of follow-up of our current study
was 128 months (94 to 185). To evaluate long-term functional results,
the range of shoulder flexion and abduction, Quick Disabilities
of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with
a comparison of preoperatively, interim and at the final outcomes. The
fusion was examined radiographically in all.Aims
Patients and Methods
The aim of this study was to determine whether the rates of revision
for metal-on-metal (MoM) total hip arthroplasties (THAs) with Pinnacle
components varied according to the year of the initial operation,
and compare these with the rates of revision for other designs of
MoM THA. Data from the National Joint Registry for England and Wales included
36 mm MoM THAs with Pinnacle acetabular components which were undertaken
between 2003 and 2012 with follow-up for at least five years (n
= 10 776) and a control group of other MoM THAs (n = 13 817). The
effect of the year of the primary operation on all-cause rates of revision
was assessed using Cox regression and interrupted time-series analysis.Aims
Patients and Methods
We studied 57 patients with isolated lunotriquetral injuries treated by arthrodesis, direct ligament repair, or ligament reconstruction. The outcomes were compared by using written questionnaires, the Disabilities of the Arm, Shoulder and Hand (DASH) score, range of movement, strength, morbidity and rates of
The aim of this study was to compare the cost-effectiveness of
intramedullary nail fixation and ‘locking’ plate fixation in the
treatment of extra-articular fractures of the distal tibia. An economic evaluation was conducted from the perspective of
the United Kingdom National Health Service (NHS) and personal social
services (PSS), based on evidence from the Fixation of Distal Tibia
Fractures (UK FixDT) multicentre parallel trial. Data from 321 patients
were available for analysis. Costs were collected prospectively
over the 12-month follow-up period using trial case report forms
and participant-completed questionnaires. Cost-effectiveness was
reported in terms of incremental cost per quality adjusted life
year (QALY) gained, and net monetary benefit. Sensitivity analyses
were conducted to test the robustness of cost-effectiveness estimates.Aim
Patients and Methods
The primary aim of this study was to determine the surgical team’s
learning curve for introducing robotic-arm assisted unicompartmental
knee arthroplasty (UKA) into routine surgical practice. The secondary
objective was to compare accuracy of implant positioning in conventional
jig-based UKA versus robotic-arm assisted UKA. This prospective single-surgeon cohort study included 60 consecutive
conventional jig-based UKAs compared with 60 consecutive robotic-arm
assisted UKAs for medial compartment knee osteoarthritis. Patients
undergoing conventional UKA and robotic-arm assisted UKA were well-matched
for baseline characteristics including a mean age of 65.5 years
(Aims
Patients and Methods
The aim of this study was to examine the results of the acetabular
distraction technique in achieving implantation of a stable construct,
obtaining biological fixation, and producing healing of chronic
pelvic discontinuity at revision total hip arthroplasty. We identified 32 patients treated between 2006 and 2013 who underwent
acetabular revision for a chronic pelvic discontinuity using acetabular
distraction, and who were radiographically evaluated at a mean of
62 months (25 to 160). Of these patients, 28 (87.5%) were female.
The mean age at the time of revision was 67 years (44 to 86). The patients
represented a continuous series drawn from two institutions that
adhered to an identical operative technique.Aims
Patients and Methods
We studied retrospectively the results in 24 patients (25 feet) who had been treated by subtalar arthrodesis with internal compression for post-traumatic arthritis from 1988 to 1992. Fifteen patients were men (16 feet) and nine (9 feet) were women. Their mean age was 43 years (22 to 68), and the average duration of follow-up was four years (2 to 6). A single compression screw was used in all feet and iliac-crest bone grafting in ten. Union was achieved in 24 of the 25 feet (96%). Based on a clinical scale the results were excellent in 10 feet, good in 7, fair in 6, and poor in 2 and on the Angus and Cowell score they were good in 19 feet, fair in 4, and poor in 2. The two poor results were due to nonunion in one patient and reflex sympathetic dystrophy in the other. One
This study compared multiple sclerosis (MS) patients who underwent
primary total hip arthroplasty (THA) with a matched cohort. Specifically,
we evaluated: 1) implant survivorship; 2) functional outcomes (modified
Harris Hip Scores (mHHS), Hip Disability and Osteoarthritis Outcome
Score, Joint Replacement (HOOS JR), and modified Multiple Sclerosis
Impact Scale (mMSIS) scores (with the MS cohort also evaluated based
on the disease phenotype)); 3) physical therapy duration and return
to function; 4) radiographic outcomes; and 5) complications. We reviewed our institution’s database to identify MS patients
who underwent THA between January 2008 and June 2016. A total of
34 MS patients (41 hips) were matched in a 1:2 ratio to a cohort
of THA patients who did not have MS, based on age, body mass index
(BMI), and Charlson/Deyo score. Patient records were reviewed for complications,
and their functional outcomes and radiographs were reviewed at their
most recent follow-up.Aims
Patients and Methods