Epidemiological studies enhance clinical practice
in a number of ways. However, there are many methodological difficulties
that need to be addressed in designing a study aimed at the collection
and analysis of data concerning fractures and other injuries. Most
can be managed and errors minimised if careful attention is given
to the design and implementation of the research. Cite this article:
Excessive mechanical stress on synovial joints causes osteoarthritis
(OA) and results in the production of prostaglandin E2 (PGE2), a
key molecule in arthritis, by synovial fibroblasts. However, the
relationship between arthritis-related molecules and mechanical
stress is still unclear. The purpose of this study was to examine
the synovial fibroblast response to cyclic mechanical stress using
an Human synovial fibroblasts were cultured on collagen scaffolds
to produce three-dimensional constructs. A cyclic compressive loading
of 40 kPa at 0.5 Hz was applied to the constructs, with or without
the administration of a cyclooxygenase-2 (COX-2) selective inhibitor
or dexamethasone, and then the concentrations of PGE2, interleukin-1β (IL-1β),
tumour necrosis factor-α (TNF-α), IL-6, IL-8 and COX-2 were measured.Objective
Method
There is great variability in acetabular component
orientation following hip replacement. The aims of this study were
to compare the component orientation at impaction with the orientation
measured on post-operative radiographs and identify factors that
influence the difference between the two. A total of 67 hip replacements
(52 total hip replacements and 15 hip resurfacings) were prospectively
studied. Intra-operatively, the orientation of the acetabular component
after impaction relative to the operating table was measured using
a validated stereo-photogrammetry protocol. Post-operatively, the
radiographic orientation was measured; the mean inclination/anteversion
was 43° ( This study demonstrated that in order to achieve a specific radiographic
orientation target, surgeons should implant the acetabular component
5° less inclined and 8° more anteverted than their target. Great
variability (2 Cite this article:
We examined the outcomes and levels of patient
satisfaction in 202 consecutive cases of ultrasound-guided supraclavicular
brachial plexus block (SBPB) in upper limb surgery performed between
September 2007 and March 2010. All blocks were performed by orthopaedic surgeons using ultrasound
visualisation with a high-frequency linear probe. The probe was
placed in the coronal–oblique plane in the supraclavicular fossa,
and the puncture was ‘in-plane’ from lateral to medial. Most of
the blocks were performed with 0.75% ropivacaine/1% lidocaine (1:1),
with or without adrenaline in 1:200 000 dilution. In 201 patients
(99.5%) the brachial plexus block permitted surgery without conversion
to general anaesthesia. The mean procedure time for block was 3.9
min (2 to 12), the mean waiting time for surgery was 34.1 min (10
to 64), the mean surgical time was 75.2 min (6 to 232), and the
mean duration of post-anaesthetic analgesia was 437 min (171 to
992). A total of 20 patients (10%) developed a transient Horner’s syndrome.
No nerve injury, pneumothorax, arterial puncture or systemic anaesthetic
toxicity were recorded. Most patients (96.7%) were satisfied with
ultrasound-guided SBPB. This study demonstrates the efficacy and
safety of ultrasound-guided SBPB for orthopaedic surgery on the
upper limb. Cite this article:
This paper investigates whether cortical comminution
and intra-articular involvement can predict displacement in distal
radius fractures by using a classification that includes volar comminution
as a separate parameter. A prospective multicentre study involving non-operative treatment
of distal radius fractures in 387 patients aged between 15 and 74
years (398 fractures) was conducted. The presence of cortical comminution
and intra-articular involvement according to the Buttazzoni classification
is described. Minimally displaced fractures were treated with immobilisation
in a cast while displaced fractures underwent closed reduction with
subsequent immobilisation. Radiographs were obtained after reduction,
at 10 to 14 days and after union. The outcome measure was re-displacement
or union. In fractures with volar comminution (Buttazzoni type 4), 96%
(53 of 55) displaced. In intra-articular fractures without volar
comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular
fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106
of 145) displaced while in non-comminuted fractures (Buttazzoni
1), 16 % (13 of 81 ) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures
later displaced. All of the initially displaced volarly comminuted
fractures re-displaced. Displacement occurred in 31% (63 of 205)
of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution
predicted later displacement, while intra-articular involvement
did not predict displacement. Volar comminution was the strongest
predictor of displacement. Cite this article:
The indications for reverse shoulder arthroplasty
(RSA) continue to be expanded. Associated impairment of the deltoid
muscle has been considered a contraindication to its use, as function
of the RSA depends on the deltoid and impairment of the deltoid
may increase the risk of dislocation. The aim of this retrospective
study was to determine the functional outcome and risk of dislocation
following the use of an RSA in patients with impaired deltoid function.
Between 1999 and 2010, 49 patients (49 shoulders) with impairment
of the deltoid underwent RSA and were reviewed at a mean of 38 months
(12 to 142) post-operatively. There were nine post-operative complications (18%),
including two dislocations. The mean forward elevation improved
from 50° ( These results suggest that pre-operative deltoid impairment,
in certain circumstances, is not an absolute contraindication to
RSA. This form of treatment can yield reliable improvement in function
without excessive risk of post-operative dislocation. Cite this article:
We are entering a new era with governmental bodies
taking an increasingly guiding role, gaining control of registries,
demanding direct access with release of open public information
for quality comparisons between hospitals. This review is written
by physicians and scientists who have worked with the Swedish Knee
Arthroplasty Register (SKAR) periodically since it began. It reviews
the history of the register and describes the methods used and lessons
learned. Cite this article:
Substantial healthcare resources have been devoted
to computer navigation and patient-specific instrumentation systems
that improve the reproducibility with which neutral mechanical alignment
can be achieved following total knee replacement (TKR). This choice of
alignment is based on the long-held tenet that the alignment of
the limb post-operatively should be within 3° of a neutral mechanical
axis. Several recent studies have demonstrated no significant difference
in survivorship when comparing well aligned Review of the literature suggests that a neutral mechanical axis
remains the optimal guide to alignment. Cite this article:
Electromagnetic fields (EMF) are widely used in musculoskeletal
disorders. There are indications that EMF might also be effective
in the treatment of osteoporosis. To justify clinical follow-up
experiments, we examined the effects of EMF on bone micro-architectural
changes in osteoporotic and healthy rats. Moreover, we tested the
effects of EMF on fracture healing. EMF (20 Gauss) was examined in rats (aged 20 weeks), which underwent
an ovariectomy (OVX; n = 8) or sham-ovariectomy (sham-OVX; n = 8).
As a putative positive control, all rats received bilateral fibular
osteotomies to examine the effects on fracture healing. Treatment
was applied to one proximal lower leg (three hours a day, five days
a week); the lower leg was not treated and served as a control.
Bone architectural changes of the proximal tibia and bone formation
around the osteotomy were evaluated using Objectives
Methods
The aim of this study was to investigate the
effect of training on the arthroscopic performance of a group of
medical students and to determine whether all students could be
trained to competence. Thirty-three medical students with no previous
experience of arthroscopy were randomised to a ‘Trained’ or an ‘Untrained’
cohort. They were required to carry out 30 episodes of two simulated
arthroscopic tasks (one shoulder and one knee). The primary outcome variable
was task success at each episode. Individuals achieved competence
when their learning curve stabilised. The secondary outcome was
technical dexterity, assessed objectively using a validated motion
analysis system. Six subjects in the ‘Untrained’ cohort failed to
achieve competence in the shoulder task, compared with one in the ‘Trained’
cohort. During the knee task, two subjects in each cohort failed
to achieve competence. Based on the objective motion analysis parameters,
the ‘Trained’ cohort performed better on the shoulder task (p <
0.05) but there was no significant difference for the knee task
(p >
0.05). Although
The June 2014 Shoulder &
Elbow Roundup360 looks at: suprascapular nerve and rotator cuff pathology; anchors in Bankart repair: it’s not what you’ve got, but how you use it; not all shoulder PROMs are equal; reverse shoulder arthroplasty OK in trauma; not all in the mind: frozen shoulder personality debunked; open and arthroscopic repair equivalent in shoulder instability; natural history of olecranon fractures not so bleak?; and resurfacing of the shoulder: a Danish perspective.
The aim of this study was to investigate the
epidemiology of fractures of the distal radius in the Swedish population and
to review the methods used to treat them between 2005 and 2010. The study population consisted of every patient in Sweden who
was diagnosed with a fracture of the wrist between 1 January 2005
and 31 December 2010. There were 177 893 fractures of the distal
radius. The incidence rate in the total population was 32 per 10
000 person-years. The mean age of the patients was 44 years (0 to
104). The proportion of fractures treated operatively increased
from 16% in 2005 to 20% in 2010. The incidence rate for plate fixation
in the adult population increased 3.61 fold. The incidence rate
for external fixation decreased by 67%. The change was greatest
in the 50 years to 74 years age group. In Sweden, there is an increasing tendency to operate on fractures
of the distal radius. The previously reported increase in the use
of plating is confirmed: it has increased more than threefold over
a five-year period. Cite this article:
Nanotechnology is the study, production and controlled
manipulation of materials with a grain size <
100 nm. At this
level, the laws of classical mechanics fall away and those of quantum
mechanics take over, resulting in unique behaviour of matter in
terms of melting point, conductivity and reactivity. Additionally,
and likely more significant, as grain size decreases, the ratio
of surface area to volume drastically increases, allowing for greater interaction
between implants and the surrounding cellular environment. This
favourable increase in surface area plays an important role in mesenchymal
cell differentiation and ultimately bone–implant interactions. Basic science and translational research have revealed important
potential applications for nanotechnology in orthopaedic surgery,
particularly with regard to improving the interaction between implants
and host bone. Nanophase materials more closely match the architecture
of native trabecular bone, thereby greatly improving the osseo-integration
of orthopaedic implants. Nanophase-coated prostheses can also reduce
bacterial adhesion more than conventionally surfaced prostheses.
Nanophase selenium has shown great promise when used for tumour
reconstructions, as has nanophase silver in the management of traumatic
wounds. Nanophase silver may significantly improve healing of peripheral
nerve injuries, and nanophase gold has powerful anti-inflammatory
effects on tendon inflammation. Considerable advances must be made in our understanding of the
potential health risks of production, implantation and wear patterns
of nanophase devices before they are approved for clinical use.
Their potential, however, is considerable, and is likely to benefit
us all in the future. Cite this article:
Anthrax is extremely rare in the western world but is endemic to areas of south and central Asia. In early 2010 an outbreak was identified in heroin-injecting intravenous drug users in the United Kingdom and Europe. Afghanistan is currently the principal source of heroin which reaches the United Kingdom. When anthrax occurs, cutaneous disease accounts for over 95% of cases. At least 47 cases with 13 deaths have been confirmed so far. We present three cases presenting during this time with marked swelling, one resulting in compartment syndrome but all with an absence of the expected cutaneous appearances. We suggest that rather than cutaneous anthrax, these patients represent a new subcutaneous presentation of anthrax.
The June 2014 Trauma Roundup360 looks at: BMP use increasing wound complication rates in trauma surgery; can we predict re-admission in trauma?; humeral bundle nailing; how best to treat high-angle femoral neck fractures?; hyperglycaemia and infection; simultaneous soft-tissue and bony repair in terrible triad injuries; metaphyseal malunion in the forearm leading to function restrictions; delayed fixation of the distal radius: not a bad option; and fasciotomies better with shoelaces
We compared a new fixation system, the Targon
Femoral Neck (TFN) hip screw, with the current standard treatment of
cannulated screw fixation. This was a single-centre, participant-blinded,
randomised controlled trial. Patients aged 65 years and over with
either a displaced or undisplaced intracapsular fracture of the
hip were eligible. The primary outcome was the risk of revision
surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute
reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5)
in favour of the TFN hip screw (chi-squared test, p = 0.741), which
was less than the pre-specified level of minimum clinically important
difference. There were no significant differences in any of the
secondary outcome measures. We found no evidence of a clinical difference in the risk of
revision surgery between the TFN hip screw and cannulated screw
fixation for patients with an intracapsular fracture of the hip. Cite this article:
Symptoms of obstetric brachial plexus injury (OBPI) vary widely
over the course of time and from individual to individual and can
include various degrees of denervation, muscle weakness, contractures,
bone deformities and functional limitations. To date, no universally
accepted overall framework is available to assess the outcome of patients
with OBPI. The objective of this paper is to outline the proposed
process for the development of International Classification of Functioning,
Disability and Health (ICF) Core Sets for patients with an OBPI. The first step is to conduct four preparatory studies to identify
ICF categories important for OBPI: a) a systematic literature review
to identify outcome measures, b) a qualitative study using focus
groups, c) an expert survey and d) a cross-sectional, multicentre
study. A first version of ICF Core Sets will be defined at a consensus
conference, which will integrate the evidence from the preparatory
studies. In a second step, field-testing among patients will validate this
first version of Core Sets for OBPI.Background
Methods
This short contribution aims to explain how intervertebral disc ‘degeneration’ differs from normal ageing, and to suggest how mechanical loading and constitutional factors interact to cause disc degeneration and prolapse. We suggest that disagreement on these matters in medico-legal practice often arises from a misunderstanding of the nature of ‘soft-tissue injuries’.
Rarely, the extent of a malignant bone tumour
may necessitate resection of the complete humerus to achieve adequate
oncological clearance. We present our experience with reconstruction
in such cases using a total humeral endoprosthesis (THER) in 20
patients (12 male and eight female) with a mean age of 22 years
(6 to 59). We assessed the complications, the oncological and functional
outcomes and implant survival. Surgery was performed between June
2001 and October 2009. The diagnosis included osteosarcoma in nine,
Ewing’s sarcoma in eight and chondrosarcoma in three. One patient
was lost to follow-up. The mean follow-up was 41 months (10 to 120)
for all patients and 56 months (25 to 120) in survivors. There were
five local recurrences (26.3%) and 11 patients were alive at time
of last follow-up, with overall survival for all patients being
52% (95% confidence interval (CI) 23.8 to 74) at five years. The
mean Musculoskeletal Tumor Society score for the survivors was 22
(73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3)
at five years. The use of a THER in the treatment of malignant tumours of bone
is oncologically safe; it gives consistent and predictable results
with low rates of complication.
