The best time for definitive orthopaedic care is often unclear
in patients with multiple injuries. The objective of this study
was make a prospective assessment of the safety of our early appropriate
care (EAC) strategy and to evaluate the potential benefit of additional
laboratory data to determine readiness for surgery. A cohort of 335 patients with fractures of the pelvis, acetabulum,
femur, or spine were included. Patients underwent definitive fixation
within 36 hours if one of the following three parameters were met:
lactate <
4.0 mmol/L; pH ≥ 7.25; or base excess (BE) ≥ -5.5 mmol/L.
If all three parameters were met, resuscitation was designated full
protocol resuscitation (FPR). If less than all three parameters
were met, it was designated an incomplete protocol resuscitation
(IPR). Complications were assessed by an independent adjudication
committee and included infection; sepsis; PE/DVT; organ failure;
pneumonia, and acute respiratory distress syndrome (ARDS). Aims
Patients and Methods
Large femoral heads have become popular in total
hip replacement (THR) as a method of reducing the risk of dislocation.
However, if large heads are used in ceramic-on-ceramic THR, the
liner must be thinner, which may increase the risk of fracture.
To compare the rates of ceramic fracture and dislocation between
28 mm and 32 mm ceramic heads, 120 hips in 109 patients (51 men
and 58 women, mean age 49.2 years) were randomised to THR with either
a 28 mm or a 32 mm ceramic articulation. A total of 57/60 hips assigned
to the 28 mm group and 55/60 hips assigned to the 32 mm group were
followed for at least five years. No ceramic component fractures
occured in any patient in either group. There was one dislocation
in the 32 mm group and none in the 28 mm group (p = 0.464). No hip
had detectable wear, focal osteolysis or prosthetic loosening. In
our small study the 32 mm ceramic articulation appeared to be safe
in terms of ceramic liner fracture. Cite this article:
The reduced stability of hydroxyapatite (HA)-coated implants in osteopenic conditions is considered to be a major problem. We therefore developed a model of a boosted cementless implantation in osteopenic rats. Twelve-week-old rats were either ovariectomised (OVX) or sham-operated (SO), and after 24 weeks plain or HA-coated implants were inserted. They were treated with either a prostaglandin EP4 receptor agonist (ONO-4819) or saline for one month. The EP4 agonist considerably improved the osteoporosis in the OVX group. Ultrastructural analysis and mechanical testing showed an improvement in the implant-bone attachment in the HA-coated implants, which was further enhanced by the EP4 agonist. Although the stability of the HA-coated implants in the saline-treated OVX rats was less than in the SO normal rats, the administration of the EP4 agonist significantly compensated for this shortage. Our results showed that the osteogenic effect of the EP4 agonist augmented the osteoconductivity of
We report the radiological and clinical outcome of a press-fit (SLF) acetabular component at two to three years in two groups of patients having primary total hip replacement. In 69 the implant was coated with hydroxyapatite (HA) and in 40 it was uncoated. The stability of the cup was assessed by measurement of proximal migration and change in the angle of inclination. The clinical results in the two groups did not differ significantly, and the mean proximal linear wear was similar in both. Fewer radiolucent lines (RLLs) were seen on the radiographs of cups coated with
We treated 52 patients with impingement of the anterolateral soft tissues of the ankle by arthroscopic debridement. All had a history of single or multiple inversion injuries, without instability. One half had negative stress radiographs (stable group), while the others were positive (unstable group). Their mean age was 31 years and there were 35 men and 17 women. The results were assessed at a mean follow-up of 30 months. Three patients (6%) had a fair result, while 49 (94%) had an excellent or good outcome. No difference was found in the final results between the two groups (p >
0.05). We conclude that anterolateral impingement of the ankle should be considered in a patient with chronic anterolateral pain after an injury, regardless of the stability of the ankle.
In previous studies, we have demonstrated a fibrocartilaginous membrane around hydroxyapatite-coated implants subjected to micromovement in contrast to the fibrous connective tissue which predominates around similarly loaded titanium alloy implants. In the present study, in mature dogs, we investigated the effect of immobilising titanium (Ti)- or hydroxyapatite (HA)-coated implants already surrounded by a movement-induced fibrous membrane and compared the results with those of similar implants in which continuous micromovement was allowed to continue. The implants were inserted in the medial femoral condyles of 14 dogs and subjected to 150 microns movements during each gait cycle. After four weeks (when a fibrous membrane had developed), half the implants were immobilised to prevent further micromovement. The dogs were killed at 16 weeks and the results were evaluated by push-out tests and histological analysis. The continuously loaded Ti-coated implants were surrounded by a fibrous membrane, whereas bridges of new bone anchored the HA-coated implants. The immobilised implants were surrounded by bone irrespective of the type of coating. Push-out tests of the continuously loaded implants showed better fixation of those with
1. The structure ofthe cancellous bone ofthe third lumbarvertebral body from a twenty-year-old woman who died from head injuries was studied, using serial section reconstruction techniques. 2. In addition to the construction of enlarged models from different regions of the vertebral body, measurements were made of the bone area, the surface area, and the thickness and spacing of the bony structures. 3. The vertebral spongiosa consists of a complex network of bony plates perforated by rounded openings of varying size. The plates show preferential orientation in the vertical and horizontal planes, and the amount of bone is greatest towards the upper and lower surfaces of the vertebral body. 4. The mechanical significance of the structure of the vertebral spongiosa is discussed.
1. Seven new cases of primary reticulo-sarcoma of bone are recorded, including one in which a full necropsy was carried out. 2. The literature of Ewing's tumour and reticulo-sarcoma of bone has been examined and the conclusion reached that the separation of these two tumours is an artificial one. 3. The investigation of our cases confirms this observation.
1 . The repair of a simple crush injury was studied in rats, in both normally innervated and completely denervated muscle. In each case the histological findings at periods from two hours to thirty-two weeks are described. 2. The denervated muscle showed active and effective repair. 3. A comparison with the findings in normally innervated muscle establishes that the cellular processes of repair do not depend on connections with the central nervous system.
The effect of cortisone on the repair of simple muscle injury was studied in rabbits. The histological findings in the crushed muscle are described for a period up to twenty-one days after injury. Cortisone defers the onset of muscle regeneration, and retards its progress, but it does not change the course of the repair process or alter its eventual outcome under the conditions of the experiment. This apparent refractoriness of repair of muscle, as compared with that of other connective tissues, is discussed.
The classical longitudinal incision used for the direct anterior
approach (DAA) to the hip does not follow the tension lines of the
skin and can lead to impaired wound healing and poor cosmesis. The
purpose of this retrospective study was to determine the satisfaction
with the scar, and functional and radiographic outcomes comparing
the classic longitudinal incision with a modified skin crease ‘bikini’
when the DAA is used for total hip arthroplasty (THA). A total of 964 patients (51% female; 59% longitudinal, 41% ‘bikini’)
completed a follow-up questionnaire between two and four years postoperatively,
including the Oxford Hip Score (OHS), the University of North Carolina
‘4P’ scar scale (UNC4P) and two items for assessing the aesthetic
appearance of the scar and symptoms of numbness. The positioning
of the components, rates of heterotopic ossification (HO) and rates
of revision were assessed.Aims
Patients and Methods
The aim of this study was to investigate the outcome of periprosthetic fractures of the humerus and to assess the uniformity of the classifications used for these fractures (including those around elbow and/or shoulder arthroplasties) by performing a systematic review of the literature. A systematic search was conducted using the National Institute for Health and Care Excellence Healthcare Databases Advance Search. For inclusion, studies had to report clinical outcomes following the management of periprosthetic fractures of the humerus. The protocol was registered on the PROSPERO database.Aims
Methods
Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified.Aims
Methods
Aims
Materials and Methods
There is an increasing concern of osteoporotic fractures in the ageing population. Low-magnitude high-frequency vibration (LMHFV) was shown to significantly enhance osteoporotic fracture healing through alteration of osteocyte lacuno-canalicular network (LCN). Dentin matrix protein 1 (DMP1) in osteocytes is known to be responsible for maintaining the LCN and mineralization. This study aimed to investigate the role of osteocyte-specific DMP1 during osteoporotic fracture healing augmented by LMHFV. A metaphyseal fracture was created in the distal femur of ovariectomy-induced osteoporotic Sprague Dawley rats. Rats were randomized to five different groups: 1) DMP1 knockdown (KD), 2) DMP1 KD + vibration (VT), 3) Scramble + VT, 4) VT, and 5) control (CT), where KD was performed by injection of short hairpin RNA (shRNA) into marrow cavity; vibration treatment was conducted at 35 Hz, 0.3 g; 20 minutes/day, five days/week). Assessments included radiography, micro-CT, dynamic histomorphometry and immunohistochemistry on DMP1, sclerostin, E11, and fibroblast growth factor 23 (FGF23). In vitro, murine long bone osteocyte-Y4 (MLO-Y4) osteocyte-like cells were randomized as in vivo groupings. DMP1 KD was performed by transfecting cells with shRNA plasmid. Assessments included immunocytochemistry on osteocyte-specific markers as above, and mineralized nodule staining.Aims
Methods
Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions.Aims
Methods
