To analyse the influence of upper extremity trauma on the long-term
outcome of polytraumatised patients. A total of 629 multiply injured patients were included in a follow-up
study at least ten years after injury (mean age 26.5 years, standard
deviation 12.4). The extent of the patients’ injury was classified
using the Injury Severity Score. Outcome was measured using the
Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation
duration, and employment status. Outcomes for patients with and
without a fracture of the upper extremity were compared and analysed
with regard to specific fracture regions and any additional brachial
plexus lesion.Aims
Patients and Methods
We performed a systematic review of the current literature regarding
the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty. We initially identified 1305 studies, and 406 were found to be
duplicates. After exclusion criteria were applied, seven studies
were included. Outcomes extracted included pre- and post-operative
pain visual analogue scores, range of movement (ROM), strength of
pinch and grip, satisfaction and patient reported outcome measures
(PROMs). Clinical and radiological complications were recorded.
The results are presented in three groups based on the design of
the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA),
pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene
(MoP)).Aims
Materials and Methods
Injuries to the limb are the most frequent cause
of permanent disability following combat wounds. We reviewed the medical
records of 450 soldiers to determine the type of upper limb nerve
injuries sustained, the rate of remaining motor and sensory deficits
at final follow-up, and the type of Army disability ratings granted.
Of 189 soldiers with an injury of the upper limb, 70 had nerve-related
trauma. There were 62 men and eight women with a mean age of 25
years (18 to 49). Disabilities due to nerve injuries were associated
with loss of function, neuropathic pain or both. The mean nerve-related
disability was 26% (0% to 70%), accounting for over one-half of
this cohort’s cumulative disability. Patients injured in an explosion
had higher disability ratings than those injured by gunshot. The
ulnar nerve was most commonly injured, but most disability was associated
with radial nerve trauma. In terms of the final outcome, at military
discharge 59 subjects (84%) experienced persistent weakness, 48
(69%) had a persistent sensory deficit and 17 (24%) experienced
chronic pain from scar-related or neuropathic pain. Nerve injury
was the cause of frequent and substantial disability in our cohort
of wounded soldiers. Cite this article:
Extendible endoprostheses have been available for more than 30
years and have become more sophisticated with time. The latest generation
is ‘non-invasive’ and can be lengthened with an external magnetic
force. Early results have shown a worryingly high rate of complications
such as infection. This study investigates the incidence of complications
and the need for further surgery in a cohort of patients with a
non-invasive growing endoprosthesis. Between 2003 and June 2014, 50 children (51 prostheses) had a
non-invasive growing prosthesis implanted for a primary bone sarcoma.
The minimum follow-up was 24 months for those who survived. Their
mean age was 10.4 years (6 to 14). The incidence of complications
and further surgery was documented.Aims
Patients and Methods
Amputation in intractable cases of complex regional pain syndrome
(CRPS) remains controversial. The likelihood of recurrent Complex Regional Pain Syndrome (CRPS),
residual and phantom limb pain and persistent disability after amputation
is poorly described in the literature. The aims of this study were
to compare pain, function, depression and quality of life between
patients with intractable CRPS who underwent amputation and those
in whom amputation was considered but not performed. There were 19 patients in each group, with comparable demographic
details. The amputated group included 14 men and five women with
a mean age of 31 years ( All participants completed the following questionnaires: Short-Form
(SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability
Index (PDI), the Beck Depression Inventory (BDI) and a clinical
demographic questionnaire. Aims
Patients and Methods
Whiplash injury is surrounded by controversy in both the medical and legal world. The debate on whether it is either a potentially serious medical condition or a social problem is ongoing. This paper briefly examines a selection of studies on low velocity whiplash injury (LVWI) and whiplash associated disorder (WAD) and touches upon the pathophysiological and epidemiological considerations, cultural and geographical differences and the effect of litigation on chronicity. The study concludes that the evidence for significant physical injury after LVWI is poor, and if significant disability is present after such injury, it will have to be explained in terms of psychosocial factors.
In this retrospective study, we investigated
the results of revision total hip replacement (THR) using a cemented long-stemmed
Exeter femoral component, with a minimum length of 205 mm in patients
with extensive femoral bone defects. The study included 37 consecutive
patients with a mean age of 76 years (39 to 93) and a mean follow-up
of nine years (5 to 16). A total of 26 patients (70%) had a pre-operative
Endo-Klinik score of 3 or 4. Impaction bone grafting was used in
24 patients (65%). At the time of evaluation, 22 patients (59%)
were still alive and were evaluated clinically and radiologically.
A total of 14 patients died during follow-up and their data were
included until the time of their death. One reconstruction failed
after five years and five months owing to recurrent dislocation:
the hip was converted to an excision arthroplasty. Intra-operative
fractures or fissures were encountered in nine patients (24%), but
none occurred during impaction of the bone graft. Post-operative
peri-prosthetic fractures occurred in two patients (5%); both were
treated with plate fixation. At nine years, survival with the endpoint
of all-cause re-revision was 96.3% (95% CI 76.4 to 99.5); including
re-operations for any reason, it was 80.7% (95% CI 56.3 to 92.3%).
There were no re-revisions for aseptic loosening. The survival of long stem cemented femoral components following
revision THR is satisfactory in a fragile population with extensive
femoral defects. Cite this article:
Hip and groin injuries are common in athletes
who take part in high level sports. Adductor muscle tendon injuries represent
a small but important number of these injuries. Avulsion of the
tendons attached to the symphysis pubis has previously been described:
these can be managed both operatively and non-operatively. We describe
an uncommon variant of this injury, namely complete avulsion of
the adductor sleeve complex: this includes adductor longus, pectineus
and rectus abdominis. We go on to describe a surgical technique
which promotes a full return to the pre-injury level of sporting
activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed
acute adductor complex avulsion injury (six to 34 days old) underwent
surgical repair. The operative procedure consisted of anatomical
re-attachment of the avulsed tissues in each case and mesh reinforcement
of the posterior inguinal wall in seven patients. All underwent a
standardised rehabilitation programme, which was then individualised
to be sport-specific. One patient developed a superficial wound infection, which was
successfully treated with antibiotics. Of the 15 patients, four
complained of transient local numbness which resolved in all cases.
All patients (including seven elite athletes) returned to their
previous level of participation in sport. Cite this article:
Pain catastrophising is an adverse coping mechanism,
involving an exaggerated response to anticipated or actual pain. The purpose of this study was to investigate the influence of
pain ‘catastrophising’, as measured using the pain catastrophising
scale (PCS), on treatment outcomes after surgery for lumbar spinal
stenosis (LSS). A total of 138 patients (47 men and 91 women, mean age 65.9;
45 to 78) were assigned to low (PCS score <
25, n = 68) and high
(PCS score ≥ 25, n = 70) PCS groups. The primary outcome measure
was the Oswestry Disability Index (ODI) 12 months after surgery.
Secondary outcome measures included the ODI and visual analogue
scale (VAS) for back and leg pain, which were recorded at each assessment
conducted during the 12-month follow-up period The overall changes in the ODI and VAS for back and leg pain
over a 12-month period were significantly different between the
groups (ODI, p <
0.001; VAS for back pain, p <
0.001; VAS
for leg pain, p = 0.040). The ODI and VAS for back and leg pain
significantly decreased over time after surgery in both groups (p
<
0.001 for all three variables). The patterns of change in the
ODI and VAS for back pain during the follow-up period significantly
differed between the two groups, suggesting that the PCS group is
a potential treatment moderator. However, there was no difference
in the ODI and VAS for back and leg pain between the low and high
PCS groups 12 months after surgery. In terms of minimum clinically important differences in ODI scores
(12.8), 22 patients (40.7%) had an unsatisfactory surgical outcome
in the low PCS group and 16 (32.6%) in the high PCS group. There
was no statistically significant difference between the two groups
(p = 0.539). Pre-operative catastrophising did not always result in a poor
outcome 12 months after surgery, which indicates that this could
moderate the efficacy of surgery for LSS. Cite this article:
This study reports the clinical outcome of reconstruction
of deficient abductor muscles following revision total hip arthroplasty
(THA), using a fresh–frozen allograft of the extensor mechanism
of the knee. A retrospective analysis was conducted of 11 consecutive
patients with a severe limp because of abductor deficiency which
was confirmed on MRI scans. The mean age of the patients (three
men and eight women) was 66.7 years (52 to 84), with a mean follow-up
of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild
limp, and two had a persistent severe limp (p = 0.004). The mean
power of the abductors improved on the Medical Research Council
scale from 2.15 to 3.8 (p <
0.001). Pre-operatively, all patients
required a stick or walking frame; post-operatively, four patients
were able to walk without an aid. Overall, nine patients had severe
or moderate pain pre-operatively; ten patients had no or mild pain
post-operatively. At final review, the Harris hip score was good in five patients,
fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively
effective in the treatment of chronic abductor deficiency of the
hip after THA when techniques such as local tissue transfer are
not possible. Longer-term follow-up is necessary before the technique can be
broadly applied. Cite this article:
A small proportion of patients have persistent
pain after total knee replacement (TKR). The primary aim of this study
was to record the prevalence of pain after TKR at specific intervals
post-operatively and to ascertain the impact of neuropathic pain.
The secondary aim was to establish any predictive factors that could
be used to identify patients who were likely to have high levels
of pain or neuropathic pain after TKR. A total of 96 patients were included in the study. Their mean
age was 71 years (48 to 89); 54 (56%) were female. The mean follow-up
was 46 months (39 to 51). Pre-operative demographic details were
recorded including a Visual Analogue Score (VAS) for pain, the Hospital
Anxiety and Depression score as well as the painDETECT score for neuropathic
pain. Functional outcome was assessed using the Oxford Knee score. The mean pre-operative VAS was 5.8 (1 to 10); and it improved
significantly at all time periods post-operatively (p <
0.001):
(from 4.5 at day three to five (1 to 10), 3.2 at six weeks (0 to
9), 2.4 at three months (0 to 7), 2.0 at six months (0 to 9), 1.7
at nine months (0 to 9), 1.5 at one year (0 to 8) and 2.0 at mean
46 months (0 to 10)). There was a high correlation (r >
0.7; p <
0.001) between the mean VAS scores for pain and the mean painDETECT
scores at three months, one year and three years post-operatively.
There was no correlation between the pre-operative scores and any
post-operative scores at any time point. We report the prevalence of pain and neuropathic pain at various
intervals up to three years after TKR. Neuropathic pain is an underestimated
problem in patients with pain after TKR. It peaks at between six
weeks and three-months post-operatively. However, from these data
we were unable to predict which patients are most likely to be affected. Cite this article:
The June 2015 Children’s orthopaedics Roundup360 looks at: ACL reconstruction in paediatric knees; Hips, slips and cams; The adolescent clavicle; 3D fluoroscopy in DDH?; The psychiatric aspects of hip pain in adolescents; Adolescent bunions: dealer’s choice?; Medial epicondylar fractures revisited
The outcome of 219 revision total hip arthroplasties
(THAs) in 98 male and 121 female patients, using 137 long length
and 82 standard length cemented collarless double-taper femoral
stems in 211 patients, with a mean age of 72 years (30 to 90) and
mean follow-up of six years (two to 18) have been described previously.
We have extended the follow-up to a mean of 13 years (8 to 20) in
this cohort of patients in which the pre-operative bone deficiency Paprosky
grading was IIIA or worse in 79% and 73% of femurs with long and
standard stems, respectively. For the long stem revision group, survival to re-revision for
aseptic loosening at 14 years was 97% (95% confidence interval (CI)
91 to 100) and in patients aged >
70 years, survival was 100%. Two
patients (two revisions) were lost to follow-up and 86 patients
with 88 revisions had died. Worst-case analysis for survival to
re-revision for aseptic loosening at 14 years was 95% (95% CI 89
to 100) and 99% (95% CI 96 to 100) for patients aged >
70 years. One
additional long stem was classified as loose radiographically but
not revised. For the standard stem revision group, survival to re-revision
for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No
patients were lost to follow-up and 49 patients with 51 hips had
died. No additional stems were classified as loose radiographically. Femoral revision using a cemented collarless double-taper stem,
particularly with a long length stem, and in patients aged >
70
years, continues to yield excellent results up to 20 years post-operatively,
including in hips with considerable femoral metaphyseal bone loss. Cite this article:
We evaluated the duration of hospitalisation,
occurrence of infections, hip dislocations, revisions, and mortality following
primary hip and knee replacement in 857 patients with Parkinson’s
disease and compared them with 2571 matched control patients. The
data were collected from comprehensive nationwide Finnish health
registers. The mean follow-up was six years (1 to 13). The patients
with Parkinson’s disease had a longer mean length of stay (21 days
[1 to 365] Cite this article:
Lengthening osteotomies of the calcaneus in children are in general
grafted with bone from the iliac crest. Artificial bone grafts have
been introduced, however, their structural and clinical durability
has not been documented. Radiostereometric analysis (RSA) is a very
accurate and precise method for measurements of rigid body movements including
the evaluation of joint implant and fracture stability, however,
RSA has not previously been used in clinical studies of calcaneal
osteotomies. We assessed the precision of RSA as a measurement tool
in a lateral calcaneal lengthening osteotomy (LCLO). LCLO was performed in six fixed adult cadaver feet. Tantalum
markers were inserted on each side of the osteotomy and in the cuboideum.
Lengthening was done with a plexiglas wedge. A total of 24 radiological
double examinations were obtained. Two feet were excluded due to
loose and poorly dispersed markers. Precision was assessed as systematic
bias and 95% repeatability limits.Objectives
Methods