Introduction

Achilles tendon rupture (ATR) account for 10.7% of all tendon and ligament injuries and causes lasting muscular deficits and have a profound impact on patients’ quality of life^1,2. The incidence, characteristics and management of ATR in the United Kingdom is poorly understood.

Motorcycle accident-related traffic accidents contribute significantly to the burden of orthopaedic injuries seen in the South African Healthcare system. Subsequent to the Covid-19 pandemic, there has been an increase in the number of delivery drivers on the roads of South Africa. Many of these delivery drivers have no formal employment contracts. We aim to describe the demographics and injury patterns in motorcyclists involved in time dependent delivery work in South Africa; and to quantify the cost to the state of their orthopaedic surgeries.

We performed a consecutive case series study at all of the hospitals draining the study region over the period of one year. Epidemiological, clinical and cost to hospital data was collected from medical records, digital radiographs, theatre invoices and a dedicated patient questionnaire.

Extracapsular Hip Fractures (EHF's) are a significant health burden on healthcare services. Optimal treatment is controversial with conflicting evidence being reported. Currently treatment is undertaken with Intramedullary Nail (IMN) or Dynamic Hip Screw (DHS) constructs with a recent increase in IMN use (1). This study aims to conduct a systematic review of Randomised Control Trials published between 2020 and 2023 with particular focus on patient demographics and holistic patient outcomes.

Using a unified search-protocol, RCT's published between 2020 and 2023 were collected from CENTRAL, PubMed, MEDLINE and EMBASE. Rayyan software screened duplicates. Using the CASP and Cochrane Risk of Bias Tool papers were critically examined twice, and Blood Loss, Infection and Mobility described the patient journey. Patient demographics were recorded and were contrasted with geographically diverse cohort studies to compare population differences. Parametric tests were used to determine significance levels between population demographics, namely Age and Sex.

Eleven papers were included, representing 908 patients (436 Male). The mean age for patients was 64.39. There was considerable risk of bias in 7/11 studies owing to the randomization process and the recording of data. Four Cohort studies were selected for comparison representing 14314 patients. Mean age was significantly different between Cohort Studies and RCT's (Independent T-Test, df 13, t=7.8, p = <0.001, mean difference = 19.251, 95% CI = 13.888, 24.613). This was also true for sex ratios included in the studies (df 13, t = -2.268, p = 0.024, Mean Difference = -0.4884, 95% CI = -0.9702, -0.0066).

To conclude, RCT's published in the post COVID-19 era are not representative of patient demographics. This has the potential to provide inaccurate information for implant selection. Additionally further research must be conducted in how to better improve RCT patient inclusion so as to be more representative of patients whilst balancing the risks of operations.

Purpose

Long-term clinical and radiographic results and survival rates were compared between closed-wedge high tibial osteotomy (HTOs) and fixed-bearing unicompartmental knee arthroplasty (UKA) in patients with similar demographics.

Purpose:- to examine changing demographics in ACL Injury

Methods:- the data from a cohort of 117 consecutive patients with ACL injury from a study performed in 1994 was compared with the data from a cohort of 103 consecutive patients with ACL injury collected in 1994/95.

Results:- In 1994, 12% of the patients were female, in 2004 25%.

In 1994, 62% of the injuries were sustained during soccer and rugby, in 2004 58%. In 1994, 9% of injuries were sustained during skiing, in 2004 28% – a 300% increase.

In 1994 the average age was 26.5, in 2004 33. When this increase was examined in detail the average age of the skiers was 41, the soccer players 31 and the rugby players 27.

Clearly there has been a change in the demographics of ACL injury which may have a significant impact in providing NHS services for the ACL injured patient in the UK.

Prospectively collected data is an important source of information subjected to change over time. What surgeons were doing in 1999 might not be the case anymore in 2016 and this change in time also applies to a number of factors related to the performance and outcome of total hip replacement. We evaluated the evolution of factors related to the patient, the surgical procedure, socio-economy and various outcome parameters after merging the databases of the Swedish Hip Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare.

Data on 193,253 THRs (164,113 patients) operated between 1999 and 2012 were merged with databases including general information about the Swedish population and about hospital care. We studied the evolution of surgical volume, patient demographics, socio-economic factors, surgical factors, length of stay, mortality rate, adverse events, re-operation and revision rates and PROMs.

Most patients were operated because of primary osteoarthritis and this share increased further during the period at the expense of decreasing number of patients with inflammatory OA and hip fracture. Comorbidity and ASA scores increased for each year. The share of all cemented implants has dropped from 92% to 68% with a corresponding increase of all uncemented from 2% to 16%.

Length of stay decreased with about 50 percent to 4.5 days in 2012. The 30- and 90-day mortality rate dropped to 0.4% and 0.7%. Re-operation and revision rates at 2 years were lower in the more recent years. The postoperative PROMs are improving despite the preoperative pain scores getting worse.

Even in Sweden, always been considered as a very conservative country with regards to hip replacement surgery, the demographics of the patients, the comorbidities and the primary diagnosis for surgery are changing. Despite these changes the outcomes like mortality, re-operations, revisions and PROMs are improving.

Purpose of Study

The management of idiopathic clubfoot has changed substantially over the past fifty years with the Ponseti method of treatment gaining increasing popularity in recent years. The advantages of this method are its simplicity and minimal resource requirements with high published success rates. One of the disadvantages is that unless treatment protocols are meticulously adhered to, especially in the bracing stage, recurrence will occur. This study explores the demographics and highlights existing barriers to successful clubfoot treatment outcomes at two academic hospitals.

It has become a platitude that total knee arthroplasty (TKA) is an excellent operation, provides good pain relief, and over 90% survivorship at 20 years in many series. While all these points are true, total knee arthroplasty as practiced currently still will not meet the demands of many patients who will desire the procedure in the next ten years. The reasons for this include changing demographics of TKA and the changing demands of TKA candidates. TKA is being performed more frequently in patients under 60, in fact this is the fastest growing group of patients by percent growth. We performed a population-based study of trends utilization of TKA and found increasing TKA utilization in all age groups over time but the greatest increase by percent in the youngest patients. Furthermore, younger patients now no longer tend to be lowactivity patients with inflammatory disease. The percentage of patients with primary osteoarthritis and post traumatic arthritis has increased dramatically. Long-term studies of TKA have shown such durability in part because many of the younger patients were Charnley Class C patients, and because historically most TKA patients were older with an average age of most early series of around 69 years. This means there were far fewer young patients in early TKA series than in early THA series. This is important because material failures occur predominantly in younger patients and durability is a greater concern in younger patients, so one may predict that this younger, more active group will not enjoy the same level of TKA durability reported in the literature unless technology improves.

Total knee arthroplasty patients are more active than one might predict. In a study of 1200 patients surveyed at five years the average UCLA score was 7 out of 10. Younger patients achieved a higher activity level but were in general less satisfied with activity provided by TKA than older patients. This implies there is a need for better designs and surgery to facilitate more normal kinematics, more flexion, and more quadriceps strength. A study by Weiss and Noble (CORR 2002) identified specific activities associated with limitations after knee arthroplasty.

Furthermore, a study by Bourne and associates demonstrated lower satisfaction scores after total knee arthroplasty than hip arthroplasty. Finally, in our study of activity levels after knee arthroplasty we found that 16% of current patients participate in heavy labor or sports not recommended by Knee Society guidelines. These patients tend to be younger and predominantly male. This implies there is a subset of the population already doing things that will challenge the current generation of total knee arthroplasty and more patients want to do these activities and already do so. Therefore, there is a need for improved implant durability and improved knee function after knee arthroplasty. This suggests the methods of fixation may need to evolve to accommodate higher demands, and bearing surfaces definitely need to evolve to accommodate higher demands. Finally, more sophisticated implant kinematics to avoid or compensate for anterior cruciate ligament and posterior collateral ligament deficiency and more sophisticated surgery to optimize implant alignment and soft tissue balancing in the individual patient will be necessary to achieve more normal patient knee kinematic stability, strength and “feel”. Finally, we will need better and more sensitive scoring systems to detect improvements in future TKA surgery and design in the future.

Introduction: Little comparative information is available regarding asymptomatic and symptomatic rotator cuff tears. This data may lend insight to Natural History. The purpose of this study was to compare the morphology and incidence of cuff disease in people with unilateral painful shoulders.

Methods: 588 consecutive shoulder ultrasounds were reviewed in patients presenting with unilateral pain. Ultrasound has been validated in our institution as highly accurate. There were 212 pt/bilat intact cuffs, 191pt/unilateral tears, and 185pt/bilateral tears. Data for age, cuff thickness, tear size, and symptoms were tested for associations.

Results: Cuff disease increased with average age, (no tear/48.7yo,unilateral tear/58.7yo,bilateral tears/67.8yo). Logistic regression showed a 50% likelihood of bilateral tears after age 66(p< .01). Overall, a pt. with a full tear on the symptomatic side had a 35.5% incidence of an asymptomatic tear. In contrast, a symptomatic nl. or partial tears had only a 0.5% or 4.3% incidence of contralateral tear. In patients with bilateral tears, the symptomatic side was larger (p< .01). 65% of painful tears were on the dominant side(p< .01). For intact cuffs, avg thickness equaled 4.7 mm and was not affected by age, gender, or symptoms.

SUMMARY: The high incidence of asymptomatic and bilateral tears with age suggests that for some, cuff disease is intrinsic; however, the association with symptoms of hand dominance and increased tear size indicate that extrinsic factors may be important in the development of pain.

We aim to identify any changes in the demographics of ACL injured patients over the last decade. Over a twelve month period, the demographic data from 117 consecutive new patients with ACL injuries attending one consultant’s clinic in 1994 was prospectively recorded. This was then compared with data from a similar cohort of 103 consecutive new ACL injured patients attending the same clinic some twelve years later.

Since 1994, the proportion of women seen with ACL injury doubled from 12% to 25%. The proportion of skiing related injuries trebled from 9% to 28%. The average age at presentation rose by 6.5 years from 26.5 to 33. In 2006, the average age of the skiers was 40 and 72.4% of them were female compared to only 8% of non-skiers.

The population of patients with new ACL injuries has changed significantly over the last twelve years. The average age, proportion of women and number of skiing related injuries have all increased significantly. We speculate that the most likely cause of these changes is the skiing population, which has enlarged and, due to retention of participants, has aged over the period of this study (1). Most skiing injuries are sustained abroad and the vast majority of skiers buy holiday insurance to cover themselves against injury. Yet it is the NHS that ends up footing the bill for any reconstructive surgery and rehabilitation. We propose that if the insurance companies maintained responsibility for their clients’ injuries until a full recovery had been made, the NHS would save millions of pounds.

Background: Hip fractures in the elderly have epidemic character. Although hip fractures have been considered as a single, homogeneous condition, there are two major anatomic types of proximal femoral fractures: intertrochanteric and femoral neck.

Aim: The purpose of our study is determining if patients suffering from these two types of hip fracture have different characteristics. Are demographics predictor factors of the type of hip fracture following fall in the elderly?

Patients and Methods: A retrospective study of patients admitted to a tertiary referral hospital for a hip fracture between 2003 and 2007 was conducted A total of 652 patients participated in the study, aged between 64–97 years old. 159 patients were men and 493 women.

Patients were divided into two groups according to the type of hip fracture. Group 1 included 299 patients with subcapital fractures, 61 men and 238 women and the second group 353 patients with intertrochanteric fractures, 98 men and 298 women. Patients’ demographics concerning age, sex, weight, height on admission at the hospital were compared between groups.

Results: The mean age (79± 9,4) of the patients with intertrochanteric fracture was statistically significant greater(Mann-Whitney test, p=0,001) than this of the patients with femoral neck fractures (76± 11,5).The sex ratio between the two groups seem to be significant different (x2 test, p=0,029) However following stratification of the data the effect of sex on the type of fracture disappeared. Mean height (Mann-Whitney test, p=0,765) and weight (Mann-Whitney test, p=0,448) did not differ significantly between the two groups. The mean time of hospitalization for the group of intertrochanteric fractures was significantly greater than this of the subcapital group(Mann-Whitney test. p=0,001).

Conclusions: It appears that intertrochanteric fracture patients have intrinsic factors (older age and consequently poor health) impacting upon their risk of fracture and ability to recover. Differences in patient characteristics and sequelae do exist between femoral neck and intertrochanteric hip fracture patients that impact upon recovery. However somatometric characteristics as height and weight did not differ significantly between the two types of fractures.

Aims: To identify any changes in the demographics of ACL injured patients over the last decade.

Methods: Over a twelve month period, the demographic data from 117 consecutive new patients with ACL injuries attending one consultant’s clinic in 1994 was prospectively recorded. This was then compared with data from a similar cohort of 103 consecutive new ACL injured patients attending the same clinic some twelve years later.

Results:

Since 1994, the proportion of women seen with ACL injury doubled from 12% to 25%

Conclusion: The population of patients with new ACL injuries has changed significantly over the last twelve years. The average age, proportion of women and number of skiing related injuries have all increased significantly. We speculate that the most likely cause of these changes is the skiing population, which has enlarged and, due to retention of participants, has aged over the period of this study (1). Most skiing injuries are sustained abroad and the vast majority of skiers buy holiday insurance to cover themselves against injury. Yet it is the NHS that ends up footing the bill for any reconstructive surgery and rehabilitation. We propose that if the insurance companies maintained responsibility for their clients’ injuries until a full recovery had been made, the NHS would save millions of pounds.

A group of UK paediatric surgeons (the UK SCFE Study Group) convened to design pertinent trials in slipped capital femoral epiphysis (SCFE), twelve centres across the UK reviewed the demographics and management of children with SCFE.

At all contributing centres with digital PACS records, a search for terms relating to SCFE were performed. From the results, radiographs and electronically stored clinic letters were assessed to confirm the diagnosis and ascertain age at presentation, incidence of bilaterality, chronicity, stability, management and complications.

A total of 601 SCFEs presented between 2007 and 2012 to the twelve units. The mean age at presentation was 12.5 years. The left hip was nearly twice as commonly involved compared to the right (R: L = 3.3: 5.1), with bilateral presentation in 22% of patients. The most common mode of presentation was acute-on-chronic. Stable slips were over twice as common as unstable. The most common intervention was percutaneous pinning in situ. Open reduction was required in 24% of cases. The commonest complication was osteonecrosis (10.5%).

This data concurs with earlier smaller audits and highlights current demographics and contemporary management of SCFE throughout the UK and informs the subject and content of potential future randomized control trials.

Purpose: Prospective Observational Population Study to describe the incidence, demographics and pattern of spinal cord injury in British Columbia, Canada, for 10 years to 2004.

Method: Systematic analysis of prospectively collected spine registry data (Vertebase) at Vancouver General Hospital, B.C., Canada from 1995–2004.

Results: During the 10-year study period the 938 patients were admitted with a traumatic spinal cord injury. The Annual Population-Standardized Incidences ranged from 19.94 to 27.27 per million, with a median incidence of 23.34/million and with no significant change over the study period. The mean age was 39.7 years (34.73 in 1995 and 42.1 in 2004, p< 0.05) with a range of 16–92 years. 79.74 % were males. 48.2% of patients were AISA A on admission, of which 48% were quadraparetic. The most common levels of spinal cord injury were C5 (17.3%), C6 (10%), T1 (9.4%), T12 (5.8%). The Mean ASIA score was 50.22 with a range from 0–100. 19.8% of patients had a GCS£13. The mean ISS was 26.02, range of 0 – 75. Motor vehicle collisions and falls were responsible for 59% and 30% of admissions respectively. Mean length of in-hospital stay was 34 days, ranging from 1 – 275 days. In hospital mortality rate was 2.9%. ASIA Grade, Total Motor Score and anatomical level of injury all correlated directly with Length of stay (p< 0.0001).

Conclusion: Acute Traumatic Spinal Cord Injury remains a major cause of significant morbidity among young males. The incidence appears to be increasing in the elderly. Modern multidisciplinary care has greatly reduced the associated acute mortality. Despite multiple prevention strategies the Annual Population-Standardized Incidence remained unchanged over the study period.

Aim

To inform a working group of UK paediatric surgeons (the UK SCFE Study Group) convened to design pertinent trials in slipped capital femoral epiphysis (SCFE), three centres (Bristol, Newcastle and Barts and The London) reviewed the demographics and management of children with SCFE presenting between 2007 and 2012.

Background: Hemiarthroplasty of the hip is a common procedure, but information about implants and outcome is scarce. In Sweden the number of hemiarthroplasties has increased from 200 in 1998 to 4181 in 2007.

Material and Methods: Nationwide registration started in 2005. 100% of the hospitals participates, and 96% of the hemi-procedures are registrered. An analysis of 12 245 cases operated 2005–07 is presented.

Results: In the Register the mean age at surgery is 84 years (SD 7.0, 73% female). 93% are operated due to acute fracture and 6% due to failed internal fracture fixation. Cemented fixation has been used in 92% and a posterior approach in about half of the cases (52%). The Lubinus and Exeter stems are most common (41 and 23%). The Austin-Moore design has decreased from 9 to 2% during the study period.

3.2% of the patients (hips) have been reoperated, most commonly because of dislocation. Multiple reoperations are common. Male gender, secondary procedure and uncemented stem are associated with increased reoperation risk with 1.2, 1.7 and 1.8 times (1.2, CI: 1.0–1.6; 1.7, 1.3–2.3; 1.8 1.4–2.5). Use of uncemented fixation resulted in increased risk of reoperation, also with exclusion of uncemented Austin-Moore prostheses (1.8 times, 1.1–2.8).

In a separate analysis of the two most frequent designs, use of bipolar head increased the risk of revision twice (1.4–2.8) compared to unipolar head when adjusting for other risk factors. This may reflect that fitter and more active individuals get a bipolar prosthesis and are more prone to become revised should complications occur or a true increase of complications when using bipolar head. A further analysis is in progress.

Use of dorsal approach (1.6, 1.2–2.2), Austin-Moore (1.8, 1.1–3.1) and Thompson prostheses (1.8, 1.5–2.8) increased the risk of revision because of dislocation.

Summary: When treating fracture patients with hemi-arthroplasty we recommend that a well documented cemented implant with different off-set options should be used via an anterolateral approach. Use of bipolar heads may increase the risk of revision.

Two-stage exchange arthroplasty is traditionally used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards alternatives such as 1.5-stage exchange arthroplasty which takes place in one surgery. Therefore, we sought to compare (1) operative time, length-of-stay (LOS), transfusions, (2) causative organism identification and polymicrobial infection rates, (3) re-revision rates and re-revision reasons, (4) mortality, and determine (5) independent predictors of re-revision. Retrospective chart review of 71 patients who underwent either 1.5- (n=38) or 2-stage (n=33) exchange hip arthroplasty at a single institution (03/2019-05/2023). Demographics, surgical, inpatient, and infection characteristics were noted. Main outcomes evaluated were re-revision rates, re-revision reasons, mortality, and cause of death. Independent predictors of re-revision were assessed utilizing logistic regression. Mean follow: 675 days (range, 23–1,715). Demographics were not significantly different except for a higher proportion of 1.5-stage patients classified as American-Society-of-Anesthesiologists (ASA) status 3 or 4 (84.2 vs. 48.5%, p=0.002). Length of follow-up was significantly longer in the 2-stage group (924.4 vs. 458 days, p<0.001) as well as operative time (506 vs. 271 minutes, p<0.001). In the 1.5-stage group, there was a higher proportion of polymicrobial infections (23.7 vs. 3.0%, p=0.016), re-revision rates (28.9 vs. 9.1%, p=0.042) and periprosthetic infections as a cause of revision (90.9 vs. 0%, p=0.007). Mortality rates were not significantly different, and no patient died for causes related to infection. Type of surgery (1.5-stage vs. 2-stage) was the only independent predictor of re-revision (odds-ratio 4.0, 95% confidence-interval 1.02–16.16, p=0.046). Our data suggests that patients who undergo 1.5-stage exchange arthroplasty have a significantly higher re-revision rate (mostly due to infection) when compared to 2-stage patients. We acknowledge potential benefits of the 1.5-stage strategy, especially in high-risk patients since it involves single surgery. However, higher re-revision rates must be considered when counseling patients

Most patients treated at our clinical setting present during chronic osteomyelitis stage, which is anecdotally likely to be poly-microbial. Adults with poly-microbial infection have a predilection for gram-negative bacteria and anaerobes, a scenario that hypothetically leads to a higher morbidity of poly-microbial osteomyelitis following trauma. Our study looks into the epidemiology of poly-microbial osteomyelitis treated at our Tumour and Infection unit. Retrospective study of patients treated for osteomyelitis from 2016 to 2020. Records of eligible patients were retrieved for examination. Demographics such as age, sex and race were recorded. Clinical presentation, organisms cultured, including their anti-microbial sensitivities were documented. There were 63 participants in the study. 31 (49.21%) had mono-microbial osteomyelitis with 32 (50.79%) having poly-microbial osteomyelitis. Majority of the poly-microbial patients presented with a sinus (68.75%) mostly located in the tibia (50%). Multiple mixed pathogens (both gam-positive and gram-negative) were cultured in our patients and this comprised 71.21% of the total bacteria cultured. Staphylococcus Aureus was the commonest bacteria (30%) isolated, followed by Enterococcus faecalis (12%). The commonest gram-negative bacteriae cultured was Enterococcus cloacae (10%) followed by Acinetobacter baumannii (7%). Most enterobacteriacae species were sensitive to Ertapenem and Ceftazidime. A slightly higher incidence of poly-microbial osteomyelitis was found in our study than that reported in literature. Furthermore, our study demonstrated a wide variety of organisms found in poly-microbial osteomyelitis, with a large contribution made by gram-negative anaerobic rod-shaped bacteria

With an aging population and increase in total knee arthroplasty, periprosthetic distal femur fractures (PDFFs) have increased. The differences between these fractures and native distal femur fractures (NDFF) have not been comprehensively investigated. The purpose of this study was to compare the demographic, fracture, and treatment details of PDFFs compared to NDFFs. A retrospective study of patients ≥ 18 years old who underwent surgical treatment for either a NDFF or a PDFF from 2010 to 2020 at a level 1 trauma center was performed. Demographics, AO/OTA fracture classification, quality of reduction, fixation constructs, and unplanned revision reoperation were compared between PDFF patients and NDFF patients using t-test and Fisher's exact test. 209 patients were identified with 70 patients having a PDFF and 139 patients having a NDFF. Of note, 48% of NDFF had a concomitant fracture of the ipsilateral knee (14%) or tibial plateau (15%). The most common AO/OTA classification for PDFFs was 33A3.3 (71%). NDFFs had two main AO/OTA classifications of 33C2.2 (28%) or 33A3.2. (25%). When controlling for patient age, bone quality, fracture classification, and fixation, the PDFF group had increased revision reoperation rate compared to NDFF (P < 0.05). PDFFs tend to occur in elderly patients with low bone quality, have complete metaphyseal comminution, and be isolated; whereas, NDFF tend to occur in younger patients, have less metaphyseal comminution, and be associated with other fractures. When controlling for variables, PDFF are at increased risk of unplanned revision reoperation. Surgeons should be aware of these increased risks in PDFFs and future research should focus on these unique fracture characteristics to improve outcomes

At-home softcast removal with no routine clinical follow-up has shown to be safe and effective following paediatric orthopaedic trauma. It minimises clinician contact time and reduces cost. However, there is limited data on the caregiver experience. Retrospective analysis of paediatric fractures requiring application of circumferential softcast that was later removed at home. Two time points were included: (1)July–September 2022, (2)February–April 2023. Demographics data included age, fracture classification, angulation, manipulation requirement, complications or unplanned re-attendance. Caregivers were given an information leaflet on cast removal. Caregivers completed a telephone Likert questionnaire reviewing time taken to remove cast, qualitative descriptors of cast removal and overall satisfaction. 77 families were contacted at mean 93 days post injury. Mean age was 7.5 years. 41(53%) were distal radius and 20(26%) both-bone forearm fractures. The remaining were hand, elbow or tibia injuries. 40(52%) injuries required manipulation under procedural sedation with mean sagittal angulation 24 degrees. 13(17%) patients re-attended with cast problems. Caregivers estimated a mean 13 minutes to remove cast. 83% found it ‘extremely’ or ‘somewhat’ easy. 75% were ‘extremely’ or ‘somewhat’ satisfied. 71% were ‘extremely’ or ‘somewhat’ likely to recommend at-home cast removal. Qualitative descriptors ranged from from ‘traumatising’ to ‘fun’ and ‘straightforward’. The experience at our tertiary centre confirms at-home softcast removal with no further orthopaedic follow-up is safe and feasible, even in those requiring manipulation under sedation. The majority of families reported a positive experience; this however is not universal. Adequate patient information resources are integral to a positive caregiver's experiences