The object of this work was to retrospectively study the recommendations and the results of cruent reduction of idiopathic congenital displacement of the hip following ineffective orthopaedic treatment. From 1993 to 2001, 15 cruent reductions were performed in 11 children (seven girls and four boys). Initially, the 15 hips were treated by orthopaedic techniques (Pavlik harness and/or slow reduction according to the Sommerville-Petit method). Four of these have benefitted from surgical treatments after orthopaedic treatment proved to be ineffective (psoas tenotomy, Salter osteotomy). At the time of the cruent reduction the mean age was 24 months (range 9 months to 5 years). For the surgical reduction, always associated with a shortening-derotation osteotomy of femur, the Smith-Petersen antero-medial approach was used. In five of these cases, the cruent reduction was complemented by Salter osteotomy. The mean post-surgical follow-up is 5.6 years (from 1 to 9 years). In none of the hips studied was recurrence of the dislocation observed. The functional outcome, studied by Mackay criteria, is good for all the hips. No significant dysmetria of the lower limbs was present. According to the radiological criteria in the classification of Severin outcome was good or excellent in 12 hips and average in three hips. According to the Bucholz and Ogden classification, six hips showed signs of necrosis as a result of the orthopaedic treatment. The surgical treatment did not cause necrosis in the remaining nine hips. Recourse to a surgical procedure can result because of the anatomical obstacles typical of specific dislocations. Surgical reduction must be considered as an operation to preserve the hip; this operation is suitable at about 1 year of age if progressive orthopaedic practices are ineffective. Before 2 years of age, the cotyloid cavity can continue to develop after femoral head reduction, whereas, after this age, it is preferable to integrate a Salter osteotomy with the cruent reduction

Purpose: We report a retrospective series of 28 patients with trauma-induced dislocation of the knee. The purpose of our study was to evaluated long-term outcome after orthopaedic as well as surgical management of these injured knees and to propose a therapeutic attitude best adapted to the initial situation. Material and methods: The series included 28 patients, including one who had a bilateral dislocation. There were four women and 24 men, mean age 35.3 years at the time of the accident (17–69). Mean follow-up was 10.8 years. Nineteen knees were treated orthopaedically after reduction, surgery was used for ten patients. Five patients underwent an initial operation (during the first week following the accident), five had a secondary operation one to eight years after the accident. Mobility and laxity were assessed clinically. The Lysholm-Tegner and the Meyers scores were used to assess function. Radiological results were assessed with the Ahlback classification and the IKDC score to judge potential progression to single-or triple compartment osteoarthritis. Results: Clinically, mean amplitude was 105° flexion and −2° extension. Four knees were stiff with flexion = 80°. There was a persistent anterior drawer sign for all knees except four. Medial laxity (valgus) was often important (83% of the patients). Functionally, the mean Lysholm score was 80.5 (17–100). The mean pre and post-trauma Tegner score was 5.1/3. The Meyes classification showed 15 good and excellent results and eight fair and six poor results. Radiographically, more than half the patients had no sign of degenerative joint disease and only four knees has signs of true three-compartment osteoarthritis according to the Ahlback classification. Separate analysis of patients treated orthopaedically and surgically showed that good results with orthopaedic treatment concerned patients with an anterior or posterior dislocation with predominantly anterior laxity. The fair and poor results concerned six of the eight patients with initially multidimensional laxity, particularly postero-lateral laxity that persisted at last follow-up. Surgical treatment gave good results mainly when given early (four very good results out of five knees). Discussion: Recent work has demonstrated very satisfactory results for femorotibal stability after ligament reconstruction, usually with allografts. Our good functional results, comparable with earlier series, and the encouraging radiographic results have led us to chose orthopaedic treatment for selected patients (correct preservation of the posterolateral plane, particularly in case of dislocation with hyperextension corresponding to grade II in the Schenck classification), and on the contrary, to prefer early surgical treatment for the posterolateral plane. Conclusion: Management of injury to knee ligaments after femorotibial dislocations should be guided by a precise examination of the initial laxities conducted under general anaesthesia. If the posteriolateral plane is satisfactory, orthopaedic treatment followed by active rehabilitation can provide good functional and radiographic results

Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for thoracolumbar fracture. Cotrel frame instrumentation and Boëhler corset immobilisation were used.

Material and methods: In this series of 65 women and 129 men, age range 16 – 77 years, we retained one year follow-up at least for inclusion in the study. More than 85% of the patients were retained for study and the final analysis concerned 150 patients who were contacted.

All patients were in Frankel class E. In compliance with the SOFCOT 1995 Symposium, the method described by Rosset and Laulin and the international classification described by Magerl were applied to pre-operative x-rays to search for the pathogenic mechanism involved. The radiological analysis was conducted on preoperative, immediate post-operative, 1-month, 3-month, and last follow-up x-rays. The course of spinal kyphosis and angular deformation of the trauma zone and the subjacent disc were analysed. In addition to the overall series, patients with limit therapeutic indications, according to the local kyphosis and trauma-induced regional angular deformation, were also studied.

Results: For the initial indication of choice, type A1 fracture, gain in reduction was minimal for the constraining treatment. For type A3 fractures, posterior displacement of the posterior wall was not a contraindication because the posterosuperior reduction could be achieved by ligamentotoxis in the majority of the cases The gain in correction of spinal kyphosis was greater in these patients. Nevertheless, for this type of fracture, spinal kyphosis greater than 15° was an implicit sign of a potential posterior distraction lesion where osteosynthesis might be indicated, especially since the USS fixator uses a parallel assembly and authorises short instrumentations.

Conclusion: The Boëhler technique is a safe, minimally invasive and low-cost method for the treatment of thoracolumbar spine fractures, which enabled 30% correction of the spinal kyphosis. This method retains its indications for type A fractures.

Aims. The aim of this study is to define a core outcome set (COS) to allow consistency in outcome reporting amongst studies investigating the management of orthopaedic treatment in children with spinal dysraphism (SD). Methods. Relevant outcomes will be identified in a four-stage process from both the literature and key stakeholders (patients, their families, and clinical professionals). Previous outcomes used in clinical studies will be identified through a systematic review of the literature, and each outcome will be assigned to one of the five core areas, defined by the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT). Additional possible outcomes will be identified through consultation with patients affected by SD and their families. Results. Outcomes identified in these stages will be included in a two-round Delphi process that will involve key stakeholders in the management of SD. A final list including the identified outcomes will then be summarized in a consensus meeting attended by representatives of the key stakeholders groups. Conclusion. The best approach to provision of orthopaedic care in patients with SD is yet to be decided. The reporting of different outcomes to define success among studies, often based on personal preferences and local culture, has made it difficult to compare the effect of treatments for this condition. The development of a COS for orthopaedic management in SD will enable meaningful reporting and facilitate comparisons in future clinical trials, thereby assisting complex decision-making in the clinical management of these children. Cite this article: Bone Jt Open 2022;3(1):54–60

Aims. Surgery is often indicated in patients with metastatic bone disease (MBD) to improve pain and maximize function. Few studies are available which report on clinically meaningful outcomes such as quality of life, function, and pain relief after surgery for MBD. This is the published protocol for the Bone Metastasis Audit — Patient Reported Outcomes (BoMA-PRO) multicentre MBD study. The primary objective is to ascertain patient-reported quality of life at three to 24 months post-surgery for MBD. Methods. This will be a prospective, longitudinal study across six UK orthopaedic centres powered to identify the influence of ten patient variables on quality of life at three months after surgery for MBD. Adult patients managed for bone metastases will be screened by their treating consultant and posted out participant materials. If they opt in to participate, they will receive questionnaire packs at regular intervals from three to 24 months post-surgery and their electronic records will be screened until death or five years from recruitment. The primary outcome is quality of life as measured by the European Organisation for Research and the Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ) C30 questionnaire. The protocol has been approved by the Newcastle & North Tyneside 2 Research Ethics Committee (REC ref 19/NE/0303) and the study is funded by the Royal College of Physicians and Surgeons of Glasgow (RCPSG) and the Association for Cancer Surgery (BASO-ACS). Discussion. This will be the first powered study internationally to investigate patient-reported outcomes after orthopaedic treatment for bone metastases. We will assess quality of life, function, and pain relief at three to 24 months post-surgery and identify which patient variables are significantly associated with a good outcome after MBD treatment. Cite this article: Bone Jt Open 2021;2(2):79–85

Purpose of the study: Orthopedic treatment is generally proposed for minimally displaced fractures of the scapula. Surgery is indicated in the event of medialization or disorientation of the glenoid cavity. The purpose of this study was to identify rules for management of problematic cases. Material and methods: This retrospective study included 27 patients, 22 men and five women, mean age 46.7 years (range 22–83 years). The fracture was limited to the scapula in 17 and was part of thoracic syndrome in ten. Injury to the plexus was noted in three patients. Associated lesions were noted in 55% of patients. Orthopedic treatment was proposed for 15 patients (group 1) and surgical treatment for 12 (group 2): neck osteosynthesis (n=4), clavicle fixation (n=5), combined osteosynthesis (n=3). Results: Mean follow-up was 47.3 months; 21 patients were reviewed (four lost to follow-up, two deaths). Per primam healing was achieved for all fractures. There were no complications related to the surgical procedure in group 2 and no secondary displacement in either group. Mean time to resumed occupational activity was four months (range 0.2–25 months): 2.2 months (1–5 months) in group 1 and 5.5 months (0.2–25 months) in group 2. The age and gender weighted Constant score for the overall series was 96.2% (range 80–100%) with 81% excellent and very good functional outcomes. In group 1, the Constant score was 95.4% (81–100%) with 70% excellent and very good functional outcomes. It was 97% (80–100%) in group 2 with 91% excellent results. At last follow-up, there was only one case of Samilson grade 2 osteoarthritis. Discussion and conclusion: The functional outcome observed after treatment of scapular fractures is satisfactory. Orthopedic treatment should be reserved for non-displaced fractures. If there is significant medial offset of the glenoid cavity or instability, osteosynthesis of the scapular neck is indicated, possibly with reinforcement by fixation of the clavicle. Isolated osteosynthesis of the clavicle stabilizes the scapular ring but does not reduce the scapular fracture

Background. Floating shoulder (FS) is, according to Goss et al, a double disruption of the superior shoulder suspensory complex which usually results from a glenoid neck fracture and a ipsilateral midclavicular fracture. However, the interruption can interest the whole scapular belt from acromion to sterno-clavicular joint. It occurs mostly after a violent traumatism with direct lateral impact on the shoulder. That leads to complex therapeutic issues with sometimes uncertain results. Material. Between 1984 and 2009, 35 patients (30 men, 5 women), mean age 35 years [16–72] with FS, were treated in our department. Most of them sustained road accident (31cases) with polytraumatism context in 12 cases. A CT scan was realized in the majority of cases to specify the scapular fracture and look for intra-thoracic immediate complications. Mostly, glenoid neck fracture associated with a clavicular fracture has been found out (15cases). Orthopaedic treatment has been realized in 18 cases. Surgical management has been decided for open reduction of sterno-clavicular joint in 2 cases, isolated fixation of the clavicle in 9 cases, of the scapula in 3 cases, and of both scapula and clavicle in 3 cases. Criteria for clinical evaluation were an algo-functional scale (Oxford Shoulder Score, OSS), a subjective Constant Shoulder Score, a functional incapacity scale (Shoulder Simple Test, SST), scales of life quality (DASH and SF12) and global indications (Single Assessment Numeric Evaluation, SANE). Results. we noted a single migration of material. A patient presented a secondary displacement after orthopaedic treatment, and had additional surgical fixation before 6 months. In the mean follow up of 135 months [9–312], three patients were deceased and seven were unreachable. Five complained about rare pains, three of an important stiffness and chronic pains, and only one of brachial plexus injury. Functional results were satisfactory: OSS 14,75/60 [12–28], Subjective Constant score 79 [60–100], SST 10,75/12 [4–12], DASH 13,75/100 [0–84], SF12 physical 49,4 [36,8–54,8], SF12 mental 59,7 [57,2–61,8] andSANE 79% [50–100]. Discussion/conclusion. FS presents an immediate gravity because of possible intrathoracic injuries which can delay surgical treatment. FS which allowed orthopaedic treatments or required isolated fixation of the clavicle have excellent results. Scapular fractures which required surgical repair because of a significant displacement andan articular extension have more pejorative results

Purpose: Treating fractures of the femur in patients with a total hip arthroplasty is a difficult task. The frequency of these fractures is estimated at 1% to 3%. The purpose of this work was to evaluate the long-term clinical and radiological outcome and to search, by type of fracture, for factors predictive of late complications in order to improve indications. Material and methods: Since 1985, we collected data on 29 patients (17 women and 12 men) mean age 73.3 years who had a fracture of the femur after total hip arthroplasty. By definition, intraoperative fractures were excluded. Two independent operators noted epidemiological, therapeutic and imaging data and classed the fractures using the Vancouver classification. Treatments used were noted and clinical and radiological outcomes at mean follow-up of 24 months (6–140) were analysed. Results: Falls were the cause of the fractures in 31 patients (84%). Six of these patients had a revision prosthesis. Five fractures were in a zone of unprotected weakness. The fractures were trochanteric (n=9), periprosthetic (n=18), or below the stem (n=2). Nine patients were treated by isolated osteosynthesis and eleven by replacing the prosthesis. The Beals score was used to assess outcome taking into account the stability and the quality of the implant fixation as well as fracture realignment. In patients whose fracture was around the stem, outcome was excellent in two, good in one, and poor in four. For fractures of the lesser trochanter (n=4), outcome was excellent in two and good in two. For fractures below the stem (n=2), outcome was good in both. There was one case of deep infection. Discussion: Considering the same types of fractures, orthopaedic treatments produced poor results (6/11), unlike prosthesis replacement (2/11) and osteosynthesis (1/9). The number of loosenings was underestimated, leading to failure of orthopaedic treatment. Conclusion: In the event of fracture of the proximal femur in patients with a total hip arthroplasty, any suspected loosening, particularly of a cemented stem, should lead to prosthesis revision rather than orthopaedic treatment or simple osteosynthesis

Purpose: The purpose of this work was to determine the role of orthopaedic treatment as a function of initial criteria of instability and potential risk of secondary restabilisation after healing of the common anterior vertebal ligament in patients with bipediculated C2 fractures and to compare the results of surgical treatment using CE pediatric fixation of C1-C3 fractures associated with C1-C3 graft to those with C2-C3 arthrodesis using posterior screw plate fixation with a pedicular screw in C2. Material and methods: This was a retrospective analysis conducted in patients treated over a ten year period. There were 57 patients treated by two different orthopaedic surgery teams. There were 33 women and 24 mean, mean age 37 years with a maximum follow-up of 12 months. Clinical and radiographic findings were the same before treatment and at last follow-up. The surgical indication was for rupture of the common posterior vertebral ligament as assessed differently by two different surgical teams. Results: Orthopaedic treatment was given to 65% of the patients (72% and 62% for the two teams). Clinical outcome in these patients was good or excellent in 69% and 79% resepectively for the two teams. Surgical treatment was given in 35% of the cases. Cervical CD fixation produced 100% fair clinical results and 40% very good and good radiographic results with the other 60% being acceptable. For the C2-C3 plate with a pedicular screw in C2, the clinical outcome was good or very good in 53% with 34% fair and poor results and 73% good and very good and 27% poor radiographic results. Discusssion: This work demonstrated that indications or orthopaedic treatment can be extended, following the work by Roy-Cammille on the instability of these lesions introducting thus the notion of spontaneous anterior restabilisation due to healing of the common anterior vertebral ligament. For the choice of the technique, arthrodesis by cervical CD fixation remains a safe and sure technique despite the logical loss of C2-C3 rotation. Plate screw fixation with a C2 pedicular screw is more attractive but remains technically difficult

Aim. In the context of total knee arthroplasty (TKA), trauma with perigenicular fracture fixation or oncological surgical treatment, soft tissue defects can expose critical structures such as the extensor apparatus, the knee joint, bone or implants. This work compares soft tissue reconstruction (STR) between a classical pedicled gastrocnemius (GC) muscle flap and a pedicled chimeric sural artery perforator (SAP) musculocutaneous GC flap in complex orthoplastic scenarios. Method. A retrospective study was conducted on prospectively maintained databases in three University Hospitals from January 2016 to February 2021 after orthopaedic, traumatological or oncological treatment. All patients with a perigenicular soft tissue defect and implant-associated infection were included undergoing STR either with a pedicled GC flap or with a pedicled chimeric SAP-GC flap. The outcome analysis included successful STR and flap related complications. The surgical timing, preoperative planning and surgical technique are discussed together with the postoperative rehabilitation protocol. Results. 43 patients were included (22 GC muscle flaps, 21 SAP-GC musculocutaneous flaps). The GC and SAP-GC patient group were comparable in terms of age, comorbidities, defect size and follow-up. The incidence of flap related complications was comparable among the two groups. Specifically, in the SAP-GC group 1 wound dehiscence at the recipient site occurred as well as 1 distal muscle flap necrosis, 1 distal skin flap necrosis, 1 donor site infection and 1 donor site wound dehiscence. Furthermore, the donor site was closed in 9 patients while a skin graft was used in 12 patients. A significant difference was recorded with regard to re-raising the flap for further orthopaedic treatment: In the SAP-CG group (re-raise in 11 patients) no problems occurred while in the GC group (re-raise in 14 patients) in 6 patients the soft tissue did not heal completely. Conclusions. According to our clinical experience, the pedicled chimeric SAP-CG musculocutaneous flap is a relevant further development of the classical GC workhorse flap for perigenicular STR, in multiple staged procedures

Introduction. External fixators are common surgical orthopaedic treatments for the management of complex fractures and in particular, the use of circular frame fixation within patients requiring limb reconstruction. It is well known that common complications relating to muscle length and patient function without rehabilitation can occur. Despite this there remains a lack of high-quality clinical trials in this area investigating the role of physiotherapy or rehabilitation in the management of these patients. We aim to complete a systematic review of rehabilitation techniques for patients undergoing external fixator treatment for Limb Reconstruction of the lower limb. Materials & Methods. A comprehensive search of AMED, CINAHL, MEDLINE and COCHRANE databases was conducted to identify relevant articles for inclusion, using a search strategy developed in collaboration with a research librarian. Inclusion criteria consisted of adults aged 18 years and over who have experienced leg trauma (open fracture, soft tissue damage), elective leg deformity corrective surgery, bone infection or fracture non-union who have been treated with the use of an external fixator for fixation. Specific exclusion criteria were patients below the age of 18 years old, patients with cancer, treatment of the injury with internal nail, patients who underwent amputation, the use of external fixators for soft tissue contracture management, editorials, comment papers, review papers, conference proceedings and non-English papers. Titles, abstracts, and full texts were screened for suitability by pairs of reviewers according to the inclusion and exclusion criteria using Rayyan QCRI online software. Any conflicts were resolved through discussion with three independent specialist senior reviewers. Following full text screening, references lists of included articles were manually searched to ensure that all relevant studies were identified. Due to lack of evidence, forward searching was also completed for studies included in the review. Data quality was assessed using the mixed methods appraisal tool and the CERT assessment tool was utilised to look at completeness of reporting of exercise interventions. Results. A total number of 832 articles were initially retrieved from our search once duplicate articles removed. After title and abstract screening, 45 articles remained for full text screening. Of these, 11 articles met our inclusion criteria and included for data extraction. Conclusions. We expect high variability of results due to our inclusion criteria and therefore plan to conduct a narrative synthesis to summarise the findings whilst measing against the mixed methods appraisal tool and CERT assessment scores to assess the data quality. We anticipate lower assessment scores within the fewer articles found and therefore poorer-quality data. We currently are in the process of finalising this data extraction. This will be completed ready for submission and potential presentation at the BLRS conference in March 2023

Purpose: Injury of both cruciate ligaments raises difficult therapeutic problems in trauma victims. The severity of such lesions is related to the context of multiple trauma and to the general regional context associating vascular and neurological injury. Therapeutic management should be multidisciplinary to determine the appropriate strategy. Orthopaedic treatment should take into account the different diagnostic and therapeutic aspects. The purpose of this work was to detail ligament injuries observed and to assess results of treatments proposed. Material and methods: This retrospective series included 20 patients (14 men and 6 women), mean age 33 years (18–54). Five had multiple trauma with head injuries and multiple fractures. The initial diagnosis was traumatic knee dislocation in 14 patients. Seven patients underwent emergency vascular explorations with subsequent femoropopliteal bypass (n=3). Neurological lesions included three cases of complete section of the lateral popliteal sciatic. Orthopaedic treatment was used in three cases. We used external fixation for two months on the average in three patients. Six others underwent surgery (less than eight days after injury) after obtaining an MRI. The surgical strategy was based on several arguments: age, general status, level of the ligament injury. Three patients underwent secondary surgery on the anterior cruciate ligament. Outcome was assessed at a mean follow-up of 36 months (20–60). The clinical assessment of the objective result was based on frontal and sagittal laxity. The subjective result and the level of sports activities were also recorded. Radiographically, we studied the standard x-rays in single leg stance and also the stress images using telos with anterior then posterior drawer. Results: Excepting one case of amputation necessary due to the vascular and nervous injuries, orthopaedic treatment allowed an acceptable functional result in sedentary patients: good frontal stability and minimal anteroposterior residual laxity. Fourteen athletes underwent emergency surgery to repair the posterior cruciate ligament: posterior approaches in eight knees with injury of the floor with no posterior drawer at last follow-up; anterior approaches in six knees for suture of the posterior cruciate ligament and insertion of a synthetic ligament tutor with anterior cruciate ligament repair during the same operative time (two floor reinsertions, one patellar tendon plasty, and three Cho plasties). The stability of the posterior pivot was excellent but the tibial reinsertions of the anterior cruciate ligament failed. Seven knees required mobilisation under general anaesthesia 2.5 months later. Three knees underwent secondary anterior cruciate repair using the Kenneth Jones technique with negative Lachmann at last follow-up. Discussion: Excepting vascular and neurological emergencies dictating the initial therapeutic attitude, our orthopaedic management was based on a detailed identification of the lesion using emergency MRI: anterior or posterior approach, anterior cruciate repair technique dependng on association with peripheral ligament injury. Good results in terms of posterior laxity were achieved in this series, confirming the importance of emergency repair of the posterior cruciate. If the medial ligaments are intact, the anterior cruciate can be repaired in the emergency setting with a Cho plasy. In other situations, we prefer waiting before surgical repair of the anterior pivot

Abstract. Objectives. Single-event multilevel surgery (SEMLS) is the standard orthopaedic treatment for gait abnormalities in children with diplegic cerebral palsy (CP). The primary aim of this study was to report the long-term functional mobility of these patients after surgery. The secondary aim was to assess the relationship between functional mobility and quality of life (QoL). Methods. Patients were included if they met the following criteria: 1) diplegic CP; 2) Gross Motor Function Classification System (GMFCS) I to III; 3) SEMLS at age ≤ 18. A total of 61 patients, mean age at surgery 11 years eight months (SD 2y 5m), were included. A mean of eight years (SD 3y 10m) after SEMLS, patients were contacted and asked to complete the Functional Mobility Scale (FMS) questionnaire over the telephone and given a weblink to complete an online version of the CP QOL Teen. FMS was recorded for all patients and CP QOL Teen for 23 patients (38%). Results. Of patients graded GMFCS I and II preoperatively, at long-term follow-up the proportion walking independently at home, school/work and in the community was 71% (20/28), 57% (16/28) and 57% (16/28), respectively. Of patients graded GMFCS III preoperatively, at long-term follow-up 82% (27/33) and 76% (25/33) were walking either independently or with an assistive device at home and school/work, respectively, while over community distances 61% (20/33) required a wheelchair. The only significant association between QoL and functional mobility was better ‘feelings about function’ in patients with better home FMS scores (r=0.55; 95% confidence interval 0.15 to 0.79; p=0.01). Conclusion. The majority of children maintained their preoperative level of functional mobility at long-term follow-up after SEMLS. Despite the favourable functional mobility, there was little evidence to establish a link between functional status and quality of life

Purpose: The purpose of this work was to study Monteggia fracture-dislocation in children and report results of treatment. Material and methods: Thirty-two children were treated for Monteggia fracture-dislocation during a 12-year period from 1989 to 2001. The Bado classification was type I (n=22, 69%), type II (n=2, 7%), and type III (n=8, 24%). There were no type IV. Mean follow-up was seven years (1–12 yr). Mean age at treatment was six years (3–12 yr). There were 26 boys (81%) and 6 girls (19%). The right side was involved in 62% of patients. Orthopaedic treatment was use for 31 patients. Open surgery was performed for one child. Results: Early complications were rupture and migration of the osteosynthesis material and transient palsy of the posterior interosseous in one patient. Late complications were malunion with 20° ulnar varus in four patients. Residual posterior tilt of the ulna (up to 10°) was observed in two children and anterior tilt in one other. Elbow function was perfect in all children. For children had minor cubital varus. Discussion: Thirty-one children were given orthopaedic treatment with closed reduction of the ulnar fracture and radial head dislocation and immobilisation with a brachio-antebrachio-palmar brace. There were no cases of recurrent radial head dislocation, even with ulnar mal-union with 20° deviation. There were no cases of secondary displacement or recurrend dislocation despite rather unstable and oblique fractures. One patient required open reduction of the radial head followed by transcondylo-radial pinning. Closed reduction failed because of a ruptured annular ligament. In this patient, the pin was removed at three weeks because of pin fracture and migration to the wrist. Conclusion: Early orthopaedic reduction is indicated as first-intention treatment for these fractures in children. The prognosis is excellent for patients treated early. When closed reduction is impossible or in the event of recurrent dislocation of the radial head, open surgery may be needed

To examine all open fractures presenting to Bundaberg Base Hospital—from January 2007 to January 2009—by monitoring the clinical course of the patients, with attention to the time intervals between injury, presentation and orthopaedic treatment. The complications of treatment and the implications for future practice were also examined. A search was performed of all open fractures and compound fractures during the period of January 2007 until January 2009. The eligible patients were selected and their charts reviewed. The time of the injury, the time they presented to the emergency department (ED) and the time to orthopaedic treatment were noted. The site of the fracture, the Gustillo classification and the number of days of admission were recorded. Complications of the fractures were investigated. The impact of time delays and fracture severity on subsequent infections were correlated. A total of 127 admissions were recorded, 38 were excluded and 89 open fractures were included in the study: 54 upper limb, 34 lower limb and 1 pelvic fracture. Thirty-six patients had Gustillo I, 34 II, 9 IIIa, and 11 IIIb classifications. Patient arrival times were as follows: less than one hour (19%), 1–3 hours (44%), 3–6 hours (26%), 6–12 hours (8%) and greater than 12 hours (2%). From presentation, 28% of patients received treatment in 1–3 hours, 3–6 hours (27%), 6–12 hours (22%) and greater than 12 hours (22%). 40.4% of patients received treatment within 6 hours of injury and 59.5% greater than 6 hours. 33% of patients stayed in hospital 24 hours, 1–3 days (44%), 3–7 days (15%) and for greater than one week (1%). There were a total of 17 complications (19%), of which 11 (12%) were associated with infections. Of these, six were superficial wound infections and five were deep infections. Of these deep infections, two were associated with non-unions and one with a mal-union. Four complications were associated with non-infectious non-unions, one non-infectious mal-union. One had a missing bone fragment. Complications were found to be more prevalent when there was delayed treatment of the fractures. The results demonstrate that the majority of open fractures treated are upper limb and Gustillo I in classification. The complication rate for open fractures during the two year period was 19%. These findings provide a base for continued monitoring of open fracture management at Bundaberg Base Hospital

Purpose: Tillaux fractures correspond to type III joint fractures involving the anterolateral tubercle of the inferior tibia in the Salter and Harris classification. These fractures generally occur by external rotation in children about 13 years old at the time the medial part of inferior growth cartilage of the tibial epiphysis has fused. The purpose of the present study was to analyse long-term outcome in a retrospective series of twenty children. Material and methods: All twenty patients underwent physical examination and a standard radiographic work-up at last follow-up. Results were classed into three categories: good (free of pain, stiffness, gait impairment, joint degeneration), faire (moderate pain and/or stiffness and/or gait impairment without joint degeneration), poor (severe pain and/or severe stiffness and/or limping and/or joint degeneration). Results: This series included eight boys and twelve girls, mean age 12.8 years (range 3.4 – 14.9). Mean follow-up was three years eleven months (range 12 months – 8 years 9 months). Eleven patients underwent surgical treatment and nine orthopaedic treatment. The lateral segment of the growth cartilage was open in all cases but the medial segment was open in two and completely closed in six. A computed tomography scan was required in one patient to assess displacement. Outcome was considered good in eighteen patients and fair in two. These two patients had persistent pain without functional impairment at about one year follow-up. Discussion: Overall, the long-term outcome is good for Tillaux fractures if they are correctly identified and evaluated, with computed tomography if necessary, to enable appropriate surgical or orthopaedic treatment. Inappropriate management of this joint fracture can lead to joint incongruency and secondary degeneration. Most of these fractures occur in adolescents and secondary growth impairment is negligible. This type of fracture may also occur in adults. Prognosis is excellent with adapted treatment

Bone fractures are highly observed clinical situation in orthopaedic treatments. In some cases, there might be non-union problems. Therefore, recent studies have focused on tissue engineering applications as alternative methods to replace surgical procedures. Various biopolymer based scaffolds are produced using different fabrication techniques for bone tissue engineering applications. In this study, hydroxyapatite (HAp) and loofah containing carboxymethyl chitosan (CMC) scaffolds were prepared. In this regard, first 4 ml of CMC solution, 0.02 g of hydroxyapatite (HAP) and 0.06 g of poly (ethylene glycol) diglycidyl ether (PEGDE) were mixed in an ultrasonic bath until the HAp powders were suspended. Next, 0.04 g of loofah was added to the suspension and with the help of PEGDE as the cross-linking agent, then, the mixture was allowed to cross-link at 40. o. C overnight. Finally, the three-dimensional, porous and sponge-like scaffolds were obtained after lyophilization (TELSTAR - LyoQuest −85) at 0.1 mbar and −25°C for 2 days. Morphologies, chemical structures and thermal properties of the scaffolds were characterized by scanning electron microscopy (SEM), Fourier Transform infrared spectroscopy (FT-IR) and thermogravimetric differential thermal analysis (TGA/DTA), respectively. In addition, swelling behavior and mechanical properties of the scaffolds under compression loading were determined. In order to investigate biocompatibility of the scaffolds, WST-1 colorimetric assay at days 0, 1, 3, 5 and 7 was conducted by using human dermal fibroblast. Also, histological and morphological analysis were performed for cell attachment at day 7. In conclusion, the produced scaffolds showed no cytotoxic effect. Therefore, they can be considered as a candidate scaffold for bone tissue regeneration. Further studies will be performed by using bone marrow and periosteum derived mesenchymal stem cells with these scaffolds

Purpose: The floating shoulder is a special entity in traumatology of the upper limb. Bioechanically, the floating shoulder corresponds, as defined by Goss, to a rupture of the suspensor complex. Management is not well defined but must target the proper balance between the need for anatomic restauration and quality functional results obtained in the majority of cases treated orthopaedically. This apparent paradoxical situation is probably related to the precision of indications. Material and methods: Forty-five patients managed between 1980 and 2001 were reviewed retrospectively. Thirty-five presented a scapulo-cleido-thoracic syndrome, ten a scapulocleidal syndrome. Mean age at the time of trauma was 39 years and mean follow-up was 2.4 years (1–16). The patients, 36 men and nine women were mainly (76%) traffic accident victims (58% motorcycle, 33% automobile, 9% pedestrians) and 76.8% had multiple injuries. Cleidal lesions were 18 mid-third fractures, 12 acromiocleidal dislocations, three sternocleidal dislocations, seven bifocal fracrturs, three lateral third fractures and two medial third fracturs. The scapular lesion involved the body of the bone in 19 patients, the neck in 14, the glenoid cavity in two, the coracoid process in one, and multifocal fractures in nine. Results: Thirty-two patients were treated orthopaedically and twelve patients surgically, four with cleidal osteosynthesis, eight with both. The postoperative x-rays were used to assess anatomic results and the Constant score to assess functional results. Complications included six deformed calluses, with four causing major functional impairment and one requiring revision. All resulted from orthopaedic treatments. Discussion: While most patients have an indication for orthopaedic treatment, analysis of the displacemens can lead to a surgical indication. We retained the following criteria for surgical treatment: scapular neck fracture causing more than 40° angulation, glenoid medialisation-ventralisation greater than 2 cm, and displaced articular fracture. Osteosynthesis of the clavicle for floating shoulders with a major displacement appears to be the minimum prerequisite if the multiple injuries prevent optimal management

Aims. Periprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme. Methods. We used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines. Results. The consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilitation, and healthcare commissioning. The final output from the consensus process was a 14-item guideline. The guidelines make recommendations regarding increased vigilance and monitoring of those at increased risk of infection; diagnosis including strategies to ensure the early recognition of prosthetic infection and referral to orthopaedic teams; treatment, including early use of DAIR and revision strategies; and postoperative management including appropriate physical and psychological support and antibiotic strategies. Conclusion. We believe the implementation of the INFORM guidelines will inform treatment protocols and clinical pathways to improve the treatment and management of periprosthetic hip infection. Cite this article: Bone Jt Open 2023;4(4):226–233

Introduction and Objective. Medial Knee Osteoarthritis (MKO) is associated with abnormal knee varism, this resulting in altered locomotion and abnormal loading at tibio-femoral condylar contacts. To prevent end-stage MKO, medial compartment decompression is selectively considered and, when required, executed via High Tibial Osteotomy (HTO). This is expected to restore normal knee alignment, load distribution and locomotion. In biomechanics, HTO efficacy may be investigated by a thorough analysis of the ground reaction forces (GRF), whose orientation with respect to patient-specific knee morphology should reflect knee misalignment. Although multi-instrumental assessments are feasible, a customized combination of medical imaging and gait analysis (GA), including GRF data, rarely is considered. The aim of this study was to report an original methodology merging Computed-Tomography (CT) with GA and GFR data in order to depict a realistic patient-specific representation of the knee loading status during motion before and after HTO. Materials and Methods. 25 MKO-affected patients were selected for HTO. All patients received pre-operative clinical scoring, and radiological/instrumental assessments; so far, these were also executed post-operatively at 6-month follow-up on 7 of these patients. State-of-the-art GA was performed during walking and more demanding motor tasks, like squatting, stair-climbing/descending, and chair-rising/sitting. An 8-camera motion capture system, combined with wireless electromyography, and force platforms for GRF tracking, was used together with an own established protocol. This marker-set was enlarged with 4 additional skin-based non-collinear markers, attached around the tibial-plateau rim. While still wearing these markers, all analyzed patients received full lower-limb X-ray in standing posture a CT scan of the knee in weight-bearing Subsequently, relevant DICOMs were segmented to reconstruct the morphological models of the proximal tibia and the additional reference markers, for a robust anatomical reference frame to be defined on the tibia. These marker trajectories during motion were then registered to the corresponding from CT-based 3D reconstruction. Relevant registration matrices then were used to report GRF data on the reconstructed tibial model. Intersection paths of GRF vectors with respect to the tibial-plateau plane were calculated, together with their centroids. Results. Pre-operative clinical and radiological scoring confirmed MKO and associated abnormal varism. The morphological characterization of GRF was successfully achieved pre- and post- HTO on patient-specific tibial plateau. Pre-operative GFR patterns and peaks, including those related to knee joint moments, were observed medially on the knee, as expected. In post-HTO, these resulted lateralized and much closer to the tibial plateau spine, as desired. In detail, when post- is compared to pre-op, the difference of the centroids were, on average, 54.6±18.1 mm (min÷max: 36.7÷72.8 mm) more lateral during walking and 52.5±28.5 mm (24.7÷87.6 mm) during stair climbing. When reported in % of the tibial plateau width, these values became 69.2±20.1 (46.1÷81.4) and 78.1±30.1 (43.4÷98.0), respectively. Post-op also clinical scores and GA revealed a considerable overall improvement, especially in functional performances. Conclusions. The reported novel approach allows a combination of motion data, including GFR, and tibial-plateau morphology. Relevant pre- and post-operative routine application offer a quantification of the effect of the original deformity and executed joint realignment, and an assistance for surgical planning in case of HTO as well as ideally in other orthopedic treatments