Aims

Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space.

Aims

Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA), and has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA.

Aims

Frozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB.

Purpose: The aim of this study was to analyze the outcome of AO cannulated screws for undisplaced fracture neck of femur and find out the correlation in outcome with respect to co-morbidities in a general trauma unit in UK.

Method: A retrospective study was conducted using data from electronic patient record, clinical coding information, clinic letters and GP’s. 315 patients who underwent AO screws for fracture neck of femur during 2000 to 2004 were included. We looked into age, place of living, classification, mechanisn of injury, comorbidities, mobility before fracture, allergy, addictions, whether patient was anticoagulated, delay for theatre with reasons, length of stay in hospital, complications and treatment for complications. We assessed reasons for other admissions later on, need and type of another operation, consequently developed comorbidities, patient getting fracture of other side and its treatment, time and cause of death if happened?

Results: There were 81 males and 234 females in the study. Mean age of patients was 72 years (range 50–96 years). Non-union occurred in 19 patients (6%) and avascular necrosis occurred in 49 patients (15.5%). Reoperation with an arthroplasty was required in 69 patients (21.9 %). The incidence of avascular necrosis with internal fixation at 1 year was 31 (9.8%). Fifty-one (16%) patients died in 2 year period. The age, walking ability of the patient, and associated co-morbidities were of statistical significance in predicting fracture healing complications. We correlated our complications with comorbidities and found them more in patients with end-stage renal failure, steroid intake, osteoporosis and diabetes mellitus etc.

Conclusion: The rate of fracture healing complications and reoperations in patients with undisplaced fractures was high in our series with two year follow up. It was even higher in patients with age greater than 80 years and some specific comorbidities. We should also consider co-morbidities and age before deciding for internal fixation rather than only the fracture configuration (Treat patient not the X-rays). Outcome is multifactorial and depends on many predictive factors. Each patient should be evaluated carefully and we should treat the physiological age and not the chronological age.

Purpose: The aim of this study was to compare the results and length of stay of patients of early ankle fracture fixation with conventional fixation in a busy District General Hospital in UK.

Method: A retrospective study was conducted using data from case records, electronic patient record, clinical coding information, clinic letters and Picture Archiving and Communications System (PACS). Two hundred patients who underwent ankle fracture fixation from July 2004 to June 2005 were included. We looked into age, place of living, Weber classification, mechanism of injury, comorbidities especially diabetes and peripheral vascular disease, addictions mainly smoking, whether patient was anticoagulated, delay for theatre with reasons, length of stay in hospital and complications if any. Other things to looked at were, overlying skin condition, the amount of swelling at the time of presentation to A& E, associated ankle dislocation or talar shift needing reduction, injury types-open or closed or with associated neuro-vascular injury. In-operative management – what method was used ie malleolar screws, diastasis screw, fibular plating, calcaneotalotibial nail or external fixater etc.

Results: In the 12-month retrospective review, there were 200 ankle fractures that required surgical intervention. Only twenty-two of these had surgery within 12 hours (mean length of stay, 3.3 days), and sixty-seven of these had surgery within 48 hours (mean length of stay, 4.9 days), and 111 had surgery after 48 hours (mean length of stay, 9.4 days). Finally we calculated the cost (784 bed days – £235 thousands) incurred to the trust in terms of extra bed occupancy and treating the complications as a result of wait.

Conclusion: This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. We want to emphasise on the ‘Window of Opportunity’ ie initial 12 hours to fix ankle fractures to decrease overall morbidity and cost.

Purpose: To determine whether the tendon harvester can influence harvested tendon characteristics and soft tissue disruption

Summary: We compared two harvesters with regards to the length of tendon obtained and soft tissue disruption during hamstring tendon harvesting. Thirty six semitendinosus and gracilis tendons were harvested using either a closed stripper or a blade harvester in 18 paired knees from 9 human fresh cadavers. Use of the blade harvester gave longer lengths of usable tendon (p=0.002), whilst minimising the stripping of muscle (p=0.013).

Conclusion: Our results suggest that the type of harvester per se can influence the length of tendon harvested as well as soft tissue disruption. Requesting such data from the industry prior to deciding which harvester to use seems desirable.

Purpose: To evaluate the intra and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.

Summary: Fifty tibial plateau fractures were classified independently by 6 observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions 8 weeks apart.

We found that both the Schatzker and AO/OTA classifications have a high intra-observer (kappa=0.57 and 0.53 respectively), and inter-observer (kappa=0.41 and 0.43 respectively) variation. Classification of tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split conferred improved inter and intra-observer variation.

Conclusions: The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients’ outcome. Simply classifying tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split may be more reliable.

A significant number of patients return with persistent symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome. The aim of this study was to attempt to explain this fact in anatomical terms by defining the anatomy of the posterior interosseous nerve and its branches in relation to the supinator muscle and arcade of Frohse. Using standard dissection tools 20 preserved cadaveric upper limbs were dissected. The radial nerve and all its branches within the radial tunnel were exposed and a digital calliper was used to measure distances. The bifurcation of the radial nerve to posterior interosseous nerve and superficial sensory branch occurred at a median distance of 4.35mm proximal to the elbow joint-line. The bifurcation was proximal to the joint-line in 11 cases, at the level of the joint-line in one case and distal in eight cases. There was a range of 0–5 branches to the supinator originating proximal to the entry point of the posterior interosseous nerve under the arcade of Frohse at a median distance of 10.27mm (medial branches) or 11.11mm (lateral branches) distal to the elbow join-line. These branches either passed under the arcade of Frohse or entered through the proximal edge of the superficial belly of the supinator. In 10 limbs there was a variable number of branches to the supinator originating under its superficial belly and in five limbs multiple perforating posterior interosseous nerve branches within the muscle were identified. This variation in anatomy we believe may explain the persistence of symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome and suggests that careful exploration of all the nerve branches during surgical decompression should be routinely performed.