We aimed to compare reoperations following distal radial fractures (DRFs) managed with early fixation versus delayed fixation following initial closed reduction (CR). We used administrative databases in Ontario, Canada, to identify DRF patients aged 18 years or older from 2003 to 2016. We used procedural and fee codes within 30 days to determine which patients underwent early fixation (≤ seven days) or delayed fixation following CR. We grouped patients in the delayed group by their time to definitive fixation (eight to 14 days, 15 to 21 days, and 22 to 30 days). We used intervention and diagnostic codes to identify reoperations within two years. We used multivariable regression to compare the association between early versus delayed fixation and reoperation for all patients and stratified by age (18 to 60 years and > 60 years).Aims
Methods
Low Contact Stress(LCS) total knee arthroplasty was developed to reduce contact stress on the bearing surface and to minimise stresses at the interface between the host bone and the implant surface leading to long term implant survival. The rotating platform was introduced as the bearing interface when both cruciates are sacrificed. It has a central cone which engages into a matching cone in the tibial tray. This allows unconstrained axial rotation of the bearing surface. However, this potentially leaves the platform susceptible to subluxation/dislocation. The reported rate of this complication varies from 0.5% to 4.65%. In this study from a single center we report the incidence and highlight the associated causative factors found in our series. There were 1053 Low Contact Stress total knee arthroplasties performed between 1994 and 2003. We reviewed 10 knees in 9 patients who had dislocation of the polyethylene rotating platform. This amounts to 0.95% in our series. All the patients with dislocation were women. Average age was 72 years(range 62–84). Osteoarthritis was the primary diagnosis in 8 patients. One patient was suffering from rheumatoid arthritis was on long term steroid therapy and had bilateral dislocations. One patient with Osteoarthritis with Parkinson’s disease went onto have 2 recurrent dislocations. Pre-operative deformity was varus in 9 knees(range 4–10 degrees) and valgus of 15 degrees was noted in one. Time from index operation to dislocation ranged from as early as 10 days to 10 months. There was history of trauma and acute presentation only in one patient. In one patient the knee dislocated while she twisted her knee in bed and in another while climbing up the stairs. In the remaining seven patients the presentation was subacute with symptoms such as pain, decreased range of motion, swelling and a clunking sensation while walking. Although manipulation under anaesthesia was successful in 3 patients, all of them had recurrent dislocations and two patients had revision to a deepdish platform.
To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification.Aims
Methods
This article is a systematic review of the published
literature about the biomechanics, functional outcome and complications
of intramedullary nailing of fractures of the distal radius. We searched the Medline and EMBASE databases and included all
studies which reported the outcome of intramedullary (IM) nailing
of fractures of the distal radius. Data about functional outcome,
range of movement (ROM), strength and complications, were extracted.
The studies included were appraised independently by both authors
using a validated quality assessment scale for non-controlled studies
and the CONSORT statement for randomised controlled trials (RCTs). The search strategy revealed 785 studies, of which 16 were included
for full paper review. These included three biomechanical studies,
eight case series and five randomised controlled trials (RCTs). The biomechanical studies concluded that IM nails were at least
as strong as locking plates. The clinical studies reported that
IM nailing gave a comparable ROM, functional outcome and grip strength
to other fixation techniques. However, the mean complication rate of intramedullary nailing
was 17.6% (0% to 50%). This is higher than the rates reported in
contemporary studies for volar plating. It raises concerns about
the role of intramedullary nailing, particularly when comparative
studies have failed to show that it has any major advantage over
other techniques. Further adequately powered RCTs comparing the
technique to both volar plating and percutaneous wire fixation are needed. Cite this article:
