Introduction. Closed avulsion of the Flexor Digitorum Profundus (FDP) from distal phalanx most commonly affects the ring finger when an extensive force is applied to a finger in active flexion. Whilst it is undoubtably reasonable to provide treatment for those who present with symptoms, there may be a cohort of people who sustain an avulsion without noticing. This study aims to quantify the effect of ring finger FDP avulsion on overall grip strength to determine the functional effect of a missed injury. Method. Right handed volunteers, with no abnormality on examination were included (N= 42). Proximal muscle group action was excluded. Grip strength was tested using a Jamar dynamometer with and without splinting of the ring finger to block flexion at the DIPJ and repeated six times alternately to mitigate the effects of fatigue. Results. Most subjects showed a small (0.3–3kg) change in their average grip strength with the splint (N= 29). Some showed a dramatic change in their grip strength (6–11.4) (N=6) others showed no change or slight improvement with the splint (−3–0) (N=7). Data were not normally distributed (kolmogorov-smirnov p=0.023). A wilcoxon signed rank test showed a statistically significant difference in performance with, compared to without, the splint, mean 2.34kg reduction (−3.3 − 11.4) (p <0.0005. Discussion. Horton et al have examined the quadriga effect and shown that the individual strength of other digits is reduced when one FDP is isolated. This implies overall grip strength should be reduced; our data supports this assertion. However despite splinting, the majority of subjects were still within the normal range of power for age. Larger scale studies are required to assess the functional effect of repair vs conservative management

Aims

Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era.

BACKGROUND. Many patients who underwent a THA, report a feeling of more “physiological” hip and of faster recovery when bigger heads are used. The aim of this study is to evaluate the walking recovery of patients after THA with different head diameters by the means of gait analysis. MATERIALS AND METHODS. A prospective, randomized, blind study was conducted on 60 patients operated by THA at our Institution. Inclusion criteria were: primary hip arthritis, women, age between 55 and 70 years. Exclusion criteria were: other problems influencing walking ability (previous operations of the lower limbs, spine disorders, knee or controlateral hip arthritis). The same uncemented stem, same uncemented press-fit cup, same surgical technique and approach (posterolateral), same surgeons, same postoperative protocol and rehabilitation were employed. The only difference was the head diameter. The patients were randomized into three groups, of twenty patients each one (28mm Cer-on-XPE, 36mm Cer-on-XPE, >42mm Met-on-Met). The gait evaluation have been performed at three temporal steps: preoperatively, two months postoperatively and four months postoperatively. Kinematic parameters were acquired with Elite opto-electronic system (BTS, Milan, Italy) equipped with 6 cameras at 100 Hz frame rate. The system is integrated with a force platform (Kistler, CH) and a synchronic video system using two cameras (BTS, Milan, Italy). Data acquisition and processing were carried out using passive markers positioned according to Davis protocol. At least ten trials for each session were collected in order to assess the repeatability of the results. Gait analysis included kinematic parameters (temporal-spatial parameters and joint angular values) and kinetic parameters (ground interaction forces during walking). Articular moments and powers were computed on the basis of data obtained from dynamometric platform along with those given by kinematic analysis. All patients were compared to a control group. Wilcoxon signed rank test was employed for statistical evaluation. RESULTS. At a preliminary evaluation (still in progress) and statistical analysis, temporal-spatial parameters show no significant differences among the three groups. All the variables of step length, stride length, cadence and velocity show statistical significant improvements towards the standard values, in the four months follow-up in all the groups, and the improvement does not depend on the side operated. CONCLUSIONS. The preliminary evaluation of this study shows that there is no statistical significant difference in standard gait analysis parameters in patients with different head diameters (28mm, 36mm, >42mm) after THA

Aims

This study aimed to analyze the correlation between transverse process (TP) fractures of the fourth (L4) and fifth (L5) lumbar vertebrae and biomechanical and haemodynamic stability in patients with a pelvic ring injury, since previous data are inconsistent.

Our aim was to compare polylevolactic acid screws with titanium screws when used for fixation of the distal tibiofibular syndesmosis at mid-term follow-up. A total of 168 patients, with a mean age of 38.5 years (18 to 72) who were randomly allocated to receive either polylevolactic acid (n = 86) or metallic (n = 82) screws were included. The Baird scoring system was used to assess the overall satisfaction and functional recovery post-operatively. The demographic details and characteristics of the injury were similar in the two groups. The mean follow-up was 55.8 months (48 to 66). The Baird scores were similar in the two groups at the final follow-up. Patients in the polylevolactic acid group had a greater mean dorsiflexion (p = 0.011) and plantar-flexion of the injured ankles (p < 0.001). In the same group, 18 patients had a mild and eight patients had a moderate foreign body reaction. In the metallic groups eight had mild and none had a moderate foreign body reaction (p <  0.001). In total, three patients in the polylevolactic acid group and none in the metallic group had heterotopic ossification (p = 0.246).

We conclude that both screws provide adequate fixation and functional recovery, but polylevolactic acid screws are associated with a higher incidence of foreign body reactions.

Cite this article: Bone Joint J 2014;96-B:548–54.

Objectives

We aimed to further evaluate the biomechanical characteristics of two locking screws versus three standard bicortical screws in synthetic models of normal and osteoporotic bone.

As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was ≥ 3 mm.