Aims. Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize
Aims. The aim of this study was to assess the safety and
Aims. Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results. Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in
The objectives of our study were to compare patient reported outcome measures between manual and robotic-assisted total hip arthroplasty. Between 1st May 2021 and 31st August 2022, 539 consecutive patients who underwent 564 primary total hip arthroplasties were identified from the local registry database. Data were prospectively collected, and included patient demographics, American Society of Anaesthesiologists (ASA) grade, surgical approach, robotic-assistance, Oxford Hip Score (OHS), EQ-5D-3L and EQ-VAS pre-operatively and at twelve months. Robotic-assistance, compared against manual total hip arthroplasty, was associated with an enhanced median (interquartile range) OHS (46 [42 – 48] vs 43 [36 – 47], p-value < 0.001), EQ-5D-3L (5 [5 – 7] vs 6 [5 – 8], p-value 0.002), and EQVAS (90 [75 – 95] vs 80 [70 – 90], p-value 0.003) at twelve months after surgery. Robotic-assistance was confirmed to be an independent predictor of a greater OHS at twelve months on a multivariate linear regression analysis (p-value 0.001). Robotic assistance was superior to manual total hip arthroplasty in enhancing patient reported outcomes at twelve months after surgery.
Aims. The aim of this study was to investigate the association between additional rehabilitation at the weekend, and in-hospital mortality and complications in patients with hip fracture who underwent surgery. Methods. A retrospective cohort study was conducted in Japan using a nationwide multicentre database from April 2010 to March 2018, including 572,181 patients who had received hip fracture surgery. Propensity score matching was performed to compare patients who received additional weekend rehabilitation at the weekend in addition to rehabilitation on weekdays after the surgery (plus-weekends group), as well as those who did not receive additional rehabilitation at the weekend but did receive weekday rehabilitation (weekdays-only group). After the propensity score matching of 259,168 cases, in-hospital mortality as the primary outcome and systemic and surgical complications as the secondary outcomes were compared between the two groups. Results. The plus-weekends group was significantly associated with lower in-hospital mortality rates compared with the weekdays-only group (hazard ratio 0.86; 95% confidence interval 0.8 to 0.92; p < 0.001). Systemic complications such as acute coronary syndrome, heart failure, renal failure, and sepsis were significantly lower in the plus-weekends group, whereas urinary tract infection (UTI) and surgical complications such as surgical site infection and haematoma were significantly higher in the plus-weekends group. Conclusion. Additional weekend rehabilitation was significantly associated with lower in-hospital mortality, as well as acute coronary syndrome, heart failure, renal failure, and sepsis, but was also significantly associated with a higher risk of UTI and surgical complications. This result can facilitate the effective use of the limited rehabilitation resources at the weekend and improve the clinical awareness of specific complications. To establish more robust causal associations between additional rehabilitation over the weekend and
Aims. The aim of this study was to examine perioperative blood transfusion practice, and associations with
The aim of this study was to evaluate the long-term outcomes of patients who had sustained an unstable ankle fracture with a posterior malleolus fracture (PMF) and without (N-PMF). Adult patients presenting to a single academic trauma centre in Edinburgh, UK, between 2009 and 2012 with an unstable ankle fracture requiring surgery were identified. The primary outcome measure was the Olerud Molander Ankle Score (OMAS). Secondary measures included Euroqol-5D-3L Index (Eq5D3L), Euroqol-5D-VAS and Manchester Oxford Foot Questionnaire (MOXFQ). There were 304 patients in the study cohort. The mean age was 49.6 years (16.3–78.3) and 33% (n=100) male and 67% (n=204) female. Of these, 67% (n=204) had a PMF and 33% did not (n=100). No patient received a computed tomography (CT) scan pre-operatively. Only 10% of PMFs (22/204) were managed with internal fixation. At a mean of 13.8 years (11.3 – 15.3) the median OMAS score was 85 (Interquartile Range 60 – 100). There was no difference in OMAS between the N-PMF and PMF groups (85 [56.25 – 100] vs 85 [61.25 – 100]; p = 0.580). There was also no difference for MOXFQ (N-PMF 7 [0 – 36.75] vs PMF 8 [0–38.75]; p = 0.643), the EQ5D Index (N-PMF 0.8 [0.7 – 1] vs PMF 0.8 [0.7 – 1]; p = 0.720) and EQ5D VAS (N-PMF 80 [70 – 90] vs PMF 80 [60 – 90]; p = 0.224). The presence of a PMF does not affect the long-term patient reported outcomes in patients with a surgically managed unstable ankle fracture.
Aims. The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of open fractures and economic costs. Methods. Resource use was measured during the six months that followed open fractures of the lower limb in 748 adults recruited as part of two large clinical trials within the UK Major Trauma Research Network. Resource inputs were valued using unit costs drawn from primary and secondary sources. Economic costs (GBP sterling, 2017 to 2018 prices), estimated from both a NHS and Personal Social Services (PSS) perspective, were related to the degree of complexity of the open fracture based on the OTS classification. Results. Adjusted mean total NHS and PSS costs were £13,785 following treatment of complex fractures and £3,550 following treatment of simple fractures, where the open fracture wound is closed at the end of the first wound debridement, generating a mean difference of £10,235 (95% confidence interval £8,074 to £12,396). Conclusion. Following previous work correlating
Aims. The study objective was to prospectively assess
Background:. The aim of this study was to review the surgical complications and
The aims of this study in relation to distal radius fractures were to determine (1) the floor and ceiling effects for the QuickDASH and PRWE, (2) the floor and ceiling effects when defined to be within the minimal clinically important difference (MCID) of the minimal or maximal scores, (3) the degree to which patients with a floor or ceiling effect felt that their wrist was ‘normal’, and (4) patent factors associated with a floor or ceiling effect. A retrospective cohort study of patients sustaining a distal radius fracture during a single year was undertaken. Outcome measures included the QuickDASH, PRWE, EQ-5D-3L and normal wrist score. There were 526 patients with a mean age of 65yrs and 77% were female. Most patients were managed non-operatively (73%, n=385). The mean follow-up was 4.8yrs. A ceiling effect was observed for both the QuickDASH (22.3%) and PRWE (28.5%). When defined to be within the MCID of the best score, the effect increased to 62.8% for the QuickDASH and 60% for PRWE. Patients that achieved the best functional outcome according to the QuickDASH and PRWE felt their wrist was only 91% and 92% normal, respectively. Sex (p=0.000), age (p=0.000), dominant wrist injury (p=0.006 for QuickDASH and p=0.038 for PRWE), fracture type (p=0.015), and a better health-related quality of life (p=0.000) were independently associated with achieving a ceiling score. The QuickDASH and PRWE demonstrated ceiling effects following a distal radius fracture. Patients achieving ceiling scores did not consider their wrist to be ‘normal’ for them.
Objective. To compare regional body composition, bone mineral density (BMD), and
Objective. To describe demographic data,
Objective. To provide a best estimate of the average treatment effect when microfracture was chosen as the intervention of choice in patients with full-thickness cartilage defects of the knee. Design. We focussed on controlled studies which either referred to microfracture alone or in comparison with any other surgical treatment of articular cartilage of the knee. Papers including patients who had been treated by microfracture and concomitant adjuvant procedures like ACL reconstruction or meniscus repair were accepted too, whereas papers reporting on the microfracture technique combined with the implantation of a scaffold were excluded. To achieve a best estimate of the average, to be expected treatment effect we pooled pooled before–after data of study arms using microfracture. Because cartilage studies employ various scales to measure functional improvements, we standardized treatment effects using Hedges' g. To provide clinically meaningful estimates we converted the pooled summary effect back into the respective scales by multiplying the pooled effect with pooled standard deviations of each included clinical scale. Results. A systematic review of the literature revealed six papers including 200 patients with a mean age of 32 years, a mean defect size of 3 cm. 2. and a follow up period from 2 to 5 years. Four of the studies compared microfracture to autologous chondrocyte implantation and two of them to osteochondral autologous transplantation. All patients were treated by the microfracture technique as described by Steadman and by a similar rehabilitation protocol which only allowed crutch-assisted touchdown weight bearing initially. Referring to the individual studies, a comparison of the pooled estimates of Hedges' g revealed that the two papers which evaluated the youngest patients provided the highest treatment effect. On the contrary, those two papers which focussed on the largest lesions, reported the worst improvement. Finally, the remaining two papers whose patients were characterized by similar age and defect size presented comparable results. The individual standardized effect sizes were combined into an overall best estimate. Its value was 1.678, measured in units of standard deviation, with the 95% confidence interval of [1.016; 2.340] resulting in different values of the average, to be expected treatment effect when it is measured in Lysholm Score (22.1), IKDC Score (26.5) and KOOS (15.2) points. Conclusions. Our results offer a clinically intuitive estimation of the average treatment effects on common clinical scales. Compared to the preoperative situation, a significant clinical improvement can be expected for each patient. Nevertheless, the magnitudes of these treatment effects are an approximation and must be interpreted cautiously. Furthermore, we did not succeed to confirm that young age and small lesion size have a beneficial effect on the
Introduction. Undisplaced femoral neck fractures have been given little attention in the literature. By using data from the Norwegian Hip Fracture Register, this study investigates risk for reoperation and the clinical results, including pain, patient satisfaction, and quality of life, after undisplaced femoral neck fractures in elderly patients. Material and Methods. Data on 4,468 patients over 70 years of age with undisplaced femoral neck fractures operated with internal fixation (IF) were compared to 10,289 patients with displaced femoral neck fractures treated with IF (n = 3,389) or bipolar hemiarthroplasty (n = 6,900). The evaluation was based on number of reported reoperations and patients' assessment (visual analogue scales concerning pain (0–100) and patient satisfaction (0–100), and quality of life (EQ-5D)) four and twelve months postoperatively. The patients were followed for 0–1 year. The Cox multiple regression model was used to construct adjusted survival curves. Subanalyses were performed on undisplaced femoral neck fractures to investigate different risk factors for reoperation. Results. The survival rate of implants after one year was 89% after screw fixation for undisplaced fractures, 79% after screw fixation for displaced fractures, and 97% after hemiarthroplasty for displaced fractures (Kaplan Meier). Adjusted for age, sex, ASA-classification, and cognitive function the displaced fractures operated with internal fixation had higher risk of reoperation compared to the undisplaced fractures operated with internal fixation (RR 1.92, 95% CI: 1.69–2.17; p<0.001). The displaced fractures operated with hemiarthroplasty had a lower risk of reoperation compared to the undisplaced fractures (RR 0.32, 95%CI: 0.27–0.38; p<0.001). Patients treated with IF for undisplaced fractures were more satisfied, had less pain, and higher quality of life compared to patients treated with IF after displaced fractures (p<0.05). The patients treated with bipolar hemiarthroplasty for displaced fractures had, however, the least pain, were most satisfied, and reported the highest quality of life. Discussion and Conclusion. The
Mechanical ankle instability is elicited through examination and imaging. A subset of patients however report “functional” instability ie/ instability without objective radiological evidence. Little research compares operative outcomes between these groups. We hypothesised patients with “mechanical instability” were more likely to benefit from operative intervention than those with “functional instability”. This was a single centre, retrospective case note review of prospectively collected data. Inclusion criteria: over six months of symptoms, failed conservative management, surgical stabilisation between 2016–2018. Data collected: demographics, operative procedure, preoperative and postoperative PROMs. Nineteen patients were included. All had preoperative MRIs determining ligamentous involvement. Nine had radiological evidence of instability, eight had negative radiographs. Two were excluded due to no intraoperative radiographs. There was no statistical difference in preoperative MOxFQ scores between the groups (p=0.2039). Preoperative EQ5D-TTO scores were statistically different (mean mechanical 0.58 vs functional 0.26, p=0.0162) but not EQ5D-VAS scores (mean mechanical 77 vs functional 53, p=0.0806). Mechanical group's preoperative, 26 and 52 week scores respectively: Mean MOxFQ= 57.88, 22.13, 18.5. Mean EQ5D-TTO= 0.58, 0.78, 0.84. EQ5D-VAS= 77, 82, 82.5. Functional group's preoperative, 26 and 52 week scores respectively: Mean MOxFQ= 71.87, 37.75, 23. Mean EQ5D-TTO 0.26, 0.63, 0.76. EQ5D-VAS 53, 80, 88. This trend of improvement in PROMs was not reflected in patient satisfaction scores. 75% of respondents in the functional group reported dissatisfaction at 26 weeks versus no dissatisfaction in the mechanical group. We should consider counselling patients accordingly when offering surgery.
The concept of stainless steel dual mobility cups in total hip arthroplasty has demonstrated very low long-term instability rates and a 98% survival rate after 12 years. We systematically implanted titanium alloy acetabular cups during a one year period. The purpose of our retrospective study was to report the 18-year
Arthritis of the mid-foot is a common presentation to the foot and ankle clinic, resulting from primary (idiopathic), post-traumatic, or inflammatory joint degeneration. Treatment in the initial stages is conservative, with midfoot fusion regarded as the operative treatment of choice; however there is a paucity of comparative and patient reported data regarding outcomes. Patient reported outcome measures (PROMS), were prospectively collected from October-2015 to March-2018. Diagnoses were confirmed with image guided injection and initial management was conservative. In total, 66 patients were managed conservatively and 40 treated with mid-foot fusion. MOxFQ (Manchester Oxford Foot Questionnaire) and EQ-5D-3L (Euroqual) PROMS were collected pre-operatively, at 26 weeks and at 52 weeks. In the operatively managed group, the female:male ratio was 5.7:1, with a mean age of 61 (range 24–80), while in the conservatively managed group, the ratio was 2.1:1 with mean age 63 (range 29–86). In the surgically managed group, 88.2% of patients reported improvement in symptoms at 26 weeks and 88.9% at 52 weeks. This was greater than the conservatively managed group, in which 40.6% reported improvement at 26 weeks and 33.3% at 52 weeks. Mean MOxFQ improvement in the surgically managed group was +30.7 and +33.9 at 26 and 52 weeks respectively, and in the conservative group, +9.4 and +4.3, at 26 and 52 weeks. Similarly, favourable surgical outcomes were reported across all domains of EQ-5D-3L. This study has highlighted excellent early outcomes after surgical treatment and may represent promise for those patients for whom conservative management fails.
We report the functional and socioeconomic long-term
outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre
between 1973 and 1990 with multiple blunt orthopaedic injuries including
an injury to the pelvic ring, with an Injury Severity Score (ISS)
of ≥ 16. These patients were invited for clinical review at a minimum
of ten years after the initial injury, at which point functional
results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior
(group P) and 43 combined anterior/posterior pelvic ring injuries
(group A/P) were included. The mean age of the patients at injury
was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for
the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score
for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42),
being significantly worse compared with the other two groups (p =
0.004 and p = 0.024, respectively). A total of 42 patients (39%)
had a limp and 12 (11%) required crutches. Car or public transport
usage was restricted in 16 patients (15%). Overall patients in groups
P and A/P had a worse outcome. The long-term outcome of patients
with posterior or combined anterior/posterior pelvic ring injuries
is poorer than of those with an isolated anterior injury. Cite this article:
This study aimed to evaluate the effect of clavicular shortening, measured by three-dimensional computerized tomography (3DCT), on functional outcomes and satisfaction in patients with healed, displaced, midshaft clavicle fractures up to one year following injury. The data used in this study were collected as part of a multicenter, prospective randomized control trial comparing open reduction and plate fixation with nonoperative treatment for displaced midshaft clavicle factures. Patients who were randomized to nonoperative treatment and who had healed by one year were included. Clavicle shortening relative to the uninjured contralateral clavicle was measured on 3DCT. Outcome analysis was conducted at six weeks, three months, six months and one year following injury and included the Disabilities of the Arm, Shoulder and Hand (DASH), Constant and Short Form-12 (SF-12) scores, and patient satisfaction. 48 patients were included. The mean shortening of injured clavicles, relative to the contralateral side, was 11mm (+/− 7.6mm) with a mean proportional shortening of 8percnt;. Proportional shortening did not significantly correlate with the DASH (p>0.42), Constant (p>0.32) or SF-12 (p>0.08) scores at any time point. There was no significant difference in the mean DASH or Constant scores at any followup time point both when the cut off for shortening was defined as one centimeter (p>0.11) or two centimeters (p>0.35). There was no significant difference in clavicle shortening between satisfied and unsatisfied patients (p>0.49). This study demonstrated no association between shortening and functional outcome or satisfaction in patients with healed, displaced, midshaft clavicle fractures up to one year following injury.
