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: Bone Joint J 2013;95-B:548–53

Introduction. Total femur implantation is a rare and challenging procedure in final revision surgery of hip and knee arthroplasties. Reports of this operation technique are even rare in literature. In this study we retrospectively analyse our patients with total femur implants. Material and Methods. Between October 2002 and February 2009 we implanted 27 total femurs in hip and knee revision surgery cases. We used the modular prosthesis system–Megasystem C® by Waldemar Link–in all cases. Our 22 female and 5 male patients had a mean age of 76 years (range 45–88). Indications for the procedure were loosening of megaprosthesis of the hip in 12 cases; 2 with massive distal migration, 1 with penetration into the knee joint and 1 after two step revision procedure. In 13 cases a periprosthetic indicated a total femur implanatation due to massive bone loss; 1 breakage of a long femoral stem, 5 fracture of osteosynthesis materials, 3 after prosthesis revisions and 1 pseudoarhrosis of femur and tibia after knee arthroplasty. We analysed perioperative complications, clinical status and result and further revision within follow up time. Results. We were able to examine 16 patients at follow up time. Eight patients were lost to follow up and 2 have been died; 1 after fulminant pulmonal embolia after operation and 1 four years postoperatively. One total femur had to be exchanged due to infection after 1 year. Perioperative complications occurred as follows: 1 massive blood transfusion, 1 peroneal palsy, 1 ulcus ventriculis bleeding, 1 thrombosis of vena suclavia and vena jugularis, 1 sigmaresection due to diverticulosis, 1 luxations of the hip, and 2 wound necrosis. In 3 caese a revision operation swas performed; 1multiple luxtion of the hip and due to infection of the total femur implant. The range of motion of the hip was 85 degrees (range 30–90) and knee 92 degrees (range 30–110). In nearly all cases we found a lengthening of the revised limb. The general outcome of the patients was. Ten patient were very satisfied, 2 statisfied and 2 fair due to pain persistence. Two patient were mobile with one crutch, 3 used two crutches and one was able to walk with a rollator. One patient was unable to walk due to diplegia after spine fracture. Conclusion. Total femur procedure in final revision arthroplasty has a high potential of perioperative risks but has shown good clinical and mobility results in our patient group. With the Megasystem C® by Link we had a save and good performance while operation of this difficult patient group

Aims

The aim of this study was to assess the safety and clinical outcome of patients with a femoral shaft fracture and a previous complex post-traumatic femoral malunion who were treated with a clamshell osteotomy and fixation with an intramedullary nail (IMN).

Aims

Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In a single-screw nail, a tip-apex distance (TAD) greater than 25 mm has been associated with an increased risk of cut-out. The aim of the study was to examine the role of TAD as a risk factor in a cephalic double-screw nail.

Aims

The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures.

In a prospective, randomised trial of 81 patients with fractures of the ankle of AO types A, B and C we compared two regimes of postoperative management after internal fixation. The patients were mobilised either non-weight-bearing with crutches or weight-bearing in a below-knee walking plaster. We found a temporary benefit in subjective evaluation only (65 v 50 points, Mann-Whitney test, cft, p = 0.02) for those with a below-knee walking plaster. There were no significant differences between the groups in the loaded dorsal range of movement (25° v 23°, Mann-Whitney test, cft, p = 0.16) or in the overall clinical result. Both treatments were considered to be satisfactory and their choice depends on the ability to mobilise non-weight-bearing, wound healing, the type of work and personal preference

Background. The aim of the study was to assess the outcome of internal fixation using two ordinary plates with autogenous bone grafting in the management of non-union of femoral shaft fractures over a period of eleven years. Method. A retrospective study of double plating and autogenous bone grafting for un-united femoral shaft fractures performed by the two Senior Authors between 1996 and 2007. During this period, twenty-one cases were carried out. Details of preoperative, intra-operative, and postoperative findings were assessed. Postoperative follow up was recorded over a period of minimum two years. The procedure was performed using two ordinary plates; a broad lateral and narrow anterior plates. Autogenous cancellous grafts from iliac crest were used in all of the cases, and in some, half fibulas were inserted through the medullary canal of the femur. Results. A total of twenty-one patients were included in the study. All of them received previous treatment. The primary treatment was by intramedullary nailing in thirteen patients, uni-plating in four, external fixator in three, and traction in one. The average age was 32 (range from 16 to 52). The average interval between the initial fracture and the treatment of the non-unions was 13 months (range from 6 to 28 months). All wounds, both at fracture site and the graft donor site, healed primarily except one. That was at an iliac crest graft donor site, where superficial infection occurred, and was treated with antibiotics and healed 6 weeks later. All patients achieved union on an average of 16 weeks (range from 12 to 28 weeks). There has been no failure in implants. The average lower limb shortening was 0.75 cm (range from 0.5 to 1.0 cm). No one requested shoe raise. All the patients regained the preoperative range of motion at the hip and knee joints except four, who had limited flexion to 100 degrees. Conclusion. We conclude that double plating with autogenous bone grafting is not only a convenient method to treat non-union of femoral shaft fractures as it requires minimal instrumentation and equipment, but it should also be considered as a safe and accepted treatment method as postoperatively patients can be discharged early on crutches, with a high success rate. It is less expensive, an important consideration in developing countries

INTRODUCTION. Limb salvage surgery is a common treatment for patients who suffer from bone tumors. In the case of pelvic tumors this creates a challenge for the surgeon and the treatment remains controversial because the oncologic complications like local recurrence, dissemination and orthopaedic ones, like infection, haemorrhage, and mechanical problems of reconstructions Tumors affecting the acetabulum are a challenge for the surgeon because of the impact in the function of the extremity. There are many reconstruction techniques described in the literature like prosthesis, allograft systems, arthrodesis, etc…, but still there is not a gold standard due to the poor functional results at long term follow up, and the associated complications of all techniques. In this study we show the experience in our center on pelvic reconstructions after tumors affecting the acetabulum area (zone II). MATERIAL AND METHODS. We surgically treated 81 pelvic tumors from 1997 to 2009 following the Enneking and Dunham calssification attending to the localization of the tumor: Zone I 38 (iliac bone)Zone II 25 (acetabulum)Zone III 18 (pelvic branches)In zone II tumors we performed pelvic reconstruction in eight cases, with different type of prosthesis. In 5 cases we performed saddle prosthesis (group A) and in 3 cases we performed Coned-Stanmore Implants type prosthesis with sacro-iliac anchorage. The mean follow up of the serie was 3,5 years (1–6 years). In group A the mean follow up was 5 years and in group A and in group B the mean follow up was 1 year due to the recent implantation in our center of Coned type prosthesis for pelvic reconstruction. We evaluated our results with these two types of prosthesis. RESULTS. Oncologic: group A we had a local recurrence of 25% and 25% of the patients died. group B we had no cases of local or systemic recurrence and we didn't registered any death. Functional: In group A the patients showed local pain and difficulty to walk probably due to the change of the center of rotation of the hip and instability of the saddle prosthesis. In group B all patient's followed physical therapy programs without problems and were able to walk with crutches ten months after surgery. Complications:group A we had a 25% of perioperative infection and a 25% of dislocation of the prosthesis. In group B we did not have any of these complications. CONCLUSIONS. Saddle prosthesis mantain the length of the extremity and allow weight bearing but they do not give a good stability. Even if we only have one year follow up with this Coned prosthesis with sacro iliac anchorage we achieved much better functional results and a lower rate of complications

INTRODUCTION. Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery. METHODS. Fifty consecutive patients who underwent first metatarsal corrective osteotomy from January 2009 to July 2010 were reviewed. The operation type, foot side operated, postoperative complications and other conditions affecting driving were recorded from charts and operation notes. A telephonic survey was then conducted and information was recorded in a predesigned questionnaire. The questions included driving advice given by the medical staff, time interval to begin driving postoperatively, and how long the patient took to gain full confidence at driving. It was also noted whether patients required changing the type of car from manual to automatic. RESULTS. Of 50 patients, 10 never drove and were excluded. One patient had expired from unrelated health conditions. Two discontinued driving after surgery due to other (social) reasons, and one could not be contacted. The remaining thirty-six patients were analyzed. The mean age was 56.8+/-9.8 years with range of 36–74 years. Most were females (n=33, 91.7%), and the right side was operated upon in 17 (44.4%) patients. SCARF osteotomy was performed in 19 (52.8%) patients, basal osteotomy in 5 (13.9%), chevron osteotomy in 5 (13.9%) and other procedures (bunionectomy, Akin, soft tissue correction etc) were done in 7 (19.4%) patients. Out of the 28 patients driving manual cars, one required changing to automatic vehicle. The average post-operative period when patients resumed driving was 8.6 weeks with a range of 4 to 16 weeks. After SCARF, this average was 8.3 weeks (range 6–16), which was against 7.6(range 6–16) and 7.8 (range 4–12) weeks after basal and chevron procedures respectively (p=0.408). The mean period when patients reported comfortable foot control was 1.06 weeks after they had begun to drive for all groups. With SCARF this was 1.3 weeks, and 1.4 and 2.2 for basal and chevron groups respectively (p=0.162). Of the two patients that resumed driving after 16 weeks, one had infection and swelling of the foot postoperatively and the other had bilateral basal osteotomy performed simultaneously and was on crutches for 16 weeks. CONCLUSION. The mean time to resumption of automobile driving after corrective Hallux Valgus surgery is 8.6 weeks, and, on average patients takes another week to attain full confidence and comfort at driving postoperatively. There is no statistically significant difference between the types of surgery performed

Aims

Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS).

Aims

To compare the cost-utility of standard dressing with incisional negative-pressure wound therapy (iNPWT) in adults with closed surgical wounds associated with major trauma to the lower limbs.

Aims

In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia.

Aims

Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses.

Aims

Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone.

Aims

To compare the outcomes for trochanteric fractures treated with a sliding hip screw (SHS) or a cephalomedullary nail.

Aims

This study assessed the association of classes of body mass index in kg/m² (classified as normal weight 18.5 kg/m² to 24.9 kg/m², overweight 25.0 kg/m² to 29.9 kg/m², and obese ≥ 30.0 kg/m²) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures.

We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery.

At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p < 0.001). The functional outcome, as assessed by the Harris Hip score, was better in patients aged < 45 years compared with those aged > 45 years (p < 0.001).

These findings suggest that further fixation using two cannulated compression screws and a vascularised iliac crest bone graft is an effective salvage treatment in patients aged <  45 years, in whom osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.

Cite this article: Bone Joint J 2015; 97-B:988–91.

Aims

This is a prospective randomised study which compares the radiological and functional outcomes of ring and rail fixators in patients with an infected gap (> 3 cm) nonunion of the tibia.

Aims

The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures.

Conventional methods of treating ankle fractures in the elderly are associated with high rates of complication. We describe the results of treating these injuries in 48 frail elderly patients with a long calcaneotalotibial nail.

The mean age of the group was 82 years (61 to 96) and 41 (85%) were women. All were frail, with multiple medical comorbidities and their mean American Society of Anaesthesiologists score was 3 (3 to 4). None could walk independently before their operation. All the fractures were displaced and unstable; the majority (94%, 45 of 48) were low-energy injuries and 40% (19 of 48) were open.

The overall mortality at six months was 35%. Of the surviving patients, 90% returned to their pre-injury level of function. The mean pre- and post-operative Olerud and Molander questionnaire scores were 62 and 57 respectively. Complications included superficial infection (4%, two of 48); deep infection (2%, one of 48); a broken or loose distal locking screw (6%, three of 48); valgus malunion (4%, two of 48); and one below-knee amputation following an unsuccessful vascular operation. There were no cases of nonunion, nail breakage or peri-prosthetic fracture.

A calcaneotalotibial nail is an excellent device for treating an unstable fracture of the ankle in the frail elderly patient. It allows the patient to mobilise immediately and minimises the risk of bone or wound problems. A long nail which crosses the isthmus of the tibia avoids the risk of peri-prosthetic fracture associated with shorter devices.

Cite this article: Bone Joint J 2014; 96-B:817–22.