The Taylor Spatial Frame (TSF) is an hexapod external ring fixation system that can move with six degrees of freedom to correct complex limb deformities. The lengths of the struts between the rings are independently adjusted to correct the deformity. The struts form an acute and obtuse “ring-strut” angle with the ring with the sum of these angles totalling 180°. In the course of a correction schedule a strut may need to be exchanged for one of longer or shorter length. The manufacturer's instructions direct that a temporary seventh strut can be placed in any orientation to ensure stability during the exchange. We have noted several episodes of temporary frame instability during this procedure resulting in discomfort. The aim of this study was to investigate which temporary strut positions gave maximal stability. A TSF frame was constructed in a neutral alignment with a neutral strut height of 130mm. Strut 1 (red) was identified for exchange. There were 169 theoretical placement options for the temporary strut that were sequentially tested. Fast-FX™ struts were used. Strut 1 was released and the shortening that occurred was recorded using the strut length gauge. Shortening of over 10mm was considered grossly unstable.Introduction
Methods
There is increasing interest in the use of Total Hip Replacement (THR) for reconstruction in patients who have suffered displaced intracapsular hip fractures. Patient selection is important for good outcomes but criteria have only recently been clearly defined in the form of national guidelines. This study aims to investigate patient reported outcomes and satisfaction after Total Hip Replacement (THR) undertaken for displaced hip fractures and to compare these with a matched cohort of patients undergoing contemporaneous THR for osteoarthritis in order to assess the safety and effectiveness of national clinical guidelines. 100 patients were selected for treatment of displaced hip fractures using THR between 1 January 2007 and 31 December 2009. These patients were selected using national guidelines and were matched for age and gender with 300 patients who underwent contemporaneous THR as an elective procedure for osteoarthritis.Background
Methods
Osteoarthritis continues to be a major cause of pain and disability. The pathological processes leading to the end-stage of joint degeneration remain poorly understood. Advances in radiological imaging have the potential to improve understanding of the structural and functional changes observed in OA. The aim of this study was to describe the microarchitecture of the femoral head in osteoarthritis. Twenty osteoarthritic femoral heads underwent micro-computed tomography scanning at 30µm. Four parameters of micro-architecture and structure were determined: bone volume ratio (BV:TV), trabecular thickness, structural model index and degree of anisotropy. The femoral head was divided into 27 cubic volumes of interest. Analysis of variance (ANOVA) was used to assess differences between regions. Cystic and sclerotic changes were assessed qualitatively.Introduction
Methods
The association of occupation and carpal tunnel syndrome (CTS) is unclear. Population based studies have failed to prove causal relationships between certain types of work and the onset of CTS. The aim of this study was to compare the incidence of CTS with the underlying regional occupational profile and assess differences in disease severity. The study took place from 2004 to 2010 in a regional hand unit that was the sole provider of hand services to a health board. Occupation was classified according to the SOC2000 classification as published by the Office for National Statistics and compared with the National Census 2000 statistics. 1564 patients were diagnosed with CTS during the study period of which 852 were aged 16 to 74, in full time employment.Introduction
Methods
The aim of this study was to compare the long-term outcome from total knee replacement (TKR) in young versus old patients in terms of pain and functional outcome. We used our arthroplasty database, which recorded prospectively pain and American Knee Society scores at regular intervals over ten years after TKR. The procedures used a modern, cemented resurfacing type cruciate retaining prosthesis. A cohort of young patients (≤55 years) was identified. A control group of patients ≥ 56 was identified, matching for ASA, body mass index and underlying condition. Change over time was analysed using a factorial repeated measures ANOVA test, which allowed for investigation of difference between groups. 40 Knees in 26 patients were identified. 2 patients died prior to follow up, 2 were revised within the study period (1 for infection at 2 years and one for change of poly at 7 years) and a further 4 were lost to follow up. 7 knees could not be matched and were excluded. This left a study group of 24 young and 24 older knees. Pain scores (p=0.025) and American Knee Society “Knee” (p<0.001) and “Function” (p<0.001) scores changed significantly over time. There were however no statistical differences over the 10-year period in pain (p=0.436) and knee performance (0.618) but overall function was higher throughout the period in the younger group (=0.004). We conclude that Knee replacement in younger patients produces similar outcomes in terms of pain and function compared with older patients and TKR should not be withheld purely on account of age.
