Sclerostin is a negative regulator of osteoblast differentiation and bone formation, probably through inhibition of the Wnt pathway. Distraction osteogenesis (DO) can be complicated by osteopenia and poor anabolic response, which may benefit from anabolic therapy. Sclerostin antibody (Scl-Ab) has been reported to stimulate bone formation and restore bone mass and strength in aged ovariectomised rats as well as to enhance fracture healing. We sought to examine the effects of Scl-Ab in a rat model of DO.

A femoral osteotomy was stabilised with an EBI fixator in male Sprague Dawley rats, with distraction of 0.25mm twice daily to a total 7mm. Saline or Scl-Ab was administered twice weekly throughout distraction and/or up to 4 or 6 weeks post-commencement of distraction. Three groups were examined, Saline, Delayed Scl-Ab (D Scl-Ab, post distraction only) and Continuous Scl-Ab (Cont Scl-Ab).

Radiographs demonstrated a trend for increased union rates with Scl-Ab at 6 weeks, with 50% of animals for D Scl-Ab or Cont Scl-Ab versus 20% of control animals. DEXA scans at 2 weeks revealed a 63% increase in regenerate BMD in the Cont Scl-Ab group (p< 0.01) and a 41% increase in the D Scl-Ab group (p< 0.05), compared to Saline. In addition, an increase of 116% in BMC was seen in the Cont Scl-Ab group (p< 0.01). At 6 weeks regenerate bone area was increased 18% in D Scl-Ab and 23% in Cont Scl-Ab. μCT scans of the regenerate revealed an 85%-89% increase in bone volume with Scl-Ab treatment at 6 weeks (p< 0.05). Bone volume ratio (BV/TV) was increased 77%-82% (p< 0.05).

Scl-Ab treatment enhanced the amount of bone formed in this distraction model, when given throughout or post-distraction. Histological assessment of dynamic bone formation parameters will reveal the mechanism behind the enhanced repair, and its mechanical consequences will be examined.

Background

70% of breast cancer patients develop metastatic bone deposits, predominantly spinal metasases. Adult Mesenchymal Stem Cells (MSCs) are multiprogenitor stem cells found within the bone marow which have the ability to self-renew and differentiate into multiple cell types. MSCs home specifically to tumour sites, highlighting their potential as delivery vehicles for therapeutic agents. However studies show they may also increase tumour metastatic potential.

The distal femur fracture is a difficult injury that affects young men andelderly women. The tissue stripping that occurs with the traditional approach has been a factor in the development of complications like infection and nonunion. This study addresses the issue of minimally invasive approach. Does the LISS system really improve the results of such fracture?

Fifty-two patients were included in the trial from six academic trauma centres. Twenty-eight fractures had been randomised to be fixed with the LISS device, while twenty-four had the DCS implant. Type C3 fractures were excluded as they were not amenable for fixation with DCS system. All procedures were performed via minimally invasive technique. The LISS system had the targeter that helped with plate insertion and distal diaphyseal screws placement. Radiography was utilised in the case of the DCS distal screws insertion.

All fractures went onto union, except two participants in LISS group who had to be revised due to loss of reduction, in the early post-operative peroid. There were three nonunions in the same group. These required a re-operation. Further more, a LISS participant who had re-injured his distal femur (unrelated to LISS plate), was fixed with different implant. There was a single nonunion with the DCS group that needed revision surgery. There was one participant from each group who had drifted into varus. Neither required a re-operation. This translated into a 21% re-operation rate in the LISS system compared to 4% with the DCS device.

Our data supports the use of the DCS system in the fixation of distal femur fractures (except Type C3} via a minimally invasive approach. The LISS implant seems to be technique dependent. In our centre, the LISS plate had been discontinued in favour of the DCP and LCP systems.

Hypothesis

Lumbar spinal stenosis (LSS) is diagnosed by a history of claudication, clinical investigation, cross-sectional area (CSA) of the dural sac on MRI or CT, and walking distance on the treadmill test. As radiological findings do not always correlate with clinical symptoms, additional diagnostic signs are needed. In patients without LSS, we observe the sedimentation of lumbar nerve roots to the dorsal part of the dural sac on supine MRI scans. In patients with LSS, this sedimentation is rarely seen. We named this phenomenon ‘sedimentation sign’ and defined the absence of sedimenting nerve roots as positive sedimentation sign for the diagnosis of LSS. We hypothesised that the new sedimentation sign discriminates between non-specific low back pain (LBP) and LSS.

Background

Labral tears are now recognised as a common pathology especially in young adults. With advancement of arthroscopic techniques, most recent published literature is focused on short- or mid-term results of labral repair or re-fixation. There is limited data regarding long-term results of labral debridement and effect of co-existing pathology on outcomes. We investigated long-term results after arthroscopic labral debridement, the predictors of outcomes and correlation with any co-existing hip pathology.

Introduction

Evaluating the success of a treatment has changed. Currently, the emphasis is on patient-rated outcome scores rather than surgeon recording of outcome measures. Functional outcome and patient satisfaction following Dupuytren's disease surgery is poorly quantified in the literature. This study aimed to assess subjective patient hand function, disability and satisfaction using a PEM score and its correlation with residual contracture.

Introduction and Aims: While clinical variables are considered important risk factors for post-arthroplasty VTE, the role of common genetic thrombophilic factors is less clear. The aims of this study were to determine if common thrombophilic genetic polymorphisms are independent risk factors for VTE post-arthroplasty; and if clinical variables are equally or more important.

Method: A prospective study of consecutive patients undergoing elective total hip or knee arthroplasty at a single institution, involving two surgeons. Patients were interviewed to assess clinical risks. Pre-operative blood samples were taken for Factor V Leiden (FVL), Pro-thrombin G20210A (PTH) and Methylenetetrahydrofolate reductase C677T (MTHFR) testing. All patients received routine enoxaparin prophylaxis and compression stockings. Intermittent pneumatic calf compression was also used by one surgeon. Presence of DVT was assessed using bilateral lower limb duplex ultrasonography (seven ± two days post-operatively) in all patients and performed in a vascular laboratory. Symptoms suggestive of pulmonary embolism were investigated by ventilation/perfusion lung scanning.

Results: A total of 569 patients were recruited with a median age of 67 years (range 20–90). Osteoarthritis was the main surgical indication. The overall incidence of post-operative venous thromboembolism (VTE) was 26%. Of thromboembolic events, 15% VTE were proximal DVT; 84% VTE were distal DVT and only one percent were pulmonary emboli. Prevalence of the thrombophilic genotypes was: 4.6% (heterozygous FVL mutation); 2.1% (heterozygous PTH); and 10.4% (homozygous C677T MTHFR mutation). Using univariate analysis, older age (p < 0.0005), total knee arthroplasty (p < 0.0005), recent surgery (p = 0.002), general anaesthesia (p = 0.013), operation time in minutes (p < 0.0005) and use of blood transfusions (p < 0.0005) were significantly associated with post-operative DVT. None of the thrombophilic genotypes were found to be significantly associated with post-operative DVT, however the frequency of FVL and PTH was highest in patients with proximal DVT and total hip arthroplasty patients with DVT. In multivariate analysis of both genetic and clinical thrombophilic factors, only age (p=0.02) and total knee arthroplasty (p< 0.0005) were found to be significant independent risk factors for post-operative VTE.

Conclusion: We conclude that clinical factors such as age and type of surgery (total knee arthroplasty) are independent risks for post-operative VTE in patients undergoing lower limb arthroplasty. FVL, PTH and MTHFR are not significant risk factors for post-operative VTE and screening for these mutations is not indicated.