Functional outcomes of conservatively managed, valgus impacted proximal humeral fractures are poor. Operative fixation can improve results but can be technically challenging. We prospectively assessed outcomes following fixation of valgus unstable proximal humeral fractures with a novel hybrid fixed angle blade plate, at a minimum of 12 months follow up. A new hybrid fixed angle blade plate design (Fx Plate, Exactech, Gainesville, USA) was used by the senior author to treat patients with displaced and potentially valgus unstable proximal humeral fractures, at our institution between November 2012 and March 2014. The study was approved by the research and development department. Outcomes were prospectively assessed using the Oxford and Constant shoulder scores and quality of life was assessed using the SF-36 questionnaire. Radiographs were taken at regular intervals to assess fracture healing.Background
Methods
Prospectively assess the degree of finger swelling after shoulder arthroscopy, to determine whether rings should be routinely removed prior to surgery. Patients undergoing shoulder arthroscopic procedures had finger diameters measured prior and post surgery, over a three month period. The study was approved by our Research and Development department. Measurements were taken using a finger circumference gauge (Southpointe, Florida, USA) and were all performed by one researcher in a standard technique, to eliminate inter observer variability. Control measurement, using the contralateral hand, were taken. Statistical analysis was performed, using the Mann Whitney U test. 31 patients undergoing shoulder arthroscopy were included in the study and had finger diameters assessed. The median amount of finger swelling on the operated side was 2.8 mm (IQR 4.6) per digit, compared to 0 mm on the contralateral side (IQR 1.6), which was significantly greater (p=0.0003). There was no statistical difference in the amount of finger swelling when patients undergoing short procedures (less than 30 minutes operating time) were compared to patients undergoing long procedures (greater than 60 minutes).Aim
Method and Results
To evaluate the correlation between the clinical Kirk Watson test and arthroscopic Geissler classification in scapholunate instability. All patients undergoing wrist arthroscopy between April 2006 and April 2010 were evaluated. Patients were included in the study if they had a Kirk Watson test and a wrist arthroscopy with an assessment of the stability of the scapholunate joint using the Geissler classification. Patients who had a Kirk Watson test performed with subsequent normal scapholunate joint at arthroscopy were included as a control group. Geissler grades 1 and 2 and grades 3 and 4 were grouped for further analysis into low and high grade instability groups respectively.Aim
Methods
It has been postulated that a mild clubfoot does better than a severe clubfoot no matter what treatment course is taken. There have been previous efforts to classify clubfoot. For units worldwide that use the Ponseti Method of clubfoot management, the Pirani scoring system is widely used. This scoring system has previously been shown to predict the number of plasters required to gain correction. Our study aimed to investigate whether the Pirani score gave an indication of longer-term outcome using tibialis anterior tendon transfer as an endpoint. A prospectively collated database was used to identify all patients treated in the Ponseti clinic at the Royal Manchester Children's Hospital between 2002 and 2005 with idiopathic clubfoot who had not received any treatment prior to their referral. Rate of tibialis tendon transfer as well as the patient's presenting Pirani score were noted. Feet were grouped for analytical purposes into a mild clubfoot (Pirani score <4) and a severe clubfoot (Pirani score 4) category depending on initial examination. Clinic records were reviewed retrospectively to identify patients who were poorly compliant at wearing boots and bars and were categorised into having “good” or “bad” compliance with orthosis use.Introduction
Methods
Progressive arthritis can occur in association with massive tears of the rotator cuff. Altered joint kinematics are commonly proposed as the principle causative factor but this does not explain the absence of arthropathy in some patients. We have investigated the role of the
Cuff Tear Arthropathy is characterised by massive rotator cuff tears, glenohumeral joint destruction and joint effusions containing basic calcium phosphate and calcium pyrophosphate dihydrate crystals. We have investigated the role of the ANKH gene in patients with cuff tear arthropathy and the effect of mutations on protein function. The transmembrane protein ANKH transports inorganic pyrophosphate (PPi) from the intracellular to extracellular space. Control of the extracellular levels of PPi is crucial in preventing calcium crystal formation. Genomic DNA was prepared from peripheral blood leucocytes from 22 patients with cuff tear arthropathy diagnosed clinically and radiologically. All 12 exons and exon-intron boundaries from the ANKH gene were PCR amplified and sequenced with BigDye version 3.1 terminator kit (ABI), and analysed using ABI PRISM ® 3100 Genetic Analyser. ANKH complementary DNA (cDNA) was ligated with mammalian expression vector pcDNA3 and site directed mutagenesis was used to make the ANKH mutation detected in the cases. Human articular chondrocytes were transfected with the cDNA variants and PPi concentrations measured. A G-to-A single nucleotide polymorphism in the 3′ untranslated region (3′UTR) of ANKH was identified. The G/A genotype was seen more frequently in the cases (45%) when compared to controls (20%) (p= 0.0008). We observed altered levels of extracellular PPi in human chondrocytes transfected with ANKH cDNA with the 3′ UTR variant when compared with control cells and normal ANKH cDNA. Cuff Tear Arthropathy appears to be heritable via a G-to-A transition in the 3′UTR of ANKH that alters extracellular PPi concentrations in chondrocyte cells. This supports a hypothesis of a primary crystal mediated arthropathy in patients with Cuff Tear Arthropathy.
