The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment. Between October 2008 and July 2016, 14 patients with failed osteosynthesis of an atypical subtrochanteric femoral fracture were treated with a blade plate (atypical group). Their mean age was 67.8 years (60 to 74); all were female. During the same period, 21 patients with failed osteosynthesis of a typical subtrochanteric fracture underwent restabilization using a blade plate (typical group). Outcome variables included the time of union, postoperative complications, Harris Hip Score, and Sanders functional rating scale.Aims
Patients and Methods
The aim of this study was to compare the functional and radiological
outcomes in patients with a displaced fracture of the hip who were
treated with a cemented or a cementless femoral stem. A four-year follow-up of a randomized controlled study included
141 patients who underwent surgery for a displaced femoral neck
fracture. Patients were randomized to receive either a cemented
(n = 67) or a cementless (n = 74) stem at hemiarthroplasty (HA;
n = 83) or total hip arthroplasty (THA; n = 58).Aims
Patients and Methods
We describe a method of intertrochanteric osteotomy with posterior rotation of the femoral head and neck. We analysed 45 hips in 44 children and adolescents aged from six to 18 years with residual dysplasia after conservative (35) and
The aim of this study was to evaluate antegrade autologous bone
grafting with the preservation of articular cartilage in the treatment
of symptomatic osteochondral lesions of the talus with subchondral
cysts. The study involved seven men and five women; their mean age was
35.9 years (14 to 70). All lesions included full-thickness articular
cartilage extending through subchondral bone and were associated
with subchondral cysts. Medial lesions were exposed through an oblique
medial malleolar osteotomy, and one lateral lesion was exposed by
expanding an anterolateral arthroscopic portal. After refreshing
the subchondral cyst, it was grafted with autologous cancellous
bone from the distal tibial metaphysis. The fragments of cartilage
were fixed with 5-0 nylon sutures to the surrounding cartilage.
Function was assessed at a mean follow-up of 25.3 months (15 to
50), using the American Orthopaedic Foot and Ankle Society (AOFAS)
ankle-hindfoot outcome score. The radiological outcome was assessed
using MRI and CT scans.Aims
Patients and Methods
The aim of this study was to record the incidence of post-traumatic
osteoarthritis (OA), the need for total hip arthroplasty (THA),
and patient-reported outcome measures (PROMS) after surgery for
a fracture of the acetabulum, in our centre. All patients who underwent surgery for an acetabular fracture
between 2004 and 2014 were included. Patients completed the 36-Item
Short Form Health Survey (SF-36) and the modified Harris Hip Score
(mHHS) questionnaires. A retrospective chart and radiographic review
was performed on all patients. CT scans were used to assess the classification
of the fracture and the quality of reduction.Aims
Patients and Methods
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
In patients where the proximal femur shows gross deformity due
to degenerative changes or fracture, the contralateral femur is
often used to perform preoperative templating for hip arthroplasty.
However, femurs may not be symmetrical: the aim of this study was
to determine the degree of variation between hips in healthy individuals and
to determine whether it is affected by demographic parameters. CT-scan based modelling was used to examine the pelvis and bilateral
femurs of 345 patients (211 males, 134 women; mean age 62 years
(standard deviation (Aims
Materials and Methods
Displaced fractures of the lateral condyle of the humerus are
frequently managed surgically with the aim of avoiding nonunion,
malunion, disturbances of growth and later arthritis. The ideal
method of fixation is however not known, and treatment varies between
surgeons and hospitals. The aim of this study was to compare the
outcome of two well-established forms of surgical treatment, Kirschner
wire (K-wire) and screw fixation. A retrospective cohort study of children who underwent surgical
treatment for a fracture of the lateral condyle of the humerus between
January 2005 and December 2014 at two centres was undertaken. Pre,
intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean
age at the time of injury was 5.8 years (0 to 15) with a male:female
patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture
and the fracture was displaced by > 2 mm in 228 (68%). In all, 235
patients underwent K-wire fixation and 101 had screw fixation. Aims
Patients and Methods
The aim of this study was to test the null hypothesis that there
is no difference, from the payer perspective, in the cost of treatment
of a distal radial fracture in an elderly patient, aged >
65 years,
between open reduction and internal fixation (ORIF) and closed reduction (CR). Data relating to the treatment of these injuries in the elderly
between January 2007 and December 2015 were extracted using the
Humana and Medicare Advantage Databases. The primary outcome of
interest was the cost associated with treatment. Secondary analysis included
the cost of common complications. Statistical analysis was performed
using a non-parametric Aims
Materials and Methods
To evaluate the effectiveness of an institutionally developed
algorithm for evaluation and diagnosis of prosthetic joint injection
and to determine the impact of this protocol on overall hospital
re-admissions.p We retrospectively evaluated 2685 total hip arthroplasty (THA)
and total knee arthroplasty (TKA) patients prior to (1263) and following
(1422) the introduction of an infection detection protocol. The
protocol used conservative thresholds for C-reactive protein to
direct the medical attendant to aspirate the joint. The protocol
incorporated a clear set of laboratory and clinical criteria that
allowed a patient to be discharged home if all were met. Patients were
included if they presented to our emergency department within 120
days post-operatively with concerns for swelling, pain or infection
and were excluded if they had an unambiguous infection or if their
chief complaint was non-orthopaedic in nature.Aims
Patients and Methods
The posterior malleolus component of a fracture
of the ankle is important, yet often overlooked. Pre-operative CT scans
to identify and classify the pattern of the fracture are not used
enough. Posterior malleolus fractures are not difficult to fix.
After reduction and fixation of the posterior malleolus, the articular
surface of the tibia is restored; the fibula is out to length; the
syndesmosis is more stable and the patient can rehabilitate faster.
There is therefore considerable merit in fixing most posterior malleolus
fractures. An early post-operative CT scan to ensure that accurate
reduction has been achieved should also be considered. Cite this article:
The aim of this study was to analyse the effect of altered viewing
perspectives on the measurement of the glenopolar angle (GPA) and
the differences between these measurements made on 3D CT reconstructions
and anteroposterior (AP) scapular view radiographs. The influence of the viewing perspective on the GPA was assessed,
as were the differences in the measurements of the GPA between 3D
CT reconstructions and AP scapular view radiographs in 68 cadaveric
scapulae.Aims
Materials and Methods
The aims of this study were to analyse the long-term outcome
of vascularised fibular graft (VFG) reconstruction after tumour
resection and to evaluate the usefulness of the method. We retrospectively reviewed 49 patients who had undergone resection
of a sarcoma and reconstruction using a VFG between 1988 and 2015.
Their mean follow-up was 98 months (5 to 317). Reconstruction was
with an osteochondral graft (n = 13), intercalary graft (n = 12),
inlay graft (n = 4), or resection arthrodesis (n = 20). We analysed
the oncological and functional outcome, and the rate of bony union
and complications.Aims
Patients and Methods