1. The results of rehabilitation of 181 patients with fractures of the shaft of the femur are analysed. 2. The results are mainly dependent on the severity of the fracture and the method of reduction and immobilisation. It is stressed that full-time rehabilitation can help to attain the best results. 3. The advantages of intramedullary nailing of fractures of the femoral shaft are discussed

Aims

Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients.

Aims

Malignancy and surgery are risk factors for venous thromboembolism (VTE). We undertook a systematic review of the literature concerning the prophylactic management of VTE in orthopaedic oncology patients.

Aims

Computer-based applications are increasingly being used by orthopaedic surgeons in their clinical practice. With the integration of technology in surgery, augmented reality (AR) may become an important tool for surgeons in the future. By superimposing a digital image on a user’s view of the physical world, this technology shows great promise in orthopaedics. The aim of this review is to investigate the current and potential uses of AR in orthopaedics.

We performed a prospective, randomised study on 50 patients with Tscherne C1 tibial diaphyseal fractures comparing treatment with reamed and unreamed intramedullary nails. Our results show that reamed nailing is associated with a significantly lower time to union and a reduced requirement for a further operation. Unreamed nailing should not be used in the treatment of the common Tscherne C1 tibial fracture

Aims

Hip fracture patients are at higher risk of severe COVID-19 illness, and admission into hospital puts them at further risk. We implemented a two-site orthopaedic trauma service, with ‘COVID’ and ‘COVID-free’ hubs, to deliver urgent and infection-controlled trauma care for hip fracture patients, while increasing bed capacity for medical patients during the COVID-19 pandemic.

Aims

There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic.

We treated 24 patients with nonunion of tibial shaft fractures by locked intramedullary nailing, 18 by open and six by closed techniques. Union was achieved in 22 patients, failing only in two patients with active infection. Locked nailing prevented recurrence of deformity and allowed the patients to mobilise without external support. Supplementary bone grafting was essential only for major defects

1. A patient is described, the thirty-fourth reported, who shows all the skeletal changes of pycnodysostosis with the exception of the oral findings. 2. It is suggested that the pseudarthroses of the tibiae in our patient cannot be taken as evidence against normal union because of the possibility of inadequate management of the fractures. 3. We consider that the use of strong intramedullary nails in the treatment of long bone fractures in these cases is advisable

Seven cases of massive osteolysis are presented. The aetiology of this disease is as yet unknown; neither age nor sex seems to be a factor in its incidence, nor are standard bone grafts or radiotherapy successful methods of treatment. However, in this series, operation produced a satisfactory outcome for five patients at a mean follow-up of 17 years; in three of these patients a custom-built prosthesis was inserted, and in one a conventional bone graft was combined with intramedullary nailing

1. Central dislocation of the hip combined with ilio-femoral intramedullary nailing is a technically difficult operation, but one which, if well done, provides a high percentage of hip fusion without external fixation. 2. Fifteen hips have been operated upon. Twelve have fused; two cannot yet be assessed as the time since operation is too short; and one failed, presumably due to osteoporosis resulting from rheumatoid arthritis

Aims

To determine whether half-threaded screw holes in a new titanium locking plate design can substantially decrease the notch effects of the threads and increase the plate fatigue life.

1. The findings in this series of fractures of the shaft of the femur treated by intramedullary nailing confirm the observation of Smith (1959) that the incidence of non-union is significantly diminished when operative intervention is postponed more than one week from the time of the injury. 2. The series is too small to afford conclusive proof, and it offers no explanation of the opposite findings of Smith and Sage (1957), but it indicates that this very important aspect of the operative treatment of fractures ought to be submitted to thorough investigation by many more observers

A comparative study of methods for treating fractures of the distal half of the femur was carried out prospectively in the five-year period January 1973 to December 1977. The three methods compared were conservative treatment on a Thomas' splint, application of a knee-hinged cast-brace at five to seven weeks, and intramedullary nailing. The time in bed, in hospital and to union were compared as was the rate of functional recovery of the knee. It is concluded that the cast-brace provides a safe reliable method of treatment, combining the advantages of non-operative management with the early mobilisation possible with intramedullary fixation but without the disadvantages of surgical treatment

The outcome of various types of treatment for femoral fracture in children with head injury was studied retrospectively in 51 patients with 56 fractures. Of these, 36 patients (71 per cent) were in deep coma and scored 5 to 7 on the Glasgow scale. Forty-three children (84 per cent) were eventually able to walk freely. Open reduction and internal fixation proved an attractive solution for femoral fractures in children with head injury who could tolerate general anaesthesia: intramedullary nailing was safe and gave satisfactory results in 16 fractures but infection complicated three of the five fractures which were plated

The accuracy of templates used for the preoperative planning of the fixation of intramedullary fractures depends on radiological magnification. To study the accuracy of these templates, we randomly selected 100 femoral and 100 tibial radiographs taken after stabilisation by an intramedullary nail using a standard technique. We then compared the known nail length with the corresponding measurements on the radiographs. The mean magnification factor for the femur was 9% and for the tibia 7%; these differ considerably from the range of magnification of the manufacturers’ templates (femur, 15% to 17%; tibia 10% to 15%). We conclude that templates are unreliable for the selection of implant length and that this should be done by intraoperative measurements

We have reviewed 402 traumatic fractures of the femoral shaft, 320 of which had been treated by operation and had a long follow-up. Of these, 228 closed fractures and 37 open fractures had been stabilised by plating. There was no significant difference in healing between those stabilised early and those having delayed internal fixation. Re-fracture after removal of the implant occurred more often after early operation. All 55 fractures treated by intramedullary nailing healed and there were no re-fractures after nail removal. We found no correlation between delay before operation and the incidence of postoperative infection

Twenty knees, in which a total of 32 previous operations had been performed, were arthrodesed by the Charnley compression technique combined with intramedullary nailing. Patients with previous infection were excluded from the series, but three neuropathic knees were included. Bony union was evident after an average of six months in all but one patient who died three months after operation. One patient developed deep infection that resolved after removing the nail. The combined technique is simple and only limited bone resection is needed; it gives immediate stability and relief of pain with minimal morbidity

We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first week after operation. Complications included one recurrent dislocation of the THR and one fracture of an osteolytic lesion of the femoral shaft during nail insertion. Both were managed successfully. The hybrid osteosynthesis which we describe is an alternative to the use of tumour or long-stem prostheses; it has the advantage of preserving bone stock and muscle attachments