Our purpose was to determine the quality of current randomised
controlled trials (RCTs) in hand surgery using standardised metrics. Based on five-year mean impact factors, we selected the six journals
that routinely publish studies of upper extremity surgery. Using
a journal-specific search query, 62 RCTs met our inclusion criteria.
Then three blinded reviewers used the Jadad and revised Coleman Methodology
Score (RCMS) to assess the quality of the manuscripts.Aims
Materials and Methods
To evaluate whether an ultra-low-dose CT protocol can diagnose
selected limb fractures as well as conventional CT (C-CT). We prospectively studied 40 consecutive patients with a limb
fracture in whom a CT scan was indicated. These were scanned using
an ultra-low-dose CT Reduced Effective Dose Using Computed Tomography
In Orthopaedic Injury (REDUCTION) protocol. Studies from 16 selected
cases were compared with 16 C-CT scans matched for age, gender and
type of fracture. Studies were assessed for diagnosis and image
quality. Descriptive and reliability statistics were calculated.
The total effective radiation dose for each scanned site was compared.Aims
Patients and Methods
The purpose of this retrospective study was to differentiate
between the MRI features of normal post-operative change and those
of residual or recurrent disease after intralesional treatment of
an atypical cartilage tumour (ACT)/grade I chondrosarcoma. We reviewed the case notes, radiology and histology of 75 patients,
who had been treated for an ACT/grade I chondrosarcoma by curettage,
phenolisation and bone allografting between 1994 and 2005. The first
post-operative Gd-enhanced MRI scan was carried out within one year
of surgery. Patients had a minimum of two scans and a mean follow-up
of 72 months (13 to 169). Further surgery was undertaken in cases
of suspected recurrence.Aims
Patients and Methods
Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a brachial plexus injury and
were included in this retrospective study. The mean follow-up after
nerve transfer was 56 months (28 to 101, standard deviation (Aims
Methods
We describe the routine imaging practices of
Level 1 trauma centres for patients with severe pelvic ring fractures, and
the interobserver reliability of the classification systems of these
fractures using plain radiographs and three-dimensional (3D) CT
reconstructions. Clinical and imaging data for 187 adult patients
(139 men and 48 women, mean age 43 years (15 to 101)) with a severe
pelvic ring fracture managed at two Level 1 trauma centres between July
2007 and June 2010 were extracted. Three experienced orthopaedic
surgeons classified the plain radiographs and 3D CT reconstruction
images of 100 patients using the Tile/AO and Young–Burgess systems.
Reliability was compared using kappa statistics. A total of
115 patients (62%) had plain radiographs as well as two-dimensional
(2D) CT and 3D CT reconstructions, 52 patients (28%) had plain films
only, 12 (6.4%) had 2D and 3D CT reconstructions images only, and
eight patients (4.3%) had no available images. The plain radiograph
was limited to an anteroposterior pelvic view. Patients without
imaging, or only plain films, were more severely injured. A total
of 72 patients (39%) were imaged with a pelvic binder Interobserver reliability for the Tile/AO (Kappa 0.10 to 0.17)
and Young–Burgess (Kappa 0.09 to 0.21) was low, and insufficient
for clinical and research purposes. Severe pelvic ring fractures are difficult to classify due to
their complexity, the increasing use of early treatment such as
with pelvic binders, and the absence of imaging altogether in important
patient sub-groups, such as those who die early of their injuries. Cite this article:
Increasing demand for total hip and knee arthroplasty (THA/TKA)
and associated follow-up has placed huge demands on orthopaedic
services. Feasible follow-up mechanisms are therefore essential. We conducted an audit of clinical follow-up decision-making for
THA/TKA based on questionnaire/radiograph review compared with local
practice of Arthroplasty Care Practitioner (ACP)-led outpatient
follow-up. In all 599 patients attending an ACP-led THA/TKA follow-up
clinic had a pelvic/knee radiograph, completed a pain/function questionnaire
and were reviewed by an ACP. An experienced orthopaedic surgeon
reviewed the same radiographs and questionnaires, without patient
contact or knowledge of the ACP’s decision. Each pathway classified
patients into: urgent review, annual monitoring, routine follow-up
or discharge. Aims
Methods
Polyethylene wear debris can cause osteolysis
and the failure of total hip arthroplasty. We present the five-year
wear rates of a highly cross-linked polyethylene (X3) bearing surface
when used in conjunction with a 36 mm ceramic femoral head. This was a prospective study of a cohort of 100 THAs in 93 patients.
Pain and activity scores were measured pre- and post-operatively.
Femoral head penetration was measured at two months, one year, two
years and at five years using validated edge-detecting software
(PolyWare Auto). At a mean of 5.08 years (3.93 to 6.01), 85 hips in 78 patients
were available for study. The mean age of these patients was 59.08
years (42 to 73, the mean age of males (n = 34) was 59.15 years,
and females (n = 44) was 59.02 years). All patients had significant
improvement in their functional scores (p <
0.001). The steady
state two-dimensional linear wear rate was 0.109 mm/year. The steady
state volumetric wear rate was 29.61 mm3/year. No significant
correlation was found between rate of wear and age (p = 0.34), acetabular
component size (p = 0.12) or clinical score (p = 0.74). Our study shows low steady state wear rates at five years in
X3 highly cross-linked polyethylene in conjunction with a 36 mm
ceramic femoral head. The linear wear rate was almost identical
to the osteolysis threshold of 0.1 mm/year recommended in the literature. Cite this article:
A high radiographic inclination angle (RI) contributes
to accelerated wear and has been associated with dislocation after
total hip arthroplasty (THA). With freehand positioning of the acetabular
component there is a lack of accuracy, with a trend towards a high
radiographic inclination angle. The aim of this study was to investigate
whether the use of a digital protractor to measure the operative
inclination angle (OI) could improve the positioning of the acetabular
component in relation to a ‘safe zone’. We measured the radiographic inclination angles of 200 consecutive
uncemented primary THAs. In the first 100 the component was introduced
freehand and in the second 100 a digital protractor was used to
measure the operative inclination angle. The mean difference between the operative and the radiographic
inclination angles
(∆RI–OI) in the second cohort was 12.3° (3.8° to 19.8°). There was
a strong correlation between the circumference of the hip and ∆RI–OI.
The number of RI outliers was significantly reduced in the protractor
group (p = 0.002). Adjusting the OI, using a digital protractor and taking into
account the circumference of the patient’s hip, improves the RI
significantly (p <
0.001) and does not require additional operating
time. Cite this article:
Posterior tilt of the pelvis with sitting provides biological
acetabular opening. Our goal was to study the post-operative interaction
of skeletal mobility and sagittal acetabular component position. This was a radiographic study of 160 hips (151 patients) who
prospectively had lateral spinopelvic hip radiographs for skeletal
and implant measurements. Intra-operative acetabular component position
was determined according to the pre-operative spinal mobility. Sagittal
implant measurements of ante-inclination and sacral acetabular angle were
used as surrogate measurements for the risk of impingement, and
intra-operative acetabular component angles were compared with these.Aims
Materials and Methods
The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis was evaluated using the joint space width and Kellgren-Lawrence (KL) radiographic classification. The Objectives
Methods
This is a prospective randomised study which compares the radiological
and functional outcomes of ring and rail fixators in patients with
an infected gap (>
3 cm) nonunion of the tibia. Between May 2008 and February 2013, 70 patients were treated
at our Institute for a posttraumatic osseocutaneous defect of the
tibia measuring at least 3 cm. These were randomised into two groups
of 35 patients using the lottery method. Group I patients were treated
with a ring fixator and group II patients with a rail fixator. The
mean age was 33.2 years (18 to 64) in group I and 29.3 years (18
to 65) in group II. The mean bone gap was 5.84 cm in group I and 5.78
cm in group II. The mean followup was 33.8 months in group I and 32.6 months
in group II. Bone and functional results were assessed using the
classification of the Association for the Study and Application
of the Method of Ilizarov (ASAMI). Functional results were also
assessed at six months using the short musculoskeletal functional
assessment (SMFA) score.Aims
Patients and Methods
Patient-specific glenoid guides (PSGs) claim an improvement in
accuracy and reproducibility of the positioning of components in
total shoulder arthroplasty (TSA). The results have not yet been
confirmed in a prospective clinical trial. Our aim was to assess
whether the use of PSGs in patients with osteoarthritis of the shoulder
would allow accurate and reliable implantation of the glenoid component. A total of 17 patients (three men and 14 women) with a mean age
of 71 years (53 to 81) awaiting TSA were enrolled in the study.
Pre- and post-operative version and inclination of the glenoid were
measured on CT scans, using 3D planning automatic software. During
surgery, a congruent 3D-printed PSG was applied onto the glenoid
surface, thus determining the entry point and orientation of the
central guide wire used for reaming the glenoid and the introduction
of the component. Manual segmentation was performed on post-operative
CT scans to compare the planned and the actual position of the entry
point (mm) and orientation of the component (°).Aims
Patients and Methods
Fracture repair occurs by two broad mechanisms:
direct healing, and indirect healing with callus formation. The effects
of bisphosphonates on fracture repair have been assessed only in
models of indirect fracture healing. A rodent model of rigid compression plate fixation of a standardised
tibial osteotomy was used. Ten skeletally mature Sprague–Dawley
rats received daily subcutaneous injections of 1 µg/kg ibandronate
(IBAN) and ten control rats received saline (control). Three weeks
later a tibial osteotomy was rigidly fixed with compression plating.
Six weeks later the animals were killed. Fracture repair was assessed
with mechanical testing, radiographs and histology. The mean stress at failure in a four-point bending test was significantly
lower in the IBAN group compared with controls (8.69 Nmm-2 ( Bisphosphonate treatment in a therapeutic dose, as used for risk
reduction in fragility fractures, had an inhibitory effect on direct
fracture healing. We propose that bisphosphonate therapy not be
commenced until after the fracture has united if the fracture has
been rigidly fixed and is undergoing direct osteonal healing. Cite this article:
Deformity of the proximal femur in fibrous dysplasia
leads to deviation of the mechanical axis of the hip, which may lead
to the development of secondary osteoarthritis (OA). This study
investigated the prevalence and predisposing factors for the development
of OA in patients with fibrous dysplasia of the proximal femur.
We reviewed the records of 209 patients from our institutional database
with fibrous dysplasia of the proximal femur, investigating possible predisposing
factors including patient demographics, the extent of the coxa vara
deformity, the presence of peri-articular disease, and the overall
burden of skeletal disease. Of the 209 patients, 24 (12%) had radiological
evidence of OA in the ipsilateral hip. The prevalence was significantly
higher in patients with polyostotic fibrous dysplasia compared with
those with monostotic disease (p <
0.001). In a subgroup analysis of
patients with polyostotic disease, the extent of deformity (quantified
using the neck–shaft angle), and the presence of peri-articular
disease (whether in the head of the femur or the acetabulum) were
significant predictors of osteoarthritis (neck–shaft angle likelihood
ratio (LR) = 0.847 per 1° increase, p = 0.004; presence of lesion
in the head of the femur LR = 9.947, p = 0.027; presence of lesion
in the acetabulum LR = 11.231, p = 0.014). Our data suggest that patients with polyostotic fibrous dysplasia
have a high risk of developing secondary OA of the hips. This risk
is higher in patients with peri-articular disease, and those with
a more severe deformity of proximal femur. Cite this article:
Accurate, reproducible outcome measures are essential
for the evaluation of any orthopaedic procedure, in both clinical
practice and research. Commonly used patient-reported outcome measures (PROMs) have
drawbacks such as ‘floor’ and ‘ceiling’ effects, limitations of
worldwide adaptability and an inability to distinguish pain from
function. They are also unable to measure the true outcome of an
intervention rather than a patient’s perception of that outcome. Performance-based functional outcome tools may address these
problems. It is important that both clinicians and researchers are
aware of these measures when dealing with high-demand patients,
using a new intervention or implant, or testing a new rehabilitation
protocol. This article provides an overview of some of the clinically-validated
performance-based functional outcome tools used in the assessment
of patients undergoing hip and knee surgery. Cite this article:
Cement augmentation of pedicle screws could be used to improve screw stability, especially in osteoporotic vertebrae. However, little is known concerning the influence of different screw types and amount of cement applied. Therefore, the aim of this biomechanical A total of 54 osteoporotic human cadaver thoracic and lumbar vertebrae were instrumented with pedicle screws (uncemented, solid cemented or fenestrated cemented) and augmented with high-viscosity PMMA cement (0 mL, 1 mL or 3 mL). The insertion torque and bone mineral density were determined. Radiographs and CT scans were undertaken to evaluate cement distribution and cement leakage. Pull-out testing was performed with a material testing machine to measure failure load and stiffness. The paired Objectives
Materials and Methods
This study compares the outcomes of two methods
of fixation of displaced fractures of the radial neck. The 58 patients
with a mean age of 38.5 years (18 to 56), were treated in a non
randomised study with screws (n = 29) or a plate and screws (n =
29) according to the surgeon’s preference. The patients were reviewed at one year. Radiographs and functional
evaluations were carried out up to one year post-operatively, using
the Broberg and Morrey functional evaluation score, range of movement,
and assessment of complications. The mean functional scores did not differ significantly between
groups (90 (55 to 100) Cite this article:
We aimed to assess the influence of ethnicity on the incidence
of heterotopic ossification (HO) after total hip arthroplasty (THA). We studied the six-month post-operative anteroposterior radiographs
of 1449 consecutive primary THAs (1324 patients) and retrospectively
graded them for the presence of HO, using the Brooker Classification. Aims
Patients and Methods
