Chronic conditions of the wrist may be difficult to manage because
pain and psychiatric conditions are correlated with abnormal function
of the hand. Additionally, intra-articular inflammatory cytokines
may cause pain. We aimed to validate the measurement of inflammatory cytokines
in these conditions and identify features associated with symptoms. The study included 38 patients (18 men, 20 women, mean age 43
years) with a chronic condition of the wrist who underwent arthroscopy.
Before surgery, the Self-Rating Depression Scale (SDS), Hand20 questionnaire
and a visual analogue scale (VAS) for pain were used. Cytokine and
chemokine levels in the synovial fluid of the wrist were measured
using enzyme-linked immunosorbent assays and correlations between
the levels with pain were analysed. Gene expression profiles of
the synovial membranes were assessed using quantitative polymerase
chain reaction.Aims
Patients and Methods
We describe the use of a protocol of irrigation and debridement
(I&
D) with retention of the implant for the treatment of periprosthetic
infection of a total elbow arthroplasty (TEA). This may be an attractive
alternative to staged re-implantation. Between 1990 and 2010, 23 consecutive patients were treated in
this way. Three were lost to follow-up leaving 20 patients (21 TEAs)
in the study. There were six men and 14 women. Their mean age was
58 years (23 to 76). The protocol involved: component unlinking,
irrigation and debridement (I&
D), and the introduction of antibiotic
laden cement beads; organism-specific intravenous antibiotics; repeat
I&
D and re-linkage of the implant if appropriate; long-term
oral antibiotic therapy. Aims
Patients and Methods
Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1’s effects on experimental OA. Collagenase (type II) was injected twice into both knees of three-month-old rabbits to induce OA, combined with two intra–articular injections of Torin 1 (400 nM). Degeneration of articular cartilage was evaluated by histology using the Mankin scoring system at eight weeks after injection. Chondrocyte degeneration and autophagosomes were observed by transmission electron microscopy. Matrix metallopeptidase-13 (MMP-13) and vascular endothelial growth factor (VEGF) expression were analysed by quantitative RT-PCR (qPCR).Beclin-1 and light chain 3 (LC3) expression were examined by Western blotting.Objectives
Methods
Failed internal fixation of a fracture of the
proximal humerus produces many challenges with limited surgical options.
The aim of this study was to evaluate the clinical outcomes after
the use of a reverse shoulder arthroplasty under these circumstances.
Between 2007 and 2012, 19 patients (15 women and four men, mean
age 66 years; 52 to 82) with failed internal fixation after a proximal
humeral fracture, underwent implant removal and reverse shoulder arthroplasty
(RSA). The mean follow-up was 36 months (25 to 60). The mean American
Shoulder and Elbow Score improved from 27.8 to 50.1 (p = 0.019).
The mean Simple Shoulder Test score improved from 0.7 to 3.2 (p
= 0.020), and the mean visual analogue scale for pain improved from
6.8 to 4.3 (p = 0.012). Mean forward flexion improved from 58.7°
to 101.1° (p <
0.001), mean abduction from 58.7° to 89.1° (p
= 0.012), mean external rotation from 10.7° to 23.1° (p = 0.043)
and mean internal rotation from buttocks to L4 (p = 0.034). A major
complication was recorded in five patients (26%) (one intra-operative
fracture, loosening of the humeral component in two and two peri-prosthetic
fractures). A total of 15 patients (79%) rated their outcome as
excellent or good, one (5%) as satisfactory, and three (16%) as
unsatisfactory. An improvement in outcomes and pain can be expected when performing
a RSA as a salvage procedure after failed internal fixation of a
fracture of the proximal humerus. Patients should be cautioned about
the possibility for major complications following this technically
demanding procedure. Cite this article:
To assess complications and failure mechanisms of osteoarticular
allograft reconstructions for primary bone tumours. We retrospectively evaluated 38 patients (28 men, 74%) who were
treated at our institution with osteoarticular allograft reconstruction
between 1989 and 2010. Median age was 19 years (interquartile range
14 to 32). Median follow-up was 19.5 years (95% confidence interval
(CI) 13.0 to 26.1) when 26 patients (68%) were alive. In addition, we
systematically searched the literature for clinical studies on osteoarticular
allografts, finding 31 studies suitable for analysis. Results of
papers that reported on one site exclusively were pooled for comparison.Aims
Patients and Methods
The August 2015 Children’s orthopaedics Roundup360 looks at: Learning the Pavlik; MRI and patellar instability; Cerebral palsy and hip dysplasia; ‘Pick your poison’: elastic nailing under the spotlight; Club feet and surgery; Donor site morbidity in vascularised fibular grafting; Cartilage biochemistry with hip dysplasia; SUFE and hip decompression: a good option?
The aim of this study was to examine the real time A total of 50 patients (83 hips) underwent 4D dynamic CT scanning
of the hip, producing real time osseous models of the pelvis and
femur being moved through flexion, adduction, and internal rotation.
The location and size of the cam deformity and its relationship
to the angle of flexion of the hip and pelvic tilt, and the position
of impingement were recorded.Aims
Patients and Methods
The December 2015 Wrist &
Hand Roundup
The aim of this study was to compare the Push Ortho Thumb Brace
CMC and a custom-made orthosis in the treatment of patients with
primary osteoarthritis of the carpometacarpal joint of the thumb.
Our outcome measures were pain scores, tests of hand function, patient
satisfaction and patient preference. A multicentre crossover randomised controlled trial was conducted
which included 63 patients (44 women) with primary osteoarthritis
of the carpometacarpal joint of the thumb. Of these, 59 patients
with a mean age of 60.1 years (standard deviation 8.2), completed
the study. Patients used both orthoses for two weeks with a two-week washout
period in-between. Pain was measured on a 10-cm visual analogue
scale. Hand function was assessed using the Jebsen Taylor Hand Function
test, Nine Hole Peg Test, key grip, pinch grip and Functional Index
for Hand Osteoarthritis. Patient preference was assessed using the
Dutch version of the Quebec User Evaluation of Satisfaction with
Assistive Technology score.Aims
Patients and Methods
The aim of the current study was to analyse the effects of posterior cruciate ligament (PCL) deficiency on forces of the posterolateral corner structure and on tibiofemoral (TF) and patellofemoral (PF) contact force under dynamic-loading conditions. A subject-specific knee model was validated using a passive flexion experiment, electromyography data, muscle activation, and previous experimental studies. The simulation was performed on the musculoskeletal models with and without PCL deficiency using a novel force-dependent kinematics method under gait- and squat-loading conditions, followed by probabilistic analysis for material uncertain to be considered.Objectives
Methods
Fractures in patients aged ≥ 65 years constitute
an increasing burden on health and social care and are associated with
a high morbidity and mortality. There is little accurate information
about the epidemiology of fractures in the elderly. We have analysed
prospectively collected data on 4786 in- and out-patients who presented
with a fracture over two one-year periods. Analysis shows that there
are six patterns of the incidence of fractures in patients aged ≥ 65
years. In males six types of fracture increase in incidence after
the age of 65 years and 11 types increase in females aged over 65
years. Five types of fracture decrease in incidence after the age
of 65 years. Multiple fractures increase in incidence in both males
and females aged ≥ 65 years, as do fractures related to falls. Analysis of the incidence of fractures, together with life expectancy,
shows that the probability of males and females aged ≥ 65 years
having a fracture during the rest of their life is 18.5% and 52.0%,
respectively. The equivalent figures for males and females aged ≥ 80
years are 13.3% and 34.8%, respectively. Cite this article:
We report a new surgical technique of open carpal
tunnel release with subneural reconstruction of the transverse carpal
ligament and compare this with isolated open and endoscopic carpal
tunnel release. Between December 2007 and October 2011, 213 patients with carpal
tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to
67) were recruited from three different centres and were randomly
allocated to three groups: group A, open carpal tunnel release with
subneural reconstruction of the transverse carpal ligament (n =
68); group B, isolated open carpal tunnel release (n = 92); and
group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no
significant difference between the groups in terms of severity of
symptoms or lateral grip strength. Compared with groups B and C,
group A had significantly better functional status, cylindrical
grip strength and pinch grip strength. There were significant differences
in Michigan Hand Outcome scores between groups A and B, A and C,
and B and C. Group A had the best functional status, cylindrical
grip strength, pinch grip strength and Michigan Hand Outcome score. Subneural reconstruction of the transverse carpal ligament during
carpal tunnel decompression maximises hand strength by stabilising
the transverse carpal arch. Cite this article:
The October 2015 Children’s orthopaedics Roundup360 looks at: Radiographic follow-up of DDH; When the supracondylar goes wrong; Apophyseal avulsion fractures; The ‘pulled elbow’; Surgical treatment of active or aggressive aneurysmal bone cysts in children; Improving stability in supracondylar fractures; Biological reconstruction may be preferable in children’s osteosarcoma; The paediatric hip fracture
The October 2015 Wrist &
Hand Roundup360 looks at: Base of thumb arthritis – steroids not a waste of time; De Quervain’s tenosynovitis and steroids; Use your therapy time wisely!; Excision osteotomy for the carpometacarpal joint?; CORDLESS at five years?; Arthroscopy again of no benefit?; Distal radius stirring up trouble again!; Scaphoid arthroscopy under the spotlight
The December 2013 Wrist &
Hand Roundup360 looks at: Scapholunate instability; three-ligament tenodesis; Pronator quadratus; Proximal row carpectomy; FPL dysfunction after volar plate fixation; Locating the thenar branch of the median nerve; Metallosis CMCJ arthroplasties; and timing of flap reconstruction
The aim of the current study was to assess whether calcaneal broadband ultrasound attenuation (BUA) can predict whole body and regional dual-energy x-ray absorptiometry (DXA)-derived bone mass in healthy, Australian children and adolescents at different stages of maturity. A total of 389 boys and girls across a wide age range (four to 18 years) volunteered to participate. The estimated age of peak height velocity (APHV) was used to classify children into pre-, peri-, and post-APHV groups. BUA was measured at the non-dominant heel with quantitative ultrasonometry (QUS) (Lunar Achilles Insight, GE), while bone mineral density (BMD) and bone mineral content (BMC) were examined at the femoral neck, lumbar spine and whole body (DXA, XR-800, Norland). Associations between BUA and DXA-derived measures were examined with Pearson correlations and linear regression. Participants were additionally ranked in quartiles for QUS and DXA measures in order to determine agreement in rankings.Objectives
Methods
Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. An Objectives
Methods
The management of children’s fractures has evolved
as a result of better health education, changes in lifestyle, improved
implant technology and the changing expectations of society. This
review focuses on the changes seen in paediatric fractures, including
epidemiology, the increasing problems of obesity, the mechanisms
of injury, non-accidental injuries and litigation. We also examine
the changes in the management of fractures at three specific sites:
the supracondylar humerus, femoral shaft and forearm. There has
been an increasing trend towards surgical stabilisation of these
fractures. The reasons for this are multifactorial, including societal
expectations of a perfect result and reduced hospital stay. Reduced hospital
stay is beneficial to the social, educational and psychological
needs of the child and beneficial to society as a whole, due to
reduced costs. Cite this article:
