An attempt has been made to describe some of the ways in which the element of rotation, which is so important a part of the function of the normal forearm, has a bearing upon the mechanism and treatment of forearm injuries. In particular, distinction is drawn between those injuries in which the shaft of the radius remains in continuity, and those in which there is a complete fracture of the bone. In the former, rotation of the hand in the reduction will be transmitted to the upper end of the radius, and extremes of rotational movement may safely be used to obtain and hold a reduction. In the latter there is likely to be a rotational deformity between the two radial fragments, and the lower radial fragment must be placed in accurate rotational alignment with the upper. In the first group reduction, and in certain cases immobilisation, in full pronation or full supination has been shown to have a place in the treatment of those cases in which a rotation violence has shaped the pattern of the injury. Soft tissues may be used to guide and hold a reduction in a rotational injury, just as in injuries of other types. An injury caused by forced pronation should logically be treated in full supination, for only thus are the intact soft tissues on the "pronation side" of the limb used to the best advantage. In the mechanism of injuries caused by rotation violence it is emphasized that vertical compression is usually the basic force, to which a rotation force may be added by the direction of momentum of the body weight. Such injuries may be grouped into forced rotation injuries (in which the violence applied has taken the limb beyond the normal ranges of rotational movement), and injuries occurring while the limb is pronating or supinating. In the latter group the rotational element determines the pattern of the injury: pronation and flexion are closely allied, and a fracture occurring while the forearm is pronating will develop a backward angulation: so also a supination injury will produce a forward angulation. On the basis of these considerations injuries of the forearm may be classified as follows:. Injuries in which the shaft of the radius remains in continuity. Forced proiiation injuries:. 1) Forward dislocation of the head of the radius. 2) Backward dislocation of the lower end of the ulna. 3) The anterior Monteggia fracture-dislocation. These injuries should be reduced and immobilised in full supination to prevent recurrence of deformity. The lateral and posterior Monteggia injuries are probably variants of dislocation of the
The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study.Aims
Patients and Methods
The results of irrigation and debridement with component retention (IDCR) in the treatment of acutely infected total knee arthroplasties (TKAs) have been variable. The aim of this study was to assess the outcome after IDCR when combined with chronic antibiotic suppression. We also evaluated survivorship free from subsequent infection, removal of the components, and death, as well as the risk factors for failure. This was a single-centre retrospective review of 134 infected primary TKAs that were treated with IDCR. Infections within four weeks of the procedure were defined as acute postoperative infections, and those occurring more than four weeks after the procedure with symptoms for less than three weeks were defined as acute haematogenous infections. Patients were treated with intravenous antibiotics for four to six weeks, followed by chronic oral antibiotic suppression. Estimates of survival were made using a competing risk analysis. The mean follow-up was five years (2.1 to 13).Aims
Patients and Methods
Informed patient consent is a legal prerequisite endorsed by
multiple regulatory institutions including the Royal College of
Surgeons and the General Medical Council. It is also recommended
that the provision of written information is available and may take
the form of a Patient Information Leaflet (PIL) with multiple PILs
available from leading orthopaedic institutions. PILs may empower
the patient, improve compliance, and improve the patient experience.
The national reading age in the United Kingdom is less than 12 years
and therefore PILs should be written at a readability level not
exceeding 12 years old. We aim to assess the readability of PILs
currently provided by United Kingdom orthopaedic institutions. The readability of PILs on 58 common conditions provided by seven
leading orthopaedic associations in January 2017, including the
British Orthopaedic Association, British Hip Society, and the British
Association of Spinal Surgeons, was assessed. All text in each PIL
was analyzed using readability scores including the Flesch–Kincaid Grade
Level (FKGL) and the Simple Measure of Gobbledygook (SMOG) test.Aims
Patients and Methods
The aim of this study was to examine the association between
postoperative glycaemic variability and adverse outcomes following
orthopaedic surgery. This retrospective study analyzed data on 12 978 patients (1361
with two operations) who underwent orthopaedic surgery at a single
institution between 2001 and 2017. Patients with a minimum of either
two postoperative measurements of blood glucose levels per day,
or more than three measurements overall, were included in the study.
Glycaemic variability was assessed using a coefficient of variation
(CV). The length of stay (LOS), in-hospital complications, and 90-day
readmission and mortality rates were examined. Data were analyzed
with linear and generalized linear mixed models for linear and binary
outcomes, adjusting for various covariates.Aims
Patients and Methods
High-quality clinical research in children’s orthopaedic surgery
has lagged behind other surgical subspecialties. This study used
a consensus-based approach to identify research priorities for clinical
trials in children’s orthopaedics. A modified Delphi technique was used, which involved an initial
scoping survey, a two-round Delphi process and an expert panel formed
of members of the British Society of Children’s Orthopaedic Surgery.
The survey was conducted amongst orthopaedic surgeons treating children
in the United Kingdom and Ireland.Aims
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
This study reviews the use of a titanium mesh cage (TMC) as an
adjunct to intramedullary nail or plate reconstruction of an extra-articular
segmental long bone defect. A total of 17 patients (aged 17 to 61 years) treated for a segmental
long bone defect by nail or plate fixation and an adjunctive TMC
were included. The bone defects treated were in the tibia (nine),
femur (six), radius (one), and humerus (one). The mean length of
the segmental bone defect was 8.4 cm (2.2 to 13); the mean length
of the titanium mesh cage was 8.3 cm (2.6 to 13). The clinical and
radiological records of the patients were analyzed retrospectively.Aims
Patients and Methods
