Using 90% of final height as a benchmark, we sought to develop
a quick, quantitative and reproducible method of estimating skeletal
maturity based on topographical changes in the distal femoral physis. Serial radiographs of the distal femoral physis three years prior
to, during, and two years following the chronological age associated
with 90% of final height were analyzed in 81 healthy children. The
distance from the tip of the central peak of the distal femoral
physis to a line drawn across the physis was normalized to the physeal width.Aims
Patients and Methods
To review the natural history of posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. 38 patients with posteromedial bowing of the tibia presenting between 2000–2016 were identified. Mean follow up from presentation was 78 months. Seventeen patients underwent lengthening and deformity correction surgery, whilst 3 further patients are awaiting lengthening and deformity correction procedures.Purpose
Patients and Methods
The aim of this study was to report the clinical, functional
and radiological outcomes of children and adolescents with tibial
fractures treated using the Ilizarov method. Between 2013 and 2016 a total of 74 children with 75 tibial fractures
underwent treatment at our major trauma centre using an Ilizarov
frame. Demographic and clinical information from a prospective database
was supplemented by routine functional and psychological assessment
and a retrospective review of the notes and radiographs.Aims
Patients and Methods
The mucopolysaccharidoses (MPS) are a group of
inherited lysosomal storage disorders with clinical manifestations relevant
to the orthopaedic surgeon. Our aim was to review the recent advances
in their management and the implications for surgical practice. The current literature about MPSs is summarised, emphasising
orthopaedic complications and their management. Recent advances in the diagnosis and management of MPSs include
the recognition of slowly progressive, late presenting subtypes,
developments in life-prolonging systemic treatment and potentially
new indications for surgical treatment. The outcomes of surgery
in these patients are not yet validated and some procedures have
a high rate of complications which differ from those in patients
who do not have a MPS. The diagnosis of a MPS should be considered in adolescents or
young adults with a previously unrecognised dysplasia of the hip.
Surgeons treating patients with a MPS should report their experience
and studies should include the assessment of function and quality
of life to guide treatment. Cite this article:
Few studies have evaluated the relationship between patients’
pre-operative expectations and the outcome of orthopaedic procedures.
Our aim was to determine the effect of expectations on the outcome
after primary anatomical total shoulder arthroplasty (TSA). We hypothesised
that patients with greater expectations would have better outcomes. Patients undergoing primary anatomical TSA completed the Hospital
for Special Surgery’s Shoulder Expectations Survey pre-operatively.
The American Shoulder and Elbow Surgeons (ASES), Shoulder Activity
Scale (SAS), Short-Form-36 (SF-36), and visual analogue scale (VAS)
for pain, fatigue, and general health scores were also collected
pre-operatively and two years post-operatively. Pearson correlations
were used to assess the relationship between the number of expectations
and the outcomes. Differences in outcomes between those with higher
and lower levels of expectations for each expectation were assessed
by independent samples Aims
Patients and Methods
Eukaryotic translation initiation factor 3 (eIF3) is a multi-subunit complex that plays a critical role in translation initiation. Expression levels of eIF3 subunits are elevated or decreased in various cancers, suggesting a role for eIF3 in tumorigenesis. Recent studies have shown that the expression of the eIF3b subunit is elevated in bladder and prostate cancer, and eIF3b silencing inhibited glioblastoma growth and induced cellular apoptosis. In this study, we investigated the role of eIF3b in the survival of osteosarcoma cells. To investigate the effect of eIF3b on cell viability and apoptosis in osteosarcoma cells, we first examined the silencing effect of eIF3b in U2OS cells. Cell viability and apoptosis were examined by the Cell Counting Kit-8 (CCK-8) assay and Western blot, respectively. We also performed gene profiling to identify genes affected by eIF3b silencing. Finally, the effect of eIF3b on cell viability and apoptosis was confirmed in multiple osteosarcoma cell lines.Objectives
Methods
This prospective cohort study aims to determine if the size of
the tendon gap following acute rupture of the Achilles tendon shows
an association with the functional outcome following non-operative
treatment. All patients presenting within two weeks of an acute unilateral
rupture of the Achilles tendon between July 2012 and July 2015 were
considered for the study. In total, 38 patients (nine female, 29
male, mean age 52 years; 29 to 78) completed the study. Dynamic
ultrasound examination was performed to confirm the diagnosis and
measure the gap between ruptured tendon ends. Outcome was assessed
using dynamometric testing of plantarflexion and the Achilles tendon
Total Rupture score (ATRS) six months after the completion of a
rehabilitation programme.Aims
Patients and Methods
Our aim was to assess the effectiveness of a protocol involving
a standardised closed reduction for the treatment of children with
developmental dysplasia of the hip (DDH) in maintaining reduction
and to report the mid-term results. A total of 133 hips in 120 children aged less than two years
who underwent closed reduction, with a minimum follow-up of five
years or until subsequent surgery, were included in the study. The
protocol defines the criteria for an acceptable reduction and the
indications for a concomitant soft-tissue release. All children
were immobilised in a short- leg cast for three months. Arthrograms
were undertaken at the time of closed reduction and six weeks later. Follow-up
radiographs were taken at six months and one, two and five years
later and at the latest follow-up. The Tönnis grade, acetabular
index, Severin grade and signs of osteonecrosis were recorded.Aims
Methods
We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. Aims
Patients and Methods
This article presents a unified clinical theory
that links established facts about the physiology of bone and homeostasis,
with those involved in the healing of fractures and the development
of nonunion. The key to this theory is the concept that the tissue
that forms in and around a fracture should be considered a specific
functional entity. This ‘bone-healing unit’ produces a physiological
response to its biological and mechanical environment, which leads
to the normal healing of bone. This tissue responds to mechanical
forces and functions according to Wolff’s law, Perren’s strain theory
and Frost’s concept of the “mechanostat”. In response to the local
mechanical environment, the bone-healing unit normally changes with
time, producing different tissues that can tolerate various levels
of strain. The normal result is the formation of bone that bridges
the fracture – healing by callus. Nonunion occurs when the bone-healing
unit fails either due to mechanical or biological problems or a
combination of both. In clinical practice, the majority of nonunions
are due to mechanical problems with instability, resulting in too
much strain at the fracture site. In most nonunions, there is an
intact bone-healing unit. We suggest that this maintains its biological
potential to heal, but fails to function due to the mechanical conditions.
The theory predicts the healing pattern of multifragmentary fractures
and the observed morphological characteristics of different nonunions.
It suggests that the majority of nonunions will heal if the correct
mechanical environment is produced by surgery, without the need
for biological adjuncts such as autologous bone graft. Cite this article:
Total wrist arthrodesis (TWA) produces a spectrum of outcomes.
We investigated this by reviewing 77 consecutive TWA performed for
inflammatory and post-traumatic arthropathies, wrist instability
and as a salvage procedure. All operations were performed by a single surgeon using a specifically
designed pre-contoured dorsally applied non-locking wrist arthrodesis
plate at a single centre. Aims
Patients and Methods
This study compared the clinical outcomes following
mini-open rotator cuff repair (MORCR) between early mobilisation
and usual care, involving initial immobilisation. In total, 189
patients with radiologically-confirmed full-thickness rotator cuff
tears underwent MORCR and were randomised to either early mobilisation
(n = 97) or standard rehabilitation (n = 92) groups. Patients were
assessed at six weeks and three, six, 12 and 24 months post-operatively.
Six-week range of movement comparisons demonstrated significantly
increased abduction (p = 0.002) and scapular plane elevation (p
= 0.006) in the early mobilisation group, an effect which was not
detectable at three months (p >
0.51) or afterwards. At 24 months
post-operatively, patients who performed pain-free, early active mobilisation
for activities of daily living showed no difference in clinical
outcomes from patients immobilised for six weeks following MORCR.
We suggest that the choice of rehabilitation regime following MORCR
may be left to the discretion of the patient and the treating surgeon. Cite this article:
In this study we evaluated whether the Instability
Severity Index Score (ISIS) and the Western Ontario Shoulder Instability
Index (WOSI) could detect those patients at risk of failure following
arthroscopic Bankart repair. Between April 2008 and June 2010, the
ISIS and WOSI were recorded pre-operatively in 110 patients (87
male, 79%) with a mean age of 25.1 years (16 to 61) who underwent
this procedure for recurrent anterior glenohumeral instability. A telephone interview was performed two-years post-operatively
to determine whether patients had experienced a recurrent dislocation
and whether they had returned to pre-injury activity levels. In
all, six (5%) patients had an ISIS >
6 points (0 to 9). Of 100 (91%)
patients available two years post-operatively, six (6%) had a recurrent dislocation,
and 28 (28%) did not return to pre-injury activity. No patient who
dislocated had an ISIS >
6 (p = 1.0). There was no difference in
the mean pre-operative WOSI in those who had a re-dislocation and
those who did not (p = 0.99). The pre-operative WOSI was significantly
lower (p = 0.02) in those who did not return to pre-injury activity, whereas
the ISIS was not associated with return to pre-injury activity (p
= 0.13). In conclusion, neither the pre-operative ISIS nor WOSI predicted
recurrent dislocation within two years of arthroscopic Bankart repair.
Patients with a lower pre-operative WOSI were less likely to return
to pre-injury activity. Cite this article:
Cartilage defects of the hip cause significant
pain and may lead to arthritic changes that necessitate hip replacement.
We propose the use of fresh osteochondral allografts as an option
for the treatment of such defects in young patients. Here we present
the results of fresh osteochondral allografts for cartilage defects
in 17 patients in a prospective study. The underlying diagnoses
for the cartilage defects were osteochondritis dissecans in eight
and avascular necrosis in six. Two had Legg-Calve-Perthes and one
a femoral head fracture. Pre-operatively, an MRI was used to determine
the size of the cartilage defect and the femoral head diameter.
All patients underwent surgical hip dislocation with a trochanteric
slide osteotomy for placement of the allograft. The mean age at
surgery was 25.9 years (17 to 44) and mean follow-up was 41.6 months
(3 to 74). The mean Harris hip score was significantly better after
surgery (p <
0.01) and 13 patients had fair to good outcomes.
One patient required a repeat allograft, one patient underwent hip
replacement and two patients are awaiting hip replacement. Fresh
osteochondral allograft is a reasonable treatment option for hip
cartilage defects in young patients. Cite this article:
Previous studies have identified clinical and
demographic risk factors for recurrence in the treatment of idiopathic clubfoot
(congenital talipes equinovarus). Evertor muscle activity is not
usually considered amongst them. This study aimed to evaluate whether
recurrence could be predicted by demographic, clinical and gait
parameters. From a series of 103 children with clubfeet, 67 had
completed a follow-up of two years: 41 male and 26 female, 38 with idiopathic
and 29 with non-idiopathic deformities. The mean age was 3.2 years
(2.1 to 6.3). Primary correction was obtained in all 38 children
(100%) with an idiopathic deformity, and in 26 of 29 patients (90%)
with a non-idiopathic deformity. Overall, 60 children (90%) complied
with the abduction brace regime. At a mean follow-up of 31.4 months (24
to 62), recurrence was noted in six children (15.8%) in the idiopathic
and 14 children (48.3%) in the non-idiopathic group. Significant
correlation was found between poor evertor activity and recurrence
in both groups. No statistically significant relationship was found
between the rate of recurrence and the severity of the initial deformity,
the age at the time of treatment, the number of casts required or
the compliance with the brace. After correction of idiopathic and non-idiopathic clubfoot using
the Ponseti method, only poor evertor muscle activity was statistically
associated with recurrence. The identification of risk factors for
recurrent deformity allows clinicians to anticipate problems and
advocate early additional treatment to improve muscle balance around
the ankle. Cite this article:
Lumbar spinal specimens exhibited high fatigue strength. The cycles to failure are not only dependent on the maximum peak load, but also on the load offset or the amplitude, respectably. Spinal injury might be caused by whole body vibrations. The permitted exposure to vibration in the workplace is therefore limited. However, there is a lack in knowledge how external vibrations might cause internal damages. Numerical whole body models might provide the potential to estimate the dynamic spinal loading during different daily activities, but depends on knowledge about the corresponding fatigue strength. This study is aiming to determine the Summary
Introduction
In this study, we describe a morphological classification
for greater tuberosity fractures of the proximal humerus. We divided
these fractures into three types: avulsion, split and depression.
We retrospectively reviewed all shoulder radiographs showing isolated
greater tuberosity fractures in a Level I trauma centre between
July 2007 and July 2012. We identified 199 cases where records and
radiographs were reviewed and included 79 men and 120 women with
a mean age of 58 years (23 to 96). The morphological classification
was applied to the first 139 cases by three reviewers on two occasions
using the Kappa statistic and compared with the AO and Neer classifications.
The inter- and intra-observer reliability of the morphological classification
was 0.73 to 0.77 and 0.69 to 0.86, respectively. This was superior
to the Neer (0.31 to 0.35/0.54 to 0.63) and AO (0.30 to 0.32/0.59
to 0.65) classifications. The distribution of avulsion, split and
depression type fractures was 39%, 41%, and 20%, respectively. This
classification of greater tuberosity fractures is more reliable
than the Neer or AO classifications. These distinct fracture morphologies
are likely to have implications in terms of pathophysiology and
surgical technique. Cite this article:
This purpose of this study was to investigate whether prophylactic pinning of the contralateral hip in unilateral slipped upper femoral epiphysis affects subsequent femoral morphology. To determine the effect of prophylactic pinning on growth we compared contralateral hip radiographs of 24 proximal femora prophylactically pinned with 26 cases observed, in a cohort of patients with unilateral SUFE. Validated measurements were used to determine hip morphology; the articulo-trochanteric distance (ATD) and the ratio of the trochanteric-trochanteric distance (TTD) to articulo-trochanteric distance (TTD:ATD) in addition to direct measurement of the femoral neck length. Post-operative radiographs were compared to radiographs taken at a 12–84 months follow-up. Comparing pinned and unpinned hips the neck length was shorter (mean 5.1 mm vs 11.1 mm) and the ATD was lower (p=0.048). The difference between initial and final radiograph TTD:ATD ratio for each case was calculated. The average was 0.63 in the prophylactically pinned group and 0.25 in the unpinned group (p=0.07). When hips of the same patient were compared on final radiographs, there was a smaller difference in TTD:ATD between the two sides when the patient had been prophylactically pinned (0.7) as opposed to observed (1.47). This was not statistically significant (p=0.14). Universal prophylactic pinning of the contralateral hip in slipped upper femoral epiphysis is controversial and alteration of the proximal femoral morphology is one reason for this. Our results show that prophylactic pinning does not stop growth but does alter subsequent proximal femoral morphology by causing a degree of coxa vara and breva. Some loss of growth in the prophylactically pinned hip contributes to reduction in leg length inequality at skeletal maturity which is advantageous. No iatrogenic complications were observed with single cannulated screw fixation. Prophylactic pinning prevents the potential catastrophe of a subsequent slip, is safe and the effect on growth is, if anything, beneficial. Level of evidence: III
Some surgeons are reluctant to perform a reverse
total shoulder arthroplasty (RTSA) on both shoulders because of concerns
regarding difficulty with activities of daily living post-operatively
as a result of limited rotation of the shoulders. Nevertheless,
we hypothesised that outcomes and patient satisfaction following
bilateral RTSA would be comparable to those following unilateral
RTSA. A single-surgeon RTSA registry was reviewed for patients who underwent
bilateral staged RTSA with a minimum follow-up of two years. A unilateral
RTSA matched control was selected for each shoulder in those patients
undergoing bilateral procedures. The Constant–Murley score (CMS), American
Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Values
(SSV), visual analogue scale (VAS) for pain, range of movement and
strength were measured pre- and post-operatively. The mean CMS,
ASES, SSV, VAS scores, strength and active forward elevation were
significantly improved
(all p <
0.01) following each operation in those undergoing bilateral
procedures. The mean active external rotation (p = 0.63 and p =
0.19) and internal rotation (p = 0.77 and p = 0.24) were not significantly
improved. The improvement in the mean ASES score after the first
RTSA was greater than the improvement in its control group (p =
0.0039). The improvement in the mean CMS, ASES scores and active
forward elevation was significantly less after the second RTSA than
in its control group (p = 0.0244, p = 0.0183, and p = 0.0280, respectively).
Pain relief and function significantly improved after each RTSA
in those undergoing a bilateral procedure. Bilateral RTSA is thus a reasonable form of treatment for patients
with severe bilateral rotator cuff deficiency, although inferior
results may be seen after the second procedure compared with the
first. Cite this article: