Elevated synovial leukocyte count is a minor criterion derived from the musculoskeletal infection society (MSIS) widely used in clinical practice for diagnosis of prosthetic joint infection. There is evidence to suggest analysis within 1 hour, preferentially within 30 minutes, of aspiration reduces the risk of ex vivo cell lysis occurring during prolonged transport. Multiple site working is more common practice and the availability of a lab on site to perform these tests is not always possible. We aimed to assess whether we could safely perform synovial leukocyte counts within our cold site in the diagnosis of prosthetic joint infection.

We reviewed all orthopaedic synovial fluid aspirates within the lower limb arthroplasty unit from April 2021 – April 2022 performed at South Tees NHS Foundation Trust. We assessed time from aspirate to the lab using electronic data resources. This information was compared with the labs ability to perform a synovial leukocyte count to determine the impact of delays on testing.

110 patients (34.5% hips and 63.6% knees) were identified between two sites. Time from aspirate to lab ranged from 0 mins to 26 hrs 34 mins. Mean time to processing was 3hrs 10 mins. 50% of all samples had a synovial leukocyte count performed. 67% of patients had a cell differential performed. There was no difference in the ability to perform a synovial leukocyte count between samples process in < 2hours vs > 6 hours.

We conclude that it is safe practice to perform joint aspirates for the work up of periprosthetic joint infections in sites where no laboratory is immediately available as the delay to processing synovial fluid does not alter the ability to perform a synovial leukocyte count. This study will provide evidence to enable the work up of periprosthetic joint infections in cold centres and therefore reduce the delay in diagnosis and proceeding management.

Abstract

Abstract

Hip fracture principally affects the frailest in society, many of whom are care dependent, and are disproportionately at risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.

We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1st February 2019 and 31st October 2020, in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.

Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that amongst those with COVID-19 infection at presentation (n=1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.05 (95%CI 1.86–2.26), while for infections arising between 8–30 days after presentation (n=1,644) the figure was even higher at 2.52 (2.32–2.73). Malnutrition [1.44 (1.19–1.75)] and non-operative treatment [2.89 (2.16–3.86)] were the only modifiable risk factors for death in COVID-19 positive patients. Patients with previous COVID-19 initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1st January and 30th June 2020, 1,273 (99.7%CI 1,077–1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (20%–26%), with most deaths occurring within 30 days.

COVID-19 infection more than doubled early hip fracture mortality; the first 30-days after injury were most critical, suggesting that targeted interventions in this period may have most benefit in improving survival.

Aims

Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients.

Background

There is significant variation and inconsistencies in the current advice and information delivered to patients undergoing total hip replacement (THR). The aim of this study was to assess a locally developed web-based electronic resource system for patients undergoing total hip replacement (THR) surgery to see if this improves and standardises the content, structure, and delivery of information delivered to patients prior to and after surgery.

Introduction

Periprosthetic joint infection (PJI) can be difficult to diagnose. A variety of techniques have been described. The efficacy of the alpha-defensin laboratory test was examined and compared with other established modalities in the diagnostic workup of ‘real world’ arthroplasty patients.

Aim

This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture.

Aims

The aim of this study was to compare the pain caused by the application of a tourniquet after exsanguination of the upper limb with that occurring after simple elevation.

Aims

The highly cross-linked polyethylene Exeter RimFit flanged cemented acetabular component was introduced in the United Kingdom in 2010. This study aimed to examine the rates of emergence of radiolucent lines observed when the Rimfit acetabular component was implanted at total hip arthroplasty (THA) using two different techniques: firstly, the ‘rimcutter’ technique in which the flange sits on a pre-prepared acetabular rim; and secondly, the ‘trimmed flange’ technique in which the flange is trimmed and the acetabular component is seated inside the rim of the acetabulum.

Introduction

The Exeter RimFit™ flanged cemented cup features ultra-highly cross-linked polyethylene and was introduced onto the market in the UK in 2010. We aimed to examine the rates of radiolucent lines observed when the Rimfit™ cup was implanted using a ‘rimcutter’ technique with the cup sitting on a prepared acetabular rim, and a ‘trimmed flange’ technique were the flange is cut so that it sits inside the prepared acetabular rim.

The aim of this study was to review the role of clinical trial networks in orthopaedic surgery. A total of two electronic databases (MEDLINE and EMBASE) were searched from inception to September 2013 with no language restrictions. Articles related to randomised controlled trials (RCTs), research networks and orthopaedic research, were identified and reviewed. The usefulness of trainee-led research collaborations is reported and our knowledge of current clinical trial infrastructure further supplements the review. Searching yielded 818 titles and abstracts, of which 12 were suitable for this review. Results are summarised and presented narratively under the following headings: 1) identifying clinically relevant research questions; 2) education and training; 3) conduct of multicentre RCTs and 4) dissemination and adoption of trial results. This review confirms growing international awareness of the important role research networks play in supporting trials in orthopaedic surgery. Multidisciplinary collaboration and adequate investment in trial infrastructure are crucial for successful delivery of RCTs.

Cite this article: Bone Joint Res 2014;3:169–74.

Introduction

National Institute for Health and Clinical Excellence (NICE) guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractured neck of femur (NOF) in cognitively intact patients who were independently mobile prior to the injury. The National Joint Registry for England and Wales (NJR) has collected data on THRs performed since 2003. This retrospective cohort study explores risk factors independently associated with implant failure and perioperative mortality.

Background

Current analysis of unicondylar knee replacements (UKR) by national registries is based on the pooled results of medial and lateral implants. Using data from the National Joint Registry for England and Wales (NJR) we aimed to determine the proportion of lateral UKR implanted, their survival and reason for failure in comparison to medial UKR.

Background

Both surgeon and hospital volume influence patient outcomes following revision knee arthroplasty.

Introduction

Following in-depth analysis of the market leading brand combinations in which we identified implant influences on risk of revision, we compared revision in patients implanted with different categories of hip replacement in order to find implant with the lowest revision risk, once known flawed options were removed.

Purpose

To determine how patient characteristics; health status and pre-operative knee function effect patient reported satisfaction and operative success following total knee replacement (TKR). We hypothesised that a number of patient factors would influence the reported levels of symptomatic improvement (success) and satisfaction and that these two outcomes would represent different aspects of the patient's perception of outcome.

Background

The most appropriate form of chemical thromboprophylaxis following knee replacement is a contentious issue. Most national guidelines recommend the use of low molecular weight Heparin (LMWH) whilst opposing the use of aspirin. We compared thromboembolic events, major haemorrhage and death after knee replacement in patients receiving either aspirin or LMWH.

Purpose

To examine how patients viewed the outcome of their joint replacement at least one year post surgery. Emphasis was placed on investigating the relative influence of ongoing pain and functional limitation on patient satisfaction.

Introduction

We have carried out a 15 year survival analysis of a prospective, randomised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements.

Introduction

Electrolyte imbalance in the elderly is a clinical problem faced by both elderly care physicians and orthopaedic surgeons alike. Hyponatraemia is a common condition with a vague clinical profile and severe consequences if untreated. Recent medical editorials have criticised orthopaedic handling of this problem. We therefore sought to establish the incidence of hyponatraemia within our orthopaedic population and a similar age-matched elderly care population in the light of changing attitudes to fluid management.

Introduction: The recent UK national comparative audit of the use of blood in primary, elective, unilateral THR found that 25% of patients required a peri-operative transfusion. We felt this figure was higher than should be expected, especially of surgeons with a dedicated arthroplasty subspecialty. We therefore audited our own practice with particular emphasis on the relationship between surgeon volume, implant and the need for transfusion.

Methods: A retrospective review of 508 consecutive primary, elective, unilateral hip and knee arthroplasties performed over a 12 month period. Pre- and post- operative haemoglobin levels, need for transfusion, and the timing and volume of any transfusion were recorded for each patient. Analysis determined the overall rate of transfusion, the details of any such transfusion, and the effects of surgeon volume upon the transfusion rate.

Results: The transfusion rate following THR (10%) was significantly lower than those found in the national audit. The transfusion rate following TKR was 7%. Multivariate analysis demonstrated that surgeon volume (< 50 THRs/yr Vs > 50 THRs/yr) and a preop-erative Hb < 12g/dl were the only significant determinants of a need for post operative transfusion (Both p< 0.05) following both THR and TKR. Other variables (age, gender, anaesthetic type, ASA, indication, surgeon grade and experience, implant, approach) were not significant. A preoperative haemoglobin of < 12g/dl was associated with a 6 fold and 3 fold increased risk of needing a transfusion following hip and knee replacement respectively.

Discussion: The need for allogenic blood transfusion following primary arthroplasty is influenced by both patient and surgeon related factors. Surgeons who have a dedicated arthroplasty practice and perform a high volume of procedures have significantly lower transfusion rates when compared to nationally accepted figures. This has implications for both patient care and resource management.

Introduction: The Oxford Knee Score (OKS) is commonly used in the assessment of outcome for knee arthroplasty. All patients having knee arthroplasty at our institution undergo OKS at both nurse led pre-assessment and admission physiotherapy visit, a period of 10 to 30 days pre-operatively. At both instances, the scoring form is left with the patient and collected at the end of the visit.

Anecdotal evidence from our centre suggested that patients attending for arthroplasty surgery were scoring differently at each visit.

The aim of this study is to establish if there is a significant difference OKS at pre-assessment visit and on admission to the ward.

Statistical Method: A pilot study was carried out. A power calculation revealed a requirement for 44 patients to enter the study. The resultant probability was 90 percent that the study would detect a difference at a two sided 5.0 percent significance level, if the minimum clinical difference is 3 points. This is based on the standard deviation of the difference in the response variables of 6. A clinical difference of 3 is drawn from previous studies investigating the use of the OKS.

44 patients undergoing arthroplasty surgery had their OKS for both visits retrospectively analysed.

The mean of the totals of both visits was analysed and found to conform to normality and hence was further investigated by a paired samples t test.

Comparison of individual scoring revealed a violation of normality and hence was further analysed using a Wilcoxon Signed Ranks Test.

Results: A statistically significant result at the 5% level was observed t= 2.197 (44df), p= 0.03. OKS at pre-assessment was lower than at admission to the ward by 1.1 point. (−2.1 – 0.9 95% CI).

Analysis of the individual scoring at both intervals revealed only three of the pairs achieved statistical significance and in each case, the difference was less than 3 scoring units. No significant difference was seen when time between assessments was analysed.

Conclusion: This study demonstrates that although there is a difference in total scoring using the OKS between two patient episodes prior to arthroplasty, a clinically relevant difference is not detected, and neither is a statistically significant difference detected when all scoring steps are analysed.

This work supports earlier studies that pre-operative assessment using the OKS is robust to variance in the pre-operative scoring window.

All patients undergoing knee arthroplasty at our institution complete Oxford Knee Scoring (OKS) at nurse-led pre-assessment and again at an admission physiotherapy visit on the ward which may be up to 2 months later.

The aim of this study is to establish the extended reproducibility of the OKS by statistical analysis of scores taken at these intervals.

44 patients were required to achieve a 90 % probability to detect a difference at a two-sided 5 % significance level with a minimum clinical difference of 3 points, a cut off used in previous works regarding the use of OKS.

Both the overall population means and the differences between individual questions were analysed by a paired samples t test and a Wilcoxon Signed Ranks Test respectively.

Mean interval between attendance for pre-assessment and admission visit was 16 days (7–60).

A statistically significant result at the 5% level was observed for the t test t= 2.197 (44df), p= 0.03. OKS at pre-assessment was lower than at admission to the ward by 1.1 point. (−2.1 – 0.9 95% CI).

Analysis of difference between individual questions revealed only three of the pairs achieved statistical significance and in each case, the difference was less than 3 scoring units.

This study demonstrates that although there is a difference in total scoring using the OKS between two patient episodes prior to arthroplasty, a clinically relevant difference is not detected, and neither is a statistically significant difference detected when all scoring steps are analysed.

The original validation of the OKS was obtained using test-retest reproducibility over a 24 hour period. This work shows that the OKS is robust to violations in reproducibility at duration much greater than this and for practical purposes is valid if taken at any point during the pre-admission phase of care.

Background: In a recent publication from the National Joint Registry it was suggested that prosthesis type influenced patient satisfaction at one year following knee arthroplasty. In this report Unicondylar Replacement (UKR) was associated with lower levels of patient satisfaction when compared to cemented TKR. The unicondylar group did however have a significantly lower Oxford Knee Score (OKS) than the TKR group and this occurred irrespective of patient age.

A common perception is that UKR is only offered to patients with lesser disease, with a decreased clinical profile. This may explain their higher levels of dissatisfaction as the overall change in their OKS from pre to post operation would be relatively smaller than for TKR.

Aim: We hypothesised that patients listed for UKR have less severe disease and therefore a lower preoperative OKS when compared to TKR.

Methods: After sample size calculation we retrospectively analysed 76 patients who underwent either UKR or TKR under the care of a single surgeon. OKS was recorded at a dedicated pre-assessment clinic. The decision to offer UKR was based on clinical and radiological criteria as outlined by the Oxford group.

Results: There were 38 patients in either group. The mean pre-operative OKS was 39.5 (26–56, SD 7.6) in the UKR group and 41.6 (31–51, SD 5.7) in the TKR group. There was no statistical difference between these two groups (p=0.18).

Discussion: Patients listed for knee replacement have significant pain and functional impairment. In our population those suitable for UKR have similarly severe symptoms to those who do not meet the criteria for UKR and are only eligible for TKR. It remains unclear why patients undergoing UKR should be less satisfied when they have better post operative patient reported outcome scores. It emphasizes the need for careful patient selection and counselling in patient undergoing UKR.

Introduction: The incidence of degenerative scoliosis in the lumbar spine is not known. In the ageing population deformity may coexist or cause stenosis. MRI gives limited information on this important parameter and is often the only investigation used pre-operatively in the treatment of stenosis. The aim of this study was to highlight the incidence of coronal abnormalities of the lumbar spine dependent on age in a large population of patients requiring abdominal and KUB radiographs at our institution.

Method: We reviewed all abdominal and KUB radiographs performed in our hospital in the first ten months from the introduction of our digital PACS system. 2276 radiographs were analysed for the incidence of degenerative lumbar scoliosis and lateral vertebral slips in patients who are ≥ 20 years old, in ten-year age ranges. Evidence of osteoarthritis of the spine was also documented. Radiographs were included if the inferior border of T12 to the superior border of S1 was visualised and no previous spinal surgery was evident (metal work/laminectomy).

Results: 2233 (98%) radiographs were analysed. 48% of patients were female. The youngest patient was 20 and the oldest 101 years. The incidence of degenerative lumbar scoliosis, lateral listhesis and osteoarthritis increased with age.

In all age groups curves were more frequent and had greater average Cobb angles in female patients except in the 30–39 year olds–where the males equalled females in frequency and had the greatest Cobb angles.

Conclusions: Degenerative lumbar scoliosis starts to appear in the third decade of life and increases in frequency every decade thereafter, affecting almost a third of patients in the ninth decade. It is more common in female patients and has a greater magnitude. Deformity may be even greater on standing views and is important to recognise in all patients that are undergoing lumbar spinal decompressive surgery. A failure to do so may lead to inferior results or the need for further surgery.

Presentation and subsequent publication has become ‘the holy grail’ of surgical trainees. This perceived importance of presenting work is further reinforced by the fact that over sixty percent of information contained in standard orthopaedic texts is quoted from published abstracts and not full papers. There is concern that increasing reliance is placed on such work and there are calls to restrict the routine use of abstracts in this manner.

This concern is born out of evidence that conversion of presented work into peer-reviewed publication is globally poor throughout the medical specialities.

The purpose of this study is to determine the conversion rate of work presented at the Combined Services Orthopaedic Society into peer review publication.

A Medline search of 81 consecutive published abstracts over six years was carried out. Further cross-referencing was established using Dialog Datastar with a search strategy. The rate of publication of papers presented at these meetings was then compared against other medical specialities across national and international forums.

26 full paper publications were identified. This yields a conversion rate of 32%. This figure is on a par with meetings such as the BOA (35%), the AAOS (34%) and EFORT (40%). It is also a similar level to that seen with work presented at other speciality meetings.

The conversion rate of papers presented at the Combined Services Orthopaedic Society is competitive with other orthopaedic and medical meetings. Overall conversion of presented works to robust literature is poor. Reasons for low publication rates include pressures of time, insufficient planning and disputes amongst colleagues.

In light of increasing pressure on selection of trainees and the perceived need to present work at meetings, this paper reinforces the need for thorough planning when undertaking research & audit and strict acceptance criteria from organising bodies.

Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.

MRSA infections are a current concern in the elderly orthopaedic patient, with colonisation rates of between 417% reported in these patient groups. In our institution there has been concern regarding MRSA surgical site infection and cross contamination of elective and emergency patients. This prompted the unit to consider a screening programme to identify MRSA carriers. We undertook the following project to assess the feasibility and effectiveness of implementing such a screening programme.

The aim was to to ascertain the incidence of colonisation with MRSA, rate of wound infection and associated risk factors in patients admitted with a fractured proximal femur.

This was a prospective, blinded case series of 100 consecutive patients admitted to the trauma ward with a fractured proximal femur. Three swabs (axilla, nasal and perineum) were taken within 24 hours of admission. Data from each patient was collated and each patient was followed until discharge to assess for surgical site infection.

The age range was 60–97 years. 26% were admitted from institutional care. Four patients were colonised with MRSA on admission. An association was seen between patients colonised on admission and long term or recent residence in institutional care. One of these patients went on to develop colonisation of the surgical wound however this did not lead to surgical site infection and the patient was successfully treated with MRSA eradication therapy only. In these 4 patients all wounds healed satisfactorily with no evidence of infection.

While MRSA continues to be a growing concern in the press we found that rates of colonisation and subsequent infection were not high. There were no documented cases of MRSA wound infection in colonised individuals. Given the cost to detect these low levels of colonisation we do not feel that a screening regime would be cost effective or justified.

Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.

Introduction: The surgical management of proximal humeral fractures continues to be an unsolved problem for the orthopaedic surgeon. Disagreement remains over how best to fix the more challenging complex fractures in younger patients where the ultimate goals of treatment are restoration of a painless shoulder, adequate function, and preservation of humeral head viability.

The PHILOS plate attempts to improve on previously designed implants by preserving the biological integrity of the humeral head articular fragment. The minimally invasive technique minimises soft tissue damage whilst at the same time securing the reduction using multiple locking screws with angular stability, thus allowing early mobilisation.

Methods: Retrospective review of the notes and x-ray images of 54 fractures treated with the PHILOS plate between Jan 2000 and Aug 2005. Data including baseline demographics, the presence of any complications and the need for reoperation were collected. In addition 43 (81%) patients were contacted and Oxford (OSS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were calculated to assess functional recovery. All patients were contacted at a minimum of 6 months following fixation with an average follow up of 18 months (Range 6–41 months)

We also present a cost analysis relating to the use of the PHILOS plate in practice.

Results: 54 fractures in 53 patients (25F:28M). Average age 54.4. There were 26 2-part, 15 3-part and 13 4-part fractures. A total of 11 (20%) patients had complications of which 7 (13%) required reoperation. These complications included deep infection (3 cases), AVN (4), Non Union (3) and plate impingement (1).

Mean OSS and DASH at follow up were 24.8 (S.D 11.6) and 28.0 (S.D 26.9) respectively. Worse scores were seen in those patients who had complications (OSS 39.4 Vs 22.6, DASH 58.2 Vs 23.4) although this difference was not statistically significant. There was also a trend for poorer scores with increasing fracture complexity and better scores in those patients operated upon by surgeons with a specific interest in the upper limb and in patients whose surgeon had performed more than 5 fixations.

Conclusion: Our series reports a much higher complication rate (20%) than that previously published. Whilst those patients who do not suffer complications reported good functional outcomes the presence of postoperative complications was associated with poorer results. Outcomes following surgery were affected by patient, implant and surgeon related factors. Given the high rate of serious complications and their detrimental affect on outcome surgeons should give serious consideration to the appropriateness of using such implants. To clarify these issues, further prospective randomised trials are needed.

Background: In recent years an increased trend in MRSA infection has been seen in hospitals and the community, with colonisation rates of between 4 – 17% reported in these patient groups. There is also an association between carriage of Staph. Aureus and staphylococcal surgical wound infection.

In our institution there has been concern regarding MRSA surgical site infection and possible cross contamination of elective and emergency patients. There would be implications for implant related infections if this were to occur. This had prompted the unit to consider adopting a screening programme to identify and treat MRSA carriers. This would aim to minimise risk of post operative infection and cross infection. As little was actually known about the MRSA colonisation rates of admissions to our hospital we undertook the following project to assess the feasibility and effectiveness of implementing such a screening programme.

Aim: To ascertain the incidence of colonisation with MRSA, rate of wound infection and the associated risk factors in patients admitted to the trauma ward with a fractured neck of femur.

Method: A prospective, blinded case series of 100 consecutive patients admitted to the trauma ward with a fractured neck of femur. Three swabs (axilla, nasal and perineum) were taken within 24 hours of admission. Data from each patient was collected to ascertain the presence of risk factors linked to MRSA colonisation and each patient was followed until discharged to assess for surgical site infection.

Results: 304 swabs were taken from 100 patients. Age range 60–97. 26% admitted from institutionalised care and 74% admitted from their own home. Four patients were colonised with MRSA on admission (2 nasal, 2 perineal). An association was seen between patients colonised on admission and long term or recent residence in institutionalised care. One of these patients went on to develop colonisation of the surgical wound however this did not lead to surgical site infection and the patient was successfully treated with MRSA eradication therapy only. In these 4 patients all wounds healed satisfactorily with no evidence of infection.

There were three superficial surgical site infections postoperatively, all in individuals who were clear on their admission screening. Of these two were due to MRSA and one was due to MSSA. There were no cases of deep infection requiring further surgery.

Conclusion:While MRSA continues to be a growing concern we found that, in our hospital, rates of MRSA colonisation and subsequent infection were not high. There were no documented cases of MRSA wound infection in colonised individuals. Given the cost involved in swabbing all patients to detect these low levels of colonisation we do not feel that an expensive screening regimen would be cost effective or justified in our institution.

Introduction: Scoring systems for assessment of shoulder function are invaluable tools in determining changes in a patient’s condition. We utilised two commonly used assessment tools in patients with conservatively treated proximal humeral fractures to establish their behaviour in this patient group.

Methods: OSS and Constant Scores were collected prospectively at 3 and 12 months post injury, for 103 consecutive patients treated conservatively for proximal humeral fractures. Comparison of the scores was undertaken by creating scattergraphs, calculating Pearson’s correlation coefficient and producing Bland and Altman plots. Sensitivity to change was calculated using paired t-tests. Linear regression analysis was finally performed to predict Constant Score from the OSS.

Results: 177 sets of scores were collected. The scores correlated well with a correlation coefficient (r) of 0.84 (p< 0.001,n=177). This relationship was equally strong at 3 (r=0.77 (p< 0.001,n=94)) and 12 months (r=0.87 (p< 0.001,n=83)) and demonstrated a clear relationship between the scoring systems. Bland and Altman plots showed good agreement between the scores. Both scores were sensitive to change over time (OSS (t(81)=6.14,p< 0.001), Constant (t(80)=−10.27,p< 0.001)). Regression analysis produced a regression equation (R2=0.70) of: Constant Score=99.3-(1.67 times OSS). This level of model fit was statistically significant (F(1,175)=412.8,(p< 0.001))

Conclusion: This study provides information about the behaviour of two frequently used functional scoring systems in patients with proximal humeral fractures. Based on our finding we feel that these scores are appropriate assessment tools in these patients. The OSS may also be considered as an alternative for assessing longer term follow up as, being solely subjective, it is easier to administer and correlates well with the Constant Score.