Open tibial fractures typically occur as a consequence of high energy trauma in patients of working age resulting in high rates of deep infection and poor functional outcome. Whilst improved rates of limb salvage, avoidance of infection and better ultimate function have been attributed to improved centralisation of care in orthoplastic units, there remains no universally accepted method of definitive management of these injuries. The aim of this study is to the report the experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open fractures A prospectively maintained database was interrogated to identify all patients. Case notes and radiographs were reviewed to collate patient demographics and injury factors . The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventionsIntroduction
Materials & Methods
All Polyethylene Tibial components in Total Knee Arthroplasty have been in use for some years, studies showing equivalent results to Total Knee Arthroplasty (TKA) with metal-backed Tibial components at 10 years have shown no significant difference between the two on radiostereometric analysis and revision rates[1]. Post operative patient outcome data using standard metal-backed Tibial components is widely reported in the literature. This study is looking at patient outcomes following All-polyethylene tibial component TKA. We hypothesize that using standard patient outcome measures, an improvement comparable with that expected for metal-backed tibial component TKA will be shown with All-polyethylene tibial component TKA. Between August 2006 and August 2008, 229 all-polyethylene tibial component TKA were implanted at the elective orthopedic unit. The choice of implant was entirely dependent on surgeon's preference. Of the 229 patient's, 225 details were available for review, 27 did not wish to take part in the study and 1 patient died a year following surgery of an unrelated illness. The remaining 197 patients agreed to take part in the study. The patient's were contacted either in person or over the telephone and asked to completed questionnaires for standard knee scoring. These included: the Oxford Knee Score (OKS), the WOMAC Score and the SF-12 Score, both pre-operatively and post operatively.Objectives
Methods
The aim of this study was first, to determine
whether CT scans undertaken to identify serious injury to the viscera were
of use in detecting clinically unrecognised fractures of the thoracolumbar
vertebrae, and second, to identify patients at risk of ‘missed injury’. We retrospectively analysed CT scans of the chest and abdomen
performed for blunt injury to the torso in 303 patients. These proved
to be positive for thoracic and intra-abdominal injuries in only
2% and 1.3% of cases, respectively. However, 51 (16.8%) showed a
fracture of the thoracolumbar vertebrae and these constituted our subset
for study. There were eight women and 43 men with mean age of 45.2
years (15 to 94). There were 29 (57%) stable and 22 (43%) unstable
fractures. Only 17 fractures (33.3%) had been anticipated after
clinical examination. Of the 22 unstable fractures, 11 (50%) were
anticipated. Thus, within the whole group of 303 patients, an unstable spinal
injury was missed in 11 patients (3.6%); no harm resulted as they
were all protected until the spine had been cleared. A subset analysis
revealed that patients with a high Injury Severity Score, a low
Glasgow Coma Scale and haemodynamic instability were most likely
to have a significant fracture in the absence of positive clinical
findings. This is the group at greatest risk. Clinical examination alone cannot detect significant fractures
of the thoracolumbar spine. It should be combined with CT imaging
to reduce the risk of missed injury.
Thoracolumbar fractures are the most common spinal injuries resulting from blunt trauma. Missed spinal injuries can have serious consequences. Our objectives were to determine the utility of trauma series chest and abdomen computed tomographs for detecting clinically unrecognised vertebral fractures and to analyse those missed on clinical examination. The aim was to identify an ‘at-risk’ patient group with negative clinical examination warranting evaluation with CT screening.Background
Objective
