The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open tibial fracture. An initial pool of 109 items was generated from previous qualitative data relating to recovery following an open tibial fracture. These items were field tested in a cohort of patients recovering from an open tibial fracture. They were asked to comment on the content of the items and structure of the scale. Reduction in the number of items led to a refined scale tested in a larger cohort of patients. Principal components analysis permitted further reduction and the development of a definitive scale. Internal consistency, test-retest reliability, and responsiveness were assessed for the retained items.Aims
Methods
This study describes the use of the Masquelet technique to treat
segmental tibial bone loss in 12 patients. This retrospective case series reviewed 12 patients treated between
2010 and 2015 to determine their clinical outcome. Patients were
mostly male with a mean age of 36 years (16 to 62). The outcomes
recorded included union, infection and amputation. The mean follow-up
was 675 days (403 to 952). Aims
Patients and Methods
We conducted a randomised controlled trial to
determine whether active intense pulsed light (IPL) is an effective treatment
for patients with chronic mid-body Achilles tendinopathy. A total
of 47 patients were randomly assigned to three weekly therapeutic
or placebo IPL treatments. The primary outcome measure was the Victorian
Institute of Sport Assessment – Achilles (VISA-A) score. Secondary
outcomes were a visual analogue scale for pain (VAS) and the Lower
Extremity Functional Scale (LEFS). Outcomes were recorded at baseline,
six weeks and 12 weeks following treatment. Ultrasound assessment
of the thickness of the tendon and neovascularisation were also
recorded before and after treatment. There was no significant difference between the groups for any
of the outcome scores or ultrasound measurements by 12 weeks, showing
no measurable benefit from treatment with IPL in patients with Achilles tendinopathy. Cite this article:
Acetabular fractures are amongst the most complex fractures. It has been suggested that pre-contouring the fixation plates may save intra-operative time, blood loss, reduce intra-operative fluoroscopy and improve the reduction. The purpose of this study was to assess if the contouring could be done reliably using the mirror image of the uninjured hemipelvis. Using the CT data of 12 specimens with no bony abnormality 3D models were reconstructed. Using computer software (AMIRA, Visage Imaging) the mirror image of the left hemipelvis and the right hemipelvis were superimposed based on landmarks. The distances between the surfaces were then calculated and displayed in the form of colour maps. The colour maps demonstrated that for the areas around were acetabular fixation plates would be placed the differences were small. For the anterior column plate 50% of the specimens had differences of less than 1mm, which based on the work of Letournel and Judet would represent an anatomical reduction. For the posterior column plate 58% had differences of less than 1mm. This study demonstrates that there is considerable symmetry between both hemipelvises and that precontouring on the mirror image of the uninjured side is an accurate, quick and reliable method for precontouring.
The ability of activated platelets to induce cellular proliferation is well recognised. In a previous diffusion model, platelets combined with Tri-calcium phosphate (TCP) led to an osteoprogenitor mitogenic response followed by cellular differentiation. This study was designed to look at osteoprogenitor responses when cultured directly onto TCP granules combined with activated platelets. Human osteoprogenitors were loaded onto TCP with activated platelets at a low seeding density and high seeding densities. Cellular proliferation was assessed using the pico-green DNA content analysis. Differentiation towards osteoblastic phenotype was assessed using an alkaline phosphatase assay. RNA extraction, reverse transcription and quantitative real-time polymerase chain reaction was used to assess gene expression for type 1 collagen and osteocalcin. Histological assessment for live/dead staining and alkaline phosphatase was used on cultured granule samples.Introduction
Method
Acetabular fractures are amongst the most complex fractures to treat. It has been suggested that pre-contouring the fixation plates may save intra-operative time, blood loss, reduce intra-operative fluoroscopy and improve the reduction. The purpose of this study was to assess if the contouring could be done reliably using the mirror image of the uninjured hemipelvis. Using the CT data of 12 specimens with no bony abnormality 3D models were reconstructed. Using computer software (AMIRA, Visage Imaging) the mirror image of the left hemipelvis and the right hemipelvis were superimposed based on landmarks. The distances between the surfaces were then calculated. The results were collected in the form of mean distance and colour maps. The mean difference between surfaces ranged from 1.76mm and 8.47mm. The colour maps demonstrated that for the areas around were acetabular fixation plated would be placed the differences were small. For the anterior column plate 6 (50%) of the specimens had differences of less than 1mm, which based on the work of Letournel and Judet would represent an anatomical reduction. (None had a difference of more than 6mm.) For the posterior column plate 7 (58%) had differences of less than 1mm. (None had a difference of more than 3mm. This study demonstrates that there is considerable symmetry between both hemipelvises and that precontouring on the mirror image of the uninjured side is an accurate, quick and reliable method for precontouring. However the symmetry is not exact and the operating surgeon needs to be aware that fine-contouring may be required intra-operatively.
Chronic mid body Achilles A systematic review of the literature was conducted. A search of published and grey literature databases was undertaken (1999- December 2010). Two reviewers independently assessed the studies for eligibility using a strict inclusion and exclusion criteria. All eligible articles were assessed critically using the Pedro score. Data on cohort characteristics, diagnostic criteria, treatment intervention, outcome measures and results was extracted. A narrative research synthesis method was adopted.Introduction
Methods
To investigate the effects of trauma and fracture surgery on leukocyte maturation and function. Unbalanced inflammation triggered by trauma has been linked to multiorgan dysfunction (MOD) and death. In animal and cellular models, changes in neutrophil function and failure of monocyte infiltration and resolution have been implicated as possible causes. The investigators combine assays on neutrophil function with surface antigen expression on circulating neutrophils and monocytes. These are correlated with severity of traumatic injury, type of surgery and clinical outcome to help explain the aetiology of distant organ injury, and pose a case for damage control surgery.Objective
Background
The treatment of femoral non-union, especially femoral exchanged nailing, has had mixed results in the recent literature. A review of the literature has suggested that exchanged nailing may be the gold standard for the treatment of femoral non-union. Is femoral exchange nailing an acceptable method of treatment of femoral fracture non-union? What is the evidence? In this systematic review we compare four different methods for the treatment of femoral non-union. English speaking literature from 1970 to 2007 was searched using Pubmed® and OVID™ databases and a manual reference search to reveal the original research, presenting the results of the treatment of femoral non-union with exchange nailing, plating, external fixation, and isolated bone grafting. Outcome parameters chosen were union rate and speed of union. The baseline variables chosen were age, number of surgeries, infection and the type of non-union. In total, fifty six case series were identified containing 861 patients treated with exchange nailing (31 studies), 214 patients treated with plating (11 studies), 140 patients treated with external fixation (13 studies), 81 patients treated with bone grafting (4 studies). The average union rate was 89% for exchange nailing, 93% for plating and external fixation and 62% for bone grafting. Speed of union was 7.3 months for exchange nailing, 8.6 months for plating and 9.15 months for external fixation. Study of baseline variables showed patients to be older in plating and external fixation groups (range 32–44 years, P<
0.001). There were more previous operations performed in the external fixation and plating groups (3 and 1.8 vs. 1.2, P<
0.001), significantly more infected non-unions in the plating and external fixation groups as compared to the exchange nailing group (40% vs. 11.5% P<
0.001) and significantly more atrophic non-unions in the plating and external fixation groups as compared to the exchange nailing group (85% vs. 65%, P<
0.001). The literature suggests that femoral exchange nailing has an equivalent or poorer outcomes when compared to external fixation and plating in spite of having been performed in potentially less complex cases. Plating of non-union in the literature has a higher rate of associated bone grafting than femoral exchange nailing which may be responsible for marginally better union rate in the external fixation and plating groups. Isolated bone grafting without revision of fixation does not provide adequate union rate and hence may be of questionable treatment value.
After gaining COREC approval we compared the objective to subjective walking distance of patients who had sustained a fractured Os Calcis over the past two years and were allowed to full weight bear. Patients were assessed by a senior physiotherapist and Doctor. Both the American Orthopaedic Foot and Ankle Score and Maryland Score were performed. Patients were asked to estimate their maximum walking distance prior to objective treadmill assessment.
Total knee arthroplasty (TKA) is a common, effective operation but postoperative infection has devastating consequences. Several papers have associated perioperative autologous transfusion with reduced infection rates. Salvaged blood may augment the inflammatory response and central within it is polymorphonuclear leukocyte (PMN). Our hypothesis was that autologous transfusion enhances PMN activity by: increased PMN transmigration to potential infection site, enhanced phagocytosis, augmented respiratory burst activity. Our randomised controlled prospective study showed a significant increase in superoxide production by PMN of patients who received unwashed autologous transfusion supporting the clinical studies where infection rates following autologous transfusion were reduced.
PMN Migraoty Activity: PMN were isolated from citrated blood at admission, 8 and 24 hours later. The number of PMN migrating across porous tissue culture inserts in response to defined concentrations of IL-8 (zero, 10, 30 &
100ng/ml) were quantitated by peroxidase assay.