Hip fractures in elderly patients are managed at both major trauma centers (MTC) and trauma units (TU). Previous evidence has demonstrated the importance of early surgery to reduce the morbidity and mortality related to the injury. The aim of this study is to compare the ‘time to theatre' and ‘30 day mortality' in TUs versus MTC in UK.

A retrospective review of prospectively collected data on NHFD was performed. The average ‘time to theatre' in hours and ‘30 day mortality' of all hospitals were analysed between January and December 2018. Further subgroup analysis was done to check for any regional variations; in each instance a Shapiro-Wilk test was used to check for normal distribution, followed by a one-way ANOVA with a Tukey's post hoc test.

Data from 158 hospitals in England (ENG), Wales (WAL) and Northern Ireland (NI) were used; 18 of which were MTC. There were 57,936 operative cases in TUs and 8606 in MTC's. The mean time (hours) to surgery from presentation was 32.51 and 32.64 for TUs and MTC respectively (p=0.513).

There was no significant difference in ‘30 day mortality' (p=0.635) between TUs (6%) and 5.7% MTC's (5.7%), MTC's and TUs in ENG, WAL and NI (p=0.555), and MTC and WAL, NI and the different regions of ENG (p=0.209).

A significant difference was observed, between the regional practice for TUs versus MTC's in ENG, WAL and NI (p=0.001) and between MTC's and TUs in WAL, NI and the different regions of ENG (p=0.001), with patients waiting significantly longer in NI for their procedure (mean=60.25 hours, p=0.001)

There was no significant difference in time to surgery or 30 day mortality between TUs and MTC's, demonstrating comparable hip fracture care, despite MTCs need to prioritise more serious injuries.

Introduction

Patients with pre-existing dementia are more susceptible to hip fracture due to various risk factors such as age, decreased activity leading to sarcopenia and osteoporosis, Vitamin D deficiency and presence of Apolipoprotein gene. The mortality associated with dementia and fracture neck of femurs was thought to be 2.3 times more than that of patients with intact cognitive function. The aim of this study is to assess the mortality of patients at 28 days, 4 months and one year after undergoing surgery for fracture neck of femurs.

The autologous osteochondral grafting represents a treatment option for osteochondral lesions of the weight bearing articular surfaces of femoral condyles and talus. The aim of our study was to evaluate the MRI findings and to determine the correlation between the radiological and the functional outcome in the early follow up.

We performed a retrospective study and followed up 33 patients 1 to 4 years after osteochondral auto-grafting. The grafts were harvested from the anterolateral region on the lateral femoral condyle of the ipsilateral knee using an insider rinsing diamond bone-cutting instrument (DBCS). The grafts were implanted using press fit technique and mosaic plasty.

Sixteen (48%) women and 17 men were included in our follow up with an average age of 38.4 years (age range-16 to 58 yrs). The Lysholm and Foot and Ankle Osteoarthritis Scores were used for the assessment of the functional outcome. MRI scans were performed by all patients.

While the MRI results illustrated graft incorporation, the cartilage contour interruption, irregularity of the subchondral lamina, inhomogeneity and subchondral oedema are typical findings between host and graft tissues. The clinical outcome demonstrated pain relief and improved function. There was no statistically significant correlation between radiological and functional outcome (p>0.05).

The MRI is a well-recognised non-invasive diagnostic tool to assess the integration of osteochondral grafts and to evaluate the articular surface but it has a reduced clinical significance on the early post operative stages. The long-term prognostic value of the unsatisfying MRI results is unknown.

The aim of this study was to document the findings and the pathology of tennis elbow during arthroscopy in patients who had failed conservative treatment for lateral elbow pain with a presumptive diagnosis of lateral epicondylitis (tennis elbow).

Materials and Methods: We carried out a prospective study of a consecutive series of 397 patients who underwent elbow arthroscopy for lateral elbow pain previously diagnosed as lateral epicondylitis. All the patients had a period of atleast six months of various conservative treatment modalitiesin the nature of NSAIDS, bracing physiotherapy and ultrasound. The arthroscopy procedures were performed by one of two surgeons using identical standard techniques and the findings were carefully documented.

Results: There were 238 men and 159 women in the study group: mean age 51 years (range 21 to 80 years). Synovitis was present in 173(44%), degenerative changes in 232 (58%), common extensor origin inflammation in 173(44%), radial head plica in 121(30%), loose bodies in 85(21%), ostephyte formation in 45(11%) and intra-articular adhesions in 26(6%).

Of the 232 patients who had degenerative changes 186(80%) had articular cartilage changes in the lateral compartment(radial head & capitellum), partial thickness loss in n=94(51%) and full thickness cartilage loss in n=92(49%).

Conclusion: The clinical diagnosis of lateral epicondylitis is applied to patients who have a variety of pathologies involving the tissues of the lateral compartment of the elbow. In addition to inflammation and degenerative tears of common extensor origin other pathologies such as synovitis, radial head plica, loose bodies and degenerative osteoarthritis should be considered.

This diagnosis of tennis elbow is often applied to patients with degenerative changes(osteoarthritis) involving the lateral compartment.

Advanced degenerative changes involving the articular cartilage of the lateral compartment can be present in patients with little or no abnormality visible on x-ray.

We conclude that arthroscopy is a definitive diagnostic tool to evaluate the various pathologies giving rise to lateral elbow pain and also helps in planning and initiating the appropriate treatment plan directed against specific and accurate conditions causing lateral elbow pain(lateral epicondylitis)

Purpose: The purpose of this study is to evaluate the arthroscopic findings in patients who presented with persistent lateral elbow pain despite conventional conservative measures, with special regard to diagnosis specific results. The controversy regarding the etiopathogenesis, whether intraarticular, extraarticular or both continues to exist.

Method: This is a retrospective review of 280 arthroscopies of elbow in 262 patients over a period of 6 years with a minimum follow-up of 6 months. All of them are therapeutic procedures involving ECRB release, excision of plica, synovectomy or debridement of the joint. The functional outcome was assessed and recorded independently by two experienced upper limb physiotherapists using the Mayo elbow performance score.

Results: Dominant hand was involved in 68% of the cases. The average age was 54 years. Isolated pathology such as common extensor inflammation was identified in 138 (49%), synovial plica in 24 (8%) and degenerative changes confined to lateral compartment with normal appearance of articular cartilage of medial compartment is noted in 31 (11%). In the rest mixed pathology with various combinations were identified.

Conclusion: Good to excellent results were seen in those with isolated common extensor inflammation and poor outcomes were noted in 20 (7%) of patients and the common intraoperative finding seen was degenerative changes of radiocapitellar joint. This was found to be statistically significant.

Goodfellow & Bullough (1968) first described the pattern of articular cartilage wear in the elbow. More recent post mortem studies have shown that advanced degenerative changes can develop in the radio-capitellar (lateral) compartment of elbow joints of elderly subjects in which the humero-ulnar (medial) compartment remains remarkably well preserved. The significance of this post-mortem findings,in an elderly population, with unknown elbow symptom logy, who died from diverse causes, is unknown. There has been no clinically based,in vivo,study of this subject. Our study would support these observations, but indicates that symptomatic degenerative change occurs at a much earlier age than had previously been thought.

We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with elbow pain resistant to conservative treatments (age range 21–80 years: mean age 51 years). We documented established degenerative changes involving articular cartilage in 68 patients (59%). In this group we found that in 60 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with normal appearances of the articular cartilage of the medial compartment.

The findings presented in this work are in full agreement with previous work on the articular wear and biomechanics of the elbow joint. Previous studies which have been on cadaveric specimens, with findings of uncertain symptomatic relevance. To our knowledge, this finding has not previously been demonstrated in a symptomatic, young population. Unicompartmental lateral degeneration of the elbow is therefore a real clinical entity rather than a interesting post mortem finding. As such, it demands consideration in terms of investigation, diagnosis and treatment. It is likely that in the past, many patients have been misdiagnosed as having chronic lateral epicondylitis.

We consider that lateral compartment degenerative change is a distinct clinical entity. It begins in relatively young patients in whom the x ray appearance may be normal or near normal and is often diagnosed as lateral epicondylitis. Our observations taken together with the reported post mortem studies indicate that primary osteoarthritis of the elbow begins in the lateral compartment of the joint and may remain confined to the lateral compartment throughout life. We believe that new treatment strategies need to be developed specifically for patients with primary osteoarthritis as opposed to degenerative joint disease due to other causes.

The osteochondral defect in the knee and ankle joint is a difficult and common problem in young population. The bone-cartilage autologous grafting represents a recently introduced treatment option for osteochondral lesions of the weight bearing articular surfaces of femoral condyles and talus.

The aim of our study was to evaluate the MRI findings, and in particular to find out about the fate and the time needed for the graft incorporation, to assess the continuity, homogeneity and smoothness of the cartilage layer of the transplant compare to the remaining cartilage, to estimate the viability of the graft and to determine the correlation between the MRI findings and the functional outcome.

We performed a prospective study and followed up 33 patients, who underwent osteochondral autografting for defects in both medial and lateral femoral condyles as well as in the talus. The grafts were harvested from the anterolateral region of the ipsilateral knee using an insider rinsing diamond bone-cutting instrument (DBCS). The grafts were implanted using press fit technique.

16(48%) women and 17 men were included in our followup with an average age of 38.4 years (age range-16to58 yrs). There were 20(60%) osteochondral defects in the femoral condyles and 13 in the talus. 13(40%) patients gave a history of trauma. All the patients were followed up with MRI scans between 1 to 4 years postoperatively.

The MRI study illustrated a cartilage contour interruption by 16(48%) patients and 19(58%) had uneven joint surface. 9(27%) of the patients were shown to have homogeneity between the graft and the surrounding bone and cartilage tissues. A subchondral oedema was observed in 2(6%) of the cases. Only 1 patient had a subchondral bone-oedema in the graft-donor site. All the autologous grafts were incorporated by 4 years as proven by MRI scans

The MRI evaluation revealed regular incorporation of the osseous part of the graft in the subchondral bone. On the contrary, cartilage layer integration was less common. The MRI findings did not show any correlation to the clinical outcome. Hangody (2003) reports all grafts to incorporate into the recipient bed and most articular surfaces to have congruency and similar appearance to the surrounding articular cartilage and bone in 6 years.

Despite using very accurate harvested autologous osteochondral cylinders, which fit exactly the defects, match precisely the corresponding chondral and osseous layers and cause no immune reactions, it was shown in this short term MRI followup that the height and the shape of the original articular surface cannot be fully restored. However the relief of symptoms and improved functional outcome are promising findings and define bone cartilage autografting as a currently efficient treatment of osteochondral lesions of knee and talus.

The aim of the study is to assess the humero radial plica which could be a factor in causing lateral elbow pain. The cause of lateral elbow pain has been an enigma for the orthopaedic surgeons over the years. The synovial fold of the humeroradial joint has been well documented and considered as a meniscus between the articulation. They can also present as symptoms suggesting intra articular loose bodies causing pain in these patients. Our study included 117 consecutive elbow arthroscopies performed by two surgeons for a period of 18 months. All patients were initially treated non-operatively as a ‘tennis elbow’ before undergoing arthroscopy. Conservative treatment included rest, activity modification, physiotherapy including ultrasound bracing, nsaids and local corticosteroid injection. All patients were assessed using the Mayo clinic performance index for elbows both pre and post operatively. Radial head plica was found in 21(18%) out of 117 elbow arthroscopies and was resected using a soft tissue resector. There were 16 (76%) men and 5(24%) women in this affected group and all of whom were young and active with a mean age 38 years. Of the 21 patients 16(76%) had a post operative score of 90 or more (excellent) and 5(24%) had a score 75–89(good). This study addresses the fact that cause of lateral elbow pain can be due to various pathologies in the elbow and in the cases of ‘resistant tennis elbows’ we recommend that the existence of a radial head synovial plica should be considered and if present treatment should be directed at this. Our study demonstrates that by resecting the synovial plical fold, pain will be relieved and these patients regained elbow function. Since this was noted in the young active age group this could reduce the morbidity and the time for rehabilitation required especially for those involved in active sports. A similar series has not been cited in English literature

Goodfellow & Bullough (1968) first described the pattern of articular cartilage wear in the elbow. More recent post mortem studies have shown that advanced degenerative changes can develop in the radio-capitellar (lateral) compartment of elbow joints of elderly subjects in which the humeroulnar (medial) compartment remains remarkably well preserved. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with elbow pain resistant to conservative treatments (age range 21–80 years: mean age 51 years). We documented established degenerative changes involving articular cartilage in 68 patients (59%). In this group we found that in 60 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with normal appearances of the articular cartilage of the medial compartment.

The post mortem studies carried out on mainly elderly subjects demonstrated that the degree of degenerative change in the elbow is age dependant and involves predominantly the lateral compartment of the joint. Our study would support these observations, but indicates that symptomatic degenerative change occurs at a much earlier age than had previously been thought.

We consider that lateral compartment degenerative change is a distinct clinical entity. It begins in relatively young patients in whom the x ray appearance may be normal or near normal and is often diagnosed as lateral epicondylitis. Our observations taken together with the reported post mortem studies indicate that primary osteoarthritis of the elbow begins in the lateral compartment of the joint and may remain confined to the lateral compartment throughout life. We believe that new treat ment strategies need to be developed specifically for patients with primary osteoarthritis as opposed to degenerative joint disease due to other causes.