Aims

Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alternative methods that have been suggested for assessing BMD include: 1) cortical measures, such as cortical ratios and combined cortical scores; and 2) aluminium grading systems from preoperative digital radiographs. However, limited research has been performed in this area to validate the different methods. The aim of this study was to investigate the evaluation of BMD from digital radiographs by comparing various methods against DXA scanning.

Tibial plateau fractures classically present in a bimodal distribution associated with high energy mechanisms in the younger population and fragility fractures in the elderly populations as a result they are well suited for looking at the effect major trauma centre status. Military trauma surgeons in training should be exposed to as much young high-energy trauma as possible to equip them for operations.

Retrospective review of all tibial plateaus presenting to RVI 20 months before MTC status and 20 months following this.

61 patients pre, 66 post. Schatzker grade 1–4 were similar pre and post change. Post change there was an increase in Schatzker 5 (62%) and 6 (27%). High energy injuries were most common in younger males, cause was falls followed by RTAs.

MTC status has meant an increase in high energy tibial plateaus (Schatzker 5–6) These were predominantly seen in younger males with high-energy mechanisms. As this is likely to be replicated across all injuries, we would recommend military trauma surgeons have a significant period of time training in major trauma centres to ensure adequate exposure to young high energy trauma.

Open fractures are uncommon in the UK sporting population, however because of their morbidity then are a significant patient group. Currently there is very little in the literature describing the epidemiology of open fracture in sport. We describe the epidemiology of sport related open fractures from one centre's adult patient population.

Retrospective analysis of a prospectively collected database recording all sport related open fracture s over a 15 year period in a standard population.

Over the 15 year period, there were 85 fractures in 84 patients. The mean age was 29.2 years (range 15–67). 70 (83%) were male and fourteen female (17%). The six most common sports were football (n=19, 22%), rugby (n=9, 11%), cycling (n=8, 9%), hockey (n=8, 9%); horse riding (n=6, 7%) and skiing (n=6, 7%). The top five anatomical locations were fingers phalanges, 35%; tibia-fibula 23%; foreman 14%; ankle 11% and metacarpals 5%. The mean injury severity score was 7.02. Forty five patients were grade 1; 28 patients were grade 2; 8 patients were grade 3a; and 4 were grade 3b according to the Gustilo-Anderson classification system. Seven patients (8%) required plastic surgical intervention for the treatment of these fractures. The types of flaps used were split skin graft (n=4), fasciocutaneous flaps (n=2); and adipofascial flap (n=1).

We looked at the epidemiology open fractures secondary to sport in one centre over a 15 year period. Football was the most common sport (22%) and within football, the most common site was the tibia and fibula. In contrast, within the cohort a whole the majority of fractures were upper limb, with the hand being the most common site. Whilst not common in sport, when they are sustained they are frequently occur on muddy sport fields or forest tracks and must be treated appropriately. A good understanding of the range and variety of injuries commonly sustained in different sports is important for clinicians and sports therapists.

Rugby union is the second commonest cause of sporting fracture in the UK. Yet little is known about patient outcome following such fractures.

All rugby union fractures sustained during 2007–2008 in the Lothian were prospectively recorded. Patients were contacted by telephone in February 2012 to ascertain their progress in returning to rugby.

There were 145 fractures in 143 patients, including 122 upper limb and 25 lower limb fractures. 117 fractures (81%) were followed at mean 50 months (range 44–56 months). 87% returned to rugby post injury, with 85% returning to rugby at the same level or higher. 77% returned by three months and 91% by six months. In upper limb fractures 86% returned by six months and 94% by six months. In lower limb fractures 42% returned by three months and 79% by six months. 32% had ongoing fracture related problems. 9% had impaired rugby ability secondary to fractures.

Most patients sustaining a fracture playing rugby union will return to rugby at a similar level. While one third of them will have persisting symptoms post-injury, for the majority this will not impair their rugby ability.

To describe the treatment and morbidity of lower limb (LL) football fractures in regard to returning to football in a known UK population at all skill levels.

All football fractures during 2007–2008 sustained by the Lothian population were prospectively collected with the diagnosis being confirmed by the senior author when patients attended the only adult orthopaedic service in Lothian. Patients living outside the region were excluded from the study. Patients were contacted in August 2010 to ascertain their progress in return to football.

There were 424 fractures in 414 patients. 366 fractures (86%) in 357 patients (86%) were followed up with a mean interval of 30 months (range 24–36 months). Of these 32% were sustained in the LL. 88% of LL injuries returned to football compared to 85% of upper limb (UL) fractures (p=0.4). 60% of LL patients were treated as outpatients. 35% were operated on −26% had ORIF and 9% IM Nailing. The most common LL fractures were Ankle 38%, Tibial Diaphysis 14%, 5th Metatarsal 11%, Fibula 9% and Great Toe 7%. Only one of the fractures was an open injury - Gustillo Class 1 2nd Phallanx Foot. Three of the 12 patients who underwent IM nailing required fasciotomy. One patient in the operative cohort developed a significant infection. The mean time for return to football for conservative treatment was 17 weeks (range 3–104 weeks), and for operative treatment 41 weeks (range 10–104 weeks). 91% of patients treated conservatively returned to football, compared to 84% of the operative cohort (p=0.3). 43% of patients had ongoing symptoms from their injury. 9% of the operative cohort required removal of metal work or further operative intervention. 83% of patients returned to the same level of football or higher following injury. Patients under 30 were 1.4 times more likely to return to sport than those over 30 (p<0.05).

We have previously demonstrated that football is the most common cause of sporting fracture(1), yet little is known about patient outcome following fractures. LL fractures are less common than UL fractures, and there is no difference in the proportion of patients returning to football following LL fractures and UL fractures. Over half of LL fractures are treated as outpatients and the incidence of open fractures is very low. There is no significant difference between the operative and conservative groups in their return to football. In the over 30 age group, sustaining a fracture may act as a catalyst to quit football. This may explain the higher non-return rate compared to the under 30 age group. 43% of patients perceive that they have ongoing problems with their fracture over 24 months post-injury reflecting the considerable morbidity of football-related fractures.

Aims: The aims of this study were to define the incidence of knee stiffness following ACL reconstruction, to determine which patient factors were associated with this, and to assess how effective arthroscopic arthrolysis has been in treating the stiffness.

Methods: To define the incidence of stiffness, we reviewed the patient records of a consecutive cohort of 100 primary isolated ACL reconstructions using quadruple hamstring autografts (2004–2006). Stiffness was defined as any loss of motion as compared to the contra-lateral leg. The mean age at reconstruction was 30 years and the median delay between injury and operation was 15 months. To assess the effectiveness of arthroscopic arthrolysis, we then reviewed all the patients who had undergone this procedure following primary isolated ACL reconstruction (n=18: 1997–2008). The mean age at arthrolysis was 31 years and the median delay between reconstruction and arthrolysis was nine months.

Results: Following primary ACL reconstruction, the incidence of stiffness was 12% six months postoperatively. Poor compliance with physiotherapy (p< 0.005), previous knee surgery (p< 0.005), and anterior knee pain (p< 0.029) were significantly associated with stiffness. A binary logistic regression found both poor compliance with physiotherapy (Exp(B)=6.931; 95%CI, 1.609–29.859; p< 0.009) and previous knee surgery (Exp(B)=6.383; 95%CI, 1.548–26.322; p< 0.010) to be significant predictors of the stiffness. The rate of stiffness fell to 5% at 12 months, without operative intervention. Of the 18 patients who underwent arthroscopic arthrolysis, the mean extension loss improved from 7° to 1° and the mean flexion loss improved from 8° to 2°. Arthroscopic arthrolysis was significantly more effective in restoring extension loss (p< 0.029) if carried out within eight months of the primary reconstruction.

Conclusions: Knee stiffness remains a significant problem post ACL reconstruction. This can however be effectively improved by appropriately timed arthroscopic arthrolysis.

To illustrate the incidence and epidemiology of fractures due to football.

All inpatient and outpatient fractures from a prospectively collected database for a defined population in 2000 were retrospectively analysed.

There were 396 football fractures, 96% male. Football caused 39% of the 1022 sports fractures in 2000. This represented 5% of the 8151 fractures in total. The incidence was 61/105. 115/105 in males and 5 /105 in females. The average age was 22.9 years; 22.8 in males and 26.6 in females. 77% of fractures were treated as outpatients. The top five fractures representing 84% of the injuries were Radius+Ulna 30%, Phalanx 19%, Tibial+Fibula 18%, Metacarpal 11% and Clavicle 5%. 71% were upper-limb fractures. The busiest two months were October and May 17% and 14% respectively. The quietest two months were February and December at 5%.

Although the epidemiology of football injuries will vary amongst different populations, these results can be generalized to similar population bases. Results will be valuable to medical professionals supporting football teams, enabling them to focus their attention on treating the most common injuries, the majority being treated as outpatients.

Football is the most common cause of fractures in sport. As participation increases, the incidence of fractures is likely to reflect this. Upper limb fractures account for over 2/3 rd of fractures with radius+ulna fractures accounting for up to a 1/3rd of fractures; the majority can be treated as an outpatient. Therefore medical teams should be familiar with standard treatment regimes, possible impact on players’ futures and time out of sport.