Patient Outcomes Following Ankle Fracture Fixation.

BACKGROUND: Several studies have reported on potential negative predictive factors of functional outcomes after ankle fracture fixation. However, there is minimal patient-reported data on long-term outcomes. This study aimed to evaluate potential risk factors leading to a poor patient-reported functional outcome at 2 and 5 years following ankle fracture fixation. METHODS: We conducted a prospective cohort study over a 5-year period on patients undergoing open reduction and internal fixation for unstable ankle fractures. Patient demographics, medical comorbidities, fracture pattern, and fixation quality were recorded and analyzed. Patients were followed up at 2 and 5 years. Data collected include the Olerud-Molander Ankle Score (OMAS), Lower Extremity Functional Scale (LEFS), ongoing issues, and the need for further intervention. A P value <.05 was considered statistically significant. RESULTS: Out of 180 patients, follow-up data were available for 82 (46%) patients at 2 years and 94 (52%) patients at 5 years. At 2 years, age ≥60 years was a predictor of worse LEFS, while a body mass index ≥30 was a predictor of worse OMAS. Severely deformed ankle at presentation showed worse OMAS and LEFS score. However, these predictive factors were not significant at 5 years. An anatomically reduced ankle fracture fixation was more likely to have a better functional outcome at the 2- and 5-year follow-ups. A reduction in OMAS at 2 years was predictive of possible ongoing issues following surgery, which in turn increased the odds of worsening OMAS at 5 years. CONCLUSION: Achieving adequate fracture reduction during fixation is crucial for better ankle functional recovery postinjury. In this cohort, we found that patients who undergo ankle fracture fixation will have an ongoing negative impact on their functional and physical capacity at both 2 and 5 years postoperatively. Appropriate patient counseling is necessary to prepare them for the expected functional outcomes. LEVEL OF EVIDENCE: Level II, prognostic.

Current surgical management of metastatic pathological fractures of the femur: A multicentre snapshot audit.

AIMS: We aimed to find out: the typical workload for metastatic bone disease, the conventional treatment for femoral metastases and whether there is a trend for arthroplasty and endoprosthetic reconstruction. MATERIALS AND METHODS: All sequential patients undergoing surgery for femoral metastatic lesions (both pathological fracture and impending pathological fracture) of any age patient were included in the multicenter snapshot audit. Data on demographics, institutions and operative procedures were recorded. RESULTS: 24 UK Institutions were enrolled, including 7 Major Trauma Centres (MTCs). It was a 2 month audit from 1stMarch 2018. 95 cases were recorded. The mean age was 71 and 65% were female. 66 patients had a fracture at presentation and 23 an impending fracture. Breast carcinoma was the primary tumour at 23%. The mean Mirel's score is 9. The commonest fixation was with a long cephalomedullary nail (38%). Endoprostheses accounted for 24%. None of the endoprostheses were implanted at MTCs. CONCLUSION: This audit revealed large numbers of cases of femoral metastases. Although the use of endoprostheses may be increasing in Trauma Units, intramedullary nailing still predominates. Future pathways may benefit from directing resources to allow greater arthroplasty.

A systematic review of displaced paediatric distal radius fracture management: Plaster cast versus Kirschner wiring.

Displaced distal radius fractures involving the metaphysis are common childhood injuries requiring intervention. Patients frequently undergo operative treatment for these injuries. The aim of our study was to systematically review the literature comparing manipulation under anaesthesia (MUA) and Kirschner wire fixation(K wire). PRISMA guidelines were followed throughout. Medline and Cochrane databases were searched for comparative randomised controlled trials (RCTs) and cohort studies. Quality assessment was undertaken using the Jadad score, Cochrane assessment of bias tool and the Newcastle-Ottawa Scale. Data extraction was performed with customised forms. 2 RCTs and 4 cohort studies were included. There was significant variation in their methodologies, which included their inclusion criteria and threshold for remanipiulation. Re-operation rates for MUA varied from 14% to 91%. There were no recorded re-operations following K-wiring. There was a 2.2% infection rate and 4.5% rate of wire migration. There were no adverse long-term sequelae reported. All studies showed a higher re-operation rate with MUA alone. Further studies are required to identify which fracture subtypes are most susceptible to re-displacement. Current evidence suggests the use of a k-wire to stabIlise these fractures following manipulation.

Long-term follow-up of the Copeland mark III shoulder resurfacing hemi-arthroplasty.

BACKGROUND: Shoulder humeral resurfacing is being performed in increasing numbers. We report the long-term outcome of patients with the Copeland mark III humeral resurfacing hemi-arthroplasty. METHODS: Ninety-five shoulder hemi-arthroplasties were performed in 85 patients, from 1994 to 2003. Oxford Shoulder Score (OSS) and short form 12 (SF-12) questionnaires were administered. RESULTS: At 12-year follow-up, 49 patients were alive. The OSS was 35.2 and SF-12 score was 83. There were 3 revision operations and 95% survivorship at 18 years. CONCLUSION: This prosthesis has a low revision rate with few post-operative complications and good patient-reported outcome in an elderly population.

A Debilitating Orthopaedic Complication following Corticosteroid Therapy for Polymyalgia Rheumatica.

Avascular necrosis (AVN) of the scaphoid secondary to corticosteroid use is a rare entity. Previous reports in the literature refer to chronic steroid intake. We report a case secondary to low dose, short term use. AVN has a multifactorial cellular and genetic aetiology and most frequently affects the femoral head. Diagnosis relies on a high index of suspicion and early magnetic resonance (MR) scanning. Treatment options are similar to those of traumatic scaphoid nonunions and include vascularised bone grafting and scaphoid excision. Polymyalgia Rheumatica is a common condition and its treatment is led by corticosteroid use. Mild to moderate strengths are advocated. However in our report we show that even with small doses serious adverse effects can be encountered.