Proximal humerus fractures in adolescents: Experience from East of Scotland.

BACKGROUND: The management of proximal humerus fractures (PHF) in adolescent has not been agreed upon. We aim to investigate the outcomes of PHF managed conservatively in adolescents. METHODS: All shoulder radiographs performed in patients aged from 10 to 18 years and from 2008 to 2015 were reviewed. The radiological parameters, including anatomical side, Neer and Horwitz displacement grade, angulation and any residual deformities were recorded. Mail questionnaires based on the modified 15-Upper Extremities Functional Index (15-UEFI), with a maximum of 59 points, were sent out. The return of the completed anonymized questionnaire was considered as implied consent. RESULTS: 118 patients with a median age of 12 at the time of fracture were identified. The majority of the fractures were Neer and Horwitz grade I displacement and 3 children had Neer and Horwitz grade III and IV displacement. The median angulation was 25°. The median follow-up length was 26 days. 55 patients had residual angulation and 25 patients had worsened angulation. No non-union was identified. No patients underwent subsequent corrective surgeries. 35 patients responded to the questionnaire. The median 15-UEFI was 59 points. None of the patients have contacted the research or clinical team regarding any concerns. CONCLUSION: The vast majority of non-displaced and minimally displaced PHF in adolescent were managed conservatively in our unit. The functional outcomes for this cohort remain excellent even for those with residual deformities in the follow-up radiographs. Further large prospective multicenter studies on adolescent cohort with significantly displaced PHF are warranted.

Re-starting elective orthopaedic services in NHS Tayside during the COVID-19 pandemic.

BACKGROUND: Elective orthopaedic operations were suspended at the start of the COVID-19 lockdown. Three pathways were created to allow patients to undergo urgent elective operations in NHS Tayside as soon as it was deemed safe to do so. METHODS: We examined elective orthopaedic activity in NHS Tayside during and immediately after the Scottish lockdown. Elective operations performed between 27 March 2020 and 10 August 2020 were included and compared with cases performed between 27 March and 10 August in both 2018 and 2019. Primary outcomes were 30-day mortality, 30-day complications, and nosocomial infection rates of COVID-19. FINDINGS: Fewer elective operations were performed in 2020 (258) compared with 2019 (1196) and 2018 (1261). The rate of nosocomial infection in the 2020 cohort was 0%. The 30-day mortality rate was 0%. Over 98% of patients agreed to undergo surgery after a detailed consenting process. INTERPRETATION: We were able to re-start a safe elective orthopaedic service in the early stages of recovery from the COVID-19 pandemic, compatible with the guidelines set by the Royal College of Surgery of England and the British Orthopaedic Association. Our findings will serve to reassure regions with sufficient resources that it is acceptable to restart elective surgery for urgent priority cases. They may provide a template for planned surgical care in the event of further pandemics.

Acetabulum-Only Revision Total Hip Arthroplasty Is Associated With Good Functional Outcomes and Survivorship.

BACKGROUND: The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group. METHODS: We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis. RESULTS: Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes. CONCLUSION: ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate.

Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis.

We compared the medium-term outcomes of age and gender matched patients with unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). We retrospectively reviewed the pain, function and total knee society scores (KSS) for 602 UKAs and age and gender matched TKAs between 2001 and 2013. Function scores remained significantly better in UKAs from preoperative until 3years follow up. The change of function scores was not significantly different. TKAs performed better than UKAs for pain scores. Total KSS for both groups were not significantly different in the study. Fewer medical complications were reported in UKA group. 6.30% of UKAs and 2.99% of TKAs were revised. The theoretical advantages of UKA were not borne out, other than in immediate postoperative complications.

Safety of orthopedic implants in magnetic resonance imaging: an experimental verification.

Magnetic resonance imaging (MRI) is an indispensable tool for musculoskeletal imaging. The presence of metal, however, raises concerns. The potential risks are loosening and migration of the implant, heating of the metal with surrounding tissue, causing thermal damage, and artifactual distortion which compromise the diagnostic value of the procedure. The aim of this study was to test experimentally the nature and extent of the first two of these effects in orthopedic implants. The degree of ferromagnetism was evaluated by deflection studies at the portals of a 0.25 Tesla permanent magnet and 1.0 Tesla clinical MRI scanner. None of the orthopedic implants exhibited any attraction. External fixator clamps, however, showed significant ferromagnetism. The heating of implants by "worst-case" scenario imaging sequences was insignificant. Many contemporary nonferromagnetic orthopedic implants can be imaged safely. It is prudent, however, to perform ex vivo deflection studies on a duplicate implant to confirm MR compatibility. With external fixator devices exhibiting strong ferromagnetism, MRI should be avoided. With expanding indications for MRI, orthopedic implants are unlikely to limit the potential of this powerful tool.

Bilateral simultaneous hip replacement versus bilateral sequential hip replacement. A 7-year data review.

The aim of this study was to compare the outcomes of bilateral sequential versus bilateral simultaneous hip replacements, using the collarless polished taper cemented hip prosthesis, in relation to complications, revisions, patient satisfaction rates, and Harris Hip Score. Data were collected by independent practitioners and processed within the University Audit Department. A total of 594 patients were identified as having undergone bilateral hip replacement surgery. Patient satisfaction rates were consistently high in both groups. Harris Hip Scores improvements were similar and reflected a marked improvement in pain and function. The sequential bilateral group experienced an increased length of hospital stay and therefore potential cost implications, which may be offset by the lower incidence of adverse events. Bilateral simultaneous hip replacement remains an important option, for which there is strong supportive evidence.