Changing trends in the management of intertrochanteric hip fractures - A single centre experience.

With an annual incidence greater than 65,000 in the United Kingdom, hip fractures are a common but debilitating injury predominantly affecting those over 65. Treatment is based on the anatomical location of the fracture relative to the capsule of the hip joint - fractures occurring within it are treated by arthroplasty, while extracapsular fractures are an indication for fixation. Intertrochanteric fractures are further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in turn governs in the current UK guidelines whether this fixation is achieved with a dynamic hip screw or intramedullary device. Anecdotally, some units are tending towards intramedullary devices for 31A2 fractures as well, a practice which from the evidence does not appear to confer benefit and carries an excess cost. We reviewed our data submitted to the National Hip Fracture Database over the last five years and identified all intertrochanteric fractures, from which cohort we identified all patients with 31A2 fractures by review of radiographs. The cohort comprised 370 patients. We then recorded age, gender, ASA grade, abbreviated mental test score, residence from where admitted, length of stay, destination on discharge and whether any further operations were required. There was no significant difference in the demographics of the groups, year-on-year, except gender mix. There was a significant, twenty-fold rise in the use of intramedullary devices between 2011 and 2015. Length of stay, length of overall episode of care, revision rates, mortality and destination on discharge were unchanged. This use is not supported by NICE guidelines and this study offers no evidence to contradict this position. We advocate all centres examine their practice to avoid a costly intervention without clinical benefit.

Motion analysis: a validated method for showing skill levels in arthroscopy.

PURPOSE: The purpose of this study was to show the validity of a motion analysis system in its ability to differentiate between surgeons and non-surgeons when performing simple arthroscopic tasks. METHODS: We divided 35 subjects into a surgeons group (n = 20) and a non-surgeons group (n = 15). The surgeons group was further subdivided based on the amount of previous arthroscopic experience. Each participant performed 2 separate simulated arthroscopic tasks while being assessed with motion analysis equipment. The time taken, total path length, and number of movements were recorded. RESULTS: A significant difference in performance was identified between surgeons and non-surgeons (P < .0001) and between senior and junior surgeons (P < .05). We identified trends toward decreased time taken and improved economy of movement with increasing arthroscopic experience. CONCLUSIONS: This study shows the validity of a motion analysis system as a means of objective assessment of arthroscopic skills in orthopaedics. The system has been shown to differentiate between non-surgeons, junior surgeons, and senior surgeons in performing simple arthroscopic tasks. CLINICAL RELEVANCE: In the context of concerns regarding reductions in training time, this study validates the use of a simple, affordable, and reliable means of objective assessment of arthroscopic skills and training in such skills. The motion analysis system could subsequently be used as an adjunct to more traditional methods of assessment when planning strategies to teach, learn, and practice arthroscopic skills in the future.

The history and future of radiostereometric analysis.

Roentgen stereophotogrammetry allows one to localize the position of an object in space using roentgen rays. For orthopaedic purposes it was developed 35 years ago by Göran Selvik, and since that time many investigators have refined the radiostereometric calculations and evaluative software. Many uses and mathematical algorithms have been developed, and advancements in computer programs and digital radiography continue to expand its capabilities. Despite these advances, improvements in the technical accuracy and type of kinematic analyses possible have been relatively modest. However, radiostereometric analysis is now easier and less time consuming to use, with a resolution in clinical practice almost equal to what could only previously be obtained under ideal laboratory conditions. The ability to measure skeletal and implant movements with high resolution in vivo images was an important progressive step for the orthopaedic community. Radiostereometric analysis has helped develop new fields in clinical orthopaedic research and continues to improve advancements in orthopaedic health care.