Management of Distal Femur Fractures: Replacement Versus Surgical Fixation Versus Conservative Management.

INTRODUCTION: Distal femur fractures are a frequently encountered injury, especially among the ageing population. Previous studies have identified that these fractures can be managed with a variety of methods and techniques which has led to an ongoing debate and investigation to decipher the optimal approach to manage these fractures. AIM: The purpose of this study was to compare outcomes of patients managed with either distal femur replacements (DFRs), surgical fixation (SF) or conservative management. Outcomes measured included length of hospital stay, readmission rates, 30-day mortality and Oxford Knee Score. METHODS: A retrospective review was conducted, of patients admitted with distal femur fractures between June 2020 and October 2022 at Huddersfield Royal Infirmary Hospital. Patients with both native and peri-prosthetic joints were included. All patient's medical data, including imaging and operative records, were reviewed. RESULTS: A total of 42 patients were identified. There were six males and 36 females with a mean age of 78 years, a median age of 76 and a range of 35-102 years. Of these fractures, 15 were peri-prosthetic, and 27 were native joints. Of the patients, 30 had an SF, five had a DFR and the remaining seven were conservatively managed. Those managed with an SF had an average length of stay of 18 days, an Oxford score of 24 and two patients were readmitted within 30 days of discharge. For the DFR, the average length of stay was 16 days, an Oxford score of 22 and no patients were readmitted within 30 days. For the conservatively managed patients 21 days, an Oxford score of 25 and two patients were readmitted within 30 days of discharge. There was no 30-day mortality across all groups. CONCLUSIONS: From our study, we can conclude that patients who managed with a DFR had the shortest length of stay in a hospital and the lowest readmission rates when compared to alternative management techniques. There was minimal difference found between the Oxford scores between all three groups. This study shows that DFR can be a safe and reliable strategy to manage distal femur fractures. Additional research is required to further compare the outcomes of these different methods of repair.

Re-Tear Rates Following Rotator Cuff Repair Surgery.

Aim Re-tears following rotator cuff repair surgery are a common occurrence. Previous studies have identified several factors that have been shown to increase the risk of re-tears. The purpose of this study was to evaluate the rate of re-tear following primary rotator cuff repair and to identify the factors that may contribute to this rate. Method The authors performed a retrospective review, looking at rotator cuff repair surgeries performed between May 2017 and July 2019 performed in a hospital by three specialist surgeons. All methods of repair were included. All patients' medical data, including imaging and operation records, were reviewed. Results A total of 148 patients were identified. Ninety-three males and 55 females with a mean age of 58 years (range 33-79 years). Thirty-four patients (23%) had post-operative imaging with either magnetic resonance imaging or ultrasound, where it was found that 20 (14%) had a confirmed re-tear. Of these patients, nine went on to have further repair surgery. The average age of the re-tear patients was 59 (age range 39-73) and 55% were female. The majority of the re-tears were from chronic rotator cuff injuries. This paper did not identify any correlation between smoking status or diabetes mellitus and re-tear rates. Conclusions This study indicates that re-tear after rotator cuff repair surgery is a common complication. The majority of studies find increasing age to be the biggest risk factor; however, this was not the case in our study which found females in their 50s to have the highest rate of re-tear. Additional research is required to understand what factors can contribute towards rotator cuff re-rupture rates.

Mechanical Alignment in Total Knee Arthroplasty for Varus Knee Osteoarthritis Leads to Significant Tibial Bone Loss.

Background Obtaining a neutral postoperative alignment is said to be a guiding principle for performing a successful total knee arthroplasty (TKA). There are many different alignment philosophies and surgical techniques to attain the goal of proper alignment. This study aimed to radiologically measure the difference in the amount of tibial bony resection required to perform a mechanical alignment versus an anatomic alignment TKA. Methods Two observers retrospectively reviewed the long leg radiographs of 100 patients (61 females and 39 males) listed for TKA between 2015 and 2018, measuring the amount of tibial bony resection required to achieve mechanical or anatomic alignment TKA. Results These radiographs' overall lower limb mechanical axis ranged between 16° varus and 17.6° valgus (mean 4.4° varus, standard deviation (SD) 6.64). By referencing 4 mm from the worn side, the mean resection needed from the normal side of the tibial plateau is 7.6 mm in the mechanical alignment measurement and 5.2 mm in the anatomical alignment measurement (p<0.0001). Therefore, 17% of mechanical alignment cuts require a tibial cut of more than 10 mm (mean 12.382 mm). No anatomical alignment measurements exceed 10 mm. When a virtual tibial cut >10 mm is required, the medial proximal tibial angle (MPTA) is a stronger predictor of deformity than the mechanical axis. Conclusion This radiological study shows that an anatomical alignment tibial cut is more bone conserving on the tibia than a mechanical alignment tibial cut and may lead to less asymmetry of the bony cuts and greater bony preservation, but clinical correlation is needed.

Surgical Fixation of Three- and Four-Part Proximal Humeral Fractures Using the Proximal Humeral Interlocking System Plate.

Introduction The management of proximal humeral fractures ranges greatly from conservative management to surgical treatment. For those fractures requiring surgical treatment, internal fixation is the primary method. The aim of internal fixation is to achieve rigid fracture fixation until union occurs, return of shoulder range of motion, and minimise intra-and postoperative complications. The aim of this study was to evaluate the results of the Proximal Humeral Interlocking System Plate (PHILOS) used for the treatment of three-and four-part proximal humeral fractures. Materials and methods This study included 30 patients with a mean age of 54 years (range 20-80 years). Results were checked post-operatively with standard radiographs and clinical evaluation according to the Constant-Murley shoulder score. All patients were followed up for 12 months. Results Union was achieved in all patients with a mean neck/shaft angle of 130° (range 108°-150°). The mean Constant-Murley score at the final follow-up was 82.28 (range 67-96) correlating with good results. No patients developed an intraoperative or postoperative vascular injury, wound complications, or avascular necrosis of the humeral head. Conclusion Our study has shown that the surgical treatment of three- and four-part proximal humeral fractures with the use of the PHILOS plate leads to a good functional outcome. It has also demonstrated the PHILOS plate and is an effective system for fracture stabilisation provided the correct surgical technique is used with awareness of potential hardware complications.

Evaluation of the Results of Minimally Invasive Plate Osteosynthesis Using a Locking Plate in the Treatment of Distal Femur Fractures.

Introduction Distal femur fractures are serious injuries that can be difficult to treat, carry an unpredictable prognosis, and lead to long-term disability and morbidity. The introduction of minimally invasive plate osteosynthesis (MIPO) avoids direct exposure of the fracture site, improves fracture healing and decreases the incidence of complications. The aim of this study was to assess prospectively the early results of the treatment of supracondylar fractures of the femur using minimally invasive percutaneous osteosynthesis using a distal femoral locking plate. The study was a prospective study that included 20 adult patients who sustained distal femur fractures. Materials and methods  The study was a prospective study that included 20 patients suffering from supracondylar fractures of the femur. All patients had fixation of the fracture using a distal femur locking plate (less invasive stabilization system (LISS)) in a minimally invasive technique using an anterolateral or direct lateral approach to the distal femur according to the fracture classification. The follow-up was done using the functional evaluation scale for distal femoral fractures as regards range of motion, deformation, pain, walking ability, and return to work. Results The mean age was 52.80 (19-80) years. The mean body mass index of the patients was 28.50, with a range of 23-43 kg/m2. The mechanism of trauma was road traffic accidents (RTAs) in nine patients (45%) and falling from standing height in eleven patients (55%). Fractures were classified according to the Arbeitsgemeinschaft Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification. All patients were followed up for a period of six months and assessed in terms of knee range of motion, deformation, pain, walking ability, and return to work. The mean time of radiological union, in which bony trabeculae crossed the fracture gap, was 3.45 ± 0.79 months. The final results obtained were excellent in four patients (20%), good in nine patients (45%), fair in five patients (25%), and poor in two patients (10%). Complications encountered were knee stiffness (20%), superficial wound infection (10%), and shortening (15%). Conclusion LISS plating using the MIPO approach is useful in treating complex distal femoral fractures. Large studies from independent centers reporting long-term results are needed to further evaluate the role of LISS plating and the MIPO approach in the management of complex distal femoral fractures.