Dynamic hip screw fixation of subtrochanteric femoral fractures.

Introduction: A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct.

Knee Fix or Replace Trial (KFORT): a randomized controlled feasibility study.

Aims: The aim of this study was to assess the feasibility of conducting a full-scale, appropriately powered, randomized controlled trial (RCT) comparing internal fracture fixation and distal femoral replacement (DFR) for distal femoral fractures in older patients.

Patients And Methods: Seven centres recruited patients into the study. Patients were eligible if they were greater than 65 years of age with a distal femoral fracture, and if the surgeon felt that they were suitable for either form of treatment.

Pulmonary embolism following complex trauma: UK MTC observational study.

Objectives: To describe the incidence of pulmonary embolism (PE) in a critically ill UK major trauma centre (MTC) patient cohort.

Methods: A retrospective, multidataset descriptive study of all trauma patients requiring admission to level 2 or 3 care in the East of England MTC from 1 November 2014 to 1 May 2017. Data describing demographics, the nature and extent of injuries, process of care, timing of PE prophylaxis, tranexamic acid (TXA) administration and CT scanner type were extracted from the Trauma Audit and Research Network database and hospital electronic records.

Advancement of the Harrington technique for reconstruction of pathological fractures of the acetabulum.

A 59-year-old man presented with hip pain secondary to metastatic prostate carcinoma affecting multiple sites, including his left acetabulum. The patient's prognosis was good, he was active, independent, with a good quality of life, so was offered surgical reconstruction. The Harrington method involves passing metal rods from the ileum to the ischium and pubis to create a scaffold for hip replacement.

Dual mobility total hip dislocation-femoral stem loosening while attempting closed reduction: a cautionary note.

A 77-year-old man sustained an acetabular fracture after falling from a staircase and landing on his right side. He fractured the anterior column of his acetabulum and the quadrilateral plate. He underwent a single-stage open reduction and internal fixation of the fracture combined with a dual mobility total hip arthroplasty (THA).

Adult-onset hypophosphatasia diagnosed following bilateral atypical femoral fractures in a 55-year-old woman.

We report the case of a 55-year-old woman who presented to the emergency department having woken from sleep with right sided thigh swelling. Pelvic radiographs revealed bilateral atypical subtrochanteric femoral fractures (ASFFs). In the two years leading up to this admission, the patient had experienced gradually increasing pain and weakness in her legs which had resulted in a decrease in her mobility from fully mobile to bed-bound.

A retained stitch in time saves 9 - but does it increase the risk of deep prosthetic infection?

Introduction: During the posterior approach to the hip, the short external rotators are detached and secured with stay sutures. At the time of definitive closure, some surgeons incorporate the initial sutures into their repair while others discard for fresh sutures, presumably as an infection prevention measure. We have conducted a pilot study to investigate whether the incorporation of the primary stay sutures may constitute an infection risk to the patient undergoing a total hip replacement through the posterior approach.

Fix and replace: An emerging paradigm for treating acetabular fractures in older patients.

Acetabular fractures in older patients are challenging to manage. The "fix and replace" construct may present a new paradigm for the management of these injuries. We present the current challenge of acetabular fractures in older patients.

Fix and replace; an emerging paradigm for treating acetabular fractures.

Although technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm.

Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?

Background: Patients sustaining a fractured neck of the femur are typically of advanced age with multiple comorbidities. As a consequence, the proportion of these patients receiving warfarin therapy is approximately 10%. There are currently few studies investigating outcomes in this subset of patients.

Cambridge Polytrauma Pathway: Are we making appropriately guided decisions?

Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion.

Treatment of Displaced Sacroiliac Fracture Using the Lateral Window for Short Plate Buttress Reduction and Percutaneous Sacroiliac Screw Fixation.

Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.

Seizure induced polytrauma; not just posterior dislocation of the shoulder.

A 61-year-old woman sustained multiple fractures secondary to the tonic clonic muscular contractions of a seizure. Her injuries included: bilateral proximal humerus posterior fracture dislocations, manubrium fracture, unstable sixth thoracic vertebrae crush fracture, bilateral acetabular fractures and a left femoral neck fracture. Seizures are a rare but recognised cause of fracture.

Patella dislocation with vertical axis rotation: the "dorsal fin" patella.

A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a "dorsal fin" appearance of the soft tissues tented over the patella.

Patient-reported compliance with thromboprophylaxis using an oral factor Xa inhibitor (rivaroxaban) following total hip and total knee arthroplasty.

This prospective study examines patient non-compliance (NC) for an oral factor Xa inhibitor (Rivaroxaban) when used as venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. A total of 3145 patients underwent surgery from May 2010 to December 2011. At 6 weeks patients completed an anonymous self-administered questionnaire.

Function and survival after revision of hip resurfacing.

The purpose of this study was to compare functional outcome and survival of isolated acetabular, isolated femoral and both component revision after failure of primary Birmingham Hip Resurfacing. The Oswestry Outcome Centre prospectively collected data on 5000 hip resurfacing between 1997 and 2002. Of these, 182 hips were revised: 8% had revision of the acetabular component only, 42% had revision of the femoral component only to conventional stemmed prosthesis, and 50% had revision of both components to conventional total hip arthroplasty (THA).

Birmingham hip resurfacing in patients who are seventy years of age or older.

There is no published literature to support mid to long term results of hip resurfacing (HR) arthroplasty in patients over the age of 70 years. The purpose of our study was to evaluate the function HR in this age group (70 or older at the time of surgery) at medium to long term follow-up. Between July 1997 and November 2002, the Oswestry Outcome Centre independently and prospectively collected data on 5000 Birmingham Hip Resurfacings (BHRs).

Functional results of isolated femoral revision of hip resurfacing arthroplasty.

Background: Conversion of a failed femoral resurfacing component is reportedly a straightforward procedure; however, little has been published regarding the functional results following revision. Our primary aim was to compare the functional results for a group of patients who had had isolated femoral component revision after a failed hip resurfacing with those for a group of patients with a surviving hip resurfacing. Our secondary aim was to identify whether the mode of failure affects functional outcome.