Distal Femoral Replacement as a Primary Treatment Method for Distal Femoral Fractures in the Elderly.

Distal femoral fractures account for 3-6% of all femoral fractures with a similar demographic as patients suffering from proximal femoral fractures. The mortality risk can be high in such injuries, which has prompted NHS England to extend the scope of the Best Practice Tariff to include all fragility fractures of the femur. Poor bone quality, intra-articular extension, and significant comminution can make these fractures difficult to manage with fixation techniques, while early mobilisation is a key outcome in the treatment of this injury.

Trainee performed total knee arthroplasty is safe and effective: A systematic review and meta-analysis comparing outcomes between trainees and consultants.

Background: There are concerns that trainee performed knee arthroplasty (KA) may adversely affect patient outcomes. Demand for KA is projected to increase, and trainees must therefore be competent to perform it.

Methods: A systematic literature search was performed identifying articles comparing outcomes following trainee versus consultant surgeon performed primary KA.

Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review.

Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on.Post-operative patient-reported outcome measures recorded marked improvement.

The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures.

Aims: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery.

A systematic review and meta-analysis of trainee- consultant surgeon-performed elective total hip arthroplasty.

Total hip arthroplasty (THA) is one of the most commonly performed orthopaedic procedures. Some concern exists that trainee-performed THA may adversely affect patient outcomes. The aim of this meta-analysis was to compare outcomes following THA performed by surgical trainees and consultant surgeons.

Mid-term clinical outcome following rotator cuff repair using all-suture anchors.

Background: Symptomatic rotator cuff tears can cause significant pain and functional disturbance, with associated financial ramifications. Non-surgical management should always be considered initially, however if recalcitrant to these measures surgical intervention may involve open, arthroscopic-assisted mini-open or arthroscopic rotator cuff repairs. The use of trans-osseous sutures and suture anchors has been reported with good results, with no significant differences if the repair remains intact or recurrent tears occur.

Does a dedicated orthopaedic day surgery list improve delivery of trauma services?

Our aim was to implement a 23-hour pathway for uncomplicated trauma to overcome delays and improve efficiency. A retrospective review of a single surgeon series of 105 consecutive patients operated on between July 2010 and July 2011 was performed. With recently revised trauma tariffs, we believe an efficient day surgery trauma list improves theatre utilisation, reduces inpatient bed demands, prioritises major and sub-specialist trauma and delivers patient satisfaction.

A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy.

Purpose: To determine whether platelet-rich plasma (PRP) injections are associated with improved pain and function scores when compared with corticosteroid injections for plantar fasciopathy.

Methods: A systematic review of published literature was performed for studies comparing PRP injections and corticosteroid injections for plantar fasciopathy. Studies were assessed using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale (NOS).

"Meniscal" scar as a landmark for the joint line in revision total knee replacement.

Aim: To determine whether tissue identified at the joint line was actually remnant "meniscal" scar tissue or not.

Methods: Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery.

Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal.

Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints.

The Role of Wrist Fusion and Wrist Arthroplasty in Rheumatoid Arthritis.

Rheumatoid arthritis is the most common form of inflammatory arthritis with a predilection for the hand and wrist. The aggressive nature of the disease can lead to severe joint destruction causing significant disability. Surgical options for pan-carpal arthritis include total wrist arthroplasty and total wrist fusion both with varying outcomes, yet both have a role in the carefully selected patients.

Analysing the outcome of surgery for chronic Achilles tendinopathy over the last 50 years.

Aim: To determine an association between when the study was performed, the robustness of the study and the outcomes for insertional and non-insertional Achilles tendinopathy surgery.

Methods: We performed a systematic review in accordance with the PRISMA guidelines to assess the methodology of studies investigating the outcome of surgery in chronic Achilles tendinopathy over the last 50 years to identify any trends that would account for the variable results. The Coleman Methodology Scores were correlated with the reported percentage success rates and with the publication year to determine any trends using Pearson's correlation.

Chondromyxoid fibroma management: a single institution experience of 22 cases.

Background: Several different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates.

Methods: We report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system.

Van Nes rotationplasty as a treatment method for Ewing's sarcoma in a 14-month-old.

Introduction: In recent years, the rotationplasty procedure has become popular amongst tumour surgeons as an alternative to endoprosthetic replacement or amputation. There are very few documented cases of this technique in young patients with malignancy.

Presentation Of Case: We describe an extremely rare case of Ewing's sarcoma in a 14-month-old boy that involved the entire length of the left femur.

Patella fracture after medial patellofemoral ligament reconstruction using suture anchors.

The medial patellofemoral ligament (MPFL) acts as a soft tissue restraint to lateral subluxation of the patella, and is frequently damaged following patellar dislocation. A number of techniques for repair or reconstructions of the MPFL have been reported. We report two cases of patellar fracture following MPFL reconstruction utilizing suture anchors and bone tunnels that do not completely traverse the patella.

Implant use for primary hip and knee arthroplasty: are we getting it right first time?

Implants used for hip and knee arthroplasties have recently come under increased scrutiny. In England, a large variety of prostheses are currently being used. With the need for savings within the NHS of up to £20 billion over the next five years, we should be 'getting it right first time' by using the most reliable implants with proven survivorship.

Repair of osteochondral defects in joints--how to achieve success.

Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes.

Intra-articular extraskeletal myxoid chondrosarcoma of the ankle.

We describe an extremely rare case of an intra-articular extraskeletal myxoid chondrosarcoma causing devastating destruction to the ankle joint in a 71-year-old woman, which had been originally excised as a ganglion cyst. Histological analysis of the lesion revealed an extraskeletal myxoid chondrosarcoma. The patient proceeded to curative surgery with a below-the-knee amputation.

The perioperative management of skeletal metastases.

Bone metastasis is a common problem affecting a significant proportion of patients with metastatic cancer. Bone metastasis can present in a number of ways and the patients may need surgical stabilisation of their lesions. There are many important considerations in the care of these patients that need to be borne in mind including their increased anesthetic risks and potential risk of complications.