Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management: The INSITE Randomized Clinical Trial.

Importance: Fractures of the hip have devastating effects on function and quality of life. Intramedullary nails (IMN) are the dominant implant choice for the treatment of trochanteric fractures of the hip. Higher costs of IMNs and inconclusive benefit in comparison with sliding hip screws (SHSs) convey the need for definitive evidence.

Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery.

Background: Hip fractures are devastating injuries, with high health and social care costs. Despite national standards and guidelines, substantial variation persists in hospital delivery of hip fracture care and patient outcomes. This qualitative study aimed to identify organisational processes that can be targeted to reduce variation in service provision and improve patient care.

Overview of fracture liaison services in the UK and Europe: standards, model of care, funding, and challenges.

Fragility fractures represent a growing global problem, including in the United Kingdom and European countries. Reports demonstrate the benefits of national guidance and organized fragility fracture programs through fracture liaison services to deliver care to patients who sustain these injuries. The challenge of assembling multidisciplinary teams, providing routine screening of appropriate patients, and monitoring therapies where there is a known compliance problem, remains an obstacle to the success of fragility fracture treatment programs to all.

Epidemiology and outcomes of tibial plateau fractures in adults aged 60 and over treated in the United Kingdom.

Background: Tibial plateau fractures are common in older adults, often resulting from low-energy falls. Although lower limb fragility fracture care has evolved, the management of tibial plateau fractures in older patients remains poorly researched. This study aimed to define the epidemiology, treatment and outcomes of tibial plateau fractures in patients aged over 60 years.

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up.

Objectives: To evaluate the results of a new plate system using anterior approaches in the management of acetabular fractures.

Design: Retrospective case-note review.

Setting: Pelvic and acetabular tertiary center.

Long-term patient reported sexual and urological dysfunction in males after operatively treated pelvic ring injuries Do generic outcome measures identify genitourinary health problems?

Background: A consecutive series of 177 male patients, with high energy pelvic ring injuries, were treated operatively in our institution. The purpose of this study was to evaluate long-term sexual and urological dysfunction in these patients using validated disease specific patient reported outcome measures (PROMs), and identify if sexual and urological dysfunction is detectable from generic outcome scores used in the assessment of pelvic ring injury at a minimum of 10 years follow-up (range 10-22).

Methods: Surviving patients were contacted to complete validated PROMs to examine genitourinary and global functional outcome.

Machine learning outperforms clinical experts in classification of hip fractures.

Hip fractures are a major cause of morbidity and mortality in the elderly, and incur high health and social care costs. Given projected population ageing, the number of incident hip fractures is predicted to increase globally. As fracture classification strongly determines the chosen surgical treatment, differences in fracture classification influence patient outcomes and treatment costs.

Reducing unnecessary fixation of midshaft clavicle fractures.

Purpose: Displaced midshaft clavicle fractures have a non-union rate of 10-20%. Those who unite with conservative treatment have similar outcomes to those who undergo operative treatment; therefore, protocols to identify potential non-unions are important to avoid unnecessary surgery. The aim of this study is to report one such protocol.

International trauma care: initial European approaches during the COVID 19 pandemic.

The world was not prepared for the global of pandemic in early 2020 with the arrival of COVID 19. Europe has some of the most developed health care systems in the world and this article explains the initial response to the pandemic from an orthopaedic and trauma viewpoint from 8 nations. Italy reported the first cluster in February, which then rapidly spread around the continent, requiring a rapid reorganization of services.

Hip fracture systems-European experience.

European countries have established health care systems but are struggling with the increasing rise of fragility fractures in their aging population. In trying to address this significant burden, countries are establishing national guidelines and standards, focusing on hip fractures, which represent the significant cost for this patient group. This has evolved with the establishment of national audits and guidelines.

Posterior wall acetabular fracture fixation: A mechanical analysis of fixation methods.

Stable, anatomical fixation of acetabular fractures gives the best chance of successful outcome, while penetration of the acetabular articular surface with screws is associated with poor outcomes. Spring plates are an alternative to interfragmentary lag screws when penetration is a concern. A mechanical study comparing fracture stability and construct stiffness of three fixation methods for posterior wall acetabular fractures with transverse comminutions was performed.

Syndesmotic fixation in unstable ankle fractures: Does early post-operative weight bearing affect radiographic outcomes?

Objective: To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis.

Design: Retrospective comparative cohort study over a two year period.

Setting: Level 1 trauma centre PATIENTS/PARTICIPANTS: 152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included.

Open acetabular fracture: Case report and literature review.

Acetabular fractures are a rare injury, with a reported annual incidence of 3 patients per 100,000 per year. Open fractures of the acetabulum are extremely rare, with only explosive penetrating trauma (blast or gunshot injury) being previously reported. An open acetabular fracture as a result of blunt trauma is presented, in which the only indication was a wound in the buttock, in which early definitive surgical management of the injury provided a good clinical outcome.

Does Routine Postoperative Computerized Tomography After Acetabular Fracture Fixation Affect Management?

Introduction And Aims: The use of routine postoperative computerized tomography (CT) scan after acetabular fracture reconstruction remains controversial. CT scan may provide more accurate detail regarding metalwork position, retained intra-articular fragments, and quality of reduction but does expose the patient to additional radiation dosage and incurs increased cost. The aim of this study was to evaluate a protocol of routine postoperative CT scan for all acetabular fractures after surgical fixation and assess the effect this has on patient management.

Long-Term Patient-Reported Functional Outcome of Polytraumatized Patients With Operatively Treated Pelvic Fractures.

Objectives: To report the long-term functional outcome of a cohort of patients with operatively treated unstable pelvic fractures using validated patient-reported outcome measures.

Design: Long-term observational study using prospective and retrospective data.

Setting: Tertiary referral pelvic trauma center, Bristol, United Kingdom.

Open tibial fractures in major trauma centres: A national prospective cohort study of current practice.

Aims: To assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network.

Materials And Methods: Demographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016.

Results: Data was available for 646 patients with recorded grade IIIB/C fractures.

Routine Postoperative Computed Tomography Scans After Pelvic Fracture Fixation: A Necessity or a Luxury?

Introduction: There is no consensus regarding the postoperative radiology imaging protocol after pelvic fracture surgery. Some institutes routinely scan all patients after their surgery, others do not. The aim of this study was to assess the value of routine use of computed tomography (CT) scans after pelvic fracture surgery and to determine the sensitivity of conventional plain radiographs and intraoperative fluoroscopy in detecting metalwork malposition.

The value of 'binder-off' imaging to identify occult and unexpected pelvic ring injuries.

Aims: To determine the effectiveness of 'binder-off' plain pelvic radiographs in the assessment of pelvic ring injuries.

Patients And Methods: All patients requiring operative intervention at our tertiary referral pelvic unit/major trauma centre for high-energy pelvic injuries between April 2012 and December 2014 were retrospectively identified. Pre-operative pelvic imaging with and without pelvic binder was reviewed with respect to fracture pattern and pelvic stability.

The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring: a report of technique, indications and complications.

Aims: The anterior pelvic internal fixator is increasingly used for the treatment of unstable, or displaced, injuries of the anterior pelvic ring. The evidence for its use, however, is limited. The aim of this paper is to describe the indications for its use, how it is applied and its complications.

Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial.

Importance: Ankle fractures cause substantial morbidity in older persons. Surgical fixation is the contemporary intervention but is associated with infection and other healing complications.

Objective: To determine whether initial fracture treatment with close contact casting, a molded below-knee cast with minimal padding, offers outcome equivalent to that with immediate surgery, with fewer complications and less health resource use.