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BackgroundAcute carpal tunnel syndrome (ACTS) is a known complication of distal radius fractures. This study aimed to document the demographics, range of presenting symptoms and risk factors of patients who develop ACTS following a fracture of the distal radius.MethodsA retrospective review of 1189 patients with an acute distal radius fracture treated in the study centre over a one-year period were identified. Demographic and clinical variables were collected and compared between controls (did not develop ACTS) and those patients who did develop ACTS to identify factors associated with developing ACS.ResultsThere were 51 (4.3%) distal radius fractures complicated by ACTS. The mean age of patients who developed ACTS was 56 years (range, 16–89) and 73% were female. The median time of onset post-injury was one week (range, 1–12). There was no association between patient background and comorbidities with the development of ACTS. AO-OTA Type C fractures had significantly increased rates of developing ACTS.ConclusionFour percent of distal radius fractures were complicated by ACTS. There was no association between patient background and comorbidities with the development of ACTS. AO-OTA type C complete articular fractures had a significantly higher rate of ACTS. A suggested treatment algorithm for patients presenting with ACTS has been presented.Level of evidence:III.

Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods A prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months. Results The study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16). Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.

Revision knee arthroplasty surgery can range from patella resurfacing or polyethylene exchange, to staged revision and revision to a more constrained implant. Subsequently, the ability to elicit outcomes becomes difficult to obtain and hence information on functional outcome and survivorship for all modes of failure with a single revision system is valuable. We retrospectively assessed 100 consecutive revision knee replacements that were converted from a primary knee replacement to a Triathlon total stabilizer (TS) knee system (Stryker Orthopaedics, Mahwah, NJ). Inclusion criteria included failure of a primary knee replacement of any cause converted to a Stryker TS knee system. Midterm outcome of at least 5 years was required. Implants survivorship, Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), Short Form (SF-) 12, reported patient satisfaction and radiographic analysis were recorded. The all-cause survival rate at 5 years was 89.0% [95% confidence interval (CI) 87.3 to 90.7]. The all-cause survival rate was generally static after the first 4 years. The mean OKS was 27 (SD 11.9, range 0 to 46), FJS was 32.3 (SD 30.4, range 0 to 100), SF-12 physical component summary was 40.6 (SD 17.6, range 23.9 to 67.1), and mental component summary was 48.3 (SD 15.5, range 23.9 to 69.1). Reported patient satisfaction in patients who were not re-revised was 82%. The midterm survivorship of cemented Stryker Triathlon TS knee revision for all-cause mode of failure is good to excellent; however, future follow-up is required to ensure this survivorship is observed into the long term. Despite limited functional outcome, overall patient satisfaction rates are high.

Periprosthetic fractures of the proximal femur place a significant burden on the patients who endure them, as well as the medical health system that supports them. The purpose of this study was to determine whether femoral cortical thickness, as an absolute measurement, is a predictor of periprosthetic fracture pattern.A cohort of 102 patients who had sustained a periprosthetic hip fracture were retrospectively identified. This included 58 males and 44 females with a mean age of 79.8 years. The femoral periprosthetic fracture pattern was classified based on the Vancouver classification system. Stem fixation was recorded and femoral cortical thickness measured. Patients were grouped into cemented and cementless stems. The relationship between cortical thickness and periprosthetic fracture pattern was assessed using the primary stem fixation method. Receiver operating characteristic (ROC) curve analysis was used to identify a threshold in the cortical thickness that predicted fracture pattern. Multinomial logistic regression analysis was used to adjust for confounding variables to assess the independent influence of cortical thickness on the risk of sustaining a Vancouver type A, B or C.There were 65 (63.7%) patients in the cemented group and 37 (36.3%) in the cementless group. The pattern of periprosthetic fractures around cemented stems was significantly (p 0.001) influenced by the femoral cortical thickness, with a thinner cortical thickness associated with a type A fracture pattern. In contrast, no association between femoral cortical thickness and fracture pattern assessment was demonstrated in the cementless group (p = 0.82 Chi square). Comparing the rate of type A fracture patterns between the groups illustrated a significantly decreased risk in the cemented group with a cortical thickness of 7 mm (odds ratio 0.03, p 0.001). ROC curve analysis of the cemented group demonstrated a threshold value of 6.3 mm, offering a sensitivity of 83.3% and a specificity of 78.9% in predicting an A type fracture. Using this threshold, patients with a cortical thickness of 6.3 mm or less were significantly more likely to sustain a Vancouver type A fracture (OR 18.9, 95% CI 2.0-166.7, p 0.001) when compared to patients with a cortical thickness of 6.3 mm. In contrast, the ROC curve analysis did not find cortical thickness to be a predictor of fracture pattern in the cementless group. When adjusting for confounding variables, multinomial logistic regression demonstrated a cortical thickness of 6.3 mm or less was a significant predictor of a type A fracture (OR 3.28, 95% CI 1.06-10.16, p = 0.04) relative to those sustaining a type B fracture.Cortical thickness was found to influence the periprosthetic fracture pattern around cemented femoral stems, but this was not observed with cementless stems. Type A fracture patterns were significantly more likely to occur with a cortical thickness of 6.3 mm or less around cemented stems.

To (1) to determine the incidence of elderly pelvic fractures over the last decade, (2) describe the epidemiology and outcome of patients with pubic rami fractures and compare these to those patients sustaining all other pelvic fractures, and (3) identify independent predictors of length of stay, return to domicile, and 1-year mortality for patients with pubic rami fractures. We retrospectively identified 937 elderly patients (≥65 years) with pelvic fractures presenting to the study centre over a 15-year period. Patient demographics, mechanism of injury, and associated fractures were recorded for a defined 2-year period. Outcomes assessed were length of stay, return to original place of domicile, and 1-year mortality. The incidence increased from 7.9 per 100,000 to 13.1 per 100,000. The majority were fragility fractures of the pubic rami (84 %). Patients sustaining a pubic rami fracture were older, more likely to be female, less deprived and have sustained an isolated injury by a low-energy mechanism. Patients sustaining a pubic rami fracture were less likely to return to their original place of domicile. Pre-injury independence and mobility, socioeconomic status, associated fractures, energy of injury, and male gender were independent predictors of length of stay, return to original place of domicile, and 1-year mortality. The incidence of elderly pelvic fractures is increasing, and fractures of the pubic ramus have different patient demographics compared to other pelvic fractures. Patient demographics could be used to predict: length of stay, return to domicile, and 1-year mortality after a pubic rami fracture. Retrospective prognostic study, Level IV.

We present the epidemiology and incidence of proximal humeral fractures over a 17-year period for a defined urban population that represents approximately 13 % of the population in Scotland, and functional outcome in relation to the socio-economic status of the patient. The incidence of proximal humeral fractures significantly increased during the study period from 47.9/105/year to 98.7/105/year in 2008 (p