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Introduction: After surgical fixation of distal radius fractures, many patients are keen to return to driving. There are however limited guidelines assisting surgeons. The aims of this study were to determine when patients could return to driving safely after distal radius fracture fixation and determine the clinical parameters (range of motion and grip strength) that patients needed to achieve before return to safe driving could be advised., Materials and Methods: A prospective grant-funded clinical study was conducted. Patients above the age of 21 years who underwent surgical fixation with a volar plate, possessed a class 3 standard motorcar license, and were regular drivers were recruited in a single institution from 2017 to 2019. A hand surgeon and an occupational therapist who sees routine hand therapy cases, assessed the patients at regular intervals from 2 to 12-weeks post-surgery. Clinical parameters of pain, wrist range of motion and grip strength were measured. Patients underwent off and on-road driving assessments., Results: A total of 26 patients were recruited, with 21 successfully completing the driving assessment. Median time post-surgery to passing the driving test was 6 and 8-weeks for off and on-road assessments respectively. Pain score was observed to decrease over time, with a significant decrease from week 2 to week 4. Range of motion improved over time, with maximal improvement between 2 to 4-weeks post-surgery. When compared with the unaffected wrist, the difference in pronation, supination and radial deviation in the affected hand was consistently no longer statistically significant 4 to 6-weeks post-surgery., Conclusion: Patients with isolated surgically treated distal radius fractures can be recommended for a driving assessment as early as 4-6 weeks post-surgery if pain control is adequate, and clinical parameters for pronation and supination are met., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Introduction: The femoral neck system (FNS) is a safe alternative to cannulated compression screw (CCS) and dynamic hip screw (DHS) in femoral neck fractures., Methods: A dual-centre retrospective cohort study was performed on femoral neck fractures (AO type 31-B) treated with closed reduction and internal fixation using FNS, DHS or CCS between April 2016 and April 2020. Exclusion criteria were as follows: patients aged below 16 years; chronic fractures beyond 7 days; pathological fractures; fracture extension to the intertrochanteric region or ipsilateral neck and shaft fractures; and open fractures. A total of 85 patients were identified: FNS (n = 28), DHS (n = 29) and CCS (n = 28)., Results: The FNS and CCS groups had a lower Garden and Pauwels classification compared to the DHS group (both P < 0.001). Both FNS and CCS groups were comparable in postoperative orthopaedic complications (10.7% [n = 3] vs. 3.6% [n = 1], adjusted P = 0.321). The DHS group had more postoperative orthopaedic complications than the FNS group, but this was not statistically significant (27.6% [n = 8] vs. 10.7% [n = 3], adjusted P = 0.321). There were no significant differences in median time to radiological union or median femoral neck shortening at union (both P > 0.05) among the three groups., Conclusion: The new DePuy Synthes FNS is a safe alternative to CCS with comparable complication rates for femoral neck fractures that are less displaced and more stable. The FNS also appears to be a safe alternative to DHS in the fixation of femoral neck fractures for the few cases of high-energy femoral neck fractures., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Background: An increasing number of working adults undergo knee arthroplasty in Singapore. There is limited data concerning Southeast Asian patients returning to work (RTW) following knee replacement surgery. Our aim was to identify and study factors influencing patients RTW following total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA)., Methods: Patients who underwent TKA or UKA between August 2017 and March 2020 in our center were included in this study. Outcomes include RTW and duration prior to RTW., Results: 441 patients underwent TKA (295 women, 146 men, mean age 67.3 years) and 69 underwent UKA (48 women, 21 men, mean age 61.1 years). Patients who underwent TKA returned to work earlier (mean 83.7 ± 27.1 days) compared to UKA (mean 94.4 ± 42.3 days). 90.0% of TKA patients RTW compared to 95.5% who underwent UKA. Of patients who RTW, 94.3% of the TKA group returned to employment of the same nature compared to 92.9% of UKA patients. Patients who RTW were of a younger age (p = 0.03), white collared workers (p = 0.04), and had independent preoperative ambulatory status (p < 0.01)., Conclusion: Younger and independently ambulating patients may have better capacity for rehabilitation and RTW post arthroplasty surgery., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA)., Methods: A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured., Results: Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups., Conclusion: Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)