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Venous thromboembolic disease is a major global cause of morbidity and mortality. An estimated 10 million episodes are diagnosed yearly; over half of these episodes are provoked by hospital admission/procedures and result in significant loss of disability adjusted life years. Temporary lower limb immobilisation after injury is a significant contributor to the overall burden of venous thromboembolism (VTE). Existing evidence suggests that pharmacological prophylaxis could reduce overall VTE event rates in these patients, but the proportional reduction of symptomatic events remains unclear. Recent studies have used different pharmacological agents, dosing regimens and outcome measures. Consequently, there is wide variation in thromboprophylaxis strategies, and international guidelines continue to offer conflicting advice for clinicians. In this review, we provide a summary of recent evidence assessing both the clinical and cost effectiveness of thromboprophylaxis in patients with temporary immobilisation after injury. We also examine the evidence supporting stratified thromboprophylaxis and the validity of widely used risk assessment methods. [ABSTRACT FROM AUTHOR]

Purpose: Distal femoral periprosthetic fractures above a total knee replacement in elderly patients are technically challenging to treat. Bone quality is often poor, the fractures comminuted, and post-operative mobilisation is difficult. This study assesses the clinical, radiological and functional outcome of revision knee distal femoral replacement (DFR) in these fractures. Methods: We identified 14 patients over 70 years of age (70-94) who underwent DFR for periprosthetic fractures above a knee replacement. All the 14 fractures were classified as Su type III. Clinical and radiological records were retrospectively reviewed. The mean of clinical follow-up was 27 months (8-46). Functional outcome was assessed using Oxford Knee Score and EQ-5D (UK English Version) score at a mean time of 35 months (20-65). The Knee Society patient category score was also evaluated. Results: The median post-operative knee flexion was 100° (range 90°-135°). Nine patients (64%) returned to their pre-fracture level of mobility or better. The median post-operative Oxford Knee Score was 27 (range 4-40). The median EQ-5D was 11 (range 6-12). Cognitive impairment negatively impacted the functional outcome in four patients. One patient died early post-operatively, and two patients had complications. Conclusions: DFR led to satisfactory outcome in our patients with a relatively low complication rate. In our experience, revision knee distal femoral replacement is an appropriate method to treat elderly patients who sustained periprosthetic Su et al. type III distal femoral fractures in association with poor bone stock, caused by osteoporosis and/or comminution. [ABSTRACT FROM AUTHOR]

Aims: To determine whether the size of the prostheses used in revision knee arthroplasty may be accurately and reproducibly predicted using analogue or digital pre-operative templating techniques. Methods: Pre-operative radiographs were templated using analogue radiographs and acetate templates, digital radiographs and acetate templates and digital radiographs and digital templating software. Results: Overall accuracy of predicting the size of implant used at surgery was 44%. There was no significant difference in the accuracy of the various templating techniques (p = 0.098). Conclusions: Templating in revision knee arthroplasty is neither of suitable accuracy nor reliability enough to safely recommend its use for implant size prediction. [ABSTRACT FROM AUTHOR]

The rectus femoris muscle is the most frequently involved quadriceps muscle in strain pathologies. The majority of quadriceps muscle belly injuries can be successfully treated conservatively and even significant tears in the less active and older population, non-operative management is a reasonable option. The authors report the delayed presentation of a 17-year-old male who sustained an injury to his rectus femoris muscle belly while playing football. This young patient did not recover the functional outcome required to get back to running and participating in sport despite 15 months of physiotherapy and non-operative management. Operative treatment using the ligament augmentation and reconstruction system ligament to augment Kessler repair allowed immediate full passive flexion of the knee and an early graduated physiotherapy programme. Our patient was able to return to running and his previous level of sport without any restrictions. [ABSTRACT FROM AUTHOR]

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality., Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality., Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation., Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes., Competing Interests: A. A. H. H. Nasser and A. Mahmood report funding from Queen Elizabeth Hospital Birmingham Charity Trauma Research and Education Fund, related to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Venous thromboembolic disease is a major global cause of morbidity and mortality. An estimated 10 million episodes are diagnosed yearly; over half of these episodes are provoked by hospital admission/procedures and result in significant loss of disability adjusted life years. Temporary lower limb immobilisation after injury is a significant contributor to the overall burden of venous thromboembolism (VTE). Existing evidence suggests that pharmacological prophylaxis could reduce overall VTE event rates in these patients, but the proportional reduction of symptomatic events remains unclear. Recent studies have used different pharmacological agents, dosing regimens and outcome measures. Consequently, there is wide variation in thromboprophylaxis strategies, and international guidelines continue to offer conflicting advice for clinicians. In this review, we provide a summary of recent evidence assessing both the clinical and cost effectiveness of thromboprophylaxis in patients with temporary immobilisation after injury. We also examine the evidence supporting stratified thromboprophylaxis and the validity of widely used risk assessment methods., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Hip replacement in patients with proximal femoral deformity and end stage arthrosis is technically challenging. The purpose of this study was to measure the subsidence rate of custom femoral stems using EBRA-Femoral Component Analysis (FCA) software, as an indicator of achievement of primary stability. We retrospectively reviewed 14 hips in 12 consecutive patients who underwent this procedure between June 2008 and Feb. 2011. There were 7 males and 5 females with a mean age 41 years (22-60). The primary diagnosis in the majority of the cases was Perthes and DDH with secondary osteoarthritis. The average follow up period was 36 ± 10 months (19-51 months). Average subsidence was the 0.96 mm ± 0.95mm (0- 2.9 mm). All patients had signs of osteointegration at the metaphyseal level. We conclude that the 3D-CT guided custom made femoral stem produces reliable proximal 'fit and fill' and osteointegration without the need of a corrective osteotomy in patients with proximal femoral deformity but long term studies are needed to assess the performance of this femoral stem.

Large head modular metal-on-metal total hip replacement (MoMTHR) has been shown to have increased revision rates in the National joint registry and in literature. We reviewed 41 consecutive patients with 44 hips who had large head MoM THR using a Birmingham Hip Resurfacing (BHR) cup/Synergy stem combination between June 2005 and Nov 2009 with a mean followup of 59.5 months. In this series we had a revision rate of 6.8% (3/44) for adverse reaction to metal debris (ARMD), persistent groin pain and instability. Kaplan-Meier analysis showed a mean cumulative survival rate of 79.2% (95% CI: 75.5%-82.9%) In addition there is a subset of 5/44 patients (113%) with mild grade groin pain who may need revision in the future. Based on these findings, we do not recommend performance of large head MoMTHR in the future.

The eye lens remains transparent because of soluble lens proteins known as crystallins. For years γ-crystallins have been known as the main lens proteins in lower vertebrates such as fish and amphibians. The unique growth features of the lens render it an ideal structure to study ageing; few studies have examined such changes in anuran lenses. This study aimed to investigate protein distribution patterns in Litoria infrafrenata and Phyllomedusa sauvagei species. Lenses were fractionated into concentric layers by controlled dissolution. Water-soluble proteins were separated into high (HMW), middle (MMW) and low molecular weight (LMW) fractions by size-exclusion HPLC and constituents of each protein class revealed by 1DE and 2DE. Spots were selected from 2DE gels on the basis of known ranges of subunit molecular weights and pH ranges and were identified by MALDI-TOF/TOF MS following trypsin digestion. Comparable lens distribution patterns were found for each species studied. Common crystallins were detected in both species; the most prominent of these was γ-crystallin. Towards the lens centre, there was a decrease in α- and β-crystallin proportions and an increase in γ-crystallins. Subunits representing taxon-specific crystallins demonstrating strong sequence homology with ζ-crystallin/quinone oxidoreductase were found in both L. infrafrenata and P. sauvagei lenses. Further work is needed to determine which amphibians have taxon-specific crystallins, their evolutionary origins, and their function., (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)