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Background: Hemiarthroplasty (HA) is a common form of treatment for displaced neck of femur fractures. There is ongoing debate as to whether cemented or uncemented HA is a more superior treatment modality. The aim of this study was to compare the outcomes between patients that underwent cemented HA to uncemented HA. Secondarily, we analysed the costs associated of each treatment option. Methods: This was a retrospective study conducted at a busy district general hospital. The study included 335 patients that were treated with either a cemented or uncemented HA for a displaced neck of femur fracture between January 2017 and December 2018. Data collected included age, sex, American Society of Anesthesiologist (ASA) score, treatment modality, length of stay (LOS) and general costs. Results: 197 (58.8%) of the cohort underwent cemented HA and 138 (41.2%) underwent uncemented HA. Mean age for the cemented cohort was 84.7 years and 85.9 years in the uncemented group (p = 0.31). There was no significant differences between the groups with regard to mean LOS and discharge disposition (p = 0.44). There were no significant difference in 30-day and 1-year mortality between the two groups (p = 0.2). We did find a statistically significant difference in the costings between the two procedures, with cemented HAs costing £66 more than uncemented HAs (p < 0.001). Conclusion: We found that both cemented and uncemented HAs produced comparable results. We found a statistically significant reduction in operative time and costs associated with uncemented HA. Uncemented HA implants may be considered where a shorter operation duration is essential. [ABSTRACT FROM AUTHOR]

• Talus fractures are anatomically complex injuries associated with poor outcomes and high complication rates. • This was a large series of talus fractures. Overall AVN rate was 6% and non-union rate was 2%. The postoperative infection rate was 4%. • AVN and malunion often cause chronic pain, difficulties in performing activities of daily living and decreased mobility. • Our study found talar body fractures are more common than previously reported, talar neck fractures still cause the greatest rates of AVN and post-traumatic arthritis. • This information is useful during consenting and preoperatively when planning these cases to ensure these outcomes are prevented. Talus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. We retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. The mean age was 35 years (range: 18–76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. Our study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated. [ABSTRACT FROM AUTHOR]

Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results. We describe the pathophysiology of this injury and the unique method of fixation, which can be an alternative effective method to repair these injuries. [ABSTRACT FROM AUTHOR]

Introduction: Calcaneal fractures are rare in children. These fractures are often misdiagnosed as a consequence of their subtle clinical and radiographic presentation. The purpose of this paper was to identify prognostic factors on the basis of type of fracture, age and treatment. This would enable suggestions to be made with regards to treatment for these fractures.Methods: A full literature search was performed to find studies that were clinically orientated, in the English language and involved children (under the age of 16). Studies with no outcome data were excluded.Results: There were a total of 284 patients reviewed in 26 peer-review publications. Two hundred and eight patients had intra-articular fractures. The non-operatively managed joint depression type fractures had poor outcomes in 21% of patients. In those who underwent surgical fixation for these fractures, 3 patients had reduced subtalar motion, and three had pain, one of whom required a subtalar arthrodesis at 7 months. In the tongue type fracture group, the outcomes were similar in those treated operatively and non-operatively. Extra-articular fractures were found to be much less common than the intra-articular fractures. They also became less common in older children. Generally, the outcomes were good, irrespective of treatment. Only 2 patients with type 1B fractures had poorer outcomes.Discussion: This is a rare injury and outcomes may be poorer in those who do not have adequate anatomical reduction. Displaced intra-articular fractures in all age groups should be considered for anatomical reduction of the articular surface, to guarantee good outcomes and prevent future pain and arthritis. Extra-articular fractures in children are less severe, do well with conservative treatment, and rarely require operative intervention. [ABSTRACT FROM AUTHOR]

Purpose: The Bologna-Oxford (BOX®) total ankle arthroplasty (TAA) is a three-component mobile-bearing implant gaining popularity in Europe. We aimed to analyse the outcomes of this TAA.Methods: We retrospectively analysed data on 34 consecutive BOX® TAAs performed at a single centre with a mean follow-up of 58 months. Radiographic outcomes, such as periprosthetic lucency and alignment, were measured and recorded. Prospectively captured clinical scores and range of movement (ROM) were also recorded.Results: There were significant improvements in patient-reported outcome scores recorded in the Manchester-Oxford Foot Questionnaire (MOxFQ) for pain (43.8 ± 20.2, p < 0.001), standing and walking (55.6 ± 19.8, p < 0.001), social activities (45.0 ± 26.9, p < 0.02) and visual analogue score (VAS) (3.1 ± 2.5, p < 0.001). Mean improvement in ROM postoperatively was 18.7° (p < 0.001), with post-operative dorsiflexion 8.8° (10°-25°) and plantar flexion 32.6° (20°-40°). There was evidence of asymptomatic lucency on five radiographs (15%), which was present in 10% at three years. Nine patients had complications (26%): six (18%) requiring secondary surgery and one requiring revision (3%) for infection.Conclusions: We have demonstrated 97% survivorship at a mean of 58 months. There are maintained improvements in clinical and radiological outcomes and reoperation that are consistent with the literature. [ABSTRACT FROM AUTHOR]

Objective: To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity.Materials and Methods: Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups.Results: In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48° vs 37 °, p < 0.001; and 216° vs 176°, p < 0.0001 respectively).Conclusion: Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190° suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190° may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. [ABSTRACT FROM AUTHOR]

Background: The incidence of infected femoral artery pseudoaneurysms is likely to increase with increasing numbers of femoral artery interventions. Methods: Case report and review of literature. Results: We present a case of dehiscence of a vein patch repair of an infected femoral pseutoaneurysm treated with ligation of vessels and coverage by rectus abdominis muscle flap. Conclusion: We consider the use of this flap as a good second line option for the coverage of exposed femoral vessels, in the presence of sepsis, particularly when the external iliac artery has been ligated. [ABSTRACT FROM AUTHOR]

Objective: To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Materials and methods: Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. Results: In hips with a pincer, the hip was medialised by 37 % ( p = 0.03), more proximal by 5 % ( p = 0.05) and more posterior by 9 % ( p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48° vs 37 °, p < 0.001; and 216° vs 176°, p < 0.0001 respectively). Conclusion: Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190° suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190° may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. [ABSTRACT FROM AUTHOR]

X-linked hypophosphataemic rickets (XLHR) is a genetic disorder resulting from a genetic mutation in the PHEX gene. This may cause ossification of soft tissue structures risking spinal cord compression. We present the first known case of cervical dural calcification secondary to XLHR to cause myelopathic symptoms due to cord compression. [ABSTRACT FROM AUTHOR]