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Background: We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Methods: Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs. Pre- and postoperative visual analogue scores and movement were documented. Postoperative radiographs were obtained at 6 weeks, 6 months and 1 year. Results: Seven patients were identified, all female, with a median age of 28.0 years. All but one had 3b disease and the median follow-up was 2 years (range 13–112 months). A mean 9/10 preoperative VAS score improved to 1/10 by 3 months postoperatively (p < 0.001, paired t-test). No major complications were seen, and implants were stable radiologically. Conclusions: A semi-constrained pyrocarbon lunate can provide good results for patients with advanced Kienböck’s disease, offering an alternative to proximal row carpectomy salvage surgery. Level of Evidence: Level IV (Therapeutic)

Idiopathic avascular necrosis (AVN) of the carpal bones of the wrist is rare. The lunate and the scaphoid are the two most commonly affected, the lunate being the more common of the two. AVN of a fractured proximal pole of the scaphoid is a well-known problem following trauma; however idiopathic AVN of the scaphoid not related to acute trauma is a rare event with few cases described in literature. There is no consensus on the optimal surgical management of these conditions, although treatment is largely based on the stage at presentation and the expertise and repertoire of the surgeon. In this paper, we present a review of the symptoms, classifications, risk factors and management of these rare conditions.

Aim To determine whether there is a correlation between the length of forearm to the distal interphalangeal joint (DIPJ) of the little finger and length of antegrade intramedullary (IM) femoral nails in adults. Study Design and Methods: Measurements from the tip of the olecranon to the DIPJ of the ipsilateral upper limb was taken in 30 patients undergoing antegrade IM femoral nails. The length of the IM nails inserted was determined by intra-operative measurements using a guide wire. The two measurements were analysed for correlation and mean difference. Results The mean forearm to DIP of little finger length was 38.86 with a standard deviation of 2.83. The mean IM length and standard deviation were 38.56 and 2.77 respectively. The difference between the two means 0.3 (95% CI). Correlation testing between the two variables shows a positive relationship (Pearson Correlation factor of 1). The scatter plot shows a positive linear relationship. Conclusions Length of the forearm from the tip of the olecranon to the DIP joint of the little finger represents the ideal length of IM nail for the femur. It can be readily performed with the use of a tape measure and can serve as a useful adjunct to determining ideal length in cases where the contralateral femur cannot be used.

Between 1999 and 2005, we treated 41 patients with a total hip arthroplasty for failed fixation of a hip fracture. This study had three purposes: (1) to determine the reason/s for fixation failure (2) to record difficulties/complications encountered in converting to a salvage arthroplasty and (3) to compare the outcome of these patients (Group 1) with a matched group of patients who underwent a primary hip arthroplasty (Group 2). Failure to achieve a good reduction and optimal screw placement was evident in 80% of cases of failed fixation. A high incidence of complications was recorded in the perioperative period during conversion to a salvage arthroplasty. Functional outcome was statistically inferior in Group1; this group also had a higher incidence of complications. Radiographs at 2 years postoperatively showed evidence of femoral stem loosening in 16% of the salvage group compared with 3% in the primary hip arthroplasty group.

Objective To assess the incidence and distribution of recreational equestrian injuries seen in the Kent and Sussex region and review the available literature on this subject. Design This is a retrospective case series with historical controls. Setting Kent and Sussex region, England. Main outcome measurement Injuries related to horses in the recreational setting. Methods Subjects were selected from our acute injury database. Notes of all patients presenting with horse riding-related injuries between January and December 2010 were reviewed. Skeletal injuries were confirmed using our Picture Archiving and Communications Systems (PACS) system. Data were tabulated and grouped using Microsoft Excel software. Statistics were calculated using Graph Pad software. Results During the study period, 155 patients presented with a total of 199 injuries related to horses, accounting for 0.3% of all presentations; 69% were soft tissue injuries. The most commonly affected areas were the extremities (77 patients, 49.7%) followed by injuries to the head (38 patients, 24.5%) and trunk (36 patients, 23.2%). Seventeen patients (11%) were admitted. Patients presenting with head injuries suffered significantly more injuries compared to other groups (1.65 compared to 1.4 injuries, p < 0.0002). Conclusion A larger number of persons were riding for a longer period of the year compared to previous studies in the United Kingdom. There was also a shift in the patterns of injury seen in this population over the last two to three decades.

Background: Fibrous thickening of the flexor tendon synovium is a common finding during carpel tunnel decompression. This is generally accepted to indicate tenosynovistis. The aim of the study was to determine whether non-transparent, cloudy white thickening of the flexor tenosynovium corresponds to histological appearance of tenosynovitis. Method: We retrospectively identified 49 wrists in 47 patients who underwent flexor tenosynovectomy during treatment for carpel tunnel decompression. The indication for synovectomy was clinical abnormality of the tenosynovium intra-operatively. Histological reports were retrospectively reviewed. A post-operative functional outcome score was compared between patients who underwent decompression alone and those who underwent decompression and synovectomy. Complication rates between the two groups were compared. Results: Of the 49 slides analysed, inflammation was present in 10.1% 5 slides) only. Oedema was present in 51% 25 Slides). The mean functional outcome score for group 1 was 10 and 11.7 for group 2. This was statistically insignificant p 0.065). The complication rates between the two groups were equal. Conclusion: We conclude that clinical abnormality is a poor predictor of histological appearance of tenosynovitis.

There is no clear consensus on the optimal management of the patella during total knee arthroplasty (TKA). While original prosthetic designs did not include a patella resurfacing option,1) all contemporary designs provide this option. Indications for resurfacing include grade2,3) cartilage degeneration as well as the presence of inflammatory arthritis.4) The main contraindication to resurfacing is insufficient patellar bone stock. Arguments for and against resurfacing the patella exist. While anterior knee pain has been described after TKA when the patella is not resurfaced3) complications including patella fracture, osteonecrosis, instability, and patella clunk syndrome have been described in cases in which it was resurfaced.4) Contributing to this therapeutic dilemma is a large body of evidence supporting both practices. Waters and Bentley2) found a significantly higher incidence of anterior knee pain in unresurfaced patients. They also found that patients who had bilateral TKAs where only one side was resurfaced reported better outcomes on the resurfaced side. Burnett and Bourne5) in the longest published follow-up study to date found a 4 times revision rate in the nonresurfaced group (primarily for anterior knee pain) but no difference in functional outcome at 10 years. Recent meta-analyses by Parvizi et al.,6) Pakos et al.,7) and Nizard et al.8) have all concluded that resurfacing the patella decreases the incidence of anterior knee pain post-TKA and reduces the risks of revision surgery. Given this large number of studies comparing these practices and the inconclusive results of these, we set out to examine the views of practicing orthopaedic surgeons in the United Kingdom on patella resurfacing during TKA as well as their practice and the rationale for this in order to derive a consensus on this issue.

Purpose: This study was undertaken to evaluate the efficacy of a proximal humeral locking plate, and to specifically study the effect of patient age and fracture type on the outcome. Materials and Methods: Thirty-one cases of proximal humeral fractures fixed by using the proximal humeral interlocking (PHILOS) plate were reviewed. Results: Average functional scores (minimum 18 months post operation) per AO / ASIF fracture type were 25.3 for type A, 21.4 for type B, and 22.7 for type C. There was no statistically significant difference between the groups. The functional scores for patients over 65 years of age were significantly inferior ( P = 0.03). At a final radiological review (mean 12 months post operation), 30 (96%) of the patients demonstrated fracture union. Seven patients (22.5%) required a second surgical procedure. Conclusion: We obtained both good functional results and bone healing with the PHILOS plate, irrespective of fracture type; the older patients had a poorer outcome. We caution the surgeons on the high potential for reoperations with its use.