Injury
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Dislocation of a hip hemiarthroplasty used to treat a hip fracture is a serious complication. The aim of this study was to identify whether a delay in the time from fracture to surgery causes an increase in the rate of post-operative hip dislocation. From a single center, data from intracapsular neck of femur patients treated with hip hemiarthroplasty was collected between October 1986 to August 2021. ⋯ For the 197 patients with no history of a fall, there were 5 (2.5%) dislocations (p=0.036, 95% confidence interval of difference 0.15 to 0.97 for comparison with surgery within two days). For the 399 patients with a delay of more than four days from injury till surgery, there were nine dislocations (2.3%) (p=0.045, 95% confidence intervals of difference 0.20 to 0.89 for comparison with surgery within two days). This study demonstrates an increase in the risk of dislocation for those patients with no history of a fall and those with a delay of more than four days from injury to surgery.
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Finger nerve injuries have a significant impact on hand function and can result in reduced sensation, pain and impaired coordination. The socioeconomic implications of these injuries include decreased workplace productivity, reduced earning potential, and financial burdens associated with long-term medical treatment and rehabilitation. However, there is a lack of comprehensive literature regarding the incidence, mechanisms, and associated injuries of finger nerve lesions. ⋯ Finger nerve injuries are the most prevalent type of nerve injury, often resulting from small lacerations. These injuries have substantial societal costs and can lead to prolonged sick leave. Understanding the epidemiology and etiology of finger nerve injuries is crucial for implementing effective preventive measures. Accompanying tendon injuries and the anatomical location of the nerve lesions can impact sensory recovery and treatment outcomes. Proper management of peripheral finger nerve lesions is essential for optimizing functional outcomes and minimizing the impact on daily activities. Treatment options should be tailored to the severity and underlying cause of the nerve injury.
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Newer intramedullary (IM) nails have become another option in the fixation of proximal tibia fractures. There is limited data on the successful use of these implants in intra-articular and extra-articular fractures of the proximal tibia, and no studies assessing the ability of these implants to maintain alignment with early weight bearing. Our objective was to determine whether immediate weight bearing after IM fixation, with or without supplemental plate or screw fixation, of proximal third tibial fractures (OTA/AO 41A-C) results in a change in alignment prior to union. 35 patients with 39 proximal tibia fractures from 2015 to 2020, all treated with IM nailing with or without supplemental plate or screw fixation, all made weight-bearing as tolerated following surgery, were included. ⋯ The mean change in MPTA was 0.048 +/- 2.8 degrees (P=0.92), and mean change in PPTA was 0.264 +/- 3.67 degrees. 92.3% of fractures had normal final coronal plane alignment, with MPTA between 85.0 and 90.0 degrees. 89.7% of fractures had normal final sagittal plane alignment, with PPTA between 77.0 and 84.0 degrees. No patients required reoperation for malalignment. In OTA/AO type 41 fractures, immediate weight bearing after IM nail fixation, with or without supplemental plate or screw fixation when indicated, leads to minimal change in final coronal or sagittal alignment, and was well tolerated in most patients. [authors blinded for review].
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The Clinical Frailty Scale (CFS) is a 9-point scaling system used to categorise the frailty of patients. The CFS is well-established as a prognostic tool for decision-making within healthcare settings. However, the relationship between the CFS as a predictor for orthopaedic outcomes is limited. This review aims to provide an overview of the efficacy of the CFS as a prognostic tool for predicting orthopaedic outcomes. ⋯ Higher CFS scores are associated with poorer orthopaedic outcomes. However, it is difficult to quantify the true impact due to the limited number of high-quality studies. Further work to characterise the relationship between both gross and functional outcomes associated with the utilisation of the CFS in orthopaedic settings is essential to ascertain the utility of this simple score to improve resource allocation and provide effective consent to patients.
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Multicenter Study
Determinants of non-union after standard plate fixation for combined radial and ulnar fractures in adults.
Treatment of mid-shaft fractures of both forearm bones in adults typically consists of individual plate fixation of each bone according to AO principles. The primary objective of this multicentre retrospective study was to identify predictive and prognostic factors of failed bone union after internal fixation with a standard plate in adults. 130 mid-shaft fractures of both forearms occurred in 92 men and 38 women, who had a mean age of 35.1 years were reviewed; 42 were open: 31 were Gustilo type I, 10 were type II and 1 was type III. All patients underwent ORIF using a direct approach over the supinator crest for the ulnar fracture and using an anterior approach at the level of the radial fracture by dynamic compression plate in 90 cases and a limited-contact dynamic compression plate in 40 cases, all with 3.5 mm diameter screws. ⋯ The type of plate used and the number of screws placed on either side of the fracture site had no effect on union. This patient series had a similar non-union rate to the one reported in other published studies, likely because the technical rules were followed. A lack of statistical power probably prevented us from identifying prognostic factors for bone union.