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Synopsis: 220 patients with isolated pertrochanteric femoral fractures were randomized to receive surgical intervention with a short or long cephalomedullary nail.Primary outcomes of interest included the Short Form 36 (SF-36) questionnaire and the Harris Hip Score.Secondary outcomes of interest included implant failure, peri-implant failure, mortality, operative time, estimated blood loss and the incidence of re-operation.Outcomes were assessed up to 12 months post-operation.Results revealed significantly favourable 3 month Harris Hip scores, lower operative time and lower estimated blood loss in the short nail group compared to the long nail group. No significant differences... Read More »
Level 2 RCT
5%
Synopsis: Acute syndesmotic injures are commonly associated with ankle fractures, and can have long-term implications on patient function and stability.Suture buttons and syndesmotic screws are the two most commonly used techniques to treat these injuries.The authors randomized 97 patients to suture button versus syndesmotic screw fixation.Outcomes included the American Orthoapedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS), Olerud-Molander Ankle score (OMA), pain on walking on a visual analogue scale (VAS), and the EuroQol-5-D (EQ-5D).Follow-up time was five years post-operatively.The suture button had significantly higher AOFAS and OMA scores, significantly less frequent ankle osteoarthritis and better maintenance of reduction.There was no difference in terms of VAS or EQ-5D. Overall, suture button... Read More »
Conference Report
5%
Synopsis: Previous studies have established the success of non-operative treatment following Achilles tendon rupture.37/60 patients were analyzed in this follow-up study comparing an early weight-bearing protocol to standard weight-bearing protocol during dynamic rehabilitative treatment of acute Achilles tendon ruptures.The primary outcome of interest was the Achilles Tendon Rupture Score (ATRS).Secondary outcomes of interest included heel raise height and work, as well as the return to level (heavy, light but active, sedentary) of work and sporting, and the incidence of re-rupture.Follow up was performed at 4.5 years post-operation.At 4.5 years, there were no significant differences between the early weight-bearing and usual care groups in ATRS score, heel raise height or heel raise work.All 37 patients had return to some level of work by the 4.5 year follow up, and 33/37 patients had returned to some level of sporting activity. Three cases of... Read More »
Level 2 RCT
4%
Synopsis: Open fractures are common and potentially devastating.Their treatment remains focused on early irrigation and debridement.The question of whether negative pressure wound therapy is helpful remains unclear.The authors performed a secondary analysis of patients from the FLOW Trial who had Gustilo II and III lower extremity fractures.A propensity score matching system was applied to assess the risk of developing deep infection.Health-Related Quality of Life was also measured on the Short Form-12 (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS).270 matched pairs were analyzed.Those treated with negative pressure wound therapy had significantly higher risk of deep infection at 12 months and poorer quality of life at 6 weeks, 6 months, and 12 months. Overall, negative pressure... Read More »
Conference Report
3%
Synopsis: Hip fractures are an exceedingly common injury.Much new evidence has been established through international randomized controlled trials which has helped to inform their management.The management of Garden I and II (non-displaced or minimally displaced) fractures remains unclear in the elderly.The authors performed a secondary analysis of data from the FAITH trial to assess risk factors for subsequent arthroplasty after fixation of Garden I and II fractures in the elderly.555 patients were included in the sample. The authors found... Read More »
Conference Report
2%
Synopsis: Ankle fractures are one of the most common injuries treated by orthopaedic surgeons.No globally accepted algorithm exists for post-injury imaging.It is unclear whether routine x-rays change management or simply present an extra expense.The authors randomized 247 patients to routine care (X-rays at 1, 2, 6, and 12 weeks) versus a reduced-imaging protocol (radiographs at 6 and 12 weeks only performed if clinically indicated.Outcomes included the Olerud-Molander Ankle Score (OMAS), the American Academy of Orthopaedic Surgeons (AAOS) ankle score questionnaire, the EuroQol 5-Dimensions 3-Level (EQ-5D-3L), and Short Form 36 (SF-36).In addition, pain, number of radiographs and healthcare costs were measured.154 (63%) patients underwent surgery.Patients in the reduced-imaging group had significantly fewer median radiographs (4 vs.5, p < 0.005).OMAS, AAOS, EQ-5D-3L, pain levels, health perception, self-perceived recovery, and complications did not differ between the two groups.Radiography costs were significantly lower in the reduced imaging group (-48 euros per patient).Overall costs were comparable between groups.Overall, a reduced imaging protocol resulted in fewer x-rays and lower radiography costs with no impact on function. Overall costs, however,... Read More »
Conference Report
2%
Synopsis: Traditionally, tibial shaft fractures have been fixed with intramedullary nailing using an infrapatellar technique.A suprapatellar technique has been used more recently, but the optimal approach is unknown.A randomized controlled trial was performed comparing suprapatellar to infrapatellar nailing was performed in 45 patients.Outcomes included alignment and operative time.The investigators found that suprapatellar nailing resulted in faster operative times with no difference in overall alignment.Overall, suprapatellar nailing may at the very least offer the advantage of shorter operative time, though it is unclear which approach the surgeons were more experienced with. Read More »
Conference Report
2%
Synopsis: A non-inferiority trial including 356 patients presenting to a general practitioner with traumatic knee complaints were randomized to receive immediate referral for magnetic resonance imaging (MRI) or usual protocol directed by the guidelines provided by the Dutch college of general practitioners.The primary outcome of interest was the Lysholm knee score.Secondary outcomes of interest included the EQ-5D quality of life questionnaire, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), pain on a numeric rating scale (NRS), as well as patient perceived recovery and satisfaction.Follow up was performed at 6 weeks, 3, 6, 9 and 12 months. Results found no... Read More »
Level 2 RCT
1%
Synopsis: 13 ACE reports (4 reviews/ meta-analyses, 9 RCTs) were included from the OrthoEvidence database that compared operative versus nonoperative or operative versus operative treatments for displaced midshaft clavicle fractures.The findings of this review demonstrated that surgical procedures led to a lower rate of nonunion and malunion with better functional outcome when compared to nonoperative treatment. Comparisons of operative treatments indicated that an optimal surgical procedure - between plate fixation, nailing, and pin fixation - could not be determined based on union rates or functional outcome. The results of... Read More »
ACE Review
1%
Synopsis: Syndesmotic injuries can be fixed using suture button (Tightrope) or screw fixation.Another abstract presented at OTA 2019 revealed better five-year results with suture button fixation.This study performed a pre-planned subgroup analysis of randomized controlled trial.42 patients were included, and contralateral ankles served as controls. Overall, Tightrope fixation... Read More »
Conference Report