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  1. Article ; Online: Failure of dual plating in a complex open distal femur fracture as the result of major trauma.

    Ward, Thomas Robert William / Garala, Kanai / Riemer, Bryan

    BMJ case reports

    2021  Volume 14, Issue 12

    Abstract: A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution ... ...

    Abstract A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.
    MeSH term(s) Bone Plates ; Femoral Fractures/diagnostic imaging ; Femoral Fractures/surgery ; Femur ; Fracture Fixation, Internal ; Fractures, Comminuted/diagnostic imaging ; Fractures, Comminuted/surgery ; Humans ; Middle Aged
    Language English
    Publishing date 2021-12-01
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-245362
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Treatment of supracondylar periprosthetic femoral fractures with retrograde intramedullary nailing versus distal femoral plating: A systematic review and meta-analysis of current evidence.

    Wall, Rosemary / Syed, Farhan / Arastu, Mateen / Riemer, Bryan / Boutefnouchet, Tarek

    Orthopaedics & traumatology, surgery & research : OTSR

    2022  Volume 109, Issue 5, Page(s) 103489

    Abstract: Background: Supracondylar periprosthetic fractures, when amenable to fixation, can be treated by either retrograde intramedullary nailing (RIMN) or plating. There is paucity of evidence regarding the superiority of one fixation method over the other. ... ...

    Abstract Background: Supracondylar periprosthetic fractures, when amenable to fixation, can be treated by either retrograde intramedullary nailing (RIMN) or plating. There is paucity of evidence regarding the superiority of one fixation method over the other. This review aims to determine which fixation method leads to better functional outcomes and perioperative complications.
    Hypothesis: Superiority of intramedullary nailing in terms of fracture healing and surgical complications when compared to distal femoral plating.
    Materials and methods: Using PRISMA guidelines, a systematic search was performed. Studies which reported comparative outcome data following the two interventions were included. Qualitative data analysis and narrative synthesis were reported. Pooled comparisons were conducted when similar quantifiable outcomes were reported in a minimum of three studies.
    Results: A total of 151 records were generated by the search. Eight studies met the eligibility criteria so were included in the final analysis. The studies comprised a total of 407 cases, with a follow up period ranging from 1 to 15 years. 252 cases were treated with plate fixation and 155 with RIMN. All studies were mitigated by heterogeneity and methodological limitations. The review showed marked variation in descriptive fracture classifications. Narrative data synthesis was conducted. Although guarded by the methodological limitations of individual studies, outcomes showed that mean time to union was equivalent; 5.88 months for RIMN compared to 6.75 months in plating, standardised mean difference=0.28 (95% CI -0.02-0.58). Similarly, no statistically significant differences were reported between RIMN and plating for deep infection (OR:1.41 95%CI 0.40-5.00) and revision surgery (OR: 0.74, 95%CI 0.39-1.41).
    Discussion: Clinical outcomes showed a tendency that favours intramedullary nailing; however, generalisation of results was not possible. Future priority must be awarded to higher quality research in the form of a collaborative multicentre observational studies to delineate appropriate major diagnostic categories, ultimately informing a large comparative trial using condition specific validated outcome measures.
    Level of evidence: III, meta-analysis.
    MeSH term(s) Humans ; Fracture Fixation, Intramedullary/methods ; Arthroplasty, Replacement, Knee/adverse effects ; Femoral Fractures/etiology ; Fracture Fixation, Internal/methods ; Periprosthetic Fractures/etiology ; Bone Plates/adverse effects ; Femoral Neck Fractures/surgery ; Treatment Outcome
    Language English
    Publishing date 2022-11-25
    Publishing country France
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ISSN 1877-0568
    ISSN (online) 1877-0568
    DOI 10.1016/j.otsr.2022.103489
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Does size matter? Outcomes following revision total hip arthroplasty with long or primary stems: a systematic review and meta-analysis.

    Sahemey, Rajpreet / Ridha, Ali / Stephens, Alastair / Farhan-Alanie, Muhamed M / Kozdryk, Jakub / Riemer, Bryan / Foguet, Pedro

    Arthroplasty (London, England)

    2024  Volume 6, Issue 1, Page(s) 4

    Abstract: Background: Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study ... ...

    Abstract Background: Femoral reconstruction with long stems is widely accepted as the standard in revision total hip arthroplasty (rTHA). However, long stems can be technically challenging to insert and can compromise bone stock for future revision. This study aimed to identify whether there was a difference in outcomes with using a long versus primary or short femoral stem in revision.
    Methods: We performed a systematic review and meta-analysis of all articles comparing long and primary stem length in rTHA for Paprosky 1-3B femoral defects. The primary outcome measure was the reoperation rate after rTHA. Secondary outcomes included infection and dislocation rates, periprosthetic fracture, loosening, mortality, and patient-reported outcome measures (PROMs).
    Results: The results of 3,102 rTHAs performed in 2,982 patients were reported from 9 eligible studies in the systematic review, of which 6 were included in the meta-analysis. The mean patient age was 67.4 and the mean follow-up lasted 5 years (range, 1-15 years). There was no significant difference in the reoperation rate (odds ratio 0.78; 95% confidence interval, 0.28-2.17, P = 0.63). Similarly, there was no significant difference in dislocation or periprosthetic fracture risk. Harris Hip Score was better with primary stems by a mean difference of 14.4 points (P < 0.05). Pooled 5-year stem-related survival was 91.3% ± 3.5% (SD) for primary stems and 89.9% ± 6.7% (SD) for long stems.
    Conclusions: A primary stem provided non-inferior outcomes compared with long stems in rTHA with Paprosky type 1-3B femoral defects. Primary stems may yield a more straightforward technique and preserve distal bone stock for future revision particularly in younger patients. In older patients with lower functional demands and who would benefit from a decreased risk of complications, a long cemented stem is recommended.
    Language English
    Publishing date 2024-01-09
    Publishing country England
    Document type Journal Article
    ISSN 2524-7948
    ISSN (online) 2524-7948
    DOI 10.1186/s42836-023-00228-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: The characteristics and predictors of mortality in periprosthetic fractures around the knee.

    Nasser, Ahmed A H H / Sidhu, Manpreet / Prakash, Rohan / Mahmood, Ansar / Osman, Khabab / Chauhan, Govind S / Nandra, Rajpal / Dewan, Varun / Davidson, Jerome / Al-Azzawi, Mohammed / Smith, Christian / Gawad, Mothana / Palaiologos, Ioannis / Cuthbert, Rory / Wignadasan, Warran / Banks, Daniel / Archer, James / Odeh, Abdulrahman / Moores, Thomas /
    Tahir, Muaaz / Brooks, Margaret / Biring, Gurdeep / Jordan, Stevan / Elahi, Zain / Shaath, Mohammed / Veettil, Manoj / De, Chiranjit / Handford, Charles / Bansal, Mohit / Bawa, Akshdeep / Mattar, Ahmed / Tandra, Varun / Daadipour, Audrina / Taha, Ahmed / Gangoo, Shafat / Srinivasan, Sriram / Tarisai, Mandishona / Budair, Basil / Subbaraman, Krishna / Khan, Farrukh / Gomindes, Austin / Samuel, Arjun / Kang, Niel / Kapur, Karan / Mainwaring, Elizabeth / Bridgwater, Hannah / Lo, Andre / Ahmed, Usman / Khaleeq, Tahir / El-Bakoury, Ahmed / Rashed, Ramy / Hosny, Hazem / Yarlagadda, Rathan / Keenan, Jonathan / Hamed, Ahmed / Riemer, Bryan / Qureshi, Arham / Gupta, Vatsal / Waites, Matthew / Bleibleh, Sabri / Westacott, David / Phillips, Jonathan / East, Jamie / Huntley, Daniel / Masud, Saqib / Mirza, Yusuf / Mishra, Sandeep / Dunlop, David / Khalefa, Mohamed / Balakumar, Balasubramanian / Thibbaiah, Mahesh / Payton, Olivia / Berstock, James / Deano, Krisna / Sarraf, Khaled M / Logishetty, Kartik / Lee, George / Subbiah-Ponniah, Hariharan / Shah, Nirav / Venkatesan, Aakaash / Cheseldene-Culley, James / Ayathamattam, Joseph / Tross, Samantha / Randhawa, Sukhwinder / Mohammed, Faisal / Ali, Ramla / Bird, Jonathan / Khan, Kursheed / Akhtar, Muhammad A / Brunt, Andrew / Roupakiotis, Panagiotis / Subramanian, Padmanabhan / Bua, Nelson / Hakimi, Mounir / Bitar, Samer / Al Najjar, Majed / Radhakrishnan, Ajay / Gamble, Charlie / James, Andrew / Gilmore, Catherine / Dawson, Dan / Sofat, Rajesh / Antar, Mohamed / Raghu, Aashish / Heaton, Sam / Tawfeek, Waleed / Charles, Christerlyn / Burnand, Henry / Duffy, Sean / Taylor, Luke / Magill, Laura / Perry, Rita / Pettitt, Michala / Okoth, Kelvin / Pinkney, Thomas

    The bone & joint journal

    2024  Volume 106-B, Issue 2, Page(s) 158–165

    Abstract: 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.: ... ...

    Abstract 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.
    MeSH term(s) Adult ; Humans ; Periprosthetic Fractures/etiology ; Knee Joint/surgery ; Knee/surgery ; Arthroplasty, Replacement, Knee/adverse effects ; Femoral Fractures/surgery ; Rheumatic Diseases/etiology ; Rheumatic Diseases/surgery ; Retrospective Studies ; Reoperation
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2697156-2
    ISSN 2049-4408 ; 2049-4394
    ISSN (online) 2049-4408
    ISSN 2049-4394
    DOI 10.1302/0301-620X.106B2.BJJ-2023-0700.R1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study.

    Nasser, Ahmed Abdul Hadi Harb / Prakash, Rohan / Handford, Charles / Osman, Khabab / Chauhan, Govind Singh / Nandra, Rajpal / Mahmood, Ansar / Dewan, Varun / Davidson, Jerome / Al-Azzawi, Mohammed / Smith, Christian / Gawad, Mothana / Palaiologos, Ioannis / Cuthbert, Rory / Wignadasan, Warran / Banks, Daniel / Archer, James / Odeh, Abdulrahman / Moores, Thomas /
    Tahir, Muaaz / Brooks, Margaret / Biring, Gurdeep / Jordan, Stevan / Elahi, Zain / Shaath, Mohammed / Veettil, Manoj / De, Chiranjit / Bansal, Mohit / Bawa, Akshdeep / Mattar, Ahmed / Tandra, Varun / Daadipour, Audrina / Taha, Ahmed / Gangoo, Shafat / Srinivasan, Sriram / Tarisai, Mandishona / Budair, Basil / Subbaraman, Krishna / Khan, Farrukh / Gomindes, Austin / Samuel, Arjun / Kang, Niel / Kapur, Karan / Mainwaring, Elizabeth / Bridgwater, Hannah / Lo, Andre / Ahmed, Usman / Khaleeq, Tahir / El-Bakoury, Ahmed / Rashed, Ramy / Hosny, Hazem / Yarlagadda, Rathan / Keenan, Jonathan / Hamed, Ahmed / Riemer, Bryan / Qureshi, Arham / Gupta, Vatsal / Waites, Matthew / Bleibleh, Sabri / Westacott, David / Phillips, Jonathan / East, Jamie / Huntley, Daniel / Masud, Saqib / Mirza, Yusuf / Mishra, Sandeep / Dunlop, David / Khalefa, Mohamed / Balasubramanian, Balakumar / Thibbaiah, Mahesh / Payton, Olivia / Berstock, James / Deano, Krisna / Sarraf, Khaled / Logishetty, Kartik / Lee, George / Subbiah-Ponniah, Hariharan / Shah, Nirav / Venkatesan, Aakaash / Cheseldene-Culley, James / Ayathamattam, Joseph / Tross, Samantha / Randhawa, Sukhwinder / Mohammed, Faisal / Ali, Ramla / Bird, Jonathan / Khan, Kursheed / Akhtar, Muhammad Adeel / Brunt, Andrew / Roupakiotis, Panagiotis / Subramanian, Padmanabhan / Bua, Nelson / Hakimi, Mounir / Bitar, Samer / Najjar, Majed Al / Radhakrishnan, Ajay / Gamble, Charlie / James, Andrew / Gilmore, Catherine / Dawson, Dan / Sofat, Rajesh / Antar, Mohamed / Raghu, Aashish / Heaton, Sam / Tawfeek, Waleed / Charles, Christerlyn / Burnand, Henry / Duffy, Sean / Taylor, Luke / Magill, Laura / Perry, Rita / Pettitt, Michala / Okoth, Kelvin / Pinkney, Thomas

    Injury

    2023  Volume 54, Issue 12, Page(s) 111152

    Abstract: Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital ... ...

    Abstract Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.
    Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality.
    Results: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality.
    Conclusion: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance.
    MeSH term(s) Adult ; Humans ; Male ; Periprosthetic Fractures ; Retrospective Studies ; Cohort Studies ; Arthroplasty, Replacement, Hip/adverse effects ; Peripheral Vascular Diseases/surgery ; Pneumonia ; Renal Insufficiency ; Hip Fractures ; Reoperation
    Language English
    Publishing date 2023-10-24
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2023.111152
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 778: Show issues Location:
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