Alexia Karantana

Total ankle replacement in patients with significant pre-operative deformity of the hindfoot

We carried out 123 consecutive total ankle replacements in 111 patients with a mean follow-up of four years (2 to 8). Patients with a hindfoot deformity of up to 10 degrees (group A, 91 ankles) were compared with those with a deformity of 11 degrees to 30 degrees (group B, 32 ankles). There were 18 failures (14.6%), with no significant difference in survival between groups A and B. The clinical outcome as measured by the post-operative American Orthopaedic Foot and Ankle Surgeons score was significantly better in group B (p = 0.036). There was no difference between the groups regarding the post-operative range of movement and complications. Correction of the hindfoot deformity was achieved to within 5 degrees of neutral in 27 ankles (84%) of group B patients. However, gross instability was the most common mode of failure in group B. This was not adequately corrected by reconstruction of the lateral ligament. Total ankle replacement can safely be performed in patients with a hindfoot deformity of up to 30 degrees . The importance of adequate correction of alignment and instability is highlighted.

A revolution in the management of fractures of the distal radius

The recent development of locking-plate technology has led to a potential revolution in the management of fractures of the distal radius. This review examines the evidence for pursuing anatomical restoration of the distal radius and the possible advantages and pitfalls of using volar locking plates to achieve this goal. The available evidence for adopting volar locking plates is presented and a number of important and, as yet unanswered, questions are highlighted.

Surgical treatment of distal radial fractures with a volar locking plate versus conventional percutaneous methods: a randomized controlled trial.

BACKGROUND The aim of this study was to compare the outcomes of displaced distal radial fractures treated with a volar locking plate with the results of such fractures treated with a conventional method of closed reduction and percutaneous wire fixation with supplemental bridging external fixation when required. Our aim was to ascertain whether the use of a volar locking plate improves functional outcomes. METHODS A single-center, pragmatic, randomized controlled trial was conducted in a tertiary care institution. One hundred and thirty patients (eighteen to seventy-three years of age) who had a displaced distal radial fracture were randomized to treatment with either a volar locking plate (n = 66) or a conventional percutaneous fixation method (n = 64). Outcome assessments were conducted at six weeks, twelve weeks, and one year. Outcomes were measured on the basis of scores on the Patient Evaluation Measure (PEM) and QuickDASH questionnaire (a shortened version of the Disabilities of the Arm, Shoulder and Hand, or DASH, Outcome Measure), EuroQol-5D (EQ-5D) scores, wrist range of motion, grip strength, and radiographic parameters. RESULTS The rate of follow-up at one year was 95%. Patients in the volar locking-plate group had significantly better PEM and QuickDASH scores and range of motion at six weeks compared with patients in the conventional-treatment group, but there were no significant differences between the two groups at twelve weeks or one year. Grip strength was better in the plate group at all time points. The volar locking plate was better at restoring palmar tilt and radial height. Significantly more patients in the plate group were driving at the end of six weeks, but this did not translate to a significant difference between groups in terms of those returning to work by that time. CONCLUSIONS Use of a volar locking plate resulted in a faster early recovery of function compared with use of conventional methods. However, no functional advantage was demonstrated at or beyond twelve weeks. Use of the volar locking plate resulted in better anatomical reduction and grip strength, but there was no significant difference in function between the groups at twelve weeks or one year. The earlier recovery of function may be of advantage to some patients. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Interventions for treating wrist fractures in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects (benefits and harms) of interventions for common distal radius fractures in children, including skeletally immature adolescents.

Medical staff need to be aware of major incident planning.

EDITOR—Last month the BMA warned that too few people in the United Kingdom know how to respond to a terrorist attack.1 Its concerns about too few senior officials being aware of plans and recommendations to improve preparedness are sensible, but we believe that not enough medical staff are aware of their role in the …

Laparoscopic proctocolectomy with restorative ileal‐anal pouch

Objective  The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery.

Simultaneous Bilateral Total Ankle Replacement Using the S.T.A.R.: A Case Series

Level of Evidence: V, Expert Opinion

Extra-articular fractures of the distal radius--a European view point.

There is no unified consensus view on the management of distal radius fractures within Europe. This is partially because of the failure of clinical studies to demonstrate superiority of one treatment technique over the others. Nonclinical factors, such as cost and operating room availability, also contribute to the decision making regarding treatment, and there remains uncertainty as to the criteria that need to be fulfilled to achieve a good functional result. This article therefore does not describe a unified European viewpoint, but the viewpoint of two Europeans working within the health care system of one European country.

Cost-effectiveness of volar locking plate versus percutaneous fixation for distal radial fractures: Economic evaluation alongside a randomised clinical trial.

This study compares the cost-effectiveness of treating dorsally displaced distal radial fractures with a volar locking plate and percutaneous fixation. It was performed from the perspective of the National Health Service (NHS) using data from a single-centre randomised controlled trial. In total 130 patients (18 to 73 years of age) with a dorsally displaced distal radial fracture were randomised to treatment with either a volar locking plate (n = 66) or percutaneous fixation (n = 64). The methodology was according to National Institute for Health and Care Excellence guidance for technology appraisals. . There were no significant differences in quality of life scores between groups at any time point in the study. Both groups returned to baseline one year post-operatively. NHS costs for the plate group were significantly higher (p < 0.001, 95% confidence interval 497 to 930). For an additional £713, fixation with a volar locking plate offered 0.0178 additional quality-adjusted life years in the year after surgery. The incremental cost-effectiveness ratio (ICER) for plate fixation relative to percutaneous fixation at list price was £40 068. When adjusting the prices of the implants for a 20% hospital discount, the ICER was £31 898. Patients who underwent plate fixation did not return to work earlier. We found no evidence to support the cost-effectiveness, from the perspective of the NHS, of fixation using a volar locking plate over percutaneous fixation for the operative treatment of a dorsally displaced radial fracture.

Putting the ‘systematic’ into searching – tips and resources for search strategies in systematic reviews:

The quality of the methodology of published systematic reviews in hand surgery is highly variable. This is especially the case with the proliferation of nonCochrane Reviews in recent years. There are many potential deficiencies in systematic review methods, which can lead to a risk of bias or erroneous conclusions (Garcia-Doval et al., 2017). A fundamental aspect is the quality of the literature search strategies employed. Some published systematic reviews in hand surgery have search strategies that are simplistic, omit relevant terms, or contain basic syntax errors, while some do not search a comprehensive range of databases. In some cases, the search strategy is not even documented adequately or at all, despite the requirements of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline (Moher et al., 2009). This means the search strategy cannot be checked and reproduced (a key indicator of quality). A poor search can lead to the omission of relevant studies, with a potentially significant impact on any subsequent analysis and the conclusions reached. In this article we aim to provide helpful tips for systematic review authors to avoid common errors and optimize their search strategies. The article should also help readers to critically appraise and interpret existing reviews. It is not intended as a comprehensive guide to systematic searching. Detailed advice on searching for studies is available online in the Cochrane Handbook for Systematic Reviews of Interventions (Lefebvre et al., 2011). It takes time and expert training to learn how to compile a comprehensive and sensitive search strategy, and there are many pitfalls for the unwary. We suggest that it is always best to attend a systematic review training course to learn from experts before starting.