Orthopaedics and Trauma最新文献

Distal humerus fractures are common, and when they occur in elderly patients with osteoporotic bone or poor subchondral bone stock, intra-articular fragmentation is common and management can be challenging. Osteosynthesis may be impossible or associated with a high risk of complications in this subset of patients, and total elbow replacement may be the preferred treatment. Elbow hemiarthroplasty for unreconstructable distal humerus fractures has emerged as an alternative treatment option and now accounts for over 50% of arthroplasty procedures for distal humerus fractures in England. This article aims to look at the indications, contraindications, surgical anatomy and technique as well as the outcomes and complications of elbow hemiarthroplasties.

There are a number of factors that can contribute to the exacerbation of tendinopathies around the elbow. In order to effectively manage patients, it is important to understand the natural progression of these conditions, injury mechanisms, potential risk factors and the range of pathological manifestations. Presently, disease-modifying treatments for tendinopathy are lacking, placing non-operative approaches, staged physiotherapy and support at the forefront of primary options. Conservative management proves successful for medial and lateral epicondylitis, though some cases may require up to a year for improvement. Short-term relief can be achieved with non-steroidal anti-inflammatory drugs and corticosteroid injections, although their long-term efficacy is uncertain, and evidence for alternative injection therapies is limited. Surgical intervention can be considered if non-operative management proves ineffective after 6–12 months, often involving open resection, debridement, and repair. While arthroscopic techniques offer promise, they present inherent risks, particularly in patients with prior surgeries. Despite the rarity of distal triceps and biceps tendinopathies, prompt diagnosis and non-operative approaches are pivotal, with surgery considered if symptoms persist after 6 months. Overall, favourable outcomes can be achieved for common elbow tendinopathies with control of risk factors and appropriate care.

The aim of this article is to provide frailty education that is relevant to the orthopaedic surgeon. An ageing population has led to an increase in the number of orthopaedic operations in patients living with frailty. Accumulating evidence suggests that a patient's outcome is better estimated by measuring their frailty score rather than their chronological age. If a patient lives with frailty, they are much more susceptible to complications and mortality. This article will explain how to identify frailty, what complications are associated with frailty and when, and what, interventions can be used to help reduce complications. It will also educate on current British Orthopaedic Association and Centre for Perioperative Guidelines for patients living with frailty, for both trauma and elective patients.

We evaluated the effectiveness of plasma-rich protein injections (PRP) in terms of pain, patient-reported outcomes and function in degenerative joint disease and tendinopathy. The search strategies were ran in Ovid Medline and Ovid Embase in October 2023 by a clinical librarian. Results were limited to the last 10 years. The search terms used were ‘platelet rich plasma’ and ‘orthopaedics’. After screening and the eligibility process this resulted in 18 randomized control trials (RCTs). We analysed 18 level 1 RCTs in regard to gluteal tendinopathy, hip osteoarthritis, patella tendinopathy, knee osteoarthritis, Achilles tendinopathy, plantar fasciitis, rotator cuff tendinopathy and elbow tendinopathy. Further research, such as meta-analyses and double-blinded trials with more patients, longer follow-up and with a placebo group, is needed to better elucidate the safety and efficacy of PRP injections.

This article provides a narrative summary of current understanding of football injuries in female athletes. We summarize the epidemiological data and compare differences between levels of competition, from amateur through professional. Underlying intrinsic risk factors such as anatomic, biomechanics and endocrine factors are outlined. Extrinsic risk factors such as football boot design and playing surface are detailed. We briefly report on the outcomes of women's injury prevention programmes and their success in reducing ankle injuries.

Climate change is undoubtedly a global threat, with extreme weather events, air pollution, and food insecurity disproportionately impacting low-income countries. The healthcare sector, whilst responsible for 4.4% of global net carbon emissions, has been slow in addressing its environmental footprint. This article explores the needs and challenges to achieve sustainable orthopaedic surgery. Orthopaedic surgery continues to create a large carbon footprint, primarily through the use of single-use consumables and energy-intensive operating theatres. While efforts to reduce environmental harm have primarily targeted changes within the operating theatre, a comprehensive approach must consider the entire surgical pathway. The principles of reduce, reuse and recycle are paramount. Reducing surgical caseload and advancing digital healthcare afford opportunities to streamline patient interactions, reduce travel emissions and improve efficiency. Furthermore, reevaluating routine practices, such as preoperative investigations and postoperative care, can minimize unnecessary resource consumption. Improving the sustainability of orthopaedics will bring conflicting clinical, financial and environmental challenges. However, with increasing awareness among healthcare professionals and support from it's professional bodies, there is growing momentum toward sustainable orthopaedic surgery. Transitioning to sustainable orthopaedic surgery neccesitates a broad approach encompassing prevention, optimization, and streamlining of the surgical pathway. Addressing environmental concerns alongside clinical outcomes is imperative for the future of orthopaedic surgery.

Historically, orthopaedic implants required little clinical evidence before market introduction, either in the USA or the European Union (EU). There have been major incidents, with faulty designs or manufacturing techniques resulting in patient harm. The new EU Medical Device Regulations (MDR) have significantly changed the requirements around the introduction to the market of new medical devices in the EU. Initiatives like CORE-MD are founded to improve this process. EUDAMED will provide a mandatory European implant safety register. Real-world data, such as implant registries, have a major role to play in the continuous monitoring of implants, but this depends on them having high completeness (>95%) as well as coverage. Registries can also be used for post-market surveillance. Although implant registries use endpoints such as revision, as well as patient-reported outcomes, long-term follow-up is still needed to detect mediocre implants. For new designs, this often takes too long and potentially exposes patients to mediocre implants. This can be prevented by using more accurate, highly predictive methods at early follow-up (at 1 year), such as implant migration studies. Furthermore, registry-based or nested randomized controlled trials can be used to evaluate new implant designs and surgical techniques. Monitoring implants through registries remains vital in order to detect early or late unexpected failures related to the implant, surgical technique or indication, enhancing both implant development as well as patient safety.