Orthopaedics and Trauma最新文献

With an ageing population, hip fractures are a progressively worsening global burden that impact both the patient and healthcare systems. More than half of hip fractures are intracapsular and the majority of them are treated with arthroplasty surgery for pain relief and restoration of mobility. For most hip fracture patients, who are generally older and frail, the aim of the surgeon is to provide treatment with the lowest possible mortality, complication and revision rates, coupled with improved health-related quality of life. Registry data show more favourable outcomes with cemented rather than cementless hemiarthroplasty in this challenging patient group. This article describes the techniques for cementing the femur during a hemiarthroplasty to recreate the patient's anatomy, as well as how to perform safe cementing techniques to reduce the risk of cement related complications.

Hip fracture is now a major public health issue with increasing global incidence. Older patients with hip fractures are associated with significant morbidity and mortality. There are robust evidence and guidelines that support the use of a multidisciplinary team in managing older patients with hip fractures. Efficient delivery of hip fracture care requires collaboration amongst a diverse team of specialists and healthcare professionals, including the emergency department team, orthogeriatrician, anaesthetist, nursing team, physiotherapist, occupational therapist and orthopaedic surgeon. In this review, we aim to provide an update on the multidisciplinary team and orthogeriatric management of elderly patients with a hip fracture. A higher level of adherence to the care standards have been shown to associated with positive outcomes.

Achilles tendon ruptures are fairly common injuries that are often unfortunately missed, leading to the development of chronic tendoachilles (TA) ruptures. Patients present with gait abnormalities and significant ankle plantarflexion weakness. Imaging modalities such as ultrasound (US) and magnetic resonance imaging (MRI) are used to confirm the diagnosis and help in surgical planning. Most chronic TA ruptures require surgical management, with non-operative management being reserved for medically unfit patients due to generally poor outcomes. A multitude of surgical reconstruction options have been described in the literature, each with its benefits and disadvantages. Ultimately, the choice of surgical technique depends on the residual gap that is present following debridement of the scar tissue that forms a bridge between the ruptures ends of the Achilles tendon, graft availability and the treating surgeon's preference. Surgery results in an improvement in patient-reported outcomes, with the majority going back to their pre-injury level activities. However, surgery is also associated with a fair number of complications, the most common being wound healing problems, infections, neurological injury and deep vein thromboses for which patients need to be appropriately counselled for.

Sporting foot and ankle injuries in older athletes are scarcely documented, however, they can play a key role in ending one's professional career. The term ‘older athlete’ itself comprises a large amount of age groups depending on various factors, mainly depending on the type of sport. Ankle inversion/injuries sprains are by far the most common with the anterior talofibular ligament being most frequent to tear about 75%, these injuries can range from a simple sprain, to more serious conditions which require accurate diagnosis and early treatment to ensure a full and expedient return to sports. Syndesmosis injury count for 1–18% of injuries following an ankle sprain. Deltoid ligament tear in combination with lateral ligament complex may need acute surgery; peroneal tendon injury and retinaculum tear are found mainly to affect the peroneus longus tendon in this group. Overuse chronic pathologies and arthritis are the leading cause of damage in this athlete group. The orthopaedic surgeon needs to be aware of the more subtle presentations of significant injuries and use appropriate imaging to make the diagnosis and treat the athlete appropriately to enable them in maintaining a professional/semi-professional career as long as possible, this review explores this topic into detail.

The peroneal tendons work to both evert the foot and stabilize the hindfoot on plantarflexion and push off. The tendons are frequently injured as part of sprains and soft tissue injuries to the ankle joint, but diagnosis and treatment are often delayed. Athletes participating in activities with repetitive ankle motion, particularly those involving cutting and twisting movements, as well as those with certain anatomical features, are prone to peroneal tendon injury. Often synovitis and low-grade tendinopathy of the peroneal tendons can be managed with physiotherapy and bracing. Large longitudinal tears, rupture, and subluxation or dislocation of the tendons from the retromalleolar groove are more likely to be treated operatively, although pre-surgical rehabilitation will still be useful in chronic cases. Other surgical procedures can be combined as part of an effective treatment plan such as ankle arthroscopy, ligament stabilization and realignment procedures such as a lateralizing calcaneal osteotomy and Barouk–Rippstein–Toullec first metatarsal elevation osteotomy for non-neurogenic cavus. Persistent weakness in the peroneal tendons post injury may contribute to worsening hindfoot varus deformity: in turn, this leads to further stress on peroneus brevis which can lead to its rupture and consequently further deformity if untreated.

Lisfranc injuries remain one of the most potentially debilitating foot injuries, often resulting in long-term chronic pain, arthritis and a delayed return to work. About 20% of injuries sustained by athletes are in the foot, with midfoot injuries being the second most common type. About 3.5% of severe injuries in this category are career ending. Male athletes have a higher incidence of severe injuries, twice more likely needing surgery and three times more likely to end their career early. Female athletes have a high incidence of stress injuries due to the known ‘female athletic triad’ contributing to it. Low-energy injuries are often treated non-operatively. Severe injuries need operative management as well as metalwork removal in most cases later. The importance of early recognition, correct classification, whether to manage non-operatively and the postoperative rehabilitation are the key components of a chance to a good recovery and possible return to sports in athletes. As the diagnosis is similar for both athletes and non-athletes, this review will summarize the relatively little evidence on the epidemiology, management and outcomes for Lisfranc injuries in athletes.

Ankle sprains are one of the most common musculoskeletal injuries. A sprain is defined as the stretching or tearing of ligaments; in the ankle these are the lateral ligamentous complex, deltoid ligament and distal tibiofibular syndesmosis ligaments. The mechanism of injury dictates which ligaments get injured, with the most common being inversion injuries causing anterior talofibular ligamentous sprain. Initial management of an ankle sprain consists of protection, rest, ice, compression and elevation. After the first 72 hours, the treatment depends on the severity of the sprain, with physiotherapy forming the mainstay of treatment in the majority of cases. In addition to strengthening exercises proprioceptive re-training helps with rehabilitation. The goal of treatment is to prevent chronic instability from occurring. Aside from syndesmotic injuries, surgical treatment is rarely required in the acute setting. Delayed ligamentous reconstruction may be required if chronic instability occurs, and is described as being an anatomic or non-anatomical reconstruction. This article reviews the anatomy, pathophysiology, clinical assessment and management of patients with ankle sprains.