Evolution in the Management of Patella Fractures.

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation.

Incidence, Management, and Hospital Costs of Orthopaedic Injuries of E-Scooter Riders in Western Australia.

The use of electric scooters (e-scooters) is increasing in Australia and internationally. The increasing availability of e-scooters has led to a rise in the number of injuries, with most patients sustaining orthopaedic injuries. This retrospective case series describes the incidence, management, and hospital costs of the orthopaedic injuries, which presented to the emergency department (ED) of the major trauma center in Western Australia. Data on demographics, ED dispatch destination, management, follow-up clinics, and hospital costs were collected between 2017 and 2022. Since June 2020, there have been 61 e-scooter crashes, which resulted in orthopaedic injuries, with more than half of the crashes occurring after the introduction of regional e-scooter sharing schemes. Thirty-two patients (52%) were admitted to the hospital. The most common orthopaedic fracture was to the upper limb (44%), followed by the lower limb (41%) and the axial skeleton (15%). Fourteen (23%) patients sustained more than one fracture. Twenty-two patients (36%) required operative management. The median number of outpatient clinic attendances per patient was 3 (interquartile range (IQR): 1-5), with inpatients requiring twice the number of clinics as compared to those discharged from the ED. The median cost per presentation was AU$5880.60 (IQR: AU$1283.10-AU$21,150.90) with inpatient costs exceeding those discharged from the ED. The range of the total costs was AU$413.80 to AU$100,239.80. The rise in the accessibility of e-scooters in Western Australia has led to a rise in ED presentations with orthopaedic injuries. Considering the recent implementation of e-scooter sharing schemes in metropolitan areas, ongoing surveillance of e-scooter injuries by clinicians and policy makers is warranted to inform harm minimization strategies.

Repeat Anterior Cruciate Ligament Injury and Return to Sport in Australian Soccer Players After Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft.

BACKGROUND: Soccer is the most commonly played team sport in the world and a high-risk sport for anterior cruciate ligament (ACL) injury and subsequent ACL reconstruction (ACLR). PURPOSE: To assess the rate of further ACL injury in patients who have undergone ACLR with hamstring tendon autograft after soccer injuries in Australia and to determine factors associated with repeat ACL injury and return to soccer. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: From a prospectively collected database, a series of 1000 consecutive ACLRs using hamstring autografts performed in soccer players were identified. Patients were surveyed at a minimum 5 years after reconstruction, including details of further ACL injuries to either knee, return to soccer or other sports, and psychological readiness per the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale. RESULTS: Of the 862 participants reviewed, ACL graft rupture occurred in 85 (10%) and contralateral ACL rupture in 68 (8%) within 5 years after the reconstruction. The 5-year ACL graft survivorship was 94% for females and 88% for males. The survivorship of the contralateral ACL was 92% for males and 90% for females. When compared with those aged >25 years, the odds of ACL graft rupture was increased by 4 to 5 times in those aged 19 to 25 years and 3 to 7 times in those ≤18 years. Further ACL injury to the graft or contralateral knee occurred in 44% of males aged ≤18 years. Risk factors for further ACL injury were younger age at time of surgery, male sex, and return to soccer. Graft diameter did not influence ACL graft rupture rates, and 70% of patients returned to soccer after ACLR. The mean ACL-RSI score was 59, and patients who reported more fear of reinjury on this scale were less likely to have returned to soccer. CONCLUSION: The prevalence of ACL graft rupture (10%) and contralateral ACL rupture (8%) was near equivalent over 5 years in this large cohort of mostly recreational Australian soccer players. ACLR with hamstring autograft is a reliable procedure, allowing 70% of patients to return to soccer in this high-risk population. Risk factors for further ACL injury are progressively younger age at time of surgery, male sex, and return to soccer. Graft diameter was not a factor in ACL graft rupture, indicating that other factors, particularly age, are of primary importance.

Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur.

BACKGROUND:: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. PURPOSE:: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. METHODS:: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). RESULTS:: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. CONCLUSION:: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.

Mid-term clinical results of the cementless R3 cup and Polarstem total hip arthroplasty.

BACKGROUND: There has been a shift from cemented to uncemented hip arthroplasty. One popular uncemented combination is the R3 acetabular cup with Polarstem, having the lowest revision rate in the UK National Joint Registry. However, there are no medium-term clinical outcomes on this combination in the literature. The aim of this study is to review our centre's outcomes with this combination using conventional bearings with a minimum of 7-year follow-up. METHODS: Using our centre's arthroplasty database, we identified all patients that underwent a total hip arthroplasty using these implants from August 2009 to December 2010. One hundred and forty-four procedures were performed. The primary outcome was revision rate, and the secondary outcomes were clinical and radiological evaluation. RESULTS: The mean cohort age at surgery was 68.3 years. There were three revisions, of which only one underwent a cup revision. The mean Oxford Hip Score at 7-year follow-up was 38. Radiological evaluation of both acetabular and stem component did not show any radiolucency at 7-year follow-up. Kaplan-Meier survivorship analysis showed an implant survival rate of 97.69% at 7 years using revision for all causes as endpoint. The risk of revision was 1.47% at 7 years. CONCLUSION: Our revision rates are comparable to the UK's National Joint Registry, with excellent clinical and radiological outcome. Our results correlate with the allocated rating of 7A* by the Orthopaedic Data Evaluation Panel for both R3 acetabular cup and Polarstem.

Management of shoulder pain after a cerebrovascular accident or traumatic brain injury.

BACKGROUND: Shoulder pain after a cerebrovascular accident or traumatic brain injury is a common but often under-recognized problem. It is due to a number of causes including inferior subluxation, spasticity, adhesive capsulitis, and heterotopic ossification. Many of these are amenable to surgical intervention. METHODS: Literature review of current evidence. RESULTS: This article shows that there are multiple treatment options in this group of patients, and it is important to understand these as clinicians in delivering quality care to this complex group of patients. CONCLUSION: This review article describes how careful clinical assessment can differentiate between causes of shoulder pain and guide best management.