Electrical treatment of tibial non-union: a prospective, randomised, double-blind trial.

Electrical stimulation in the treatment of bony non-union has been used in different forms for many years. However, there is still a lot of uncertainty about its efficacy. We, therefore, undertook a prospective, randomised, double-blind trial to try and determine its effect. Over a period of 5 years, 34 consecutive patients with a tibial non-union met our "criteria for inclusion". Each patient had an oblique fibular osteotomy, followed by a unilateral external fixator. They were then randomly allocated one of two machines. Group 1, the active group, received electrical stimulation from an active machine. Group 2, the dummy group, had an identical machine but without any current passing through the active coils. They were then followed up for 6 months and evaluated clinically and radiologically for bony union. Unfortunately, there was by chance, an imbalance in smoking habit between the two groups. The union rate in the subgroup that smoked was 75% (6/8) in the active group as compared to 46% (6/13) in the dummy group. The active group of non-smokers had 100% (10/10) union rate, compared to 67% (2/3) in the dummy group. Overall 24 out of the 34 patients progressed to union. Out of 18, 16 (89%) in the active group showed bony union as compared to 8/16 (50%) in the dummy. There was, thus, a statistically significant positive association between tibial union and electrical stimulation (odds ratio 8, 95% CI: 1.5-41, P=0.02).

The effect of pulsed irrigation on the incidence of heterotopic ossification after total hip arthroplasty.

Heterotopic ossification (HO) is a common complication of total hip arthroplasty (THA). Pulsed lavage is being used with increasing frequency for THA. A prospective randomized, double-blind trial was initiated to determine if pulsed lavage affected the incidence of HO. A total of 94 THAs in 91 patients were analyzed. No significant difference in the incidence of HO was found between the 2 groups. Hypertrophic osteoarthritis was found to be a significant risk factor for HO. The findings suggest that the osteogenic precursor cells thought to be involved in the pathogenesis of HO possibly are derived from within the local soft tissues in the proximity of the hip joint.

Interobserver variation using the AO/ASIF classification of long bone fractures.

A comprehensive classification system has been proposed by the AO/ASIF Foundation for the classification of long bone fractures. After an explanatory talk and with the aid of an illustrated pamphlet, 18 orthopaedic surgeons were asked to classify 10 long bone fractures according to the AO system. Three of the participating surgeons had previous experience of the classification system. After individual classification, a consensus classification was derived and the results of the individual and consensus codings were compared. Only 32 per cent of all codings agreed with the final consensus. There was no difference between the surgeons with previous experience of the system (66 per cent) and novice coders (69 per cent) in the number of inaccurate codes when compared with the consensus codes. Reasons for error in coding are discussed. It is recommended that if the AO system is used for the purposes of research and computer-based audit, a consensus of opinion is used as the basis of classification.