Carbon-Fiber-Reinforced PEEK Intramedullary Nails Defining the Niche.

BACKGROUND: Carbon-fiber-reinforced Polyetheretherketone (CFR-PEEK) nails are gaining interest as they have biomechanical properties potentially capable of overcoming disadvantages of conventional metal nails. CASE SUMMARY: Three cases are illustrated which required superior mechanical toughness, compatibility with radiotherapy, and postoperative advanced imaging. CONCLUSION: CFR-PEEK nails seem to have a niche role in distinct groups of patients.

An accurate method of determining a single-plane osteotomy to correct a combined rotational and angular deformity.

Conventional osteotomy used for the correction of deformity is performed out of the plane of deformity creating a wedge either opening or closing when the deformity is corrected. Deformity that is a combination of rotation and angulation exists in a single plane that is oblique to the coronal, sagittal and axial planes depending on the magnitude of deformity measured in each plane. Accurate planning and a simple method of finding this oblique plane operatively is presented. This method starts by finding the bisector of angulation. This is marked by a wire that lies in the plane of angulation and along the bisector of angulation. The saw blade is rotated about this bisector axis according to the proportion of angulation and rotation. There is no second reorientation of the saw blade required making the final plane much easier to define. This single-plane oblique osteotomy allows accurate realignment of the limb.

Overcoming barriers to secondary prevention in hip fracture patients: An electronic referral and management system for osteoporosis.

BACKGROUND: Numerous studies have shown that osteoporosis is both under diagnosed and under treated in patients with fragility fractures. We describe the use of an electronic automated referral system to enable multidisciplinary assessment and treatment of osteoporosis in patients admitted with fragility fracture of the hip. METHODS: An electronic referral system was developed from the hospital's trauma software database. This automatically refers patients admitted with fragility fracture of the hip to osteoporosis services. Data were collected prospectively from May to July 2007, when referral was dependent on members of the orthopaedic team and from August to October 2007, after the implementation of the electronic referral system. Primary outcomes were presence of a referral to osteoporosis services, organisation of bone density scan and follow up appointment in patients less than 75 years, and treatment with osteoporosis medication in patients greater than 75 years of age. RESULTS: There were a total of 90 patients, 47 in the non-intervention group and 43 in the intervention group. In the non-intervention group 8/47 patients (17%) were referred to osteoporosis services whilst 43/43 (100%) were referred in the intervention group. Of patients greater than 75 years, 10/32 (31.3%) were started on a bisphosphonate in the non-intervention group compared to 28/34 (82.4%) in the intervention group. Of patients less than 75 years, 1/15 (7%) in the non-intervention group had a DEXA scan booked and appropriate follow up arranged, compared to 7/9 (78%) in the intervention group. There was significant difference between both groups in all outcomes (p<0.0001). CONCLUSION: We present an electronic system which facilitates delivery of osteoporosis services and significantly improves management of osteoporosis in patients admitted with fragility fracture. We recommend the use of such programmes to facilitate multidisciplinary assessment and treatment of osteoporosis in orthopaedic trauma patients.

Antibiotic-loaded cement in revision joint replacement.

The infected joint replacement remains a difficult clinical challenge. Antibiotic-loaded cement provides one therapeutic solution that combines mechanical stability and antibiotic delivery.