Type of publication:
Systematic Review

Author(s):
*Patel, R; McConaghie, G; Khan, M M; Gibson, W; Singh, R; Banerjee, R.

Citation:
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(3):143-150, 2024.

Abstract:
PURPOSE OF THE STUDY: Vascularised bone grafting (VBG) and non-vascularised bone grafting (NVBG) are crucial biological reconstructive procedures extensively employed in the management of bone tumours. The principal aim of this study is to conduct a comparative analysis of the post-resection outcomes associated with the utilisation of vascularised and non-vascularised bone grafts. MATERIAL AND METHODS: A comprehensive and systematic literature review spanning the years 2013 to 2023 was meticulously executed, utilising prominent online databases including PubMed/Medline, Google Scholar, and Cochrane Library. Inclusion criteria were restricted to comparative articles that specifically addressed outcomes pertaining to defect restoration following bone tumour resection via vascularised and non-vascularised bone grafting techniques. The quality of research methodologies was assessed using the Oxford Quality Scoring System for randomised trials and the Newcastle Ottawa Scale for non-randomised comparative studies. Data analysis was conducted using SPSS version 24. Key outcome measures encompassed the Musculoskeletal Tumour Society Score (MSTS), bone union duration, and the incidence of post-operative complications. RESULTS: This analysis incorporated four clinical publications, enrolling a total of 178 participants (comprising 92 males and 86 females), with 90 patients subjected to VBG and 88 to NVBG procedures. The primary endpoints of interest encompassed MSTS scores and bone union durations. Although no statistically significant distinction was observed in the complication rates between the two cohorts, it is noteworthy that VBG exhibited a markedly superior bone union rate (P<0.001). CONCLUSIONS: Our systematic evaluation revealed that VBG facilitates expedited bone union, thereby contributing to accelerated patient recovery. Notably, complication rates and functional outcomes were comparable between the VBG and NVBG groups. Moreover, the correlation between bone union duration and functional scores following VBG and NVBG merits further investigation.

Type of publication:
Systematic Review

Author(s):
*Patel, R; Orfanos, G; Gibson, W; Banks, T; McConaghie, G; Banerjee, R.

Citation:
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 91(2):109-119, 2024.

Abstract:
PURPOSE OF THE STUDY: Hip osteoarthritis (OA) has a prevalence of around 6.4% and is the second most commonly affected joint. This review aims to assess the clinical outcomes of intra-articular high molecular weight hyaluronic acid (HMWHA) in the management of hip osteoarthritis. MATERIAL AND METHODS: We conducted a comprehensive search across PubMed, Google Scholar, and the Cochrane Library for randomised trials investigating the effectiveness of high molecular weight hyaluronic acid (HMWHA) in the treatment of hip osteoarthritis. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. To synthesise the data, we utilised the Standardised Mean Difference (SMD) for assessing pain relief through the Visual Analogue Scale (VAS) and the Lequesne index (LI) for evaluating functional outcomes. Risk Ratio (RR) was calculated to assess the occurrence of complications. RESULTS: A total of four studies involving HMWHA and control groups were included. The standardised mean difference (SMD) for the Visual Analogue Scale (VAS) (SMD -0.056; 95% CI; -0.351, 0.239; p = 0.709) and the Lequesne index (SMD -0.114; 95% CI; -0.524, 0.296; p = 0.585) were not statistically significant. Analysis for complications demonstrated an overall relative risk ratio (RR) of 0.879 (95% CI; 0.527, 1.466; p = 0.622), and was not statistically significant. DISCUSSION AND CONCLUSIONS: Intra-articular HMWHA in hip OA can significantly reduce pain and improve functional recovery when compared with the condition before treatment. However, there is no significant difference between HMWHA, or saline, or other therapeutic treatments. Currently, available evidence indicates that intra-articular HMWHA in hip OA would not increase the risk of adverse events.

Type of publication:
Conference abstract

Author(s):
*Mark Garton, *Jenni Rowlands, *Richard Roach

Citation:
Abstract submitted to Bone Research Conference, 2024

Abstract:
Background: Metatarsal fractures are common and disabling fractures, frequently triggered by low-energy injuries, or less often by repetitive loading. ‘Atypical’ metatarsal fractures have also been reported during prolonged anti-resorptive therapy, but a causal relationship remains speculative. Despite their clinical and economic importance, the epidemiology of metatarsal fractures remains poorly understood. We present a detailed service evaluation of radiologically-confirmed metatarsal fractures identified within Shropshire, over a three-year period. Methods: Radiology reports for all adults (≥18 years) attending hospital or community radiology departments between May 2020 and April 2023, were searched electronically using the terms ‘metatarsal’ AND ‘fracture’. All distinct patient episodes with ≥1 confirmed metatarsal fracture were identified for further analysis, and all duplicates were excluded. Age at fracture, sex, fracture type/distribution and mechanism of injury (where known) was recorded. Age- and sex-specific fracture rates were estimated by decade of life, using contemporaneous demographic data. Results: 1121 (758 female) patient-episodes of metatarsal fracture were identified, comprising 312, 397 and 412 individuals in years 1-3 respectively. Mean (SD) age at fracture was 50.7 (18.9) years, with 961 (85.7%) metatarsal fractures occurring in isolation, most (n= 736) affecting the fifth metatarsal. Smaller numbers fractured two (n=72), three (n=63), or four (n=15) metatarsal bones. Most fractures (59%) affected the metatarsal base, and less often the shaft (26%), neck (12%) and head (3%). Fractures were most often oblique (n=410), transverse (n=359) or comminuted (n=120), and only 70 patients had stress fractures. Estimated trauma levels were low (n=632), moderate (n=109), high (n=43) and unknown (n=246), and inversion and falls-related injuries the most commonly reported mechanism. Estimated annual fracture rates per 100,000, increased from 105 among women aged 18-29 years to 153 aged 50-59 years, with a second peak of 142 aged 80-89 years. For men at the same time points, rates were 102, 40 and 31. Although numerically less frequent, metatarsal neck fractures showed the greatest sex difference, becoming exponentially more common in women with age, compared to a gradual age-related decline in men. Discussion: Metatarsal fractures are common, usually affecting the fifth metatarsal in isolation, and often caused by low energy injuries, as shown by previous authors. Lower incidence during Covid lockdown may be genuine or reflect reduced ascertainment. Our estimates of age- and sex-specific fracture rates suggest pronounced sex differences in metatarsal fracture rates with age, which requires further study and linkage to known risk factors and relevant medication exposure.

Type of publication:
Journal article

Author(s):
Nasser, Ahmed A H H; Sidhu, Manpreet; Prakash, Rohan; Mahmood, Ansar; Osman, Khabab; Chauhan, Govind S; Nandra, Rajpal; Dewan, Varun; Davidson, Jerome; Al-Azzawi, Mohammed; Smith, Christian; Gawad, Mothana; Palaiologos, Ioannis; Cuthbert, Rory; Wignadasan, Warran; Banks, Daniel; Archer, James; Odeh, Abdulrahman; Moores, Thomas; Tahir, Muaaz; Brooks, Margaret; Biring, Gurdeep; Jordan, Stevan; Elahi, Zain; Shaath, Mohammed; Veettil, Manoj; De, Chiranjit; Handford, Charles; Bansal, Mohit; Bawa, Akshdeep; Mattar, Ahmed; Tandra, Varun; Daadipour, Audrina; Taha, Ahmed; Gangoo, Shafat; Srinivasan, Sriram; Tarisai, Mandishona; Budair, Basil; Subbaraman, Krishna; Khan, Farrukh; Gomindes, Austin; Samuel, Arjun; Kang, Niel; Kapur, Karan; Mainwaring, Elizabeth; Bridgwater, Hannah; Lo, Andre; *Ahmed, Usman; *Khaleeq, Tahir; El-Bakoury, Ahmed; Rashed, Ramy; Hosny, Hazem; Yarlagadda, Rathan; Keenan, Jonathan; Hamed, Ahmed; Riemer, Bryan; Qureshi, Arham; Gupta, Vatsal; Waites, Matthew; Bleibleh, Sabri; Westacott, David; Phillips, Jonathan; East, Jamie; Huntley, Daniel; Masud, Saqib; Mirza, Yusuf; Mishra, Sandeep; Dunlop, David; Khalefa, Mohamed; Balakumar, Balasubramanian; Thibbaiah, Mahesh; Payton, Olivia; Berstock, James; Deano, Krisna; Sarraf, Khaled M; Logishetty, Kartik; Lee, George; Subbiah-Ponniah, Hariharan; Shah, Nirav; Venkatesan, Aakaash; Cheseldene-Culley, James; Ayathamattam, Joseph; Tross, Samantha; Randhawa, Sukhwinder; Mohammed, Faisal; Ali, Ramla; Bird, Jonathan; Khan, Kursheed; Akhtar, Muhammad A; Brunt, Andrew; Roupakiotis, Panagiotis; Subramanian, Padmanabhan; Bua, Nelson; Hakimi, Mounir; Bitar, Samer; Al Najjar, Majed; Radhakrishnan, Ajay; Gamble, Charlie; James, Andrew; Gilmore, Catherine; Dawson, Dan; Sofat, Rajesh; Antar, Mohamed; Raghu, Aashish; Heaton, Sam; Tawfeek, Waleed; Charles, Christerlyn; Burnand, Henry; Duffy, Sean; Taylor, Luke; Magill, Laura; Perry, Rita; Pettitt, Michala; Okoth, Kelvin; Pinkney, Thomas

Citation:
Bone & Joint Journal. 106-B(2):158-165, 2024 Feb 01

Abstract:
Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality. Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation. Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes.

Altmetrics:

Type of publication:
Journal article

Author(s):
*Crooks S.A.; *Paavana T.; *Heaver C.

Citation:
Orthopaedics and Trauma. 38(1) (pp 56-64), 2024. Date of Publication: February 2024.

Abstract:
Exertional leg pain is a common problem in the athletic population, presenting with a constellation of similar symptoms. Delayed or incorrect diagnosis and treatment may result in significant morbidity and avoidable cessation of activity. Multiple causes such as chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), nerve or vascular entrapment syndromes may be responsible. A thorough history and focused clinical examination is mandated, and may yield clues as to the definitive diagnosis. Investigative adjuncts include imaging, compartment pressure measurement and electrodiagnostic studies. Whilst specific management depends on the underlying cause, the mainstay of initial management is activity modification, with surgery reserved for those who fail to respond to conservative measures.