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Background Snowboarding is a very common sport especially among young adults. Common injuries are hand, wrist, shoulder and ankle injuries. Purpose of this study was to analyze different injury pattern in children and young adults comparing with adults. Methods Patients who were admitted for ambulant or stationary treatment as a result of injury practicing snowboard received a questionnaire and were divided into three groups (children, young adults and adults) according to their age. Between october 2002 and may 2007 1929 injured snowboard sportsmen were included in the study. Data such as location, date and time of accident as well as information about the slope were carried out. In addition snowboard skills were classified and patients were questioned whether they wore special protectors. Results 32.5% of injured patients were female (n = 626) and 67.5% male (n = 1303) with a mean age of patients of 21.9 (7-66) years. 13% of all patients were in group I (children), 19.2% in group II (young adults) and 67.8% in group III (adults).Most common injuries with 60% of all accidents were injuries of the hand wrist especially in children beginning with snowboard sports. Injuries on the regular track were most common followed by jumps in the kicker park and rails in the fun-park. 20.6% in group I, 13.6% in group II and 12.8% group III did not wear any protectors. Conclusion Children and adolescents presented different injury patterns than adults. Young participants of up to 14 years of age are endangered especially during the first days of learning this sport. Further development of protectors with regard to biomechanical characteristics is important to achieve an optimal protective effect. Level of evidence 2b. © 2020 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.Aims There has been significant interest in day-case and rapid discharge pathways for unicompartmental knee replacements (UKR). Robotic-assisted surgery has the potential to improve surgical accuracy in UKR. However, to date there are no published studies reporting results of rapid-discharge pathways in patients receiving UKR using the NAVIO ◊ robotic system. Methods A retrospective analysis identified 19 patients who were safely discharged within 24 h following UKR using the NAVIO ◊ robotic system between June 2017 and October 2019. All patients went through a standardised UKR pathway protocol. Pre-operatively patients underwent education sessions and anaesthetic assessment, with selected patients undergoing occupational/physiotherapy assessment prior to surgery. All patients received a general anaesthetic with local anaesthetic infiltration prior to closure; nerve blocks were not used routinely. A multi-modal analgesic regime was utilised. Patients were discharged home once they were safe to mobilise on ward, had normal vital signs and pain was adequately controlled. Patients were discharged with outpatient physiotherapy referral and consultant follow up at 6 weeks. Results All patients were discharged within 24 h; there were no post-operative complications and no readmissions to hospital. The mean length of stay was 19.5 h (SD = 6.8), with patients seen twice on average by physiotherapy post-operatively. Active range of motion at 6 weeks was 105.8°, with all patients mobilising independently. The median 6-month post-operative Oxford Knee Score was 44 out of 48. Conclusion This initial feasibility study suggests that patients may be safely discharged within 24 h of UKR using the NAVIO robotic system. Appropriate patient selection will ensure successful discharge. Further prospective studies are needed. Crown Objective The purpose of this study is to estimate stress distribution occurring in the humerus during elevation and external rotation of the arm.Methods contact forces and moments were estimated using telemeterized shoulder implants. An accurate three-dimensional (3D) finite element (FE) model of the natural scapula was developed, and loaded by data obtained by instrumented prosthesis. Results Stresses of about 40 MPa were found on the homerus during the elevation phase acting at 30° and 80°, while a peak of 60 MPa was found during the external rotation phase at 20°. The stress aging on scapula was of about 45 MPa, while the acromion was subjected at about 30 MPa. Stresses aging on ligaments were of about 15 MPa. Conclusion These results indicated that the transfer of major muscle and joint reaction take place predominantly through the thick bony ridges, and stresses induced can be dangerous especially for patients with shoulder problems or during the first post-operative weeks after shoulder fractures or joint replacements. © 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Objective To quantify the number of women presenters and their roles at national meetings across all orthopaedic sub-specialties. Methods A retrospective review of annual meeting programs for 2008 and 2017 from ten North American orthopaedic societies was conducted. Results A statistically significant increase was seen in the proportion of women presenting at society annual meetings between 2008 and 2017 (p  less then  0.0001). Women were more often authors presenting abstracts (p  less then  0.0001)) and less frequently faculty/instructors (p = 0.0051) and moderators/chairs (p = 0.0003) when compared to men. Conclusion Men continue to hold a higher proportion of more respected roles within orthopaedic academia. © 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Currently, the most commonly used method of treatment of patients with fractures of the metacarpal bones is closed reposition with immobilization of short-arm cast. This often leads to dislocation of fragments, their malunion, which leads to wrist functionality disorders and reduces the quality of patients' life. The main way to eliminate the deformities ‒ osteotomy of the metacarpal bones, followed by osteosynthesis. Purpose of the study ‒ to give a clinical assessment of the results of surgical treatment of patients with posttraumatic deformities of the Metacarpals, based on the use of a new method of corrective osteotomy. EZM0414 mouse Methods. The proposed new method V-shape open angle of the osteotomy of the metacarpal bones whit malunion, followed by subsequent fixation of mini-plates (RF Patent for the invention No. 2651893 from February 20, 2017). The long-term results (in one year) of treatment of five operated patients with the consequences of closed fractures of the fourth and fifth metacarpal bones are presented prevent shortening of the bone. The use of stable osteosynthesis with low-profile mini-plates makes possible early functional management of patients, which prevents stiffness in the joints of the fingers. © 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Introduction Ligament injuries around the wrist leading to chronic wrist pain are often a diagnostic dilemma.Various imaging modalities like wrist radiographs, CT and MRI have been used to improve the diagnostic accuracy. The objective of this study was to assess the value of MRI & direct magnetic resonance arthrography (MRA) of the wrist for detecting & evaluating tears of the triangular fibrocartilage complex (TFCC) & scapholunate & luno triquetral interosseous ligament (LTIL & SLIL) injuries in comparison with arthroscopy of the wrist. Materials & methods All patients presenting with chronic wrist pain of more than 3 months duration with suspected ligament injuries were included. MRI was performed with 8 channel wrist coil on 1.5 T machine. (PHILIPS, Netherlands). MRA was performed after obtaining consent. Retrospective MR findings were then correlated with results in those patients who underwent arthroscopy. Arthroscopic correlation was obtained in 22 (46.8%) cases out of the 45 patients who underwent both MRI & MRA. Results The gold standard arthroscopic procedure diagnosed 15 peripheral & 6 central TFCC tears in 22 patients. 4 scapholunate ligament tears were also identified. MRI diagnosed 16 peripheral & 5 central TFCC tears in these 22 patients. MRA identified 9 central tears and 14 peripheral tears. The sensitivity in diagnosing an overall TFCC tears with MRI as well as MRA was 94.4 & 100%. The specificity of the MRI and MRA in diagnosing an overall TFCC tear was 100% & 75% respectively. Discussion & conclusions Direct MRA has better sensitivity in detecting TFCC central tears. In view of 'substantial' agreement between MRI & MRA with Kappa analysis, conventional MRI can be relied on, in diagnosing TFCC injury. With comparatively low specificity, caution and restraint is advised in interpreting MRA, which may influence decision on surgery. Crown Aim To conduct a systematic review and meta-analysis comparing the incidence of fracture-related infections (FRI) following surgical management of closed and open fractures in HIV-positive and HIV-negative patients. Methods A systematic literature search was conducted using MEDLINE, ProQuest, Web of Science, The Cochrane Library and Scopus. Our own files and reference lists of identified key articles were also searched. We included studies where the primary outcome was the development of FRI in patients with open and closed fractures. Results Eleven studies were included for data synthesis. HIV-positive patients had a non-significant increase in FRI when compared to HIV-negative patients (in open and closed fractures combined). Open fractures treated in the pre-antiretroviral era had a 5.6 times greater risk for developing a FRI. In the post-antiretroviral era (1997 onwards) HIV-positive patients did not have a greater risk of FRI than HIV-negative patients for both open and closed fractures. The small retrospective natures of these studies, together with the heterogeneous outcome definitions used, are limitations to this study. Conclusion While there are few large prospective studies, the available data suggests that before the introduction antiretroviral therapy HIV infection was associated with a greater risk of FRI. In the post-antiretroviral era HIV infected patients did not show an increased risk of FRI. © 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.Periprosthetic distal femoral fractures are occurring in increasing numbers. There is limited research into outcomes and mortality. This study aimed to assess the 1 year mortality and complications requiring further surgery in the two years following a presentation with a periprosthetic distal femoral fracture. A retrospective case series of periprosthetic distal femoral fractures at a single trauma centre was undertaken. All patients were included who presented with a distal femur periprosthetic fracture between 1st January and 2008 and 31st March 2015. 60 patients with 49 females and 11 males. Mean age was 80.7. Median time to surgery was 63 h 42 (70%) underwent open reduction internal fixation, 13 (21.7%) underwent revision arthroplasty and 5 (8.3%) underwent non-operative treatment. Median length of stay was 14 days. There were 12 (20%) complications requiring further surgery within 2 years. There were 2 (3.3%) deaths in 30 days and 8 (13.3%) within 1 year following fracture. Periprosthetic distal femoral fractures are becoming a common orthopaedic presentation.

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