Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

Background Upper limb arthroplasty is an increasingly used treatment modality for end-stage joint disease of the shoulder, elbow and wrist. Whilst complications have been reported, the risk of venous thromboembolism has received less attention when compared to the lower limb. Guidance to aid clinical decision-making remains limited. This review aims to ascertain whether venous thromboembolism prophylaxis is beneficial after upper limb major joint replacement surgery. Methods A systematic review was performed in April 2019, utilising EMBASE, MEDLINE, Cochrane and Google Scholar. All clinical studies reporting venous thromboembolism incidence and risk reduction (after prophylaxis) in upper limb joint replacement were included. Results Twenty-four observational studies were identified. The reported incidence of venous thromboembolism ranged from 0.2% to 16% (weighted mean 0.68%) and 0.2% to 0.8% (weighted mean 0.49%) in shoulder and elbow arthroplasty, respectively. No records for wrist arthroplasty were found. In the literature, baseline venous thromboembolism risk of patients without an operation is reported as 0.5%. Discussion There is a lack of good quality evidence regarding the risks and benefits of venous thromboembolism prophylaxis in upper limb major joint replacement surgery. We recommend further research, ideally formal randomised controlled trials to guide recommendations. Although venous thromboembolism is rare in upper limb surgery, surgeons should remain vigilant to this possibility.

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Background: Recent discussions have compared the use of closed-chain and open-chain kinetic exercises in the management of patellofemoral pain. Literature shows disparity over the preferred method. While the clinical effectiveness of the two different approaches has been compared, there is no information in the literature on the effect of these exercise types on the vasti muscles of the thigh. This study compared the impact of open-chain and closed-chain exercise regimes on the architecture of the vastus medialis oblique. Methods: Vastus medialis oblique architecture was measured using ultrasound in 23 young, asymptomaticvolunteers. Matched subjects were then assigned to one of two six-week exercise programmes, using either closed-chain or open-chain kinetic exercises. Results: Both groups showed a significant increase in mean vastus medialis oblique fibre angle, (from 70.27° to 74.5° [OCKE] of both open-chain and closed-chain exercises. However, no significant difference was found between the two groups. Conclusions:The results of this study suggest that both open-chain and closed-chain exercise regimes have an equal effect on the architecture of the vastus medialis oblique after six weeks of exercise therapy.