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Wound contamination of primary THR occurs frequently in both standard and ultra-clean operating theaters and contamination is greater at the end of surgery than at the beginning (p=0.04). In this small series, we found no differences in wound contamination between standard and ultra-clean theaters (p=0.1).

Dr Colin Roberts, equine veterinary consultant, University of Cambridge, outlines the procedure and how it has evolved to be the sophisticated technique it is today

Aims This prospective cohort study reports the 10-year survivorship, patient-reported outcome measures and radiographic outcomes of the first series of the Epoca resurfacing head total shoulder arthroplasty. Methods From July 2008 to July 2014, 59 Epoca resurfacing head total shoulder arthroplasties were implanted in 50 patients by a single surgeon. Minimum 4.8 year and maximum 11.3 year follow-up (mean: 7.9 years) was analysed using the latest available Oxford Shoulder Score. Kaplan–Meier survivorship analysis was performed with revision as the end point. Most recent radiographs were reviewed for component radiolucency, osteolysis and proximal humeral migration. Results Two shoulders underwent revision (3.4%); one for pain with posterior subluxation following a fall, the other for pain with failure of the glenoid. Kaplan–Meier analysis revealed 10-year survivorship of 98.2% (95% confidence intervals: 88.0%–99.8%). Mean Oxford Shoulder Score improved significantly compared to pre-operative values from 18.2 (5–45) to 46.6 (36–48) ( p < 0.001). Fifty-three shoulders underwent radiographic analysis (89.8%). This revealed humeral radiolucency in two cases (3.8%), glenoid radiolucency in three cases (5.7%) and radiographic rotator cuff failure in eight cases (15.1%). Conclusion This prospective cohort study shows excellent 10-year survivorship, medium to long-term clinical and radiological results and for the Synthes Epoca resurfacing head total shoulder arthroplasty. Evidence level IV.

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IntroductionPilon fractures represent a small percentage of all lower extremity fractures, but cause a disproportionate amount of disability and impairment. Modest clinical results of treatment of pilon fractures is the rule with only 25-71 % of patients having good or excellent results [1,4,5,7]. The popular understanding of the mechanism by which pilon fractures are created has been axial loading.The creation of a pilon fracture in the laboratory setting has been a challenge. Lauge-Hansen, using amputation specimens secured to boards which he manually twisted, was only able to create the pronation-dorsiflexion variety of pilon fractures [2]. To our knowledge, there are no reports of reliable methods of creating pilon fractures in the laboratory setting.The goal of our study was to create pilon fractures experimentally. The first objective was to determine the magnitude of axial loads required to create pilon fractures. The second objective was to evaluate the relationship between the extent of fracture comminution and the magnitude of axial loads which create pilon fractures. Materials and MethodsIn this IRB-exempt study, nine lower limb cadaveric specimens (distal two thirds of the tibia-fibula, ankle and foot) were obtained from the Body Bequeathal Program at a level-one trauma center. Four of the limbs were embalmed by standard procedures, while the remaining five were lightly embalmed. The specimens came from cadavers with no prior history of lower extremity injuries or surgery, and included the entire lower limb from six inches below the knee. Specimens were frozen at -20 degrees Celsius and thawed 24 hours prior to testing. Prior to testing, the specimens were radiographed to establish any pre-existing pathology including fractures or osteoporosis, as this would make comparison between mechanical testing results difficult. The limbs were transported to the University of Tennessee Engi- AbstractThe popular understanding of the mechanism which creates pilon fractures has been axial loading. The purpose of this project was to study the biomechanics of pilon fractures using contemporary mechanical testing in a cadaveric model. We attempted to reproduce pilon fractures in nine ankles using a drop-tower apparatus and measuring the force each foot met on impact. The position of the foot during impact and the height from which the foot was dropped was changed for each test. Limbs were radiographed both before and after injury and then grossly dissected. We were unable to reproduce a tibial pilon fracture using this methodology. Our results suggest that the mechanism of injury causing pilon fractures may be more complex than axial loading alone.