BackgroundOperative management of displaced, intra-articular calcaneal fractures is associated with improved functional outcomes but associated with frequent complications due to poor soft tissue healing. The use of a minimally invasive sinus tarsi approach to the fixation of these fractures may be associated with a lower rate of complications and therefore provide superior outcomes without the associated morbidity of operative intervention.MethodsWe reviewed four prospective and seven retrospective trials that compared the outcomes from the operative fixation of displaced intra-articular calcaneal fractures via either an extensile lateral approach or minimally invasive fixation via a sinus tarsi approach.ResultsPatients managed with a sinus tarsi approach were less likely to suffer complications (OR = 2.98, 95% CI = 1.62–5.49, p = 0.0005) and had a shorter duration of surgery (OR = 44.29, 95% CI = 2.94–85.64, p = 0.04).ConclusionIn displaced intra-articular calcaneal fractures, a minimally invasive sinus tarsi approach is associated with a lower complication rate and quicker operation duration compared to open reduction and internal fixation via an extensile lateral approach.

Purpose.To compare outcome and cost following local infiltration analgesia (LIA) versus standard analgesia in total knee arthroplasty (TKA). Methods. 13 men and 33 women (mean age, 67.5 years) underwent TKA by a single surgeon and received LIA (n=24) or standard analgesia (n=22), depending on the availability of the senior anaesthetist. Results. The 2 groups were comparable at baseline in terms of age, gender, body mass index, American Society of Anesthesiologists score, and range of motion. Compared with the standard analgesia group, the LIA group resulted in a shorter mean length of hospital stay (4.9 vs. 2.7 days, p<0.0001) and higher proportion of patients able to straight leg raise on discharge (38% vs. 86%, p=0.0011), as well as lower pain scores in the first 3 days and greater range of motion at all time points. Respectively in the standard analgesia and LIA groups, the mean cost per patient for all analgesic medication was A$129.25Local infiltration analgesia versus standard analgesia in total knee arthroplasty

Contrary to the literature, this study found that the morbidity and mortality outcomes of patients with NOF fracture who presented initially to rural hospitals were equivalent to those who presented to a secondary orthopaedic referral centre. However, those who first presented to rural hospitals had a shorter duration of stay in the acute setting.

BackgroundIatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint.MethodsWe studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively.ResultsWe determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips.ConclusionWe have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.

We describe a new technique for treating U-shape sacral fractures which reduces the morbidity associated with surgery and maintains lumbosacral motion.