Femoral impaction bone allografting has been developed as a means of restoring bone stock in revision total hip replacement. We report the results of 75 consecutive patients (75 hips) with a mean age of 68 years (35 to 87) who underwent impaction grafting using the Exeter collarless, polished, tapered femoral stem between 1992 and 1998. The mean follow-up period was 10.5 years (6.3 to 14.1). The median pre-operative bone defect score was 3 (interquartile range (IQR) 2 to 3) using the Endo-Klinik classification. The median subsidence at one year post-operatively was 2 mm (IQR 1 to 3). At the final review the median Harris hip score was 80.6 (IQR 67.6 to 88.9) and the median subsidence 2 mm (IQR 1 to 4). Incorporation of the allograft into trabecular bone and secondary remodelling were noted radiologically at the final follow-up in 87% (393 of 452 zones) and 40% (181 of 452 zones), respectively. Subsidence of the Exeter stem correlated with the pre-operative Endo-Klinik bone loss score (p = 0.037). The degree of subsidence at one year had a strong association with long-term subsidence (p < 0.001). There was a significant correlation between previous revision surgery and a poor Harris Hip score (p = 0.028), and those who had undergone previous revision surgery for infection had a higher risk of complications (p = 0.048). Survivorship at 10.5 years with any further femoral operation as the end-point was 92% (95% confidence interval 82 to 97).
Background Despite advances in primary THA, dislocation remains a common complication. In New Zealand (NZ), dislocations are reported to the National Joint Registry (NJR) only when prosthetic components are revised in the treatment of a dislocation. Closed reductions of dislocated hips are not recorded by the NJR. Questions/purposes We compared the true dislocation rate for patients receiving primary THA in the Wellington region with the rate reported by the NZ NJR for the same group of patients. Methods The NZ NJR identified 570 patients undergoing primary THA from
ObjectivesThe mechanisms of upper limb injuries in road traffic accidents have not been widely investigated or understood. The present study was designed to obtain more specific information on upper limb injuries sustained by front seat occupants involved in front-and side-impact collision car accidents. Its purpose was to identify injuries that are a priority for prevention and further research.Methods Hospital records, radiographs and, where appropriate, crash data were reviewed. Data were analyzed to identify the frequency and severity of upper limb injuries, the mechanism of injury and the impairment sustained, in accordance with the American Medical Association guide. The total financial costs for NHS management, as well as that relating to the upper limb injury, were calculated.Results Sixty-two cases were reviewed (34 males), with a mean (range) age of 44 years (18 years to 83 years). There were 20 clavicle fractures of which 18 were right sided, and often attributed to a 'seat-belt effect'. There were also 17 wrist and 13 forearm fractures. The median (range) upper limb Abbreviated Injury Score was 2 (2 to 4) and the overall Injury Severity Score was in the range 1 to 50 (median 6). In terms of impairment, the upper extremity sensory deficit was in the range 0% to 9% and motor deficit 0% to 22.5%, giving up to 5% sensory and 13.5% motor 'whole person impairment'. The mean treatment cost for upper limb management was £2200 compared to a mean total injury treatment cost of £11,000 per person.
DiscussionThe present study has served to identify the range and subsequent costs (impairment and financial) of upper limb injuries in road traffic accidents. These data will be used by researchers to advance the design of current and future car crash dummies in the upper limb and to allow accurate finite element remodelling. These data may be used in support of legislative changes in the future.
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