RSS 1.0Trauma and Orthopaedics
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Test yourself answer: a young male with right shoulder pain.No abstract available
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Right sided shoulder pain in an adolescent: answerNo abstract available.
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Wide awake local anaesthesia no tourniquet surgery of the foot and ankle: a review of indications, technique, patient satisfaction, and complicationsWide-awake surgery of the hand was surrounded by a lot of apprehension, mainly over concerns around using epinephrine near digits and its potential to cause digital ischemia and necrosis. With multiple reports underlining its safety and effectiveness, it is now being widely adopted in hand and wrist surgery. The British Society for Surgery of the Hand has already published guidelines on operating outside of main theatres, with an emphasis on wide awake local anaesthesia no tourniquet (WALANT). However, the same cannot be said for its use in foot and ankle procedures. There have been a handful of reports describing WALANT in bony and soft tissue procedures of the foot and ankle, with varied success. We aim to describe the scope of WALANT in these procedures and explore in detail its current role in the domain of lower extremity wide-awake surgery.
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Porcine submucosal extracellular matrix wrapping of the ulnar nerve in revision cubital tunnel surgeryThe wrapping technique aims to protect the nerve when the nerve bed is compromised or more commonly to prevent the recurrence of scar tethering following neurolysis. A wrap provides a physical barrier to scar and helps restore the paraneurial gliding layer. This study aimed to evaluate the results of the AxoGuard® nerve protector, a porcine-derived submucosal extracellular matrix (PECM), used as an adjunct in persistent or recurrent cubital tunnel syndrome (CuTS). This retrospective cohort study evaluated patients diagnosed, between 2012 and 2020, with neuropathic pain who underwent revision surgery. Patients were categorised into Group A (revision surgery only) and Group B (revision surgery and adjunctive PECM nerve wrapping). Disease severity was scored at the baseline and six months post-operatively using the McGowan classification. A linear regression model was used to assess the effect of wrapping the ulnar nerve on the clinical outcome at six months. Fifty-nine nerves were treated; among them, adjunctive PECM wrapping was used in 32 nerves. Disease severity at baseline was similar between the groups. After adjusting for differences in baseline characteristics, participants in Group B improved with a significant difference of 0.43 McGowan points over Group A (95% CI (0.01-0.86), p = 0.049). There were no implant-related complications. Group B improved with excellent or good outcomes in 84.4% patients at the final follow-up. Persistent or recurrent CuTS were associated with neuropathic pain and significant nerve scar tether. The use of PECM appears to lead to improved clinical symptoms, possibly by reducing adhesions and encouraging physiological glide. LEVEL OF EVIDENCE: Level III evidence.
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The effect of injurious compression on the elastic, hyper-elastic and visco-elastic properties of porcine peripheral nerves.The aim of this study was to characterise the viscoelastic and hyper-elastic properties of the ulnar nerve before and after compression has been induced, in order to aid the understanding of how the mechanical properties of nerves are altered during nerve compression, a contributing factor to cubital tunnel syndrome. Ulnar nerves were dissected from porcine legs and tensile tested to 10% strain. The Young's modulus and Yeoh hyper-elastic model were used to evaluate the materials elastic and hyper-elastic properties respectively. Dynamic mechanical analysis (DMA) was used to evaluate the viscoelastic properties over a range of frequencies between 0.5 Hz and 38 Hz. The nerves were then compressed to 40% for 60 s and the same tests were carried out after compression. The nerves were stiffer after compression, the mean Young's modulus before was 0.181 MPa and increased to 0.601 MPa after compression. The mean shear modulus calculated from the Yeoh hyper-elastic model was also higher after compression increasing from 5 kPa to 7 kPa. After compression, these properties had significantly increased (p < 0.05). The DMA results showed that the nerves exhibit frequency dependent viscoelastic behaviour across all tested frequencies. The median values of storage modulus before compression ranged between 0.605 and 0.757 MPa across the frequencies and after compression between 1.161 MPa and 1.381 MPa. There was a larger range of median values for loss modulus, before compression, median values ranged between 0.073 MPa and 0.216 MPa and after compression from 0.165 MPa to 0.410 MPa. There was a significant increase in both storage and loss modulus after compression (p < 0.05). The mechanical properties of the nerve change following compression, however the response to decompression in vivo requires further evaluation to determine whether the observed changes persist, which may have implications for clinical recovery after surgical decompression in entrapment neuropathy.
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The endocrinology of sarcopenia and frailty.Sarcopenia describes low muscle mass and strength associated with ageing, whilst reduced physical performance indicates the severity of the condition. It can happen independently of other medical conditions and can be a key feature of the frailty phenotype. Frailty is a syndrome of increased vulnerability to incomplete resolution of homeostasis, following a stressor event. Researchers have described the implications of hypothalamic pituitary dysregulation in the pathogenesis of both entities. This review summarizes the recent evidence in this area as well as other endocrine factors such as insulin resistance and vitamin D status and outlines current research priorities. We conducted searches to PubMed and Embase databases for articles, reviews and studies reporting new data on the interaction between hormones of the endocrine system and frailty and/ or sarcopenia in the last 5 years. Interventional studies, cohort studies, case-control studies and animal studies were included. Clinical trials register was also searched to identify ongoing relevant studies. Studies have given us insights into the complex relationships between factors such as anabolic hormones, glucocorticoids and vitamin D on muscle strength and performance and their involvement in ageing phenotypes. However, robust randomized controlled trials are needed to consolidate existing evidence in humans and inform clinical practice. Current evidence supports hormone replacement in patients with confirmed deficiencies, to optimize health and prevent complications. Hormone replacement has limited use for age-related conditions. Current interest is focused on muscle/bone/fat interactions and health outcomes in "sarcopenic obesity." A life-course approach to improving 'health-span' is advocated. Lifestyle factors such as nutrition and physical activity have important interactions with body composition, physical function and metabolic outcomes. Large-scale clinical trials will determine the efficacy and long-term safety of hormone supplementation in the management of sarcopenia and frailty.
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Outcomes of free vascularized fibular grafts in treating massive forearm skeletal defectsIntroduction: Reconstructing long bone defects in the upper limbs, particularly the radius and ulna, poses significant challenges. These defects, resulting from trauma, tumors, infections, or congenital anomalies, require precise surgical intervention for functional restoration. Traditional non-vascularized autogenous bone grafts have limitations, such as resorption and limited biological activity. To address these challenges, free vascularized fibular grafts (FVFGs) have been developed, offering enhanced recovery by supplying nutrients and structural support, particularly in large defects or compromised vascularity. Materials and methods: This retrospective study reviewed patients with significant forearm skeletal defects treated with FVFGs at our institution from January 2008 to January 2019. Included were patients with radius or ulna defects exceeding 8 cm due to trauma, tumor excision, or non-union fractures. Data on demographics, clinical details, surgical techniques, and outcomes-including graft union time, complications, range of motion, and the disabilities of the arm, shoulder and hand (DASH) scores-were analyzed. Results: Eight patients, with a mean age of 27.6 years and an average defect length of 9.8 cm, were included. All patients achieved graft union within an average of 4 months, with no tumor recurrence or significant complications. Functional outcomes showed mean forearm pronation of 56.9 degrees, supination of 52.5 degrees, and a mean DASH score of 17.7. Conclusions: FVFG is a safe and effective technique for managing complex forearm bone defects, providing high union rates and good functional outcomes. It should be considered a primary option for large forearm skeletal defects.
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The effect of video-assisted learning on pre-operative knowledge and satisfaction for total knee arthroplasty surgery: a randomised-controlled studyIntroduction: Traditionally, surgical procedures are explained through consultations between the surgeon and the patient to ensure informed consent. Patient education enhances engagement and knowledge, aiding informed decision-making. This study aimed to assess the effect of an educational video on preoperative patient knowledge and satisfaction in the context of total knee arthroplasty (TKA) as an adjunct to the consent process. Methods: A prospective randomized controlled study involving 100 patients in dedicated elective orthopedic units in UK-based hospitals was conducted. After consultation with a dedicated knee surgeon and a preoperative education day for TKA run by dedicated orthopedic nurse specialists, patients were randomized into one of two limbs (video vs no video) at a 1:1 ratio. The treatment group (video group) was shown a video about the principles and steps of the procedure, including the recovery time. Following this, a 10-point knowledge test was completed, and patients rated their satisfaction with the preoperative education on a scale of 0-10. Results: Patients in the video limb group had a significantly greater mean knowledge score and greater satisfaction with preoperative education than patients who did not view the video. The video group (n = 49) had a mean knowledge score of 8.73 +/- 0.159 compared to 7.68 +/- 0.281 for the nonvideo limb (n = 50) (p < 0.05). The video group had a mean satisfaction score of 9.00 +/- 0.123 compared to 8.40 +/- 0.121 for the nonvideo limb group (p < 0.05). Conclusion: Video-assisted consent in total knee arthroplasty improves preoperative knowledge and patient satisfaction when used as an adjunct in the consent process. A simple, standardized video, either pre- or post-consultation could reinforce information that the patient receives in a simple effective manner, allowing for true informed consent.
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The British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysis: the epidemiology and two-year outcomes from a prospective cohort in Great Britain.Aims: The aim of this study was to inform the epidemiology and treatment of slipped capital femoral epiphysis (SCFE). Methods: This was an anonymized comprehensive cohort study, with a nested consented cohort, following the the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) framework. A total of 143 of 144 hospitals treating SCFE in Great Britain participated over an 18-month period. Patients were cross-checked against national administrative data and potential missing patients were identified. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. Results: A total of 486 children (513 hips) were newly affected, with a median of two patients (interquartile range 0 to 4) per hospital. The annual incidence was 3.34 (95% confidence interval (CI) 3.01 to 3.67) per 100,000 six- to 18-year-olds. Time to diagnosis in stable disease was increased in severe deformity. There was considerable variation in surgical strategy among those unable to walk at diagnosis (66 urgent surgery vs 43 surgery after interval delay), those with severe radiological deformity (34 fixation with deformity correction vs 36 without correction) and those with unaffected opposite hips (120 prophylactic fixation vs 286 no fixation). Independent risk factors for avascular necrosis (AVN) were the inability of the child to walk at presentation to hospital (adjusted odds ratio (aOR) 4.4 (95% CI 1.7 to 11.4)) and surgical technique of open reduction and internal fixation (aOR 7.5 (95% CI 2.4 to 23.2)). Overall, 33 unaffected untreated opposite hips (11.5%) were treated for SCFE by two-year follow-up. Age was the only independent risk factor for contralateral SCFE, with age under 12.5 years the optimal cut-off to define 'at risk'. Of hips treated with prophylactic fixation, none had SCFE, though complications included femoral fracture, AVN, and revision surgery. PROMs demonstrated the marked impact on quality of life on the child because of SCFE. Conclusion: The experience of individual hospitals is limited and mechanisms to consolidate learning may enhance care. Diagnostic delays were common and radiological severity worsened with increasing time to diagnosis. There was unexplained variation in treatment, some of which exposes children to significant risks that should be evaluated through randomized controlled trials.
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The British Orthopaedic Surgery Surveillance study: Perthes' disease: the epidemiology and two-year outcomes from a prospective cohort in Great Britain.Aims: The aim of this study was to evaluate the epidemiology and treatment of Perthes' disease of the hip. Methods: This was an anonymized comprehensive cohort study of Perthes' disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children's hip disease in the UK participated over an 18-month period. Cases were cross-checked using a secondary independent reporting network of trainee surgeons to minimize those missing. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. Results: Overall, 371 children (396 hips) were newly affected by Perthes' disease arising from 63 hospitals, with a median of two patients (interquartile range 1.0 to 5.5) per hospital. The annual incidence was 2.48 patients (95% confidence interval (CI) 2.20 to 2.76) per 100,000 zero- to 14-year-olds. Of these, 117 hips (36.4%) were treated surgically. There was considerable variation in the treatment strategy, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery. A total of 348 hips (88.5%) had outcomes to two years, of which 227 were in the late reossification stage for which a hip shape outcome (Stulberg grade) was assigned. The independent predictors of a poorer radiological outcome were female sex (odds ratio (OR) 2.27 (95% CI 1.19 to 4.35)), age above six years (OR 2.62 (95% CI (1.30 to 5.28)), and over 50% radiological collapse at inclusion (OR 2.19 (95% CI 0.99 to 4.83)). Surgery had no effect on radiological outcomes (OR 1.03 (95% CI 0.55 to 1.96)). PROMs indicated the marked effect of the disease on the child, which persisted at two years. Conclusion: Despite the frequency of containment surgery, we found no evidence of improved outcomes. There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery.
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Using DEXA to diagnose impending atypical femoral fracture in an asymptomatic patient on long term bisphosphonates: A case report of a missed opportunity for fracture preventionWe report a patient who sustained an AFF (Atypical femoral fractures) after 15 years of bisphosphonate treatment. DEXA scans can be utilized to identify early evidence of AFF in asymptomatic patients up to 9 years before the development of an AFF.
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Prevalence of Bertolotti's syndrome in lumbosacral surgery proceduresIntroduction: Bertolotti's syndrome (BS) describes the relationship between low back pain (LBP) and lumbosacral transitional vertebra (LSTV). It is a factor that is sometimes overlooked when it comes to evaluating and treating LBP. Because of the different diagnostic modalities and criteria used in the research, the LSTV incidence in the general population varies greatly, and hence the link between LSTV and LBP remains contentious. Some researchers found no link between low back pain and LSTV. As a result, the management of BS remains controversial and multiple treatments have been suggested, including locally injected steroid and various surgical approaches. Methods: This retrospective cohort study included a total of 288 patients who underwent lumbosacral surgical procedures for disc prolapse, lumbar canal stenosis, spondylolithesis and post-laminectomy syndrome during the period between January 2016 and May 2020. Trauma, tumours and scoliotic patients were excluded. All data were collected from the departmental database. All cases were done by the same surgical team at El Hadra University Hospital Spine Unit, Egypt. The patients were divided into two groups. Group A consisted of 133 patients in whom LSTV was detected by radiologic findings. In contrast, Group B consisted of 155 patients in whom LSTV was not detected. Results: In our study, the overall prevalence of LSTV among 288 patients who underwent lumbosacral surgical interventions was 46.2%. On comparing the incidence of surgical interventions between both groups, there was non-significant difference in most of surgical interventions. The incidence of L3-5 double-level posterior lumbar interbody fusion (PLIF) among LSTV patients was 16.5% compared to 4.61% in the other group. The incidence of L4-S1 double-level PLIF among LSTV patients was 15.04% compared to 7.24% in the other group. Regarding adjacent segment pathology, the incidence of lumbar canal stenosis and degenerative spondylolithesis was higher in the LSTV group (20.3% and 11.3%, respectively) compared to the non-LSTV group (9.7% and 5.2%, respectively). The incidence of disc prolapse was lower in the LSTV group (56.39%) compared to the non-LSTV group (71.0%). There was a non-significant difference between the incidence of lytic spondylolithesis and postlaminectomy syndrome between both groups. Conclusion The overall prevalence of LSTV among all cases who underwent lumbosacral surgical procedures at the El Hadra University Hospital was 46.2%. The incidence of lumbar canal stenosis and degenerative spondylolithesis was higher in the LSTV group compared to the non-LSTV group. However, the incidence of disc prolapse was lower in the LSTV group compared to the non-LSTV group. The incidence of disc prolapse and degenerative spondylolithesis at the L4-5 level was higher in the LSTV group compared to the non-LSTV group. In contrast, the incidence at L5-S1 was lower in the LSTV group compared to the non-LSTV group. Hence, LSTV is considered a risk factor for disc degenerative changes at the level above the transitional vertebra level.
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The management of failed cubital tunnel decompression.Cubital tunnel decompression is a commonly performed operation with a much higher failure rate than carpal tunnel release.Failed cubital tunnel release generally occurs due to an inadequate decompression in the primary procedure, new symptoms due to an iatrogenic cause, or development of new areas of nerve irritation.Our preferred technique for failed release is revision circumferential neurolysis with medial epicondylectomy, as this eliminates strain, removes the risk of subluxation, and avoids the creation of secondary compression points.Adjuvant techniques including supercharging end-to-side nerve transfer and nerve wrapping show promise in improving the results of revision surgery.Limited quality research exists in this subject, compounded by the lack of consensus on diagnostic criteria, classification, and outcome assessment.
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Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tearsAims: The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis. Methods: This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome. Results: In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome. Conclusion: Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity.
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Scapular winging secondary to serratus anterior dysfunction: analysis of clinical presentations and etiology in a consecutive series of 96 patients.Background: This study aimed to establish the relative incidence of etiologies causing serratus anterior (SA) dysfunction in patients with proven abnormality on needle electromyography. Methods: This was a retrospective review of patients with scapular winging secondary to SA dysfunction. Each patient underwent a detailed clinical, radiological, and neurophysiological assessment to arrive at the precise etiological diagnosis. Patients with atypical clinical features were referred for a neurologist's assessment. Hematological and genetic testing were requested at the discretion of the neurologist. A scapular winging severity score based on clinical signs was devised to aid clinical grading. Results: Between 2014 and 2020, a consecutive series of 108 patients with suspected SA dysfunction were assessed, of whom 96 met the inclusion criteria. There were 34 females and 62 males, with a mean age of 38 years (range, 15-77 years). Winging affected the right scapulae in 69 patients, the left scapulae in 17 patients, and was bilateral in 10 patients. This was caused by a myopathic disorder in 12 (12%) patients. Eighty-four (88%) patients had a long thoracic nerve lesion, caused by cervical pathology (2), iatrogenic injury (2), trauma (33), and neuralgic amyotrophy (NA) (47). Among those with NA, winging resolved spontaneously within 3 years of onset in 22 patients (mean duration, 16 months; range, 3-36 months). No patients recovered fully if their duration of winging lasted longer than 3 years. Patients with palsy secondary to NA tended to have a worse severity of winging than those due to a traumatic cause (P = .04). Conclusion: NA accounted for approximately half of the patients with SA dysfunction; therefore, it is essential to also consider the differentials of myopathy, trauma, iatrogenic injury, and spinal pathology. We recommend the judicious employment of ancillary tests and a low threshold of referral to a neurologist, in order to arrive at the exact diagnosis to accurately guide patient treatment.
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Thirty-day mortality for proximal femoral fractures treated at a U.K. elective center with a site-streaming policy during the COVID-19 pandemic.COVID-19 led to the reconfiguration of U.K. orthopaedic trauma services because surgical capacity was threatened in acute centers. We report the 30-day mortality of proximal femoral fractures in older adults treated at an elective orthopaedic center. Methods: Patients >60 years old who presented with a proximal femoral fracture to any of 4 sites in the regional trauma network were transferred to our elective center for emergency surgery. Care was modeled according to the National Institute for Health and Care Excellence guidelines, and efforts were made to treat all patients within 36 hours. Data were collected prospectively, and mortality outcomes were recorded. Results: Of the 192 patients who presented to the elective orthopaedic center, 167 were treated there. The median age of the latter patients was 88 years (interquartile range, 83 to 79 years). The median Charlson Comorbidity Index was 4 (interquartile range, 4 to 6). The median time from emergency department admission to surgical treatment was 24.5 hours (interquartile range, 18.8 to 34.7 hours). The 30-day rate of mortality was 10.2%. A total of 29 (17.4%) tested positive for COVID-19 during their admission, of whom 10 died, for a case-fatality rate of 34.5%. There were no significant differences in age (p = 0.33) or Charlson Comorbidity Index (p = 0.13) between patients who tested positive and those who did not. There was no significant difference in age between those who tested positive and died and those who tested positive and did not die (p = 0.13), but there was a significant difference in Charlson Comorbidity Index between those subgroups (p = 0.03). Conclusions: During a pandemic, an elective orthopaedic center can be reconfigured to a surgical center for older patients with proximal femoral fractures with acceptable health-care quality outcomes. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Two-stage reconstruction of infected Charcot foot using internal fixation : a promising functional limb salvage technique.Aims: In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. Methods: We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months' follow-up. Results: We identified 23 feet in 22 patients with a mean age of 56.7 years (33 to 70). The mean postoperative follow-up period was 44.7 months (14 to 99). Limb salvage was achieved in all patients. At one-year follow-up, all ulcers have healed and independent full weightbearing mobilization was achieved in all but one patient. Seven patients developed new mechanical skin breakdown; all went on to heal following further interventions. Fusion of the hindfoot was achieved in 15 of 18 feet (83.3%). Midfoot fusion was achieved in nine of 15 patients (60%) and six had stable and painless fibrous nonunion. Hardware failure occurred in five feet, all with broken dorsomedial locking plate. Six patients required further surgery, two underwent revision surgery for infected nonunion, two for removal of metalwork and exostectomy, and two for dynamization of the hindfoot nail. Conclusion: Two-stage reconstruction of the infected and deformed Charcot foot using internal fixation and following the principle of 'long-segment, rigid and durable internal fixation, with optimal bone opposition and local antibiotic elusion' is a good form of treatment provided a multidisciplinary care plan is delivered. Cite this article: Bone Joint J 2021;103-B(10):1611-1618.
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Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.Purpose: The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. Methods: A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. Results: The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. Conclusion: LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.
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A surge in the incidence of invasive Group A Streptococcus hand infections: a single Hand Unit experience.We highlight an increase in the number of invasive Group A streptococcal soft tissue infections and present the impact of those on the hand surgery service, based on a single Hand Unit experience at the Pulvertaft Hand Centre.