Cephalomedullary nailing systems, including the Trochanteric Femoral Nailing-ADVANCED™ (TFNA) (DePuy Synthes, Raynham, Massachusetts, United States), are widely utilised for stabilising proximal femoral fractures. A pivotal aspect of the procedure involves ensuring adequate tip-apex distance (TAD) of the lag screw below 25 mm, a measure that substantially diminishes the cutout rate. We introduce a simple method to accurately estimate the intraoperative TAD in TFNA fixation. This technique relies on the known diameter of the shaft of the screw (the root diameter), just proximal to the threaded section. The new technique is simple, easy, and effective in potentially reducing operative time and improving the accuracy of estimating TAD during cephalomedullary hip fracture stabilisation surgery.

Background: Ischial tuberosity avulsion fracture (ITAF) is a rare injury affecting predominantly adolescent athletes yet lacks standardised management protocols. This study aims to investigate the diverse management preferences among hip surgeons regarding ITAF and share our preferred surgical technique and management. Methods: In a cross-sectional study, 237 British Hip Society members were surveyed regarding various aspects of ITAF management, including preferences for operative versus non-operative approaches, surgical techniques and postoperative rehabilitation regimens. Sixty-two surgeons responded, yielding a 26% response rate. Results: Thirty-six surgeons (58.1%) favoured conservative treatment, while 26 (41.9%) preferred surgery based on the degree of displacement. Among those advocating for surgery, 16 (61.5%) deemed displacement ≥20mm as significant, with 5 (19.2%) considering ≥15mm significant and another 19.2% regarding any displacement as significant. Prone theatre positioning was overwhelmingly preferred by 96.2%, with a majority (65.4%) favouring the transverse gluteal crease approach. Postoperatively, 11.5% preferred immediate full weight bearing, while 88.5% opted for six weeks of non-weight-bearing following surgery. Among conservative management advocates, 29% allowed unrestricted weight-bearing post-injury, 11.3% preferred weight-bearing until further review and 59.7% opted for partial weight-bearing for at least six weeks. Conclusions: This study highlights the absence of a consensus on ITAF management. We present our preferred approach through a case analysis involving an ITAF patient treated at our department to enhance understanding of this rare injury and potentially improve management strategies.

A native arthritic knee locked in full extension is a rare presentation to an orthopaedic clinic. Often, fixed deformity cases present with an element of fixed flexion due to either a mechanical or non-mechanical block, but a full extension deformity has not been reported in the literature. The treatment of these complex cases often involves consideration of the biopsychosocial impact of the deformity, and holistic patient care is warranted. This case report explores the symptoms, investigations, management, and postoperative recovery of a 60-year-old patient presenting with a rare fixed extension deformity. The condition had a significant impact on the patient's physical and psychological state, and its impact on quality of life should not be dismissed. Multiple imaging modalities and surgical options were considered prior to surgical management with total knee arthroplasty. The management of this condition was demonstrated to be suitably treated with total knee arthroplasty with good postoperative function and recovery. However, further larger study series are required to provide more robust evidence as to the optimal management strategy.

Purpose To determine whether non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors affect healing rate, functional outcomes, and patient satisfaction after rotator cuff repair. Methods Medline, EMBASE, PsychINFO and the Cochrane Library were searched for randomized controlled trials (RCTs) investigating the use of NSAIDs and COX-2 inhibitors after arthroscopic rotator cuff repair. Primary outcomes included healing and retear rate, determined by radiological imaging. Secondary outcomes included shoulder-specific outcome measures and the visual analog scale (VAS). Risk of bias was graded using the Cochrane risk-of-bias v2.0 tool. The GRADE framework was used to assess certainty of findings. Results Seven RCTs with a total of 507 patients were included (298 randomized to NSAID/COX-2 vs 209 randomized to control). NSAIDs use did not yield a difference in retear rate (P = .77). NSAIDs were shown to significantly reduce pain in the perioperative period (P = .01); however, no significant difference was present at a minimum of 6 months (P = .11). COX-2 inhibitors did not significantly reduce pain (P = .15). Quantitative analysis of ASES and UCLA scores showed NSAIDs significantly improved functional outcomes versus control (P = .004). COX-2 inhibitors did not significantly improve functional outcomes (P = .15). Two trials were deemed “low” risk of bias, four trials were graded to have “some concerns”, and one trial was graded to have “high” risk of bias. Retear rate and functional PROMs were deemed to have “low” certainty. VAS pain scale was graded to have “moderate” certainty. Conclusions This systematic review and meta-analysis indicates that NSAIDs do not affect healing rate after arthroscopic rotator cuff repair, but they do significantly improve postoperative pain and functional outcomes. No significant difference was seen in pain or functional outcomes with the use of COX-2 inhibitors.

Background: Improvements in outcomes following hip and knee revision arthroplasties have been demonstrated following the introduction of specialised orthopaedic services in the form of 'hub and spoke' networking models. In light of the COVID-19 pandemic, these networks have undergone some inevitable adaptations. We investigated the impact of recent adaptations on the performance of our regional revision arthroplasty network. Methods: A retrospective review of all referrals that were discussed at our regional revision arthroplasty meeting, over 2 separate phases, was undertaken. Phase 1 included data between March 2018 and April 2019, representing an interval prior to COVID-19 pandemic. Phase-2 included data between September 2020 and March 2021 (during COVID-19 pandemic). Data were collected from East Midland South Orthopaedic Network (EMSSON) database and included data relating to indication and time to revision surgery, surgeon's proposal plan, network proposal plan, and executed definitive plan. We compared and analysed network performance between 2 phases. Results: In phase 1, 99 cases were discussed in EMSSON meetings, equating to 35.7% of the region's revision arthroplasty volume, according to the National Joint Registry (NJR) records. Plan alterations were recommended in 48/99 cases (48.5%), of which 41/48 (85.4%) were adhered to. Phase 2 included 98 discussed cases, equating to 81.6% of the region's revision arthroplasty volume. Plan alterations were recommended in 20/98 cases (20.4%), all of which were adhered to (100%). Adherence to recommended adaptations showed significant improvement (p < 0.03). Conclusions: Based upon our observations, a greater volume and proportion of revision arthroplasty cases are now being discussed. Adherence to MDT recommendations has significantly improved following the described adaptations. The number of recommended adaptations to management plans have decreased, indicating an educational value of the network.Overall, these findings demonstrate a trend towards NHS England's target of 100% of revision arthroplasty cases undergoing MDT discussion.