Summary Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0.83, 95% CI 0.63–1.09; p=0.18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1.91, 1.06–3.44; p=0.0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0.82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0.41) and sepsis (seven [1%] vs six [1%]; p=0.79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated.

Driving reaction times of 30 right knee arthroscopy patients were measured using a computer-linked car simulator. Each patient was tested pre-operatively and 1 week after and 4 weeks after arthroscopy. As controls, 25 normal subjects were also tested. In the control group the average reaction time was 634 ms; the measurements at 1 week and at 4 weeks were 550 ms and 582 ms, respectively. In the arthroscopy group the average reaction time pre-operatively was 736 ms; the measurements 1 week and 4 weeks post-operatively were 920 ms and 685 ms, respectively. Two clinical tests (the stepping and standing tests) were also performed at each assessment. Statistical analysis showed a good correlation between these and reaction time. We conclude that it is appropriate for patients to delay their return to driving for at least 1 week, and that the actual timing of return to driving may be determined by performance on these two clinical tests.

Risk, III.

Three-dimensional (3-d) surface models of human carpal bones obtained from Computed Tomography (CT) were used to investigate their kinematic behavior throughout the entire physiological range of motion of the human wrist joint. The 3-d motion of the bones was visualized graphically by the finite helical axis (FHA) and smooth animations. It was found that extension mainly occurs in the radial-carpal joint and flexion is shared between the radialcarpal and midcarpal joints. During radial and ulnar deviation, the relative motion between the scaphoid and lunate was larger than in flexion-extension. This study will improve our understanding of carpal bone motion in a range of wrist poses, and will provide morphological data for the design of a functional wrist replacement arthroplasty.

Background: The purpose of this study was to evaluate the rate of union of scaphoid fractures managed with volar plating and assess postoperative complications. Methods: Retrospective consecutive case series of 28 patients with scaphoid fractures, 9 acute and 19 chronic nonunions, undergoing surgical fixation with volar scaphoid plating by a single surgeon between 2013 and 2019. Patients were followed up for a minimum of 3 months with scaphoid bony union being confirmed on radiograph or computed tomography. Postoperative complications and need for plate removal were recorded. Results: Overall union rate of 96% with all 19 chronic nonunions demonstrating radiological union and 1 of 9 acute fractures not uniting and requiring revision surgery. The only postoperative complication identified was symptomatic plate impingement which necessitated plate removal in 57% of cases. Conclusions: This case series demonstrates volar plating of scaphoid fractures can be used as an alternative technique to achieve union.