Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment

AIM

To report the 15-year follow-up of displaced intra-articular calcaneal fractures from a randomised controlled trial of conservative versus operative treatment published in 1993.

PATIENTS AND METHODS

Of the initial study, 46 patients (82%) were still alive at a mean of 15 years post injury and 26 patients (57%) agreed to review. The patients had been randomly allocated to either conservative or operative treatment in the original study. Clinical [American orthopaedic foot and ankle society hindfoot scale (AOFAS), foot function index (FFI) and calcaneal fracture score] and radiological (Böhler's angle and calcaneum height) outcome measures were used. The grade of osteoarthritis was also assessed at long-term follow-up.

RESULTS

At long-term follow-up, the clinical outcomes were not different between conservative versus operative treatment. AOFAS hindfoot scale: conservative=78.5 and operative=70, p=0.11; FFI: conservative=24.4 and operative=26.9, p=0.66; calcaneal fracture score: conservative=70.1 and operative=63.5, p=0.41. The radiological outcomes were also not different between both groups. Böhler's angle: conservative=10.4 degrees and operative 16.9 degrees , p=0.07; height of calcaneum: conservative=37.2mm and operative=38.2mm, p=0.57; grade of osteoarthritis of the sub-talar joint: p=0.54. There was no correlation between Böhler's angle and the outcome measures in either group.

CONCLUSION

The results of this 15-year follow-up of displaced intra-articular calcaneal fracture randomised controlled trial were equivalent between conservative and operative treatment and demonstrate similar findings to those at one year follow-up.

Survivorship of the Charnley Elite Plus cemented femoral stem

We report the results of the Charnley Elite Plus femoral stem in multiple surgeons' hands at a minimum of 3 years after implantation. Over a 4-year period, 244 patients underwent 268 primary hip arthroplasty procedures using this particular stem. Patients underwent postal and radiographic review at a mean of 4.5 (3.0--6.8) years following their arthroplasty. There were five revision procedures for aseptic loosening (5/268; 1.9%). Radiological assessment revealed gross radiological failure in a further 12 femoral stems (12/208; 5.8%). In the best case scenario, using revision for aseptic loosening as the endpoint, the survivorship for this period was 98.1%. If radiographic failures are incorporated into this endpoint, survivorship is 93.1%. This failure rate at an early stage raises concerns as to the long-term survivorship of this prosthesis.

Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow up

OBJECTIVE

This article presents the results of a three and a half year follow up of patients recruited to a randomised controlled clinical trial comparing circumferential mucosectomy (stapled haemorrhoidectomy) vs conventional haemorrhoidectomy.

METHODS

Patients were assessed in an outpatient setting to examine a number of outcome measures.

RESULTS

Our data suggest that at the three and a half year follow up, there are no significant differences in outcome between the two groups.

CONCLUSIONS

It will be important to review the long-term results of larger trials.

Hospital versus home management of children with buckle fractures of the distal radius

Our aim was to determine whether children with buckle fractures of the distal radius could be managed at home after initial hospital treatment. There were 87 patients in the trial: 40 had their short-arm backslab removed at home three weeks after the initial injury, and 47 followed normal practice by attending the fracture clinic after three weeks for removal of the backslab.

Clinical examination six weeks after the injury showed no significant difference in deformity of the wrist, tenderness, range of movement and satisfaction between the two groups. Fourteen (33%) of the hospital group compared with five (14%) (p = 0.04) of those managed in the community stated that they had problems with the care of their child’s fracture. It was found that both groups, given a choice, would prefer to remove their child’s backslab at home (p < 0.001). Our findings show that it is clinically safe to manage children with buckle fractures within the community.

Hospital versus home management of children with buckle fractures of the distal radius. A prospective, randomised trial

Our aim was to determine whether children with buckle fractures of the distal radius could be managed at home after initial hospital treatment. There were 87 patients in the trial: 40 had their short-arm backslab removed at home three weeks after the initial injury, and 47 followed normal practice by attending the fracture clinic after three weeks for removal of the backslab. Clinical examination six weeks after the injury showed no significant difference in deformity of the wrist, tenderness, range of movement and satisfaction between the two groups. Fourteen (33%) of the hospital group compared with five (14%) (p = 0.04) of those managed in the community stated that they had problems with the care of their child's fracture. It was found that both groups, given a choice, would prefer to remove their child's backslab at home (p < 0.001). Our findings show that it is clinically safe to manage children with buckle fractures within the community.

Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial

BACKGROUND

Haemorrhoidectomy is commonly an inpatient procedure because it is frequently associated with postoperative pain. Day case haemorrhoidectomy is a similar operation to that used on inpatients but with different strategies for managing postoperative pain. Circumferential mucosectomy (stapled haemorrhoidectomy) may be associated with less postoperative pain than conventional haemorrhoidectomy. We compared stapled haemorrhoidectomy with conventional haemorrhoidectomy in patients with third degree haemorrhoids.

METHODS

We randomly assigned 22 patients to conventional haemorrhoidectomy by the diathermy dissection or to stapled haemorrhoidectomy with the use of an intraluminal stapling device. Patients were discharged when free of pain, took co-codamol as required, completed visual analogue charts each day, and were assessed at 1 and 6 weeks postoperatively for symptom control.

FINDINGS

All patients received the assigned treatment. Mean inpatient stay was lower in the group assigned to stapled as opposed to conventional haemorrhoidectomy (1.09 [0.3] vs 2.82 [0.09] nights, p<0.001), experienced less pain overall (p=0.003), and returned to normal activities sooner (8.1 [1.53] vs 16.9 [2.33] days, p<0.005). Stapled haemorrhoidectomy controlled symptoms of prolapse, discharge and bleeding in all patients.

INTERPRETATION

Stapled haemorrhoidectomy is an effective treatment for third degree haemorrhoids with significant advantages for patients compared with conventional haemorrhoidectomy.