Journal of Orthopaedics,Trauma and Rehabilitation

There are a lot of debates on the advantages and safety profile of one stage bilateral knee arthroplasty. Most of the studies focus on total knee replacement, and it may not be applied directly to unicompartmental knee replacement (UKR). We would like to compare the early results of one and two stage bilateral UKR in our center.

This is a retrospective review of all the bilateral medial UKR done in our center in 2018–2019. Patients’ demographic data, operative time, postoperative blood, length of stay (LOS) and complications were recorded. The number of admissions, pre-operative assessment sessions (PAS), and weeks of post-operative physiotherapy were analyzed. Clinical outcome was measured by Knee society knee score and range of motion (ROM).

Our center performed 97 UKR in 2018–2019, with 50 UKR performed in 25 patients, among which 16 received one stage while 9 received two stage bilateral UKR. Both groups had similar mean age, BMI, sex ratio, ASA grading, pre-operative knee score and ROM. Patient in the one stage group required only 1 PAS/admission/operation to treat both knees with a mean LOS of 7.3 days and 7.8 weeks of physiotherapy, while those in the two stage group required 2 PAS/admissions/operations with a mean cumulative LOS of 9.8 days and 14.1 weeks of physiotherapy. The mean cumulative operative time was similar for both groups but the one stage group only required 1 operative session. There was no difference in blood loss and there was no transfusion or complication. The post-operative knee score and ROM at 3 and 6 months were similar for both groups.

In suitable patients with bilateral medial OA knee, one stage bilateral UKR offers simliar early clinical outcome with shorter rehabilitation duration but without increasing complications compared with two stage. Resources can therefore be better utilized.

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that involves symmetrical small and large joints. Despite DMARDs, biological agents and anti-inflammatory agents, severe damage to the joint cartilage occurs, mainly due to the growing synovium. Total knee replacement in RA has been an enormous boon to those who are suffering from pain and deformity because of severe restriction of knee joint movement.

To evaluate the clinical, functional and radiological outcomes after TKR for inflammatory arthropathy and to identify potential factors that affect the functional outcome after TKR for Rheumatoid Arthritis.

Patients who underwent total knee arthroplasty for rheumatoid arthritis during the period 2011–2018 were recruited for the study after informed consent. The American Knee Society scores and functional scores were used for the functional outcome and assessment. Preoperative scores were obtained from previous medical records. Paired t test was done to determine the significance in changes between the preoperative and postoperative scores. Bivariate analysis using Spearman correlation and logistic regression analysis was performed to assess the influence of various factors on the postoperative knee scores.

The average age of patients at the time of TKR was 54 years, all were in stage IV disease, and the majority were women (n = 20). The significant improvement (p = 0.000) was observed between the preoperative (57.3) and postoperative (97.4) Knee Society scores, as well as improvement in functional scores from 36.3 preoperative to 85.2 points postoperatively after TKR. Steroid usage had a significant positive correlation. The duration of disease and involvement of the other joint had a significant negative correlation to postoperative functional scores.

Total Knee Replacement has been proved as one of the most successful surgical interventions for reducing pain and enhancing physical function in inflammatory arthritis patients.

A large number of ruptures of the Achilles tendon occurs in the watershed hypovascular region (zone II) of the tendon which is approximately 2–6 cm proximal to the insertion of tendon at calcaneum. Chronic Achilles tendon rupture in the watershed area makes end to end repair of tendon less feasible and the neglected distal stump is often inapt for repair. A number of surgical techniques have been described for repair of chronic Achilles tendon in zone II. Our study was conducted with the objective of determining the efficacy and functional outcome of Bosworth’s technique that involves gastrocnemius-soleus turndown of proximal Achilles tendon.

The study was conducted in a total of five patients with chronic tear of Achilles tendon and the Bosworth technique was used for repair in all the patients. All the patients were followed up for a period of 1 year and the functional outcome was assessed by scoring system devised by Leppilahti et al.

four out of the five patients showed excellent functional at the end of 1 year follow up. A good functional outcome was seen in one of the patients. All the patients were able to resume work 6 months postoperatively.

The Bosworth’s technique is an excellent surgical procedure for repair of chronic Achilles tendon rupture in the watershed zone of the tendon.

The most common complication in the surgery for rotator cuff (RC) tears is postoperative shoulder stiffness. The evidence for the postoperative treatment of this condition is scarce. This study assessed the effects of a postoperative program at the onset of shoulder stiffness following arthroscopic RC repair.

A single-group pre- and post-test design was included. Participants performed a 6-week program. Primary outcomes were shoulder and upper limb function assessed with the Constant–Murley and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires, respectively. Secondary outcomes included pain intensity at rest and during movement with the visual analog scale (VAS), and shoulder range of motion assessed with a goniometer.

A total of 115 adult males were included. The intervention produced a positive effect on the Constant–Murley (+35.6 points, p<0.001) and DASH questionnaire (−26.2 points, p = 0.005); VAS at rest (−2.8 cm, p<0.001); VAS at movement (−2.7 cm, p<0.001); and shoulder ROMs.

The program showed clinically and statistically significant benefits in most of the functional outcomes in the study participants.

One in 10 patients presenting for total hip arthroplasty (THA) will have significant osteoarthritis in both hips. In appropriately selected individuals, one-stage bilateral THA is a treatment option. This study aims to compare outcomes of one-stage bilateral THA with two-stage procedure.

A retrospective review of a single surgeon series was conducted comparing One-stage bilateral THA (n = 59) with two-stage bilateral THA (n = 50). The primary outcomes were post-operative complication and the Oxford Hip Score. The secondary outcome was a financial analysis.

Complications were infrequent and comparable between both groups. Oxford hip scores were slightly higher in the one-stage group. One-staged bilateral THA had a lower cost but hospital tariff is higher for two-stage bilateral THA.

In appropriately selected patients with bilateral hip arthritis, one-stage bilateral THA gives good clinical outcomes. However, the current payment system in the NHS makes two-stage bilateral THA more financially viable to the hospital.

Morton’s neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications.

Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients.

Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN.

Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin.

In this study, we want to search the effectiveness of Duloxetine on the severity of pain and quality of life in patients with chronic low back pain who had posterior spinal fixation.

In this randomized, placebo-controlled trial done in 6 months 50 patients who had CLBP and were candidates for PSF surgery selected and divided into two groups (drug and placebo). They filled the VAS, SF-36, and Hamilton questionnaires before surgery and after 6 weeks from using 30 mg of duloxetine or placebo.

Significant differences were evidenced among groups for the Visual Analogue Scale (P = 0.005) and Verbal Analogue Scale (p = 0.003). Patients in the Duloxetine group have more visual and verbal pain scores than the placebo group. In the quality of life, there was a significant difference between the two groups before the intervention. Also, significant differences were evidenced among groups for the Hamilton Anxiety Rating Scale (p = 0.17). After the intervention, only the Hamilton Anxiety Rating Scale (p = 0.001) and ‘bodily pain’ and ‘general health’ subscales of quality of life (p = 0.008, 0.004, respectively) have a significant difference between the two groups. There was a significant difference between pre and post-intervention in the Hamilton Anxiety Rating Scale only in the duloxetine group. Also, in terms of quality of life, the subscales of ‘physical role’, ‘emotional role’, ‘physical pain’ and ‘total score of quality of life’ in the duloxetine and placebo groups were significantly different between pre and post-intervention. However, the subscales of ‘physical function’ and ‘general health’ were significantly different only in the duloxetine group between pre and post-intervention.

The results suggest that the use of duloxetine in patients who had spinal surgery can help to better control back pain, on the other hand, it can cause a better psychological condition that affects the quality of life.

High Volume Distension Injection (HVDI) is a treatment adjunct in chronic mid-portion Achilles tendinopathy. This study analysed whether HVDI is safe and effective in an outpatient clinic setting.

Retrospective service evaluation of 18 participants over 18 months. Ultrasound-guided saline, corticosteroid and bupivacaine was injected to disrupt vasculo-neural ingrowth, with post-procedure eccentric exercises. Mean follow-up was 8 weeks. Outcomes used were Numeric rating Scale (NRS) of pain, tendon thickness and Modified Ohberg score (MOS) of neovascularisation measured on Ultrasound and Doppler imaging.

Mean reduction in NRS was 5.30 ± 2.53 (P < 0.001). Mean tendon thickness reduction was 0.21 ± 0.17 cm (P < 0.001). Median MOS improved from 2.00 ± 2.00 to 1.00 ± 3.00 (P = 0.009). No complications occurred. 11 participants had successful primary HVDI, 3 responded to a second injection. Two non-responders were referred for surgery and two referred for alternative therapy by patient preference.

Significant reduction in pain, tendon thickness and neovascularity was observed in 78% of patients. Recurrence in 39%. HVDI with eccentric training is safe and effective intervention in outpatient clinic setting.

Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre.

Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed.

Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence.

We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.

Although the majority of total knee arthroplasty cases have good outcome and survival, some arthroplasty eventually required revision. While early outcomes of revision knee arthroplasty are well reported, there is relatively fewer literatures reporting on the longer term outcome of revision knee arthroplasty. This study aims to review the outcome of revision knee arthroplasty for a longer term, and also make comparison between the two common indications for revision arthroplasty of infection and aseptic loosening.

This study reviews all total knee arthroplasty revision performed at a single center over a 11 year period. Of the 48 cases found, 35 cases not lost to follow-up had a mean follow-up duration of 10.6 years (SD 2.9) for aseptic loosening, and 10.1 years (SD 2.6) for infection. Data of initial arthroplasty, revision arthroplasty, demographics, follow-up outcome were obtained, analyzed and compared.

Revision arthroplasty due to infection had more cases that required use of varus/valgus constraints (p ∼ 0.008) and extensile surgical exposure of quadriceps snip (p ∼ 0.005) compared to aseptic loosening. The survival at 10 years for this study is 91% overall (aseptic loosening 93.3%, infection 89.3%). Infection cases had significant initial improvement for range of motion (p ∼ 0.001) and use of walking aid (p ∼ 0.04) at post-operation 1 year, but no significant differences between the infection and aseptic loosening cases at 5 years and 10 years follow-up. Comparison between the two groups on other factors including initial arthroplasty, operative details, demographics, post-operative details and X-rays showed no statistically significant difference.

Currently there is no gold standard clinical test or investigation available to diagnose piriformis syndrome. We have found a pose used by the patients to describe the pain in the gluteal region in cases of suspected piriformis syndrome. This pose in our study has been described as ‘hand on hip sign’ (HHS). In this study, we aim to assess the significance of this sign in screening of patients with piriformis syndrome.

Seventy patients presenting with pain in the gluteal region with radiculopathy between the age group of 18 years and 60 years were included. All patients were asked to locate the site of the pain in the gluteal region. The demonstration of pain by the patients was noted. If the description matched the description of HHS, it was considered to be positive, else it was considered negative. All patients were subjected to four piriformis-specific confirmatory clinical tests. Considering that there is no single confirmatory test, any patient in whom any two piriformis-specific signs were elicited was considered as a case of piriformis syndrome. Using the data, sensitivity, specificity and positive and negative likelihood ratio of the HHS in the diagnosis of piriformis syndrome were calculated. Inter-test comparison was also made using Cohen’s kappa statistic.

HHS was found to have a sensitivity of 86% and a specificity of 75%. It also has a high positive predictive value of 94% and a positive likelihood ratio of 3.44. Inter-test reliability comparison showed that there was a fair to moderate agreement between HHS and other confirmatory piriformis-specific tests.

HHS serves as an effective screening test in the identification of piriformis syndrome.

Fixation of displaced midshaft clavicle is well known to decrease nonunion, malunion and shoulder disability as compared to nonoperative treatment. This study was done to compare the clinical and functional outcome of group 1 clavicle fractures treated with anatomic locking plates (ALP) versus Titanium elastic nail (TEN).

We studied patients presenting with displaced midshaft clavicle fractures treated with ALP or TEN. The study period was from Jan 2013 to Dec 2016. Patients were reviewed and at each visit clinical and radiological progress of union was noted, complications if any were noted, functional assessment was done using the quick Dash score and Constant Murley score.

A total of 116 patients met our inclusion criteria. 62 patients were treated with TEN and 54 with ALP. Bony union was achieved at an average of 11.8 weeks in the TENS group and 12.8 weeks in the ALP group post operatively and this was found to be significant. The mean postoperative Constant Murley score in the ALP and the TEN groups were 92.8 (range 80–97), and 93.7 (82–97) respectively. The mean postoperative quick dash score in the ALP and TEN groups were 2.48(range from 0 to 6.8) and 2.1 (range 0–9.1) respectively.

Both Anatomical locking plate and TEN are good options for the treatment of non-comminuted mid clavicular fractures as they have a similar functional outcome. TEN nail insertion has the advantage of being minimally invasive, having a faster union time and may be recommended in midshaft clavicle fractures without comminution.

Reconstruction of complex, open-grade distal femur fracture with bone defect presents an orthopaedic surgeon with a distinctive challenge as they are often associated with contaminated, compromised soft tissue and poor host condition. Conventional techniques like vascularized fibula transfer, autologous bone grafting or distraction osteogenesis focus mainly over bone union without taking infection control into consideration. The aim of this study is to evaluate the outcome of induced membrane technique in the reconstruction of open distal femur fracture with bone defect.

10 such patients were retrospectively evaluated. Union was considered when a minimum of two cortices were seen on a radiograph. Knee Society Score was used to evaluate the functional outcome.

The average length of the defect was 5.7cm (3–10 cm) with mean interval period between the two stages being 42.7 days (34–51 days). Internal fixation was carried out in all cases. In 7 patients we used a mixture of cancellous autograft and cancellous allograft mixed in a ratio of 3:1. In the remaining 3 patients we used only cancellous autograft. Radiological union was achieved in all patients with mean union time of 8.5 months (7–11 months). Mean knee score was 79 (69–86) and mean function score was 71.5 (60–80).

The induced membrane technique is an economical, technically less demanding technique for reconstruction of distal femur fracture with bone defects. The results are reproducible with a high success rate and without the need of any special instrumentation. It bestows infection control and prevents graft resorption. Long reconstructive period and donor site morbidity are matters of concern.

Transtibial amputation and subsequent prosthetic fitting can cause prolonged hospital length of stay (LOS). Recently, a two-staged admission pathway for new transtibial amputees was introduced in a local hospital to shorten hospital LOS.

A retrospective cohort study was performed to review the 5-year outcomes of major lower extremity amputation in a local hospital and to compare the difference in LOS and functional outcomes between traditional (group 1) and two-staged (group 2) admission pathways for new transtibial amputees.

The fitting rate was 55% in transtibial amputees, 14% in transfemoral amputees, and only 3.7% in dementia patients. For new transtibial amputees, the mean postoperative LOS was significantly reduced by 32.8 days in group 2. Besides, more patients in group 2 were able to walk without aid.

LOS for new transtibial amputees can be greatly reduced by the two-staged admission pathway to minimize hospital operational cost.

Recently, there is more emphasis on the role of core muscles in pathogenesis and rehabilitation of patellofemoral pain (PFP). We aimed to investigate whether increased core muscle strength and endurance improve clinical outcomes.

In a randomized controlled trial, 60 patients (M/F: 25/35, age = 32.28 (5.9) years) with PFP were randomly allocated into two groups of routine exercise (control) and combined core plus routine exercise (intervention). Home exercise was scheduled at least 5 times/week for 12 weeks. We assessed the outcomes of pain (Visual analogue scale) and function (Anterior knee pain score) before and immediately after interventions.

Significant improvements were reported in both groups (P < 0.001). There were significant between-group differences in both outcomes in favor of the intervention (Pain: 12.4, CI 95%: 7.1–17.8, P < 0.001; Function: 6.4, CI 95%: 2.2–10.5, P = 0.003).

Outcome improvements were significantly greater in intervention group. Inclusion of core stability exercises may lead to additional benefits.

Gait analysis constitutes an essential part of orthopedic rehabilitation assessment. Previous studies indicate that observational-based gait analysis lacks reliability and requires extensive clinical training. Therefore, gait analysis in the clinical practice heavily relies on technical aids. The aim of the present study is to develop a reliable gait analysis assessment tool that can accurately assess clinically relevant gait cycle parameters in daily clinical practice.

In this pilot study, a new gait analysis and motion score (GAMS), comprising 10 observational and 5 technically measured (e.g. pressure plate) gait parameters, was developed. The parameters were dichotomously operationalized, reflecting pathological versus physiological manifestations of the parameters. The rating algorithm was administered by 12 raters using videotaped treadmill sessions of 10 orthopedic subjects (n = 120 ratings). Inter-rater reliability was calculated using the intraclass correlation coefficient (ICC) and the percentage of rating agreement.

The mean (standard deviation (SD)) GAMS ratings ranged from 10.0 (1.1) to 21.5 (1.3) points. The overall GAMS ICC was 0.98 (95% confidence interval (CI) 0.96–1.00), whereas the ICC of observational parameters alone was 0.97 (95% CI 0.93–0.99). The mean (SD) percentage of rating agreement was 86.1% (3.3%). For the observational parameters, the mean (SD) rating agreement was 82.5% (4.5%).

This new GAMS shows excellent overall inter-rater reliability for a continuum of functional gait statuses. The new score may be an appropriate clinical tool to objectively evaluate patients’ gait patterns. Furthermore, the GAMS may find application as a clinician-reported outcome measure in orthopedic rehabilitation. Further studies are required to verify the validity and accuracy of the new GAMS and its functionality in assessing clinical changes in gait patterns.

The American Academy of Orthopaedic Surgeons produces clinical practice guidelines for the treatment of orthopedic injuries. We examined the strength of the evidence underlying these recommendations in order to answer the following questions: (1) Have AAOS work groups improved guideline creation practices to locate evidence to generate strong recommendations? (2) Is there variability in the available evidence based on anatomic site or stage of care? (3) Has the level of evidence supporting improved over time?

Twenty-two current guidelines of the Academy were examined which yielded 408 individual recommendations. These recommendations were assigned one of five strength of evidence ratings (strong, moderate, limited, inconclusive, consensus) by the guideline panel, based on the availability and quality of the supporting evidence. From these guidelines, we extracted all of the recommendations and their corresponding evidence ratings. We then classified the recommendations by stage of care, year, and anatomical site.

The distribution of the levels of evidence was as follows: 77 (18.9%) were based on consensus; 53 (13.0%) were inconclusive; 93 (22.8%) were based on limited evidence; 112 (27.5%) were based on moderate evidence; and 73 were based on (17.9%) strong evidence. Strong strength of evidence was found in 45.2% of the recommendations for preventive/screening/diagnostic care, 41.1% of nonsurgical treatment, 45.1% of surgical treatment, 51.1% of rehabilitation/postoperative treatment, and 45.5% of the recommendations that had mixed stages of care. Inconclusive strength of evidence was found to be prevalent from 2009–2013, but was eliminated starting in 2014.

Only 73 (17.9%) recommendations generated by the Academy in its 22 clinical practice guidelines are based on a “strong” strength of evidence. More robust research is needed in orthopedics to bolster confidence in the recommendations in future guideline updates.

The first objective of this study is to determine the reference Tibial Tubercle-Trochlear Groove (TT-TG) distance on MRI in Southern Chinese population. The second objective is to investigate the correlation between TT-TG distance and (i) age, (ii) sex, (iii) height, (iv) weight and (v) Body Mass Index (BMI) respectively.

Three hundred MRI knees performed in two different centres between August 2017 and October 2018 were included. All patients were prospectively recruited after MRI referral from Orthopaedics department. The TT-TG distances were measured by two radiologists independently. Measurement reliability was assessed using intraclass correlation coefficient (ICC). One sample t-test was used to compare the results between this study and other published studies. Spearman’s rank correlation coefficient was used to determine correlations between the TT-TG distance and age, sex, height, weight and BMI respectively.

There was no statistical significance between the mean of TT-TG distances from the two radiologists (P-value = 0.32). The measurement reliability was excellent (ICC = 0.922 ± 0.02). The mean of averaged TT-TG distance was 8.32 ± 0.33 mm (range 2.01 to 17.48 mm). There were no statistical significant differences in means of TT-TG distance between laterality and gender. There were statistically significant correlations between (i) TT-TG distance and age (p-value = 0.009), and (ii) TT-TG distance and height (p-value = 0.014).

The reference TT-TG distance on MRI in Southern Chinese population was 8.32 ± 0.33 mm. Statistically significant correlations were established between (i) TT-TG distance and age; and (ii) TT-TG distance and height.

Minimal invasive fixation of fragility pelvic fracture is feasible with advancement of computerized navigation. However, the clinical outcomes compared with conservative care were seldom mentioned.

This is a retrospective study comparing the outcomes of elderly with stable pelvic fracture treated conservatively or operatively using computerized navigation. Outcome parameters included pain score, analgesics requirement, length of hospital stay and complication(s), if any.

Operations were performed in 15 patients from July 2017 to November 2018. A retrospective cohort of 37 patients who were treated conservatively was recruited. In the operative group, it showed a statistically significant reduction in analgesics consumption at 4-week time only. There was significant improvement in pain score at 1-week, 4-week and 3-month time. Patients showed earlier return to premorbid walking status. No major surgical complication was noted.

Treating fragility pelvic fracture with computerized navigated screw fixation achieve better pain control, reduction in analgesics requirement and earlier mobilization.

The purpose of this radiological study was to assess the posterior laxity of a single model of a total knee arthroplasty design (TKA) having a medially constrained (MC) or a Posterior-Stabilized (PS) polyethylene insert using a well-documented stress x-ray. To the authors knowledge, this is the first report evaluating MC TKA outcomes according to the “kneeling view.”

Sixty patients with non-traumatic primary knee osteoarthritis undergoing TKA were first matched by age, sex, BMI and diagnosis and then divided in two groups: group A (37 knees) received a MC TKA and group B (23 knees) a PS implant made by the same manufacturer. In all cases the posterior cruciate ligament (PCL) was resected. All patients underwent the same postoperative “kneeling view” and were also clinically evaluated according to the Knee Society Score (KSS) and Oxford Knee Score (OKS). Radiographic measurements were taken by tracing a line along the posterior cortex of the tibia and then measuring the perpendicular distance to a point marked at the posterior corner of Blumensaat’s line.

At 12 months minimum FU, no statistically significant differences were found between the two groups in all the clinical scores. There was a statistically significant difference on kneeling view values between the two groups (P = 0.0002): the mean value in the MC group was −1.97 ± 3.8 mm while was −5.6 ± 3.1 mm in the PS group. In both groups, the average position of the posterior cortex of the tibia was anterior to the posterior corner of Blumensaat’s line, showing absence of instability in flexion.

This study highlighted that the PCL removal, accompanied by a precise surgical technique, did not increase the instability in flexion in two groups of patients having the same TKA design but polyethylene inserts characterized by different levels of constraint.

Necrotising soft tissue infection (NSTI) is rare but fatal. Andreasen proposed finger test as an early diagnostic tool to differentiate NSTI from other soft tissue infections. We aim to evaluate the accuracy and reproducibility of the test for the diagnosis of NSTI.

Patients who were admitted to our department from 2012 to 2016 with suspicion of NSTI and finger test done were retrospectively reviewed. Finger test was done and interpreted as described by Andreasen. Definitive diagnosis of NSTI was confirmed with surgical and pathological findings.

Among the 35 patients included in the study, NSTI was confirmed in 10 cases. Finger test had a sensitivity of 100%, a specificity of 80%, positive predictive value of 66.7%, negative predictive value of 100% and an overall accuracy of 85.7%. There was no difference in demographics or comorbidities between NSTI and non-NSTI groups. Surgeons involved had 76.7% agreement and moderate reproducibility (kappa = 0.48) on the diagnostic criteria of finger test.

A negative finger test was reliable to exclude NSTI and a positive test suggested further surgical exploration. Yet, clinical judgement was still of paramount importance to treat NSTI promptly.

Degenerative disk disease is a global and common debilitating condition with substantial healthcare and economic costs. Disc-Fx is a relatively new minimally invasive, percutaneous nucleo-annuloplasty procedure aimed to alleviate symptoms of discogenic back pain via manual discectomy with nuclear and annular modification via means of radiofrequency ablation. The aim of this retrospective study is to report the 1-year outcomes, efficacy and safety of the percutaneous nucleo-annuloplasty procedure for treatment of discogenic back pain in the local Hong Kong population.

This retrospective study consists of 16 patients with a total of 24 levels from 2017 to –2019 with at least 6 months of chronic back pain failing conservative management, MRI-confirmed disc degeneration, and who have undergone percutaneous nucleo-annuloplasty via Disc-Fx procedure. All patients had plain radiography and magnetic resonance imaging prior to procedure. Percutaneous nucleo-annuloplasty was only performed in patients with confirmed discogenic back pain via a positive provocative test on discography.

The mean functional outcome of Oswestry Disability Index improved from 46.25 points preoperatively to 24.12 at the of 1-year follow-up (p-value = 0.00). The Numerical Pain Rating Scale improved from 6.25 points to 4.4 points (p-value: 0.01) and 14.56 points to 8.85 points (p-value = 0.01) at preoperative to 1-year post-procedure respectively. There were no reported procedural related complications in the study population.

The procedure of percutaneous nucleo-annuloplasty shows to be a relatively safe procedure that can be considered in patients with discogenic back pain. Larger studies would be desired to draw further conclusions about its efficacy.

As the geriatric population increases, the incidence of intertrochanteric fractures (ITF) has also increased significantly. There are various modalities to treat these fractures. In this study our aim is to analyse outcomes of Proximal Femoral Nail (PFN) in comparison to those of Dynamic Hip Screw (DHS) for the treatment of ITF.

This study was carried out during 2017–20. 150 patients of unstable ITF (AO type 31-A2, 31-A3) in elderly were randomly divided into two groups of 75 each and were treated either by DHS or PFN and were followed up regularly.

The results were compared between the groups and statistical analyses were performed. The results were assessed with Harris Hip Score(HHS) & Parker Palmer mobility score (PPMS) which were better in PFN group.

PFN is a better fixation device for unstable ITF (31 A2 and 31 A3) in elderly patients.