Journal of Orthopaedics,Trauma and Rehabilitation

Paediatric hip fracture is rare but the consequences can be devastating. Retrospective analysis was performed in a local trauma centre.

This study retrospectively reviewed 18 paediatrics patients with hip fracture from 2000 to 2021 in a territory hospital in Hong Kong. Serial hip images and clinical symptoms were reviewed.

Significant (44.4%) amount of patients had injury during sports. An ambulatory status on presentation (16.7%) had to be highlighted. Despite a higher incidence of avascular necrosis (44%) reported, only two patients required salvage operation. The mean follow-up time was 77 months.

A shift in mechanism of injury and presentation from historical local data in 1986 to recent 20 years were identified. The mechanism of injury shifted from prior road traffic accident to sports injury. Preserved mobility after hip fracture was common, reminding medical practitioner to stay vigilant for early diagnosis. Higher avascular necrosis rate was reported but limited salvage operations were noted. Larger cohort with longer follow-up time would be needed for analysis of risk factors associated with avascular necrosis.

There is a notable lack of data concerning the morphology of the distal radioulnar joint (DRUJ) in the Chinese population. This study aims to evaluate the normal parameters of the wrist and DRUJ using multiplanar reconstruction (MPR) computed tomography (CT) images in a cohort of Chinese subjects.

A total of 39 subjects with 42 CT wrist scans, collected between July 2018 and December 2021, were retrospectively selected and processed into MPR images using OsiriX MD software. The assessed parameters included radial height, radial inclination, palmar tilt, ulnar variance, DRUJ angle and sigmoid notch morphology (based on Tolat's cadaveric study).

The wrist parameter results were consistent with those of previous studies. The coronal morphology of the DRUJ was categorized as C-type (50%), Flat-shape type (26%), Ski-slope type (14%), and S-type (10%). The C-type sigmoid notch was the most prevalent morphology, representing 50%.

MPR CT shows strong reliability in assessing wrist and DRUJ parameters. These measurements are clinically relevant for the evaluation and treatment of wrist pathologies and will contribute to future clinical research.

Implant cut-out is the commonest post-fixation complication of intertrochanteric fractures. It increases socioeconomic and healthcare burdens as well as patient morbidity in its geriatric population. This study identifies cut-out risk factors to prevent its occurrence.

This is a retrospective analysis of 203 patients with intertrochanteric fractures treated with a short Proximal Femur Nail Antirotation (PFNA) nail from April 2021 to March 2022 at a major Hong Kong tertiary hospital. Variables studied included gender, age, pre-morbidities, fracture side, fracture type, reduction quality, Tip-Apex Distance (TAD), and Cleveland 9 zones.

The cut-out rate was 2.72%. Significant risk factors included male gender (p = 0.036), chronic kidney disease (p = 0.039), and TAD≥25 mm (p < 0.001). Cut-out likelihood increased 263.53 times with a TAD>25 mm. Patients with good reduction quality had significantly lower cut-out rates (p = 0.018).

Both preoperative and operative variables affect cut-out rates. Optimizing TAD and reduction quality is crucial.

To compare the long-term oncological outcome of neoadjuvant bisphosphonates and denosumab in extremity giant cell tumor of bone (GCTB) with curettage.

Fifty-five patients were retrospectively reviewed from 2003 to 2023. All patients underwent curettage and cementation and received three doses of postoperative zoledronate. They received either preoperative zoledronate (n = 41) or denosumab (n = 14). Both groups’ local recurrence (LR) rate and LR-free survival were calculated.

The mean follow-up time for the zoledronate and denosumab group were 10.7 and 5.1 years, respectively (p = 0.006). The LR rate in the denosumab group (57%) was significantly higher than the zoledronate group (27%), p = 0.039. The zoledronate group had significantly greater LR-free survival than the denosumab group (p = 0.020). There was no correlation between the number of upfront denosumab doses and local recurrence (p = 0.573).

Upfront zoledronate showed a higher LR-free survival for extremity GCTB with curettage at a mean follow up of 9.3 years.

Current studies indicate that delayed soft-tissue coverage for Gustilo III open fractures of extremities is associated with higher complication rates. However, achieving the recommended time frame for coverage is often not possible, and may result in worse outcomes.

Our goal was to determine infection rates and complications of prolonged recumbency in patients with delayed coverage.

A retrospective review of patients from January 2018 to March 2023 with Gustilo IIIB and IIIC fractures of the distal tibia, ankle, and foot that underwent free flap reconstruction was performed. We excluded patients with less than 2 initial debridements, less than 6 months of follow-up, and those with locoregional flaps.

18 patients were included, with a mean follow-up duration of 13.9 months. The mean time to coverage procedure was 12.9 days. 16 patients had delayed coverage performed 8 or more days from index injury, of which, only 1 developed a soft-tissue infection, and none in either group developed osteomyelitis or complications of prolonged recumbency.

Contrary to published literature, our study showed that delayed coverage did not yield a very significant infection rate. We postulate that these lower rates may be due to: (i) multiple debridements performed (mean = 4), (ii) consultant-led debridements, (iii) the use of adjuncts including antibiotic cement beads, local vancomycin powder, and gentamicin-collagen sponge.

Developmental dysplasia of hip (DDH) is a major paediatric musculoskeletal problem that can cause lifelong disability if left untreated. Hong Kong currently adopts universal clinical assessment and selective ultrasound screening. This study aims to obtain a cluster-based epidemiology of DDH and to evaluate the effectiveness of the current screening system. It is also aimed to look for implication of capsular laxity and to propose optimal timing for first ultrasound.

Records of children referred to orthopaedics clinic in a major regional hospital for suspected DDH with ultrasound hips performed in 2017–2019 were reviewed. Patient demographics, ultrasound results, treatment and outcome of DDH were reviewed.

Totally, 929 patients were referred with ultrasound hips done. Twelve of them were diagnosed with DDH. Another 2 patients presented late. The incidence of DDH in 2017–2019 was 0.89/1000 live births and delay diagnosis was 0.13/1000 live births. The open reduction rate was 0.19/1000 live births. Ninety-one patients had capsular laxity and normal follow-up ultrasound. Patients with capsular laxity were significantly younger than those without capsular laxity by Mann–Whitney U test. A statistically significant higher proportion of patients was found to have capsular laxity if first ultrasound was done before 6 weeks old (p < 0.001).

The incidence of DDH in the studied cluster is comparable to local study published a decade ago. The current system is justified given the comparable results of late diagnosis and open reduction rate to other developed countries. Purely capsular laxity is benign ultrasonographic finding and 6weeks old is a reasonable time to perform the first ultrasound to prevent overdiagnosis of it.

Reverse shoulder arthroplasty (RSA) was traditionally used in treatment of massive rotator cuff arthropathy. In recent years, this surgical modality was adopted to be an alternative in the treatment of acute complex fracture of proximal humerus for geriatric patient and this management is gaining its popularity. This is a local study that aims at comparing the functional outcomes among the two surgical options in treatment of acute complex fracture of proximal humerus (3-parts, 4-parts, and fracture dislocation), i.e. open reduction and internal fixation (ORIF), and RSA.

A retrospective review was conducted on patients aged ≥60 years who underwent RSA or ORIF for acute proximal humeral fractures between 2015 and 2023 at a single local center. Data were extracted from the Clinical Management System. Outcomes included Oxford shoulder score (OSS), range of motion (ROM), revision rates, and intra-operative parameters. This study incorporates computed tomography-based stratification of Neer classification to optimize fracture characterization and ensure appropriate treatment allocation. Statistical analysis employed Chi-square test for categorical comparison, and ANOVA for group comparisons.

60 patients were included (29 ORIF, 31 RSA). RSA patients were older (mean age 77 vs. 67 years, p < 0.001) with higher Charlson Comorbidity Index (CCI) scores (p = 0.040). For 4-part fractures, RSA showed superior OSS (41.2 vs. 30.2, p = 0.006) despite older age/poorer CCI. For 3-part fractures, no significant differences were observed in OSS or ROM. Revision rates were higher in ORIF (6.9% vs. 0%, p = 0.137).

RSA is preferable for 4-part fractures due to better functional outcomes, even in older patients with poorer comorbidities. ORIF remains appropriate for 3-part fractures and dislocations, offering comparable outcomes with less operative time and cost. Still, careful case selection, pre-operative planning, good surgical technique, and rehabilitation are the keystones for successful surgery.

Segmental fractures of long bones often result from high energy trauma. Anatomical reduction of the intercalated segment results in further devascularisation and increases risk of non-union. A less invasive approach is presented here in an attempt to handle these difficult fractures.

From 2008 to 2023, eight consecutive cases of patients with segmental forearm fractures treated with pre-bend or anatomical plate using either minimal or less invasive approach were analysed retrospectively. The surgical techniques and relevant anatomy are explained and illustrated with cases. The clinical outcomes including range of rotation and function, and rates of non-union and infection were compared to eight other cases of segmental forearm fractures treated with traditional open reduction and internal fixation (ORIF).

Seven segmental ulna and three segmental radius fractures were fixed using less invasive approach. Four patients attained good range of movement and normal activity of daily living function. One patient required revision ORIF with bone graft. No iatrogenic neurovascular injury was noted.

Less invasive approach is a feasible alternative for segmental forearm fractures, especially if there is severe soft tissue injury. High rate of fracture union can be achieved with less surgical damage to the injured forearm.

Metacarpal (MC) epiphyses are normally found proximally for the first and distally for the second to fifth metacarpal bones. Pseudoepiphyses are infrequently found at the non-epiphyseal ends of metacarpal bones during the normal pediatric growth process. This is the first study aiming to investigate the radiological prevalence and features of metacarpal pseudoepiphyses in the Hong Kong Chinese population.

Standard bone age radiographs of children (chronological age 5 to 10) taken in two regional hospitals from Jan 2016 to Dec 2020 were analyzed. Exclusion criteria include: advanced bone age older than 11 years old, non-Chinese ethnic origin, history of hand trauma and skeletal dysplasia. Partial pseudoepiphyses can involve either or both the radial or ulnar cortices with no continuation in between. Complete pseudoepiphyses are those that extended across the full width of the metacarpal bone. The prevalence of metacarpal pseudoepiphysis was documented. The effect of Gender and Age differences on the prevalence of pseudoepiphysis was analyzed with chi-squared test using SPSS 26.

A total of 421 radiographs (94 males; 327 females) were reviewed. The prevalence of pseudoepiphysis of 1st, 2nd, 3rd, 4th and 5th metacarpal bones was 25.7%, 21.1%, 0%, 0% and 23.5%, respectively. Complete pseudoepiphysis was most commonly seen in the 1st metacarpal bone (3.3%). Occurrence of pseudoepiphysis in single bone (36.1%) is more common than occurrence in multiple bones (15.4%). Combined 2nd and 5th metacarpal pseudoepiphysis is the most common pattern (38.5%). Gender (1st MC p = 0.19; 2nd MC p = 0.592; 5th MC p = 0.159) and Age (1st MC p = 0.103; 2nd MC p = 0.093; 5th MC p = 0.211) showed no differences on the prevalence of pseudoepiphysis.

There is a high prevalence of metacarpal pseudoepiphysis in the Hong Kong Chinese population. Understanding the radiological prevalence and features of metacarpal pseudoepiphyses is important to avoid misinterpretation as fractures in pediatric patients.