Epidemiology of fractures

Over the last decade, Scotland’s health system has increasingly diverged from the health system in England. Scotland has pursued an approach stressing integration and partnership among all parts of its NHS as opposed to an English approach in part driven by market forces. Comparatively fewer organizational and structural changes, in addition to consistent policy objectives, have provided a strong launching pad for achieving improvement. Substantial increases in funding have led to significant growth in the clinical workforce and numerous performance targets have been set to improve population health, the quality and outcomes of health care, and the efficiency of the health system. As a result, Scotland has made well-documented progress in terms of population health and the quality and effectiveness of care. However, a number of challenges remain. More progress is needed to close the gap in health status between Scotland and other developed countries, and to address persistent inequalities in health within Scotland. As in many other countries, increased fiscal pressures may make it difficult to maintain current levels of health care quantity and quality in future.

United Kingdom (Scotland): health system review

Aim Comparison of unfixed, CRIF, and ORIF of the posterior malleolus fragment (PMF) regarding the frequency of trans-syndesmotic fixation and quality of reduction in trimalleolar (equivalent) fractures. Material and Methods Retrospective registry study. Patients with a trimalleolar (equivalent) ankle fractures were identified within the departments’ fracture database. General demographics, treatment details, and fracture specific details (CT-scans) were assessed. Patients were grouped per the PMF treatment: not addressed, CRIF, ORIF. Results 236 patients (53.0 ± 18.3 (range: 18–100) years), 58.1% female were eligible. The mean size of the PMF was 21.4 ± 10.4% (range: 2.7–55.9%), 71.6% were ≤25% of the tibial plafond. PMF fixation: Untreated 48.3%, CRIF 18.6%, ORIF 33.1%. ORIF of the PMF significantly (p  25%). ORIF resulted in a significantly (p  Conclusion All posterior malleolus fragments, independent of their size, should be treated by ORIF, as this restores syndesmotic stability significantly more often than untreated PMF or CRIF.

Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability

Background:Several devices for obtaining dynamic fixation of the syndesmosis have been introduced in recent years, but their efficacy has been tested in only a few randomized controlled trials (RCT...

Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials:

Aims In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw...

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Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial.

Ankle fractures with syndesmotic stabilisation are associated with a high rate of secondary osteoarthritis

Return to sport following Lisfranc injuries: A systematic review and meta-analysis.

Acute fractures in sport are a significant problem for the athlete, given that fractures can result in one of the longest return times to sport of all injuries.

Gary F. Keenan

Papers

Ankle fractures with syndesmotic stabilisation are associated with a high rate of secondary osteoarthritis

Return to sport following Lisfranc injuries: A systematic review and meta-analysis.

Acute Fracture Injuries in Sport