The edition · Orthopaedics
Locking plates beat tension-band wiring for displaced patellar fractures in a blinded randomised trial
A 122-patient multicentre trial favours plate fixation on symptoms, sport and quality of life; a wrist fracture proves a missed window for osteoporosis treatment; and Cochrane finds the evidence for fracture prevention drugs in men is very uncertain.
The edition in brief
Five findings for orthopaedic surgeons. A patient- and assessor-blinded multicentre trial randomised 122 adults with displaced patellar fractures to locking plate fixation or tension-band wiring; at 12 months plates gave clinically meaningful KOOS gains in symptoms (10.4 points), sport and recreation (14.1) and quality of life (10.9), with less hardware removal, fixation failure and reoperation. A Japanese claims cohort of 23,589 matched pairs aged 65-89 found a distal radius fracture was followed by more hip fractures (2.58 vs 2.00 per 100 person-years), yet only 17.6% began osteoporosis treatment within a year. A Cochrane review of 17 trials (4,132 men aged 50 or older) found the effect of bisphosphonates, PTH analogues, denosumab and romosozumab on fractures in men very uncertain, because trials were small and short. The interim report of a double-blind trial of 107 patients found robotic arm-assisted medial unicompartmental knee arthroplasty more accurate than jig-based surgery, with less early pain and shorter stay, but no difference in Oxford Knee Score at two years. Linked UK primary and hospital care data on 476,620 arthroplasties put six-month VTE at 1.5%, with more than 30% of events visible only through the linked data.
A wrist fracture after 65 marks skeletal fragility, but only 18% started osteoporosis treatment
Every low-energy wrist fracture in an older adult should leave fracture clinic with a bone health referral or treatment plan.
Cochrane: the fracture benefit of osteoporosis drugs in men is very uncertain
Keep treating men with fragility fractures, usually with a bisphosphonate, but be honest that fracture-reduction evidence in men is thin.
Robotic medial UKA was more accurate with faster early recovery, but two-year Oxford scores were no different
Robotic medial UKA gives more accurate implants and faster early recovery; do not promise better two-year function.
VTE after arthroplasty is 1.5% at six months, and a third is invisible to hospital data
Warn arthroplasty patients that VTE can present weeks after discharge, and audit VTE with community data, not readmissions alone.
Three questions before discharging an older patient from fracture clinic
Before discharging any low-energy fracture over 50, ask about the fall, bone health and previous falls, and write 'fragility fracture' in the letter.
Locking plates gave better knee function than tension-band wiring for displaced patellar fractures
For a displaced patellar fracture, choose locking plate fixation over tension-band wiring where plates are available.
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