Abstract Introduction: Increasing age is associated with an increased incidence of necrotising fasciitis. In this study, we aimed to compare the clinical presentation, investigations, microbiology and clinical outcome in elderly (age ≥60 years) and nonelderly (age <60 years) patients with extremity necrotising fasciitis. Methods: A retrospective review of patients with extremity necrotising fasciitis who were surgically treated between January 2005 and December 2021 was conducted. The following patient outcomes were studied: amputation and mortality rates, length of stay, performance of surgery within 24 h and accuracy of diagnosis at presentation. Results: A total of 167 patients were treated. Of these patients, 66 (39.5%) were aged ≥60 years and 101 (60.5%) were aged <60 years. Elderly patients were more likely to have ischaemic heart disease ( P = 0.001), immunosuppression ( P = 0.019) and bullae ( P = 0.025) on presentation. Significantly more elderly patients had monomicrobial gram-negative infections ( P = 0.006). Elderly patients had significantly higher amputation (42.4% vs. 22.8%, P = 0.01) and mortality (34.8% vs. 18.8%, P = 0.02) rates. Conclusion: In patients aged ≥60 years, necrotising fasciitis of the extremities is associated with significantly increased risk of amputation and mortality. It is important for the treating surgeon to be aware of this association, so that early appropriate empirical antibiotics and radical surgical debridement can be initiated and the patient appropriately counselled.

The current systematic review and meta-analysis aim to pool together the incidence and risk factors of osteoarthritis following osteochondritis dissecans of the knee. The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed and Cochrane Library with the keywords being “knee” and “osteochondritis dissecans” or “osteochondral lesion”. All original human studies that reported the incidence or risk factors of osteoarthritis following osteochondritis dissecans of the knee were included. Nine studies with 496 patients were included. The incidence of osteoarthritis following osteochondritis dissecans is 0.39 (95% CI 0.19–0.59). Patients with a body mass index greater than 25 kg/m2 had a significantly increased risk of osteoarthritis. Fragment excision had an increased relative risk of 1.89 (95% CI 1.19–3.01) of osteoarthritis as compared to fragment preservation. Significant heterogeneity was identified when comparing between juvenile and adult osteochondritis dissecans. The size of the lesions moderated the between-study heterogeneity with regards to the incidence of osteoarthritis, with the relative risk of osteoarthritis in lesions bigger than 4 cm2 being 2.29 (95% CI 1.24–4.23). No other risk factors, including gender of the patient, location of osteochondritis dissecans, stability of osteochondritis dissecans, and surgical versus non-surgical management were significant risk factors. Significant risk factors for osteoarthritis were increased body mass index and fragment excision. Probable but inconclusive risk factors were the age of the patients and the size of the osteochondritis dissecans. The gender of the patient, location of osteochondritis dissecans, the stability of osteochondritis dissecans, and surgical versus non-surgical management of osteochondritis dissecans when appropriate were not significant risk factors.

PurposeThe purpose of this prospective, randomized, double-blinded, placebo-controlled study was to determine if pregabalin, when given perioperatively in addition to patient-controlled analgesia morphine, paracetamol and etoricoxib, is effective in reducing morphine requirements and moderating pain scores after primary total knee arthroplasty. We hypothesize that there would be no difference in postoperative opioid requirements, postoperative pain scores, and functional scores with the use of perioperative pregabalin.MethodsEighty-seven patients who underwent primary total knee arthroplasty were randomised and allocated to two groups. One group received capsules containing pregabalin 75mg, and the other a placebo-one capsule before surgery and one capsule once per night up till postoperative day 2. Multimodal analgesia provided for all patients in this study included femoral nerve block, intravenous patient-controlled analgesia (morphine), paracetamol and etoricoxib. The primary outcome of patient's pain control was based on the measurement of cumulative morphine consumption during the first 72h postoperatively.ResultsPregabalin did not reduce the cumulative or effective morphine consumption at 48h and 72h post-operation. There were also no significant differences noted in pain scores at 48h and 72h after surgery, functional range of motion of the operated knee at 72h post-op, or outcomes recorded on the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 36-Item Short Form Survey (SF-36) questionnaires at 3 and 6months post-op. None of the patients demonstrated common adverse reactions to pregabalin.ConclusionThis study showed no reduction in postoperative opioid requirements, or improvement in early postoperative pain scores or functional outcomes at 6months, with perioperative use of pregabalin. Orthopaedic surgeons may consider this when selecting an analgesic regimen for their patients.Level of evidenceII.

Dear Editor, Fredrich Busch was the first author to describe a coronal plane fracture of the lateral femoral condyle. It was, however, Albert Hoffa who was credited with discovering this fracture. Recent recommendations have been made to rename isolated, intra-articular, coronal plane fractures of the distal femur, or the “Hoffa fracture” to “Busch-Hoffa fractures”.1 These fractures have been reported to more commonly involve the lateral side.2 The configuration of this fracture causes it to be inherently unstable; hence poor outcome is usual with non-operative management, with malunion being recognised as a common late complication even after surgical management.2,3,4,5 This paper discusses the case of a young adult male presenting with a grade II (Letenneur classification)9 Hoffa fracture—his management, complications and outcomes.