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Bone & Joint Open
Vol. 2, Issue 3 | Pages 150 - 163
1 Mar 2021
Flett L Adamson J Barron E Brealey S Corbacho B Costa ML Gedney G Giotakis N Hewitt C Hugill-Jones J Hukins D Keding A McDaid C Mitchell A Northgraves M O'Carroll G Parker A Scantlebury A Stobbart L Torgerson D Turner E Welch C Sharma H

Aims

A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients’ quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures.

Methods

A randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient self-reported assessment of physical disability) at 12 months. This will also be measured at baseline, three, six, and 24 months after randomization. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the five-level EuroQol five-dimenison score (EQ-5D-5L), complications (including bone healing), resource use, work impact, and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 17 - 17
1 Dec 2015
Humphrey J Pervez A Walker R Abbasian A Singh S Jones I
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Background

Management of failed total ankle replacements (TAR) remains a difficult challenge. Ankle arthrodesis, revision TAR, debridement and amputation are all utilized as surgical options. The purpose of the study was to review a series of failed TAR surgically managed in our tertiary referral centre.

Methods

A retrospective review of 18 consecutive failed TARs, either within or referred to our institution, which required surgical management were reviewed. The average age was 58.2 (range 25–77) with 11 males and 6 females.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 18 - 18
1 Nov 2014
Walker R Bolton S Nash W Jones I Abbasian A
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Introduction:

The Best Practice Tariff (BPT) for hip fractures was introduced in April 2010 to promote a number of quality markers, including surgery within 36 hours. We conducted an audit to see whether the introduction of the BPT has had an inadvertent adverse effect on delay to fixation of unstable ankle fractures.

Method:

We compared the delay to surgery for 50 consecutive patients with unstable ankle fractures in the 2009 financial year with another 50 patients treated in the 2011 financial year, ie one year after the introduction of the BPT. There were no other changes in service in our department in this period. All radiographs were reviewed and classified using the Lauge-Hansen system by 2 surgeons. Excel was used for data analysis using unpaired T-Test and chi-squared test to assess significance.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 9 - 9
1 Nov 2014
Walker R Chang N Dartnell J Nash W Abbasian A Singh S Jones I
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Introduction:

In 2009 the Smart Toe implant was introduced as an option for lesser toe fusion in our department. The Smart Toe is an intramedullary device made from Nitinol, an alloy that can change shape with a change of temperature, expanding within the intramedullary canals of the proximal and middle phalanx to achieve fixation. The advantages of the Smart Toe are that patients are spared 6 weeks with K-wires protruding from their toes and there is no need for wire removal. We conducted a retrospective review of radiographic and clinical outcomes to assess the performance of this implant.

Methods:

We present a consecutive series of 192 toe fusions using the Smart Toe implant in 86 patients, between January 2009 and November 2013. All radiographs and case notes were reviewed to assess for radiological fusion, satisfactory clinical outcome and complications.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 1 - 1
1 Jan 2014
Wong F Mushtaq N Jones I Singh S Abbasian A
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Introduction:

Recent published studies have examined the normal dimensions of the syndesmosis on CT. However, previous anatomical studies have shown variations of the articulating facets within the tibialae fibularis and may contribute to the false appearance of increased spacing within the syndesmosis. In this study, we measured and compared anterior and posterior distances of the distal tibiofibular(DTF) syndesmosis on MRI and CT imaging.

Methods:

We identified adult patients who had had both a CT scan and an MRI scan of their ipsilateral ankle to investigate symptoms unrelated to the DTF syndesmosis. The anterior and the posterior DTF dimensions were measured on CT and MRI axial images, at the level of the distal tibial physeal scar. This was taken from anterior tubercle of tibia and from the most anterior aspect of the posterior tibial tubercle to the nearest point of medial aspect of the fibula. The geometrical shapes of the syndesmosis and the anterior tibial tubercle were also recorded.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 7 - 7
1 Apr 2013
Jones H Hickey B Ghaffar A Perera A
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Background

Despite the suggestion by Virchow in 1856 that thrombosis was the result of venous stasis, endothelial dysfunction and hypercoagulability there are some fundamental questions which remain to be answered. The published studies fail to provide specific details such as cast type and anatomical location of the thrombosis, but instead focus on the incidence of VTE and which chemical thromboprophylaxis is most effective. Previous studies of VTE in trauma patients have involved small numbers of patients and have not look at the risk medium to long term risk. Most importantly they have not looked at the site of the VTE. This makes interpretation of the link between cast and VTE even more complex.

Methodology

We analysed 1479 consecutive trauma cast applications and the incidence of symptomatic VTE in the six months following the injury. The diagonosis, cast type and site of the VTE was recorded.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 1 - 1
1 Sep 2012
Hickey B Morgan A Jones H Singh R Pugh N Perera A
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Introduction

The muscles of the leg collectively comprise the calf pump, however the action of each muscle group on calf pump function is not known. Patients with foot or ankle injury or surgery are often advised to perform foot and ankle movements to help prevent deep venous thrombosis. Our aim was to determine which foot and ankle movements were most effective in stimulating the calf pump. Method: Nine healthy participants were enrolled in this research and ethics approved prospective study. Participants with a previous history of peripheral vascular disease, varicose veins, deep venous thrombosis or previous foot and ankle surgery were excluded. Each participant followed a standardized protocol of foot and ankle movements, starting with foot in neutral position and the baseline and movement peak systolic velocity within the popliteal vein was measured during each movement. The movements tested were toe dorsiflexion, toe plantar flexion, ankle dorsiflexion, ankle plantar flexion.

Results

The mean patient age was 34 years (range 28–58), the majority were female (n = 6). All movements resulted in statistically significant changes in peak systolic velocity (p = <0.05). In order of decreasing peak velocity the exercises which had greatest effect on calf pump function were: Ankle dorsiflexion (101cm/s), Ankle plantarflexion (84cm/s), Toe dorsiflexion (63cm/s), Toe plantarflexion (59cm/s).

We have shown that all four exercises significantly increased calf pump function. The greatest effect was seen with ankle movements.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 14 - 14
1 Sep 2012
Morgan S Jones C Palmer S
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Open cheilectomy is an established surgical treatment for hallux rigidus. Cheilectomy is now being performed using minimally invasive (MIS) techniques. In this prospective study we report the outcome of minimally invasive cheilectomy comparing the results with a matched group who had cheilectomy using standard open procedure

Methods

Prospective study of 47 patients. 22 patients had MIS cheilectomy between March 2009 and September 2010. We compared the outcome with a matched group (25 patients) who had open cheilectomy. Functional outcome was assessed using the Manchester Oxford Foot and ankle questionnaire (MOXFQ). The MOXFQ is a validated questionnaire designed to be self-completed and used as an outcome measure for foot surgery. Patients' satisfaction and complications were recorded.

Results

In the MIS group, the median follow up was 11 months (4–23). The median preoperative MOXFQ score was 34/64(23) and the median postoperative score was 19/64 (p = <0.02). In the open group the median follow up was 17 months (9–27). The median preoperative MOXFQ score was 35/64 and the median postoperative score was 7.5/64 (p = <0.0001). The metric score of the three domains of the MOXFQ showed statistical improvement in both groups. The improvement didn't reach statistical significance between the open and MIS groups. There were three failures in the open group (Fusion) compared to none in the MIS.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 18 - 18
1 Sep 2012
Davies H Davenport C Oddy M Flowers M Jones S
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Introduction

Medial calcaneal displacement osteotomy with an FDL tendon transfer is a common method of correcting pes planus deformity secondary to grade II tibialis posterior dysfunction. There is currently no evidence that calcaneal displacement alters the centre of pressure in the foot from a medial to a more central position as the normal shape is reconstituted.

Materials and Methods

We prospectively evaluated 12 patients undergoing flatfoot reconstruction. Each patient had a preoperative AOFAS hindfoot score, pedobariographs and antero-posterior and lateral radiographs. This was repeated 6 months following surgery.