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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_8 | Pages 41 - 41
10 May 2024
Sandiford NA Atkinson B Trompeter A Kendoff D
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Introduction

Management of Vancouver type B1 and C periprosthetic fractures in elderly patients requires fixation and an aim for early mobilisation but many techniques restrict weightbearing due to re-fracture risk. We present the clinical and radiographic outcomes of our technique of total femoral plating (TFP) to allow early weightbearing whilst reducing risk of re-fracture.

Methods

A single-centre retrospective cohort study was performed including twenty-two patients treated with TFP for fracture around either hip or knee replacements between May 2014 and December 2017. Follow-up data was compared at 6, 12 and 24 months.

Primary outcomes were functional scores (Oxford Hip or Knee score (OHS/OKS)), Quality of Life (EQ-5D) and satisfaction at final follow-up (Visual Analogue Score (VAS)). Secondary outcomes were radiographic fracture union and complications.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 39 - 39
1 Jun 2023
Chandra A Trompeter A
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Atypical femoral fracture non-union (AFFNU) is both, rare (3–5 per 1000 proximal femur fractures) and difficult to treat. Lack of standardised guidelines leads to a variability in fixation constructs, use of bone grafting and restricted weight bearing protocols, which are not evidence based. We hypothesised that there is no change in union rates without the use of bone grafting and immediate weight bearing post-operatively does not lead to increased complications.

Materials & Methods

A retrospective review of all consecutively treated AFFNU cases between March 2015 to December 2019 was carried out. 9 patients with a mean age of 63.87 years and M:F ratio of 7:2 met the inclusion criteria. Primary outcome variable was radiographic union at 12 months after revision surgery. All surgeries were carried out by a single surgeon. Fixation construct, neck-shaft angle, use of bone graft and immediate postoperative weight bearing protocols were recorded.

Results

Radiographic union was achieved in 7 of 9 patients (78%) after first revision surgery. 1 patient achieved union after 2nd revision surgery and 1 patient died in the early post-operative period due to pulmonary embolism. No bone grafting was used in any of the patients and weight-bearing as tolerated was allowed from the first post-operative day. The mean neck-shaft angle after non-union surgery was 136 degrees.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 36 - 36
1 Jun 2023
Rashid L Trompeter A Saw A
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Introduction

Osteotomy is a key step in distraction osteogenesis. Various techniques of osteotomy have been described with its own benefits and pitfalls. Percutaneous osteotomy using multiple drill holes is one of the most widely used osteotomy techniques. It still remains a challenge however to keep the drill holes aligned prior to the osteotomy. Moreover, the efficacy of percutaneous irrigation practice to keep the temperature low during drilling with this technique is also debatable. With an aim to overcome these challenges, we are introducing a device called the Double Barrel Drill Sleeve (DBDS) to perform percutaneous osteotomies. We attempted to compare this method to the conventional multiple drill holes technique using laboratory experiments and clinical data.

Materials & Methods

DBDS has two adjacent parallel barrels that can fit 3.2 to 3.5 mm diameter drill bits. It has a guide member at the drilling end that can be inserted through a pre drilled hole at the near and far cortices of a bone. This provides a constant rotating point for drilling of holes through the barrels. An osteotomy simulation was performed to compare percutaneous drilling with DBDS vis-a-vis a conventional single drill sleeve (SDS) by qualified orthopaedic surgeons, mainly to assess the drilling patterns of both techniques. Percutaneous drilling was done on PVC pipes wrapped in thick sponge to simulate tubular bone with surrounding soft tissue. We also assessed the effect of indirect irrigation on temperature during drilling using the DBDS against a control group on a cadaveric bone model. Ultimately we reviewed our patients who had undergone osteotomy for distraction osteogenesis with DBDS and the conventional technique, and compared their outcomes.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_7 | Pages 62 - 62
4 Apr 2023
Rashid M Islam R Marsden S Trompeter A Teoh K
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A number of classification systems exist for posterior malleolus fractures of the ankle. The reliability of these classification systems remains unclear. The primary aim of this study was to evaluate the reliability of three commonly utilised fracture classification systems of the posterior malleolus.

60 patients across 2 hospitals sustaining an unstable ankle fracture with a posterior malleolus fragment were identified. All patients underwent radiographs and computed tomography of their injured ankle. 9 surgeons including pre-ST3 level, ST3-8 level, and consultant level applied the Haraguchi, Rammelt, and Mason & Molloy classifications to these patients, at two timepoints, at least 4 weeks apart. The order was randomised between assessments. Inter-rater reliability was assessed using Fleiss’ kappa and 95% confidence intervals (CI). Intra-rater reliability was assessed using Cohen's Kappa and standard error (SE).

Inter-rater reliability (Fleiss’ Kappa) was calculated for the Haraguchi classification as 0.522 (95% CI 0.490 – 0.553), for the Rammelt classification as 0.626 (95% CI 0.600 – 0.652), and the Mason & Molloy classification as 0.541 (95% CI 0.514 – 0.569). Intra-rater reliability (Cohen's Kappa) was 0.764 (SE 0.034) for the Haraguchi, 0.763 (SE 0.031) for the Rammelt, 0.688 (SE 0.035) for the Mason & Molloy classification.

This study reports the inter-rater and intra-rater reliability for three classification systems for posterior malleolus fractures. Based on definitions by Landis & Koch (1977), inter-rater reliability was rated as ‘moderate’ for the Haraguchi and Mason & Molloy classifications; and ‘substantial’ for the Rammelt classification. Similarly, the intra-rater reliability was rated as ‘substantial’ for all three classifications.


Bone & Joint Open
Vol. 3, Issue 10 | Pages 746 - 752
1 Oct 2022
Hadfield JN Omogbehin TS Brookes C Walker R Trompeter A Bretherton CP Gray A Eardley WGP

Aims

Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK.

Methods

Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 30 - 30
1 Apr 2022
Brookes C Trompeter A Kolli V Dardak S Allen E Cho B
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Introduction

Lower limb amputation is associated with significant morbidity and mortality. Reflecting the predominance of vascular or diabetic disease as a cause for lower limb amputation, much of the available literature excludes lower limb amputation secondary to trauma in the reporting of complication rates. This paucity in the literature represents a research gap in describing the incidence of complications in lower limb amputation due to trauma, which we aim to address.

Materials and Methods

Retrospective analysis of a prospectively collected database of all traumatic lower limb amputations secondary to trauma from a regional multidisciplinary amputee service at Queen Mary's Hospital. Electronic patient records and paper notes were consulted for evidence of re-operation, infection (superficial or deep), phantom limb pain and neuroma. 222 patients were screened and 108 included in the data analysis.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 33 - 33
1 Apr 2022
Chester J Trompeter A van Arkel R
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Introduction

Non-union is debilitating, costly and affects 2–8% of intramedullary fixed fractures. Clinical data suggest that percutaneous interfragmentary screws offer a less invasive alternative to exchange nailing. This study aimed to assess their efficiency with biomechanical analyses.

Materials and Methods

A tibia was prepared for finite element analysis by creating a fracture of AO classification 42A2b, prior to reaming and insertion of an intramedullary nail. A callus was modelled as granulation tissue and gait loads were applied. The model was validated against published data and with sensitivity studies. The effects of weightbearing, fracture gap and angle, percutaneous screws and exchange nailing were compared through quantification of interfragmentary motion and strain, with the latter used to gauge healing performance via mechano-regulation theory.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 48 - 48
1 May 2021
Togher C Shivji F Trompeter A
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Introduction

Non-union is agonising for patients, complex for surgeons and a costly burden to our healthcare service; as such, its management must be well defined. There is debate as to the requirements for the successful treatment of such patients, in particular, the need for additional biological therapies to ensure union. This study's primary aim was to determine if operative treatment alone was an effective treatment for the non-union of long bones in the upper and lower limbs compared to the pre-existing literature using biological therapies.

Materials and Methods

A single-centre retrospective cohort study using prospectively collected data was performed. Inclusion was defined as patients 16 years or older with a radiologically confirmed non-union of the upper or lower limb long bones managed with surgical treatment alone between 2014–2019, with at least a 12 month follow up. Patients with bone defects or whose non-unions were treated with biological therapies were excluded from this study. The primary aim was assessed via the outcomes of union, time to union and RUST score.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 56 - 56
1 May 2021
Bence M Kothari A Riddick A Eardley W Handley R Trompeter A
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Introduction

Non-unions often arise because of high strain environments at fracture sites. Revision fixation, bone grafting and biologic treatments to treat long bone fracture non-union can be expensive and invasive. Percutaneous strain reduction screws (PSRS) can be inserted as a day-case surgical procedure to supplement primary fixation at a fraction of the cost of traditional treatments. Screw insertion perpendicular to the plane of a non-union can resist shear forces and achieve union by modifying the strain environment. A multi-centre retrospective study was undertaken to confirm the results of the initial published case series, ascertain whether this technique can be adopted outside of the developing institution and assess the financial impact of this technique.

Materials and Methods

Retrospective analysis was performed for all PSRS cases used to treat un-united long bone fractures in four level 1 trauma centres from 2016 to 2020. All patients were followed up until union was achieved or further management was required. Demographic data was collected on patients, as were data about their injuries, initial management and timings of all treatments received. A comparative cost analysis was performed comparing patients treated with PSRS and with traditional non-union surgery methods.


Bone & Joint Open
Vol. 1, Issue 7 | Pages 330 - 338
3 Jul 2020
Ajayi B Trompeter A Arnander M Sedgwick P Lui DF

Aims

The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era.

Methods

A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 54 - 54
1 Dec 2018
Sandiford N Pierce R Dabis J Mitchell P Trompeter A Jonathan H
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Aim

Antibiotic-eluting calcium compounds can be used to deliver antibiotics in the management of prosthetic joint infection (PJI). Described omplications include wound drainage, heterotopic ossification(HO) as well as hypercalcaemia which is potentially life threatening.

The aim of this study is to assess the incidence of hypercalcaemia and other complications between two calcium based antibiotic delivery systems.

Method

A retrospective study was performed. Thirty two patients treated with Stimulan or Cerament Calcium based antibiotic delivery system between August 2014 to January 2017 were included.

Seven patients received Cerament, 21 cases received Stimulan and one patient received both.

The volume used as well as pre- and post-operative serum calcium were recorded as well as any wound related complications and radiologic changes suggestive of heterotopic ossification. The postoperative serum adjusted Calcium were taken weekly during the initial post operative period.

Patients with overactive parathyroid disease and pre-existing renal disease were excluded.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 32 - 32
1 May 2018
Iliopoulos E Ads T Trompeter A
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Introduction

Plate fixation for distal femoral fractures is a commonly used method of fracture stabilisation. Many orthopaedic surgeons traditionally do not allow their patients to weight bear for the first 6 weeks after surgery, fearing of loss of fracture reduction and metalwork failure. The aim of this study is to investigate whether the post-operative weight bearing status after plate fixation influences the outcome in terms of loss of reduction and metalwork failure.

Materials & Methods

A retrospective data collection from all patients who treated in our hospital surgically for distal femoral fractures, from January 2015 until June 2017. Inclusion criteria were the operative treatment of these fractures with plate fixation. Patients who were treated with retrograde nail, primary total knee replacement or screw fixation were excluded from the study. Patient, injury and surgery demographic data was collected. The immediate post-operative weight bearing status of these patients was noted. Weight bearing status was divided into two groups – Group 1 (Non and touch weight bear – the non-weight bearing group) and Group 2 (Weight bear as tolerated / Full weight bear – the weight bearing group). Radiological data about fracture displacement or metalwork failure was collected at the six weeks and three months follow up after the operation, using a standardised measurement for displacement performed independently by two authors (EI, TA).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 18 - 18
1 May 2018
Williamson M Iliopoulos E Jain A Ebied W Trompeter A
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Background

There exists no consensus opinion as to the most suitable post-operative rehabilitation and weight bearing status for proximal tibia articular fractures treated with internal fixation using plates and screws.

Objectives

The aim of this study is to investigate whether the post-operative weight bearing status is associated with loss of reduction and articular collapse.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_8 | Pages 6 - 6
1 Feb 2013
Granville-Chapman J Nawaz S Trompeter A Newman K Elliott D
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Intramedullary nailing of tibial fractures is commonplace and freehand techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radio-lucent bolster. This requires the imaging C-arm to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement; reaming and nail insertion are all performed well above most surgeons' shoulder height. If instead the leg is hung over the edge of the table, the assistant must crouch and hold the leg until the nail is passed beyond the fracture.

We describe a method of nailing which is easier both for the surgeons and the (often inexperienced) radiographer and present a series of 87 consecutive cases managed with this technique.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XV | Pages 4 - 4
1 Apr 2012
Beech Z Trompeter A Singleton AJ Cooper G Hull GJ
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Hip resurfacing arthroplasty is an established and effective intervention for osteoarthritis of the hip in the young active patient, relying on the principle of femoral bone-stock preservation. A recognised mode of failure is neck thinning leading to radiological evidence of neck collapse and clinical failure.

We report on a series of these slow-neck-failure patients and highlight the increased incidence of this phenomenon in post-menopausal female patients. This is a single operator, single implant series; 172 cases were identified from databases at our institution. 76 were female, mean (SD) age 52 (7) years. 96 were male, mean (SD) age 51(12) years. 15 (8.7%) patients required revision. 12 (80%) were female, 9 (75%) of these were due to slow neck failure. In the men one patient developed ALVAL requiring removal of his bilateral hip resurfacings, the other failure mode was early femoral neck failure. Mean time to failure was 6 months in men and 37 months in women. This difference in failure rates is also seen in the NJR figures.

This review confirms the relatively high incidence of premature failure in post-menopausal females. NICE guidance in 2003, currently under review, stated that resurfacing is indicated in male patients up to 65 and female patients up to 60. As a result of this study we are currently advising post-menopausal patients that this risk of early failure may make total hip replacement a preferable option to resurfacing arthroplasty.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 309 - 309
1 Jul 2011
Phadnis J Trompeter A Gallagher K Wan E Elliott D Newman K
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Aim: To assess mid to long-term functional and symptomatic outcome after internal fixation of the distal radius.

Methods: All patients operated upon between June 2004 and October 2007 were retrospectively assessed using the ‘Disabilities of arm, shoulder and hand’ (DASH, range 0–100), and Mayo wrist (range 0–100) functional scoring systems. Fractures were classified according to the AO system. All patients were treated in one unit by the same group of surgeons using standard accepted techniques. Revision operations and patients treated at greater than four weeks after injury were excluded. Radiographic analysis of time to union was also performed.

Results: 201 patients underwent surgical fixation of which, 183 patients were contactable for follow up (9% loss). Only these patients were included in the study. Mean age was 62.5 years. Mean follow up time was 30 months. Mean time to surgery was eight days. 74% had good/excellent Mayo and 75% good/excellent DASH scores. 2% of patients had a poor outcome with both scores. 28 % reported no functional or symptomatic deficit. There was a 14% overall complication rate (6% major). Mean time to union was 8.39 weeks. Time to union increased with advancing AO grade. There was no significant difference in scores with regard to postoperative immobilisation, time to surgery, time to follow up, patient age, surgeon grade or fracture type.

Conclusion: This is one of the largest series of its type and the results compare favourably with other published operative and non-operative treatment modalities. This is a safe, reproducible technique with excellent functional outcome and is recommended as the treatment of choice when surgery is indicated for these fractures.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 31 - 31
1 Mar 2009
Rose D Rahman W Chan H Trompeter A Palmer S
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Purpose of study: To determine whether positioning the operated limb in flexion on a CPM machine reduces blood loss following uncemented total knee replacement. We also sought to determine whether limb arterial pressure, represented by ankle-brachial pressure index (ABPI), is affected by position of the limb.

Methods: We compared two groups of age and sex matched patients undergoing uncemented total knee replacement. The control group were treated in the postoperative period with the leg positioned flat in extension (48 patients). The CPM group were placed on a CPM machine at 90° of knee flexion for twelve hours immediately post-operatively (46 patients). Haemoglobin and haematocrit levels, blood transfusion requirement, length of hospital stay, range of motion and complications were compared.

In addition, we measured ankle and brachial pressures in a separate group of 39 patients with the limb in three different positions: flat with the knee in extension (ABPI 1), raised with the knee in extension (ABPI 2), and finally with the knee flexed to 90° (ABPI 3).

Results: The CPM group demonstrated a smaller drop in haemoglobin level (2.5 vs 3.1, p=0.013) and a reduced blood transfusion requirement (3 patients vs 14 patients, p < 0.05) in the post-operative period when compared to the control group. There was no significant difference in haematocrit drop, discharge range of motion, complications or length of hospital stay between the two groups.

ABPI measurements were calculated in the standard fashion, the mean ABPI in each limb position being 1.17 (ABPI 1), 0.87 (ABPI 2) and 0.83 (ABPI 3) respectively.

Conclusions: Short-term use of a CPM machine in the post-operative period reduces blood loss and appears safe following uncemented total knee replacement. We found limb arterial pressure to be reduced to the greatest extent with the limb in a position of 90° flexion at the knee, which may account for the reduction in blood loss seen in the CPM group.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 584 - 584
1 Aug 2008
Trompeter A Gill K Mobasheri R Agarwala S Appleton M Palmer S
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Aims: To determine the difference between macroscopic and microscopic appearances of the anterior cruciate ligament (ACL) in patients with osteoarthritis undergoing total knee replacement.

Methods: Patients admitted for routine total knee replacement (TKR) for osteoarthritis were assessed. The integrity of the ACL was noted as normal, moderately damaged (fissured) or complete rupture on a macroscopic level at the time of surgery. The ACL was sacrificed as a normal step in the operation and sent for histological analysis. The macroscopic and microscopic findings of ACL histology were compared using a common grading system (Grade 1 = normal, Grade 2 = moderately diseased, Grade 3 = severely diseased).

Results: The sample contained 48 patients, 17 male and 31 female, age range 55–87 years (mean 73). After exclusions, at surgery 7 ACL ruptures and 8 moderately diseased ligaments (defined by the presence of visible fissuring) were found despite negative pivot shift tests preoperatively. Of the 30 ACL’s that were found to be macroscopically normal, 22 of these (73%) were microscopically moderately or severely diseased.

Conclusion: We have found that a macroscopically normal ACL does not necessarily equate to microscopic integrity in the presence of osteoarthritis. This is an important consideration given the current trend towards unicompartmental knee replacement and highlights the possible need for investigation with appropriate imaging (MRI) and arthroscopy prior to this specific surgery.