The Fracture Fixation Assessment Tool score (FFATs) was developed as an objective evaluation of post-operative fracture fixation radiographs as a means of appraisal and education. The tool has proven validity, simple to use and based upon AO principles of fracture fixation. This study has been designed to assess how FFATs changes throughout the training program in the UK. The local trauma database of a district general hospital, with trauma unit status was used to identify cases. Although FFATs is designed to apply to any fracture fixation, Weber B ankle fractures were selected as common injuries, which constitute indicative cases in T&O training. Grade of the primary surgeon and supervision level were both stratified. The initial and intraoperative radiographs were anonymised and presented to the assessor who had been blinded to the identity and grade of the surgeon, for scoring using FFATs.Background
Methods
We present our experience of treating 57 cases of bone defects associated with chronic osteomyelitis (COM) and a new algorithm for their treatment. A retrospective analysis of our operation database revealed 377 patients treated for COM (2002–2010). 76 (20%) had bone defects, of these 57 had notes and x-rays available. Data was collected on: age, sex, type/extent of bone involved, number/type of procedures, and length of stay. The tibia was most commonly affected (63%), followed by the femur (21%). Infection control procedures included debridement, drilling and sequestrectomy. Long-term antibiotics were seldom used. Prerequisites to reconstruction surgery were; fully healed skin, absence of sequestrae on x-ray and no antibiotics for 2-months. Decision on the method of treatment of defect was made depending on; age, defect size, viability of periosteum and physes, condition of soft tissues and coexisting deformity. Initial treatment was; plaster stabilisation (15), frame stabilisation (6), free fibula structural bone grafts (9), ipsilateral vascularised fibula graft (7), non-structural cancellous bone graft (8), bone transport (8) and amputation (4).
Little is known about osteomyelitis-induced bone defects, which cause massive morbidity in developing countries. Our novel research shows that these can be treated successfully, often by relatively simple methods. In the absence of ongoing infection, non-vascularised bone grafting techniques are often successful. Bone transport or vascularised grafting are more reliable but more complex solutions.
