Advertisement for orthosearch.org.uk
Results 1 - 10 of 10
Results per page:
Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 11 - 11
4 Jun 2024
Onochie E Bua N Patel A Heidari N Vris A Malagelada F Parker L Jeyaseelan L
Full Access

Background

Anatomical reduction of unstable Lisfranc injuries is crucial. Evidence as to the best methods of surgical stabilization remains sparse, with small patient numbers a particular issue. Dorsal bridge plating offers rigid stability and joint preservation.

The primary aim of this study was to assess the medium-term functional outcomes for patients treated with this technique at our centre. Additionally, we review for risk factors that influence outcomes.

Methods

85 patients who underwent open reduction and dorsal bridge plate fixation of unstable Lisfranc injuries between January 2014 and January 2019 were identified. Metalwork was not routinely removed. A retrospective review of case notes was conducted. The Manchester-Oxford Foot Questionnaire summary index (MOXFQ-Index) was the primary outcome measure, collected at final follow-up, with a minimum follow-up of 24 months. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scale, complications, and all-cause re-operation rates were secondary outcome measures. Univariate and multivariate analyses were used to identify risk factors associated with poorer outcomes.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 39 - 39
1 Apr 2022
Patel K Galanis T Nie D Saini A Iliadis A Heidari N Vris A
Full Access

Introduction

Fracture related infections (FRI) following intramedullary nailing for tibial shaft fractures remain challenging to treat with associated high patient morbidity and healthcare costs. Recently, antibiotic-coated nails have been introduced as a strategy to reduce implant related infection rates in high-risk patients. We present the largest single-centre case series on ETN PROtect® outcomes reporting on fracture union, infection rates and treatment complications.

Materials and Methods

56 adult patients underwent surgery with ETN PROtect® between 01/09/17 and 31/12/20. Indications consisted of acute open fractures and complex revision cases (FRI, non-union surgery and re-fracture) with a mean of 3 prior surgical interventions. 51 patients had an open fracture as their index injury. We report on patient characteristics and outcomes including radiological/clinical union and deep infection. The one-year minimum follow-up rate was 87.5%.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 42 - 42
1 May 2018
Mazoochy H Vris A Brien J Heidari N
Full Access

Introduction

Segmental bone defect is a challenging problem. We report our experience of bone transport by hexapod external fixator in patients with segmental defects if the tibia.

Method

We report herein 15 patients with segmental bone defect of tibia who completed their treatment protocol. All patients were treated had bone transport with Taylor Spatial Frame from 2012 to 2017. All were treated by the senior author NH. Parameters measured included age, sex, diabetes, smoking, diagnosis, method of fixation prior to treatment use of a free flap, bone defect size, frame-time, external fixation index.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_13 | Pages 4 - 4
1 Jun 2017
Davda K Wright S Heidari N Calder P Goodier W
Full Access

Introduction

The management of a significant bone defect following excision of a diaphyseal atrophic femoral non-union remains a challenge. Traditional bone transport techniques require prolonged use of an external fixator with associated complications. We present our clinical outcomes using a combined technique of acute femoral shortening, stabilised with a deliberately long retrograde intramedullary nail, accompanied by bifocal osteotomy compression and distraction osteogenesis to restore segment length utilising a temporary monolateral fixator.

Method

9 patients underwent the ‘rail and nail’ technique for the management of femoral non-union. Distraction osteogenesis was commenced on the 6th post-operative day. Proximal locking of the nail and removal of the external fixator was performed approximately one month after length had been restored. Full weight bearing and joint rehabilitation was encouraged throughout. Consolidation was defined by the appearance of 3 from 4 cortices of regenerate on radiographs.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 153 - 153
1 Jan 2013
Lidder S Masterson S Grechenig S Heidari N Clements H Tesch P Grechenig W
Full Access

Introduction

Posterior malleolar fractures are present in up to 44% of all ankle fractures. Those involving > 25% of the articular surface have a higher rate of posterior ankle instability which may predispose to post traumatic arthritis. The posterolateral approach to the distal tibia allows direct reduction and stabilization of the posterior malleolus and concomitant lateral malleolus fractures. An anatomical study was performed to establish the safe zone of proximal dissection to avoid injury to the peroneal vessels in this uncommon approach.

Methods

26 unpaired adult lower limbs were dissected using the posterolateral approach to the distal tibia as described by Tornetta et al. The peroneal artery was identified coursing through the intraosseous membrane on deep dissestion as the flexor hallucis longus muscle was reflected medially. The level of its bifurcation was also noted over the tibia. Perpendicular measurements were made from the tibial plafond to these variable anatomical locations.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 76 - 76
1 Sep 2012
Lidder S Heidari N Grechenig W Clements H Tesch N Weinberg A
Full Access

Introduction

Posterolateral tibial plateau fractures account for 7 % of all proximal tibial fractures. Their fixation often requires posterolateral buttress plating. Approaches for the posterolateral corner are not extensile beyond the perforation of the anterior tibial artery through the interosseous membrane. This study aims to provide accurate data about the inferior limit of dissection by providing measurements of the anterior tibial artery from the lateral joint line as it pierces the interosseous membrane.

Materials and Methods

Forty unpaired adult lower limbs cadavers were used. The posterolateral approach to the proximal tibia was performed as described by Frosch et al. Perpendicular measurements were made from the posterior limit of the articular surface of the lateral tibial plateau and fibula head to the perforation of the anterior tibial artery through the interosseous membrane.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 102 - 102
1 Sep 2012
Heidari N Lidder S Grechenig W Weinberg A Tesch N Gänsslen A
Full Access

Introduction

Application of an external fixator for type B and C pelvic fractures can be life saving. Anteriorly the fixator half pins can be placed in the long and thick corridor of bone in the supra-acetabular region often referred to as the low anterior ex-fix. Pins in this location are favoured as they are more stable biomechanically. The bone tunnel for the low anterior ex-fix can be visualised with an iliac oblique projection intra-operatively. In some cases despite being outside the articular surface it may still be low enough to pass through the capsular attachment of the hip joint on the anterior inferior iliac spine. We aim to provide radiological markers for the most superior fibres of the capsule to help accurate extra-capsular pin placement within the supra-acetabular bone tunnel.

Materials and Methods

Thirteen cadaveric pelves, embalmed with the method of Thiel, were used for this study. An image intensifier was positioned to acquire an iliac oblique outlet view, such that the supra acetabular bone tunnel was visualised. This was achieved by positioning the beam 30 degrees cephalad and 20 degrees medial. Both left and right hemipelves were examined in this way. A standard size metallic disc was included in all images with in the acetabulum to allow for image calibration. The proximal most fibres of the hip joint capsule were marked with a K-wire so that their relation to the bone tunnel could be clearly seen on the images.

Once all images were acquired they were calibrated and analysed using ImageJ Software to estimate the height and maximum width of the bone tunnel as seen on the images and the vertical distance of the superior most fibres of the capsule from the dome of the acetabulum.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 104 - 104
1 Sep 2012
Weinberg A Widni E Pichler K Seles M Manninger M Heidari N
Full Access

Injuries to growth plates may initiate the formation of reversible or irreversible bone-bridges, which may lead to partial or full closure of the growth plate resulting in bone length discrepancy, axis deviation or joint deformity. Blood vessels and vascular invasion are essential for the formation of new bone tissue. The aim of our study was to investigate the spatial and temporal expression VEGF and its receptors R1 and R2 as well as the ingrowth of vessels in the formation of bone bridges in a rat physeal injury model. Quantitative Real Time - Polymerase Chain Reaction (qRT-PCR) was performed for Vascular Endothelial Growth Factor (VEGF) and its R1 and R2 receptors. Samples from the proximal epiphysis, physis and metaphysis of the tibial bone were prepared for immunohistochemical analysis to demonstrate the spatial expression of VEGF and its R1 and R2 receptors as well as laminin. Kinetic expression of VEGF and VEGF-R1 mRNA documented a tendency towards an expression increase on day 7. Histological analysis showed a haematoma containing bone fragments on day 1which was replaced by a bony bridge by day 14. This remodelled and consolidated by day 82. These trabeculae were accompanied by vessel formation. Expression of VEGF was observed on the bone fragments and the haematoma from day 1 through to day 82. Although VEGF-R1 was expressed at all time points the expression of VEGF-R2 was noted until the 14th day. Physeal bone bridge formation is a combination of both enchondral and intramembranous ossification. This is in part triggered by the bony debris observed within the lesion in the first few days. By washing this debris out the likelihood of bone bridge formation may be reduced. We recommend this practice when operating on the physis in order to avoid iatrogenic physeal bar formation.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 557 - 557
1 Oct 2010
Riley N Heidari N Packer G Ravi Sivaji C
Full Access

A retrospective analysis of the treatment of distal radius fractures with an angularly stable locking plate (Matrix Plate, Stryker, UK) via a dorsal approach performed at Southend University Hospital in the United Kingdom.

91 fractures were treated over a three year period between 2004 and 2007. Dorsally angulated and displaced (including intraarticular) fractures were included. All patients commenced early mobilization without splintage on the first post-operative day.

The study group consisted of 42 men and 49 women with a mean age of 63 years. The average time to follow up was 19 months (range 6–29). The average tourniquet time was 44 minutes (20–81).

Assessment consisted of range of motion and grip strength measurement, Mayo wrist score, quick DASH questionnaire and Gartland and Werley scoring.

Complications consisted of 1 EPL rupture and 3 patients suffered extensor irritation. To date only 5 plates (5.4%) have been removed.

We demonstrate that dorsal plating using a low profile, angularly stable plate produces comparable results to volar plating. The combination of a low profile, angular stable plate, together with a modification of the standard dorsal approach, a sub-periosteal approach via the fourth and deep to the third extensor compartment reduces the incidence extensor tendon irritation. The modified approach has the benefit of direct visualization of the articular surface and direct reduction with the plate being used in both and angularly stable and buttress mode.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_III | Pages 390 - 390
1 Oct 2006
Heidari N Korda M Dattani R Hua J Blunn G
Full Access

Introduction: Periprosthetic bone loss, brought about by wear particle induced osteolysis, presents a major challenge and compromises outcome in revision Total Hip Replacement. Poor bone stock at revision hip replacement is the main indication for impaction allografting. There are well documented limitations in the use of bone graft. Autogenous bone graft is osseoinductive, though donor site morbidity and the limited amount available restrict its use. An alternative is allogenic bone graft from cadaveric femoral heads. The drawbacks of using allograft are a limited supply and the risk of disease transmission. An alternative may be the use of bone substitute materials. Usually these are used in conjunction with allograft and therefore a number of drawbacks still apply. This study investigates the use of impaction grafting without bone graft. In this study we tested Apopore, 60% porosity, 2–5 mm hydroxyappatite (HA) granules (ApaTech Ltd) in an animal impaction model with allograft as control. Hypothesis Impaction using porous granular HA induces a similar volume of new bone compared with impaction using allograft.

Methods and Materials: Cylindrical defects of 15mm diameter were created in the medial femoral condyles of 12 sheep (6 sheep in each group) and filled with 3.5 grams of either morselised ovine allograft, washed and defatted according to North London Tissue Bank protocols, or porous HA granules impacted with a specially designed impactor, 20 times with a force of 3 KN. This force was similar to that measured during impaction grafting in clinical cases. After 6 weeks the sheep were euthanized, samples embedded in resin and the amount of bone formation measured by histomorphometric analysis.

Results: Under the impaction forces used the HA graft was more impacted than allograft. In the impacted HA graft the average pore size was smaller than for impacted allograft. After 6 weeks more new bone formation was observed at the host implant interface than the middle of the implant in both groups. At the implant host interface there was 26.64% (± 2.13%) new bone formation in the allograft and 21.13% (± 4.51%) new bone formation in the HA implant. In the middle of the implants allograft produced 11.01% (± 2.07%) new bone whilst the HA produced 7.23% (± 4.05%) new bone. Two tailed t-test showed no significance in either region, p=0.28 at the interface and p=0.40 in the middle. Allograft underwent resorption, from 39.37% at time zero to 5.66% (± 2.04%) at 6 weeks, a total reduction of 85%, where as the volume of HA granules remained the same and was 49% at time zero and 48.59% (± 1.69%) at 6 weeks. Two tailed t-test showed a significant difference (p< 0.0001) between allograft and HA at 6 weeks.

Conclusions: This study shows that granular porous HA induced a similar level of bone formation as compared with allograft. Resorption of allograft in this model allowed greater ingrowth of fibrous tissue. This makes the structural scaffold much more porous, compromising stability of the construct. The HA was not resorbed after 6 weeks and hence may be more stable. HA also has the advantage of being readily available. This study demonstrates that a bone substitute material does not need to be mixed with allograft.