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Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 424 - 424
1 Sep 2009
Kochhar T Jayadev C Back DL Ratnakumar K
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Statement: This is the first report of a supracondylar femoral fracture following ACL reconstruction using a transfixation pin

Methods: A 38 yr old secretary was admitted for an elective ACL reconstruction. The operative procedure involved harvesting of the hamstrings, with drilling of an 8 mm tibial tunnel and the graft fixed with a 10 × 35mm screw. Femoral tunnel placement was performed arthroscopically and fixation of the graft in the tunnel was using the Arthrex system. No untoward events were recorded in the notes. Post-operatively, the patient was mobilised according to the surgeons standard guidelines.

At 6 week review, the patient complained of increasing pain, inability to fully weight bear and a decreased range of movement. 35 fixed flexion deformity, 30 degrees external rotation and 20 degrees of valgus of the leg. Radiographs revealed a transverse supracondylar fracture extending through the level of the pin fixation.

Subsequent surgery involved an osteotomy to correct the deformity and application of a lateral femoral plate After fixation direct inspection of the retained anterior cruciate ligament, revealed and intact graft that functioned through the full range of movement.

At nine months, the patient is fully weight bearing has returned to her pre-injury sporting level and has a range of movement of 0–110 degrees. There was no objective knee instability and the patient is satisfied with the outcome.

Femoral fractures have rarely been reported in the literature following ACL reconstruction and these are usually associated with drilling of an enlarged femoral tunnel. We report a rare case of a transverse supracondylar femoral fracture following ACL reconstruction, with the fracture occurring through the fixation tract not the femoral tunnel.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_I | Pages 75 - 75
1 Mar 2005
Kochhar T Williams R Back DL Cannon SR Briggs TWR
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This preliminary report demonstrates the effective use of Apapore in the management of benign cystic bone lesions.

The use and development of bone graft substitutes over the past ten years has increased dramatically to improve their osseo-integration to a level similar to autografting techniques without the drawbacks of comorbidity from the graft site.

Apapore is a synthetic bone graft substitute which consists of a scaffold of synthetic phase-pure hydroxy apatite with micro- and macroporosity and inter-connectivity to favour bone repair.

Nineteen patients (12M:7F) with a mean age of 18.6years (8–33 years) having had procedures for the management of benign cystic lesions of bone with grafting using Apapore were followed up retrospectively for a mean period of 8 months (1–16months). In each case the diagnosis of a benign cystic lesion was made histologically prior to surgery. The subsequent definitive procedure was performed by a consultant on the Bone Tumour Unit at the Royal National Orthopaedic Hospital (Stanmore) in each case involving curettage and impaction of Apapore into the cavity in a standard fashion as a general anaesthetic procedure in the operating theatre.

There have been no complications to date. All patients have made uneventful recoveries. Short-term radiological follow-up demonstrates excellent incorporation of the bone graft substitute and osseo-integration.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 113 - 113
1 Feb 2003
Hilton A David L Back DL Cannon SR Cobb J Pringle J Briggs TWR
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We discuss the management and outcome of 52 patients who presented with malignant tumours of the fibula over a 15-year period between1983 and 1998.

The tumour type was Osteosarcoma (23 patients), Ewing’s sarcoma (16), Chondrosarcoma (11 – of which 10 low grade) and Malignant Fibrous Histiocytoma (2). We concentrate on the two most common frankly malignant groups: Osteosarcoma and Ewing’s.

The male:female ratio of patients with Osteosarcoma was 11:12 and with Ewing’s Sarcoma was 11:5. Mean age for Osteosarcoma was 21. 5 years and for Ewing’s Sarcoma was 14. 2. The most common site of tumour was in the proximal fibula in both Osteosarcoma (19 / 23) and Ewing’s Sarcoma (10 / 16). The stage of disease at presentation was IIa or IIb in the majority of patients, with seven patients presenting with metastases.

The current investigative procedures are Radiographs, Magnetic Resonance Imaging, Radioisotope Bone Scans, Computerised Tomography of the chest and needle biopsy whereas in the past CT of the lesion and open biopsy were common. Chemotherapy was administered as per protocol at the time of diagnosis and radiotherapy was given in selected cases.

Surgery was performed on all but 3 patients, who were unfit and died. This consisted of local en bloc resection in 86. 3% and above knee amputation in 6. 8%. Whereas all the diaphyseal and distal lesions were completely excised, 9 out of 26 proximal lesions had a marginal excision, 4 of which had open biopsies. The common peroneal nerve was sacrificed in 50% of cases and this had no link to survival.

The overall 5-year survival was 33% for Osteosarcoma and 40% for Ewing’s Sarcoma, with proximal lesions doing much worse than diaphyseal and distal lesions. Patients who had marginal excisions all died within 2. 5 years.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 164 - 164
1 Jul 2002
David LA Back DL Cannon SR Briggs TWR
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Introduction: We discuss the use of the SMILES (Stanmore Modular Individualised Lower Extremity System) in revision knee arthroplasty and review the outcome of 32 cases.

Methods: The SMILES prosthesis incorporates a rotating hinge knee joint. It can overcome the major problems of bone loss and ligamentous laxity. 32 prostheses were used in 30 patients as salvage revision procedures between Sept. 1991 and Sept. 1998. Patients receiving surgery for tumours were excluded. The minimum follow-up was two years with a mean follow-up of 4 years and six months. The age of the patients ranged from 36–85 years (mean 68years and 6months). 18 of the patients were male. The original pathology was OA in 23 patients and RA in 7 patients. The number of previous arthroplasties ranged from 1–4. The main indications for a SMILES prosthesis were aseptic loosening, periprosthetic fracture and infection, in the presence of bone loss and ligamentous laxity.

Results: The patients were assessed using the Knee Society Rating Score. The mean knee score improved from 26 pre-op to 68 post-op while the mean fiction score improved from 27 to 75. Overall Knee Society scores improved from a mean of 26 to 72. The average range of motion was 60 degrees pre-op and 90 degrees post-op. Complications included: failure to eradicate infection in two patients, with one patient needing amputation; infection of the prosthesis leading to revision in one, and failure of the tibial component needing revision.

Conclusion: The Smiles has produced satisfactory results in the short to medium term, offering an alternative to amputation in some cases. The cost compares favourably with other designs and the use is increasing in frequency.