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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_11 | Pages 47 - 47
1 Nov 2022
Saxena P Lakkol S Bommireddy R Zafar A Gakhar H Bateman A Calthorpe D Clamp J
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Abstract

Background

Elderly patients with degenerative lumbar disease are increasingly undergoing posterior lumbar decompression without instrumented stabilisation. There is a paucity of studies examining clinical outcomes, morbidity & mortality associated with this procedure in this population.

Methods

A retrospective analysis of aged 80–100 years who underwent posterior lumbar decompression without instrumented stabilisation at University Hospitals of Derby &Burton between 2016–2020.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_10 | Pages 37 - 37
1 Oct 2015
Gakhar H Bommireddy R Calthorpe D Klezl Z Williams J
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Background

Loss of muscle mass (sarcopenia) and function in ageing are associated with reduced functional ability, quality of life and reduced life expectancy. In cancer patients, age related muscle loss may be exacerbated by cachexia and poor nutritional intake. Individuals with widespread disseminated disease are most prone to increasing functional decline, increased morbidity and accelerated death. However subjective assessments of physical performance have been shown to be poor indicators of life expectancy in these patients.

Aims

To develop an objective measure to aid calculation of life expectancy in cancer by investigating the association between objectively measured lean muscle mass and longevity, in 41 patients with known spinal metastases from all cause primaries.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 20 - 20
1 Jan 2013
Ahmed N Mcc Onnell B Prasad K Gakhar H Lewis P Wardal P Zafiropoulos G
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Background

Ultrasound and MRI are recommended tools in evaluating postoperative pain in metal-on-metal hip (MoM) arthroplasty.

Aim

To retrospectively compare MRI and ultrasound results of the hip with histopathology results in failed (MoM) hip arthroplasty.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 89 - 89
1 Mar 2012
Gakhar H Prasad K Gill S Dhillon M Gill S Dhillon M Sharma H
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Management of open tibial fractures remains controversial. We hypothesised that unreamed intramedullary nail offers inherent advantages of nail as well as external fixation. We undertook a prospective randomised study to compare the results of management of open tibial fractures with either an external fixator or an undreamed intramedullary nail until fracture union or failure.

Our study included 30 consecutive open tibial fractures (Gustilo I, II & IIIA) between 4 cm distal to knee and 4 cm proximal to ankle in skeletally mature adults, who presented to a level-1 trauma centre. Alternate patients were treated by either external fixation and unreamed nailing i.e. 15 in each group. Standard protocol for debridement and fixation was followed in all cases. All external fixators were removed at 6 weeks. All cases were followed up until fracture union, the main outcome measurement. 26 (87%) were males and 4 (13%) females; age range was 20-60 years (average 33.8).

All fractures in both groups united. Time to union averaged 7.9 months for both groups. Incidence of wound problems, infection, hardware failure and delayed union were comparable. However, there was higher incidence of angular deformities and stiffness of knee and ankle in external fixation group, although not statistically significant.

We found no statistically significant difference between unreamed intramedullary nailing and external fixation for the management of open tibial diaphyseal fractures, although ease of weight bearing as well as absence of angular deformities and joint stiffness were distinct advantages in the nail group. Therefore we recommend unreamed nail for Gustilo I, II and IIIA open tibial fractures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 57 - 57
1 Jan 2011
Prasad KSRK Gakhar H Dayanandam BK Karras K
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Purpose: To report concomitant dorsal dislocation of first metatarsophalangeal joint and divergent Lisfranc dislocation, a uniquely “floating forefoot” and analyse clinical pathodynamics.

Methods & Results: We treated concomitant dorsal dislocation of first metatarsophalangeal joint and divergent Lisfranc fracture-dislocation in an intoxicated patient as a heavy weight fell on foot. Closed reduction of first metatarsophalangeal joint was unstable until after open reduction and fixation of first tarsometarsophalangeal joint. First to third tarsometatarsal joints were stabilised with cannulated screws and lateral two rays with Kirschner wires. Prophylactic fasciotomies were performed to preempt potentially high risk of failure of recognition of compartment syndrome in intoxicated patient. Clinical pathodynamic analysis suggests that natural tendency to withdraw the foot contributed to primary medial loading with forced hyperextension of hallux metatarsophalangeal joint and enhanced complementary hyperflexion of midfoot. The former resulted in dorsal dislocation of first metatarsophalangeal joint.

Then load shift toward secondary axis of lateral divergent loading became the operative force to produce divergent Lisfranc dislocation, which effectively resulted in a floating forefoot.

Conclusions: Floating forefoot is a unique injury after high-energy trauma, although floating metatarsal and association between Jahss Type I complex dislocation of first metatarsophalangeal joint and Lisfranc injury were described. Floating forefoot also represents Grade V in the modified classification of metarsophalangeal injuries (Kodali Siva R K Prasad et al Modification of Clanton’s classification) as progression of injury pattern transcends the local barrier and raises the spectrum of dynamic cascade of multidirectional transmission of the operative forces with the resultant unique injury.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 207 - 207
1 May 2009
Gakhar H Prasad K Gill S Dhillon M
Full Access

As management of open tibial fractures remains controversial, we hypothesised that unreamed intramedullary nail offers inherent advantages of a nail as well as external fixation, while limiting the morbidity of external fixation.

We undertook a prospective randomised study to compare management of open tibial fractures with external fixator or intramedullary nail until fracture union or failure. Our study included 30 consecutive open tibial fractures (Gustilo I, II & IIIA) between 4 cm distal to knee and 4 cm proximal to ankle in skeletally mature adults, who presented to a level-1 trauma centre. Alternate patients were treated by external fixation or unreamed nail i.e. 15 in each group. Standard protocol for debridement and fixation was followed. External fixators were removed at 6 weeks. All cases were followed until fracture union, the main outcome measurement.

26 (87%) males and 4 (13%) females; age 20–60 years (Mean 33.8). All fractures in both groups united. Time to union averaged 7.9 months for both groups. Incidence of wound problems, infection, hardware failure and delayed union were comparable. However, there was higher incidence of angular deformities and stiffness of knee and ankle in external fixation group, although not statistically significant.

We found no statistically significant difference between unreamed intramedullary nailing and external fixation for the management of open tibial diaphyseal fractures. Ease of weight bearing as well as absence of angular deformities and joint stiffness were distinct advantages in the nailing group. Therefore we recommend unreamed nail for Gustilo I, II & IIIA open tibial fractures.