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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_9 | Pages 4 - 4
1 May 2014
Ramakrishna S Lupton C HAND C Stapley S
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The use of external fixation in the management of long bone fractures has long been recognised.

The aim of this study was to compare 3 differing constructs of Hoffman-2 and Hoffman-3 External Fixator systems to assess which potentially withstood the greatest load.

Three different constructs (2, 3 and 4-bar) of Hoffman 2 and 3 External Fixation systems were tested. A UHMWPE tube was utilised as a bone substitute to construct a biomechanically reproducible model which could be tested on an MTS testing jig. Each construct was loaded to 3, 5, 8, 12 and 15mm of displacement at the fracture gap. Each construct was cyclically loaded 200 times for each test and repeated 5 times.

The results demonstrate that the Hoffman-3 configurations withstood a load of at least twice that of the Hoffman 2 configurations across all displacements. Using a 2-way ANOVA test at all displacements the 2-bar configuration withstood greater load than the 3 bar (P<0.0001). With Hoffman 2 the 2-bar configuration withstood a greater load than the 4 bar diamond configuration.

These results demonstrate that Hoffman-3 External Fixation Device has a greater axial loading capacity than its Hoffman-2 predecessor.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 19 - 19
1 May 2013
Griffiths JT Lewis C Cannon L Lasrado I Hodkinson S Hand C
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The purpose of this study was to quantify the effect of BMP 7 and recombinant Human (rh) BMP 2 at stimulating bone formation and bone union in trauma and elective orthopaedic surgery.

Methods

We retrospectively reviewed the use of BMP 7 and rhBMP 2 at the Queen Alexandra Hospital between 2005 and 2012. The minimum follow up was three months. Inclusion criteria consisted of all patients who had failed to achieve previous surgical bone union and then received either BMP 7 or rhBMP 2 in an attempt to achieve bone union (as part of revision surgery). Patients who have not completed a minimum of three months follow up were excluded. Bone union was defined clinically and radiographically.

Results

17 patients were included (9 elective and 8 trauma patients). 9 patients received BMP2 (8 trauma and 1 elective) and 8 received rhBMP 2 (all elective). The average number of attempted fusions with autogenous bone graft prior to the use of BMP agent in the trauma and elective group was 2 and 3 respectively. The overall union rate following the use of BMP was 94.1%. 1 patient from the BMP 7 group (trauma patient) failed to unite. The union rate with BMP 7 and rhBMP 2 was 88.9% and 100% respectively. Following the use of BMP the average time to union was 117 days (BMP 7 124 days and rhBMP 2 112 days).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_3 | Pages 19 - 19
1 Jan 2013
Moras P Long J Jowett A Hodkinson S Lasrado I Hand C
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Purpose of the study

We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hindfoot problems the Portsmouth experience with the Ilizarov ring fixator.

Methods and results

We report on 10 patients who underwent ankle and hindfoot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR). All patients had undergone multiple previous surgeries which had failed. There were 7 males and 3 females in this group. Average age of the patients was 60 (47 years–77 years) Mean follow up was 32 months (6–56 months) BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening.

Patients were assessed clinically, radiologically and using functional outcome scores EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hindfoot nail. All patients were satisfied with their overall improvement in pain and function.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXII | Pages 26 - 26
1 Jul 2012
Ramakrishna S Moras P Jowett A Hodkinson S Lasrado I Hand C
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We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hind-foot problems - the Portsmouth experience with the Ilizarov ring fixator.

11 patients underwent ankle and hind-foot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR).

All patients had undergone multiple previous surgeries, which had failed. There were 8 males and 3 females in this group. Average age of the patients was 58 (43 years – 77 years) Mean follow up was 36 months (7 – 60 months). Mean frame time was 24 weeks (15 – 36 weeks). BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores - EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hind-foot nail. All patients were satisfied with their overall improvement in pain and function.

We conclude that this is an effective salvage technique for complex ankle and hind-foot problems in patients with impaired healing potential, insufficient bone stock and progressive deformity.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 262 - 262
1 May 2009
Howells N Auplish S Hand C Gill H Carr A Rees J
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Aim: To investigate the capacity for retention of arthroscopic technical skills.

Methods: Six consultant lower limb surgeons were given standardized instruction on how to perform an arthroscopic Bankart suture on a lab-based ALEX shoulder model. Each surgeon then performed a suture repair three times and returned to repeat the process on four consecutive occasions, approximately two weeks apart. Six months later the same surgeons returned again to repeat the entire process. They received no further tuition or instruction. Their performance was objectively assessed throughout using validated motion analysis equipment to produce learning curves using time taken, number of movements and total path length.

Results: The initial learning curves and the learning curves at 6 months were the same.

Conclusions: Arthroscopic skills were not retained over a 6 month period. The same learning curves were identified suggesting the need for regular repetition of this simulated task if the level of learning is to be maintained. This has implications for technically difficult arthroscopic procedures suggesting a minimum level of frequency is needed to maintain optimum surgical performance.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 351 - 351
1 Jul 2008
Hand C Rosell P Gill H Carr A Rees J
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The aim of this study was to use motion analysis to study a surgeon’s learning curve for an arthroscopic Bankart repair on a training model in a skills laboratory. Six fellowship trained lower limb surgeons unfamiliar with advanced shoulder arthroscopy performed an arthroscopic Bankart repair on an ALEX shoulder model. Standardised training was given and then an electromagnetic tracking system used to objectively assess hand movements, distance travelled by hands and time taken while the surgeons performed the technique. The arthroscopic repair was repeated three times on four consecutive occasions by each surgeon giving a total of 72 repair episodes. Analysis revealed improvement of all outcome parameters with less hand movements, less distance travelled and less time to complete the task. This study objectively demonstrates a learning curve for arthroscopic Bankart suture in a skills laboratory. It indicates the potential benefits of practicing aspects of arthroscopic techniques in a skills centre on appropriately selected models.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 352 - 352
1 Jul 2008
Matthews T Brinsden M Hand C Rees J Athanasou N Carr A
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A prospective study was carried out to determine if recognised histological features seen at surgery could help predict those rotator cuff tendon repairs which re-ruptured. 40 rotator cuff tendon edge specimens from 40 patients’ shoulders were analysed histologically following routine mini-open rotator cuff repair. 32/40 underwent Ultrasonography, at a mean time of 35 months post-operatively, to determine repair integrity. The histological features seen at surgery were then compared to the repair integrity of the tendon from which it had been taken. Rotator cuff repairs that remained intact demonstrated a greater reparative response, in terms of increased fibrobast cellularity, cell proliferation and a thickened synovial membrane, than those repairs which reruptured. Larger tears which remained intact showed a higher degree of vasacularity and a significant inflammatory component than those that re-ruptured. Good tissue quality at the time of surgery allows the repair the best chance of remaining intact despite the size of the lesion. Routine histological analysis of the tissue biopsy, preformed in the post-operatively, can now aid the clinician in terms of early management and repair prognosis.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 86 - 86
1 Mar 2008
Miniaci A Berlet G Hand C Lin A
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Although soft tissue capsulolabral repairs are the mainstay of treatment for recurrent anterior shoulder instability, bone defects are becoming more commonly recognized as additional problems for these patients. Humeral Head defects have been commonly ignored, however, there are a group of patients with failed procedures who have this as their main pathology.

The purpose of this paper is to present a review of patients with large Humeral Head impression defects with a large structural irradiated Allograft.

From April 1995 to January 2001, eighteen patients with recurrent anterior shoulder instability with Large Humeral Head Defects (> 25%) were treated with irradiated humeral allografts. Patients underwent physical and radiographic examination, subjective assessments including VAS scores for pain, instability, and satisfaction and completed a Constant and WOSI scores to determine clinical result. Radiograhic evaluation included standard radiographs and either MR or CT assessment.

Eighteen Patients with an average age of 31.5 (18–52) were reviewed at an average time of fifty months (24–96) following their surgical procedure. There were fourteen male and four female patients each having had an average of 2.1 (1–8) prior operative procedures. All patients had resolution of their instability with no documented recurrences. All patients had severe apprehension preop and this resolved completely in fifteen. Average loss of external rotation was forty degrees preop and improved to ten degrees postop. Two patients had partial collapse of the graft with symptoms of pain in External Rotation requiring screw removal. There were no other complications. Patients improved on WOSI from 1882 to 381 and had an avearage Constant score of eighty-seven postop. Subjectively all patients would have the procedure again and pain improved from 72.5 to 22.5.

There are certain situations where large humeral head defects contribute to the failure of instability repairs and ongoing instability. Allograft reconstruction with matched irradiated grafts is an excellent alternative for eliminating instability.

Funding: Smith and Nephew


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 171 - 171
1 Jul 2002
Hand C Howell G
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To review the medium term results of acute repair of rupture of the biceps brachii insertion using a single incision bone anchor anatomical repair.

Three patients with acute biceps brachii tendon insertion ruptures and treated surgically using a single incision bone anchor anatomical repair underwent dynamometer strength assessment of both arms using a KinCom isokinetic dynamometer. This was performed shortly after completion of rehabilitation (7–12 months after surgery) and again at 3.3 years after surgery.

All patients were male (mean age 40.3 years, range 34 to 53). Surgery was performed less than 7 days post injury using the same technique. Isokinetic assessment was performed at a mean of 8.7 months post surgery (range 7 to 12 months) and again at assessment (maintained at medium term assessment). All patients had returned to their full premorbid occupation and level of sporting activity. Dynamometer results of a repaired dominant limb equated to approximately the strength of a normal non dominant limb, a repaired non dominant side equated to two thirds the strength of a normal dominant limb at early assessment. This relationship was maintained at the medium term assessment, however there was a substantial increase in strength in both affected and unaffected arms.

The one incision approach, using bone anchors, is recommended as the method of choice providing an optimal surgical repair with a reduction in the risk factors theoretically associated with anatomical surgical repair. Our short-term results are comparable with other quantitative results published (for both bone anchor and non-bone anchor procedure). The medium term results how a measurable increase in strength of the repaired limb although the strength relative to the uninjured side remains the same as at early assessment.