To describe clinical situations for use of modified VAC in POC based on: diagnosis, comorbidities, BMI, wound size in cm, days following trauma when VAC was first applied, total duration of uninterrupted use, frequency of change, settings, bacterial growth, outcomes. To report the outcomes of mVAC use in POC within 6 months to help improve and standardize its application in the institution. This study involves data gathering from inpatients handled by orthopedic surgeons in training and subspecialty rotations in POC. The data collected are highly dependent on the doctors-in-charge's complete charting, thorough reporting and accurate documentation. Modified Vacuum Assisted Closure (mVAC) is used frequently in this study and is defined as a form of revised, adapted and reformed use of VAC based on available materials in the involved institution. The materials that are included are, but not limited to the following: sterile Uratex™ blue foam, nasogastric or suction tubing, phlegm suction machine, Bactigras™ and Opsite™ or Ioban™. A total of 58 patients were included in the study. The average age of the population was 35 and are predominantly male. The most common mechanism of injury was motorcycle accident and 37 of the patients were diagnosed with an open fracture of the lower extremity with open tibia fractures (22) being the most common. Average wound area measured was 24.12 cm. 3. All patients yield a bacteria growth with e. coli being the most frequent. Average during of uninterrupted use was 39 days. Of the 58 included in the study, 8 patients underwent STSG, 2 had a flap coverage surgery, 4 patients eventually underwent amputation and 33 with complete resolution of soft tissue defect after conversion to biologic dressing post-mVAC. The rest of the population were still ongoing mVAC at the end of the study. mVAC is an alternative temporary medium for soft tissue coverage for cases with or without concomitant fractures. mVAC promotes removal of exudate from the wound, supports wound apposition and granulation bed proliferation. Usage mVAC helps prepare for skin coverage procedure and on some cases leads to full resolution of defect

There is no consensus on how to evaluate and grade pin site infection. A precise, objective and reliable pin site infectious score is warranted. The literature was reviewed for pin site infection classification systems, The Modified Gordon Score (MGS) grade 0-6 was used. The aim was to test the reliability of The Modified Gordon Infection Score. The observed agreement and inter-rater reliability were investigated between nurse and doctors. MGS was performed in the outpatient clinic at Aalborg University Hospital, Denmark on 1472 pin sites in 119 patients by one nurse and one of three orthopaedic surgeons blinded to each other's judgement. The data was stored in a Red Cap Database for further statistical analysis. The observed agreement between the nurse and the 3 orthopaedic surgeons was evaluated with a one-way random-effect model with interclass correlation with absolute agreement. Furthermore the observed agreement for each of the 3 surgeons with the nurse was calculated. The distribution of MGS infection grade in the 1472 pin sites was: Grade 0; n=1372, Grade 1; n=32, Grade 2; n=39, Grade 3; n=24, Grade 4; n=5, Grade 5; n=0, Grade 6; n=0. The observed agreement between the nurse and the surgeons was calculated as 98%. The ICC estimated between nurse and the surgeons was 0,8943 (ICC >0,85 = reliable). The grading was done by three different doctors with an agreement with the nurse as follows. Rater1 (n=416) =99,5 %, Rater2 (n=1440) =97,4%, Rater3 (n=1440) =96,6%. A limitation to this study is that the dataset represents mostly clean pin sites with MGS 0. Only 100 pin sites had signs of superficial infection MGS 1-4 none above 4. We found that the MGS infection score is highly reliable for low grade infections but we cannot conclude on reliability in severe infections

To propose a modified approach to measuring femoro-epiphyseal acetabular roof (FEAR) index while still abiding by its definition and biomechanical basis, and to compare the reliabilities of the two methods. To propose a classification for medial sourcil edges. We retrospectively reviewed a consecutive series of patients treated with periacetabular osteotomy and/or hip arthroscopy. A modified FEAR index was defined. Lateral center-edge angle, Sharp's angle, Tonnis angle on all hips, as well as FEAR index with original and modified approaches were measured. Intra- and inter-observer reliability were calculated as intraclass correlation coefficients (ICC) for FEAR index with both approaches and other alignments. A classification was proposed to categorize medial sourcil edges. ICC for the two approaches across different sourcil groups were also calculated. After reviewing 411 patients, 49 were finally included. Thirty-two patients (40 hips) were identified as having borderline dysplasia defined by an LCEA of 18 to 25 degrees. Intra-observer ICC for the modified method were good to excellent for borderline hips; poor to excellent for DDH; moderate to excellent for normal hips. As for inter-observer reliability, modified approach outperformed original approach with moderate to good inter-observer reliability (DDH group, ICC=0.636; borderline dysplasia group, ICC=0.813; normal hip group, ICC=0.704). The medial sourcils were classified to 3 groups upon its morphology. Type II(39.0%) and III(43.9%) sourcils were the dominant patterns. The sourcil classification had substantial intra-observer agreement (observer 4, kappa=0.68; observer 1, kappa=0.799) and moderate inter-observer agreement (kappa=0.465). Modified approach to FEAR index possessed greater inter-observer reliability in all medial sourcil patterns. The modified FEAR index has better intra- and inter-observer reliability compared with the original approach. Type II and III sourcils accounts for the majority to which only the modified approach is applicable

The risk of AVN is high in Unstable Slipped Capital Femoral Epiphysis (SCFE) and the optimal surgical treatment remains controversial. Our AVN rates in severe, unstable SCFE remained unchanged following the introduction of the Modified Dunn Procedure (MDP) and as a result, our practice evolved towards performing an Anterior Open Reduction and Decompression (AOR) in an attempt to potentially reduce the “second hit” phenomenon that may contribute. The aim of this study was to determine the early surgical outcomes in Unstable SCFE following AOR compared to the MDP. All moderate to severe, Loder unstable SCFEs between 2008 and 2022 undergoing either an AOR or MDP were included. AVN was defined as a non-viable post-operative SPECT-CT scan. Eighteen patients who underwent AOR and 100 who underwent MPD were included. There was no significant difference in severity (mean PSA 64 vs 66 degrees, p = 0.641), or delay to surgery (p = 0.973) between each group. There was no significant difference in the AVN rate at 27.8% compared to 24% in the AOR and MDP groups respectively (p = 0.732). The mean operative time in the AOR group was 24 minutes less, however this was not statistically significant (p = 0.084). The post-reduction PSA was 26 degrees (range, 13–39) in the AOR group and 9 degrees (range, -7 to 29) in the MDP group (p<0.001). Intra-operative femoral head monitoring had a lower positive predictive value in the AOR group (71% compared to 90%). Preliminary results suggest the AVN rate is not significantly different following AOR. There is less of an associated learning curve with the AOR, but as anticipated, a less anatomical reduction was achieved in this group. We still feel that there is a role for the MDP in unstable slips with a larger remodelling component

Using a lateral approach during which the greater trochanter is excised, we performed domical pelvic osteotomy (modified chiari’s prpcedure) different from the original Chiarifs procedure. In a series of 176 modified Chiari pelvic osteotomies in 175 patients over 40 years old of the advanced coxarthrosis with acetabular dysplasia , in whom the postoperative courses were followed for more than 5 years (average, 6.9 years). JOA hip scores were improved in pain from 15.6 to 34.2 points and a total JOA score was improved from 55.7 to 76.5 points ,almost satisfactory results were obtained in 72.8% . In particular, markedly satisfactory results were obtained with respect to the improvement of pain in 84%. Radiographically, the coverage of the femoral head was markedly improved .The joint space was more dilated in 55% compared to that before surgery., however, the stage of coxarthrosis was more advanced in 18patients . In addition, the pathologic conditions of coxarthrosis had clinically deteriorated in 11 patients, resulting in treatment by total hip arthroplasty. As a result, there were more satisfactory results obtained, even in patients with advanced coxarthrosis, than expected. Based on the results of this study, we considered that the Modified Chiari’s procedure is most effectively indicated for mature patients with the flat headed hip joints complicated by acetabular sclerosis. Therefore, we perform this procedure in combination with femoral valgus osteotomy. In contrast, satisfactory results cannot be expected from this combination therapy particularly in patients with the atrophic type roundheaded hip joints exhibiting poor acetabular sclerosis. It is considered that the Modified Chiari’s procedure will be a useful treatment modality substituting for total hip arthroplasty even in mature patients, if applicable cases are carefully selected. Subsequently, we radiographically evaluated the prognosis of the acetabulum based on its preoperative status. Levels of acetabular sclerosis were classified into the following 3 grades : : atrophic, nornopholic and hypertrophic type.After surgery, the joint space was dilated or maintained in all patients with the hypertrophic type hip joints. However, most patients with the atrophic type hip joints showed the poor prognoses because the stage of coxarthrosis was further advanced in 18% of them. Concerning the capital morphology before surgery, when the prognoses were evaluated based on the preoperative capital morphology, 96% of the proliferative headed hip joints were successfully treated, while only 83% of the round headed hip joints were successfully treated. Even when the stage of coxarthrosis advanced during the prolonged period of follow-up and total hip arthroplasty is performed, it is the merit of this procedure that a larger size cup be applied without bone grafting.Because the matrix is formed satisfactorily in the newly generated acetabulum where osteotomy was performed. The present study evaluated the results of the Modified Chiari’s procedure performed mature patients with advanced coxarthrosis caused by acetabular dysplasia . Clinically, the JOA score was markedly improved in 84% patients. Radiographically, the coverage of the femoral head was more delated in 52%, compared to the joint space before surgery. However, the joint space narrowed in 18 patients, and total hip arthroplasty was performed in 6.3%. Modified Chiari method was considered to be a useful treatment modality that can sufficiently substitute for total hip arthroplasty in selected cases

Aims Pedobarography has improved the understanding of load transmission in hallux valgus. The aim of this study is to evaluate Pedobarography in Modified McBride procedure which transfers the deforming of adductor hallucis into a correcting force on the first metatarsal neck. Material and Methods Nineteen patients with 27 feet in total who underwent this procedure were included in this study. Average age was 49 yrs (range 28 – 73). Average follow up was 7 months (range 6–14 months). Pedobarography was performed before and after the operation using EMED SFX 6 system to record the contact area, total force, peak pressures and contact time for total foot, great toe and areas of foot medial to gait line. Results Pedobarographic measurements showed a statistically significant improvement in the contact area of the great toe 7.4 cm preoperatively to 8.7 cm postoperatively (17.5%, p < 0.001) and reduction in peak pressures of the great toe from 67.5 N/cm to 48 N/cm (29%, p < 0.001) and the total foot from 89 N/cm to 82 N/cm (8% p < 0.05). Conclusion We conclude that Pedobarography demonstrates the normalisation of forces in the foot following Modified McBride Procedure

Aim: As the shoulder and elbow joints share a common objective – spatial positioning of the hand – can the Modified Constant Score of shoulder function be applied to function at the elbow?. Method & Results: All patients with isolated elbow pathology over an eighteen-month period were assessed. Acute fractures and patients with shoulder and/or wrist pathology were excluded. Upper limb function was assessed using the Modified Constant Score and the Mayo Elbow Performance Index. A total of 48 patients with a variety of elbow pathologies were assessed. The mean patient age was 47.8 years, and 26 patients were male. The correlation between the two scoring systems was highly significant (correlation 0.91, t = < 0.001). Conclusion: The Modified Constant Score may be used as an assessment of both shoulder and elbow function

Introduction. The prevalence of adverse reactions to metal debris (ARMD) associated with metal on metal (MoM) hip arthroplasty has been reported to be as high as 69%. Such findings promoted the development of metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) classifications, with the aim of stratifying soft lesions by severity of disease. The Modified Oxford Classification is a straightforward system that has been shown to correlate with disease progression. Methods. The aim of this study was to test the reliability of this classification between observers. Seven observers were recruited, all with a musculoskeletal background. Using the PACS image analysis system, 20 MARS-MRI scans were provided for interpretation. Observers reviewed these scans in random order at two separate intervals over the course of five weeks. They classified them according to the Modified Oxford Classification as: ‘normal’, ‘trochanteric fluid, ‘effusion’, ‘ARMD type 1’, ‘ARMD type 2’ and ‘ARMD type 3’. Results. Statistical tests using kappa co-efficients were performed to get intra and inter observer reliabilities. Our results were compared against the grading system proposed by Landis and Koch. Our inter-rater agreement was 0.61. This is considered substantial agreement. Our intra observer scores ranged for 0.57 to 1.00 indicating consistency between the observers as individuals and as a group. Conclusion. The modified oxford classification is simple and easy to remember and has substantial reliability. It is proving to be effective in communicating, classifying and providing an understanding of disease progression

Purpose:. We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups. Method:. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group. Results:. Complications were seen in 27 patients in the Latarjet group. These included: 5 nerve injuries (3 axillary nerves, 1 musculocutaneous nerve, 1 possible suprascapular nerve) 4 of which resolved; 6 screw related complications and 7 early recurrences of the instability. There was a total reoperation rate of 8%. Patients who developed complications had an average post op Oxford score at last follow up of 36.1, while those without complications had an average score of 14.8. In the group of patients who underwent Bankhart procedures there were no recorded short or medium term complications. We specifically did not look at recurrence rates in either group as we felt our follow up times would not reflect this adequately. Conclusion:. Modified Latarjet procedure appears to have a higher short and medium term complication rate compared to the open Bankhart procedure. Once a complication occurs following a Latarjet reconstruction outcomes are significantly worse

Our aim was to compare the biomechanical strength modified side-to-side repair with modified pulvertaft technique keeping overlap length, anchor points, type of suture, suture throw and amount of suture similar.

In our study, we have used turkey tendons. Two investigators performed 34 repairs during one summer month. All mechanical testing was carried out using the tensile load testing machine. Variables measured were maximum load, load to first failure, modulus, load at break, mode of failure, site of failure, tensile strain, and tensile stress. The statistical comparison was carried by Levene's test and T test for means.

The mean maximum load tolerated by modified side-to-side repair was 50.3N(S.D13.7) and that by modified pulvertaft 46.96N(S.D: 16.4), overall it was 48.29 N (S.D: 14.57). The tensile stress at maximum load for modified pulvertaft and modified side-to-side repair was 4.2MPa(S.D: 3.1) and 4.7 MPa (S.D: 3.8) respectively {Overall 4.3MPa(S.D: 3.5)}. The tensile stress at yield was 4.01 MPa (S.D: 3.1) and 5.5 MPa (S.D: 3.7) respectively for modified pulvertaft and modified side-to-side repair {overall 4.44 MPa (S.D: 3.45)}. The tensile strain at maximum load respectively for side-to-side and modified pulvertaft repair was 7.87%(S.D: 33.3) and 7.84%(S.D: 34.02) respectively.

We found no statistical difference between 2 repairs in terms of strength, load to first failure, and maximum load to failure. The suture cut through was the commonest mode of failure.

Our study uniquely compares two techniques under standard conditions, and contrary to existing evidence found no difference.

Background: Recent evidence suggests that surgical intervention with radiotherapy is superior to radiotherapy alone. Predicting the life expectancy is critical in decision making whether to go for palliative or definitive surgery. Aim: To assess the accuracy of Modified Tokuhashi’s score (MTS) in predicting survival in patients with metastatic spinal tumours and cord compression; and to assess the incidence and role of early referral and diagnosis. Material and Methods: In this retrospective study, we collected two years’ data. Medical record was reviewed for the source of referral, delay in symptom onset to diagnosis and treatment, types of tumours, Karnofsky score to assess patients’ disability, Modified Tokuhashi score to assess the expected survival and final outcome. Results: 37 patients were included. Age ranged from 39 to 87 years(avg:64, median:66).30%(n=11) patients presented with cord compression and 70%(n=26) with instability pain. Cancer diagnosis had already been established in 57% cases off which 57% were referred from oncology and 43% from haematology. Remaining 43% patients were referred from GPs(68%) and medical specialties in the hospital(32%).51% patients presented early(< 3 months) and 22% presented late(> 6 months). Functional outcome improved in 58% patient following surgical intervention in early referral group(avg MTS:9.45) and improved in 61.5% patients in late referral group(avg MTS:9.5). In patients with cord compression, average MTS was 6.6. Expected survival was < 3 months in 45.4% and 3–12 months in the remaining patients. 81%(n=9) patients of this group had surgical intervention resulting in satisfactory functional outcome in 36%. 3 patients had surgery done within 24 hours and another 4 within 72 hours(median:58). In patients without cord compression, average MTS was 10.1. Expected survival was > 12 months in 84%. Surgical intervention was done in 84.6%(n=22) patients. 43% patients had posterior decompression and stabilisation with average MTS of 8.5 and satisfactory outcome in 56% patients. 13.5% patients had 2-stage anterior and posterior stabilisation with average MTS of 11.2 and satisfactory outcome in 100%. Average time from referral to definitive treatment was 17 days(mean:8, mode:8). Overall functional outcome was satisfactory in 84% patients. 30% patients died subsequently due to deterioration of their tumour-related problems with mainly Lung CA(36%) and Lymphoma(36%). Average MTS in these patients was 6.8. 5 patients died within 3 months of surgery. Conclusion: Modified Tokuhashi score was consistent with patients’ expected survival and functional outcome. There was no major difference in functional outcome in relation to early or late referral. We conclude that Modified Tokuhashi score is helpful to make a decision for intervening surgically

Purpose of the study. To evaluate the outcome of the Modified French osteotomy for the correction of cubitus varus resulting from a supracondylar distal humerus fracture in children. Description of methods. A retrospective review of 90 children, aged 3 to 14, who underwent a modified French osteotomy between 1986 and 2012 for the correction of cubitus varus as a result of a supracondylar distal humerus fracture. Case notes and radiographs were reviewed. The carrying angle was measured clinically and radiologically pre-operatively, post-operatively and at latest follow up. Comparison was made with the unaffected side. The outcome was graded as good if the correction of the carrying angle was within 5 degrees of the unaffected side, satisfactory if the correction was more than 5 degrees of the unaffected side but cubitus valgus was restored and poor if there was persistence of cubitus varus post correction. Any intra-operative and post-operative complications were documented. Summary of results. The average age at the time of osteotomy was 8 years. Sixty-two percent of the patients were male. The left elbow was affected 61% of the time. The average delay from time of fracture to osteotomy was 24 months. The average post-operative follow up was 3.5 months. With regard to the correction of the cubitus varus, 83% of patients had a good outcome, 17% had a satisfactory outcome, with no poor outcomes. Post-operative complications were documented in 6 patients, 3 of which required re-operation. Conclusion. The modified French osteotomy has been shown to be a safe and effective treatment for cubitus varus following supracondylar distal humerus fractures in children. NO DISCLOSURES

The aim of the study was to assess the clinical, radiological and paedobarographic outcome following modified Silver’s McBride’s procedure, in the treatment of Hallux Valgus. Between 1997 and 1999, Modified Silver’s McBrides procedure for Hallux Valgus was performed on 38 foot in 28 patients (18 unilateral and 10 bilateral). The median age was 60 years. The median follow up was 26 weeks. Clinical outcome measures consisted of pain, deformity, mobility, walking ability and shoe wear. Radiological outcome measures were Hallux Valgus angle, Intermetatarsal angle, 1st to 5th Metatarsal distance, 1st to 2nd metatarsal distance, and the DMAA (Distal Metatarsal Articular Angle). Paedobarographic (Musgrave) outcome of peak pressure, total force, time from heel strike to toe lift off post operatively were analysed. Preoperative visual analogue pain score was 5–8 and 0–4 postoperatively (p< 0.001). 34 feet had pain on walking preoperatively and only 11 had pain post-operatively. 12 were wearing special shoes pre- operatively and 5 post-operatively. Hallux Valgus angle was 34 pre-operatively and 19 post-operatively (p< 0.001). IMT angle was 14.53 pre-op and 10.88 postop (p< 0.001). 1st-5th MT distance was 67mm pre- op and 63mm post-op (p=0.001). 1st-2nd MT distance was 15 pre-op and 10 post-op (p=0.004). DMAA was 24.7 degrees. 21 foot an obliquity of the 1st tarsometatarsal joint was seen indicating an anatomical cause of metatarsus varus. Foot pressure studies showed a peak pressure of 1.37kg/cm2 , heel to toe off- time was 936.9ms and maximum load was 65.2 kg. There were 3 cases of superficial wound problems. One patient developed Hallux varus deformity, with no functional disability. Conclusion: Modified Silver’s McBride procedure for the treatment of Hallux Valgus is a soft tissue procedure and is a safe alternative to the commonly practiced osteotomies for correction of this disorder

To validate the Modified Forgotten Joint Score (MFJS) as a new patient-reported outcome measure (PROM) in hip and knee arthroplasty (THR/TKR) against the UK's gold standard Oxford Hip and Knee Scores (OHS/OKS). The MFJS is a new assessment tool devised to provide a greater discriminatory power, particularly in well performing patients. It measures an appealing concept; the ability of a patient to forget about their artificial joint in everyday life. Postal questionnaires were sent out to 400 THR and TKR patients who were 1–2 years post-op. The data collected from the 212 returned questionnaires was analysed in relation to construct and content validity. 77 patients took part in a test-retest repeatability assessment. The MFJS proved to have an increased discriminatory power in high-performing patients in comparison to the OHS and OKS, highlighted by its more normal frequency of distribution and reduced ceiling effects. 30.8% of patients (n=131) achieved excellent OHS/OKS scores of 42–48 this compared to just 7.69% of patients who achieved a proportionately equivalent MFJS score of 87.5–100. The MFJS proved to have an increased test-retest repeatability based upon its intra-class correlation coefficient of 0.97 compared to the Oxford's 0.85. The MFJS provides a more sensitive tool in the assessment of well performing hip and knee arthroplasties in comparison to the OHS/OKS. The MFJS tests the concept of awareness of a prosthetic joint, rather than pain and function and therefore should be used as adjunct to the OKS/OHS

To validate the Modified Forgotten Joint Score (MFJS) as a new patient-reported outcome measure (PROM) in hip and knee arthroplasty against the UK's gold standard Oxford Hip and Knee Scores (OHS/OKS). The original Forgotten Joint Score was created by Behrend et al to assess post-op hip/knee arthroplasty patients. It is a new assessment tool devised to provide a greater discriminatory power, particularly in the well performing patients. It measures an appealing concept; the ability of a patient to forget about their artificial joint in everyday life. The original FJS was a 12-item questionnaire, which we have modified to 10-items to improve reliability and missing data. Postal questionnaires were sent out to 400 total hip/knee replacement (THR/TKR) patients who were 1–2 years post-op, along with the OHS/OKS and a visual pain analog score. The data collected from the 212 returned questionnaires (53% return rate) was analysed in relation to construct and content validity. A sub-cohort of 77 patients took part in a test-retest repeatability study to assess reliability of the MFJS. The MFJS proved to have an increased discriminatory power in high-performing patients in comparison to the OHS and OKS, highlighted by its more normal frequency of distribution and reduced ceiling effects in the MFJS. 30.8% of patients (n=131) scored 42–48 (equivalent to 87.5–100 in the MFJS) or more in the OKS compared to just 7.69% in the MFJS TKR patients. The MFJS proved to have an increased test-retest repeatability based upon its intra-class correlation coefficient of 0.968 compared to the Oxford's 0.845. The MFJS provides a more sensitive tool in the assessment of well performing hip and knee arthroplasties in comparison to the OHS/OKS. The MFJS tests the concept of awareness of a prosthetic joint, rather than pain and function and therefore should be used as adjunct to the OKS/OHS

To determine the factors that influences the clinical outcomes in surgical correction of thoracic AIS. There are conflicting data regarding the effects of back shape and radiologic parameters on the self-reported outcomes of surgery in AIS. Prospective, cohort study; mean follow-up 29 months (range 9-88). 30 patients (5 males);. Rib hump 17 ° corrected to 7 °. Thoracic Cobb 66 ° corrected to 25 ° (63%). Lumbar Cobb 42 ° corrected to 17°. Thoracic apical vertebral translation (AVT) 48mm corrected to 18mm. Lumbar AVT 34mm corrected to 19mm. Thoracic kyphosis 29° preoperatively 23° postoperatively. Lumbo-sacral lordosis 57° preoperatively 49° postoperatively. Modified SRS Outcomes Instrument (MSRSI) filled out pre-operatively and at final follow up. Primary= rib hump, radiological (frontal Cobb correction, lumbar & thoracic AVT, sagittal profile), Modified SRS Outcomes Instrument (MSRSI) domain scores. The magnitude of the rib hump had a significant association with pain:. Rib hump vs. MSRSI pain r= -0.55 p<0.000. Similar correlations existed between rib hump and self-image (r=-0.64, p<0.0000), thoracic Cobb angle with pain (r=-0.48 p<0.0001) and self-image (r= -0.57, P<0.0000). The postoperative thoracic Cobb angle, and percentage thoracic Cobb correction had significant correlations with self-image (r=-0.55 p=0.003 & r=0.54 p0.004 respectively). The size of the rib hump has a significant impact on pain & self-image. These domains are also significantly influenced by the residual thoracic Cobb angle and overall scoliosis correction

Background

The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis.

Bone morphogenetic proteins (BMPs) have been widely investigated for treating non-healing fractures. They participate in bone reconstruction by inducing osteoblast differentiation, and osteoid matrix production.¹ The human recombinant protein of BMP-7 was among the first growth factors approved for clinical use. Despite achieving comparable results to autologous bone grafting, severe side effects have been associated with its use.² Furthermore, BMP-7 was removed from the market.³ These complications are related to the high doses used (1.5-40 miligrams per surgery)² compared to the physiological concentration of BMP in fracture healing (in the nanogram to picogram per milliliter range).⁴ In this study, we use transcript therapy to deliver chemically modified mRNA (cmRNA) encoding BMP-7. Compared to direct use of proteins, transcript therapy allows the sustained synthesis of proteins with native conformation and true post-translational modifications using doses comparable to the physiological ones.⁵ Moreover, cmRNA technology overcomes the safety and affordability limitations of standard gene therapy i.e. pDNA.⁶ BMP-7 cmRNA was delivered using Lipofectamine™ MessengerMAX™ to human mesenchymal stromal cells (hMSCs). We assessed protein expression and osteogenic capacity of hMSCs in monolayer culture and in a house-made, collagen hydroxyapatite scaffold. Using fluorescently-labelled cmRNA we observed an even distribution after loading complexes into the scaffold and a complete release after 3 days. For both monolayer and 3D culture, BMP-7 production peaked at 24 hours post-transfection, however cells transfected in scaffolds showed a sustained expression. BMP-7 transfected hMSCs yielded significantly higher ALP activity and Alizarin red staining at later timepoints compared to the untransfected group. Interestingly, BMP-7 cmRNA treatment triggered expression of osteogenic genes like OSX, RUNX-2 and OPN, which was also reflected in immunostainings. This work highlights the relevance of cmRNA technology that may overcome the shortcomings of protein delivery while circumventing issues of traditional pDNA-based gene therapy for bone regeneration.

Acknowledgement: This work has been performed as part of the cmRNAbone project and has received funding from the European Union's Horizon 2020 research and innovation programme under the Grant Agreement No 874790.

Aims: Wood is a product of nature, has a structural architecture resembling bone and is chemically polymer-like. Birchwood modified with heat and humid air was selected to study its possibilities for bone reconstruction. Methods: Bulk birchwood was prepared for 2–3 hours at temperature of 220°C in humid air, this modifies the wood chemically and physically. 16 cone shaped implants 7x4 mm in size were carved from the heat treated material (Bioactive Wood Bone, BWB) and implanted by press-fit technique into holes drilled in the distal femurs of rabbits. Untreated cones served as controls. The resected knees were embedded in plastic (Techmont, Kulzer GmBH). For evaluation histology, histomorfometry and scanning electron microscopy (SEM) were carried out. Results: In vitro SEM showed the canal structures of the wood. In vivo no articular hydrops or wound infections were seen. At 4 and 8 weeks an inflammatory cellular reaction of a mild degree with some histiocytes was observed. At 8 and 20 weeks the implant’s surface was in connection with the surrounding bone and connective tissue. Bone-implant contact at the interface required proper press-fit technique. At 8 and 20 weeks histometry revealed new bone growth covering 21% (mean, range 6–41%) of the implant surface resembling the osteoconductive bonding characteristic of biomaterials. Conclusions: Modified heat treated wood showed biocompatibility and osteoconductivity in cancellous bone defect. A bone bonding-like-phenomenon observed at the interface between the birch implant and bone illustrates it’s potentials for use as a bone substitute

Complications are an inevitable part of orthopaedic surgery, how one defines complications can have an impact on the ability to learn from them. A group of general surgeons headed by Clavien and Dindo et al.¹ have previously published their classification system for surgical complications based on the type of therapy required to correct the complication.

Our aim was to evaluate a modification of this classification system and its use over a 12-month period at our institution via our departmental audits, our hypothesis being that this would direct appropriate discussion around our complications and hence learning and institutional change.

A modified Clavien-Dindo Classification was prospectively applied to all complications recorded in the Orthopaedic departmental quarterly audits at our institution for a 12-month period (4 audits). The audit discussion was recorded and analysed and compared with the quarterly complication audits for the preceding 12-month period.

The modified Clavien-Dindo classification for surgical complications was applicable and reproducible to Orthopaedic complications in our level 1 trauma centre. It is a transparent system, objective in its interpretation and avoids the tendency to down-grade serious complications. It was easy to apply and directed discussion appropriately at our quarterly audit meetings on complications where there was a preventable outcome or important learning point. In particular modifications to VTE and Death classes allowed the unit to focus discussion on cases where complication was preventable or unexpected.

The modified Clavien-Dindo classification system is an easy to use and reproducible classification system for Orthopaedic complications in our unit it directed audit discussion towards cases where complications were preventable or had a learning point.