Hallux Rigidus affects 2–10% of population, usually treated with cheilectomy or arthrodesis, however, for the subclass of patients who refuse to undergo fusion, Arthroplasty is an alternative solution, it maintain some degree of motion and provide pain relief. Toefit; is one of the prostheses being used. It is a total joint replacement with polyethylene insert. The aim of this study is to find clinical and radiological outcomes of Toefit arthroplasty. A prospective study. Ethical committee approval was obtained. Patient who have received Toefit Arthroplasty with at least 12 months follow-up and were willing to participate in the study were included. Patients were reviewed by independent surgeon. Questionnaires were completed followed by clinical examination. This followed by radiographic assessment. Patients, who were willing to take part in the study but could not attend a clinical review, were invited to participate in telephone questionnaire. Pre and postoperative AOFAS scores were compared, patients' satisfaction and clinical and radiological outcome were assessed using descriptive statistics, t-test and survivalship analysis were done.Introduction
Method
Metatarsals stress fractures are common in athletes and dancers. Occasionally, such fractures could occur without trauma in peripheral neuropathic patients. There is no published series describing outcome of stress fractures in these patients. This study analyse these fractures, treatment and outcome. Retrospective study, January 2005 to December 2010. From a total of 324 patients with metatarsal fractures, 8 patients with peripheral neuropathy presented with second metatarsal non-traumatic fractures. Fractures were initially treated in cast for more than three months but failed to heal. Subsequently, this led to fractures of 3rd, 4th and 5th metatarsals. All patients remained clinically symptomatic due to fracture non-union. Operative treatment with bone graft and plating was used. Postoperatively below knee plaster and partial weight bearing for 12 weeks. Clinical and radiological surveillance continued until bone union.Background and objective
Material and Method
There is no published series described change in bone mineral density (BMD) after ankle replacement. We present the results of a prospective study examining the effect of total ankle replacement (TAR) upon local bone mineral density (BMD). To design a method and assess the effect of TAR loading on local ankle bones, by analysing the BMD of different area around ankle before and after Mobility TAR.Introduction
Aim
Total ankle replacement (TAR) is increasingly offered as an alternative to ankle fusion for the management of severe ankle arthritis. As with all other types of joint arthroplasty, there are risks involved and complications that occur; these increase with case complexity. We present the complications and management from a single-centre series. Since 2006, we have performed 150 Mobility TARs with up to 4 years' follow-up. We have excluded 16 that are part of a separate RCT and 10 with less than 3 months' follow-up. 124 TARs were included in our study (117 patients). Three ankles (2.4%) had superficial wound infections treated successfully with antibiotics. One ankle (0.8%) required an arthroscopic washout and debridement but the implant was retained. 11 ankles (8.9%) had a Our figures are comparable with other series. Our complication rate has not changed significantly over time. Our results, at present, suggest that most complications (98%) with the Mobility TAR can be satisfactorily managed without having a detrimental effect on the implant. There have been proven and promising results with total ankle replacement. However, there is a significant complication rate that must be made clear to the patient via informed consent; the rate still remains higher than for hip and knee arthroplasty.
The standard practice of uncomplicated total ankle replacement (TAR) involves postoperative immobilisation. Periprosthetic fracture is a well-recognised complication following ankle We have 133 TARs with 3 to 48 months' follow-up. 28 patients were excluded for the following reasons: other major procedure performed concurrently (osteotomy or tendon transfer), custom prosthesis, revision surgery, fusion conversions, or patients involved in a separate RCT (n = 16). We do not routinely immobilise patients postoperatively but allow partial to full weight-bearing as able. Outcome scores were compared to those without fractures.Introduction
Materials and Methods
Postoperative pain following (Mobility TM) ankle arthroplasty (AA) is recognised problem. This study aimed to determine pattern of postoperative pain following Ankle arthroplasty (AA). In prospective observational study 135 patients who had (AA) and follow-up of 12–36 months were included. AOFAS ankle score, patients' satisfaction, SF36 and diagrammatic mapping of postoperative pain among other parameters were collected preoperatively and postoperatively at 3 months, 6 months and the annually. Patients with AOFAS of < 50 with postoperative ankle pain were examined in details.Background
Materials and Methods
While hidden blood loss has been shown to occur in hip fractures the timing and cause have not yet been demonstrated. This study investigated the degree of pre-operative blood loss within the first 24hrs after intertrochanteric hip fracture. 188 patients with extracapsular hip fractures had their full blood count taken on admission and after 24 hours. The haemoglobin (Hb) and haematocrit (Hct) were noted at each time. Fractures were grouped as undisplaced or displaced. Those who were operated on prior to the 24hr blood sample were excluded. All patients with intracapsular or sub-trochanteric fractures were excluded, as were any who received a blood transfusion prior to their 24hr blood sample being taken. The tests for differences between blood samples and the existence of displacement were performed using paired and independent Student’s t-test. The level of significance was set at P<
0.05. All data was analysed using SPSS statistical software version 11. The overall fall in the Hb within 24hr was significant (1.6 g/dl, P<
0.001), as was the fall in the haematocrit (0.05, P<
0.05). Displaced fractures had a significantly lower Hb at 24hrs than undisplaced (10.6g/dl vs 11.8 g/dl, P=0.001). The fall in Hb was significantly greater in displaced fractures compared to undisplaced (1.7g/dl vs 1.2g/dl, P<
0.05). Changes in the Hct mirrored those of the Hb. This study identified a significant blood loss that occurs within the first 24hrs after an intertrochanteric hip fracture, prior to theatre. The cause is unlikely to be secondary to dehydration as the Hct fell with the Hb. Thus the most likely cause is the trauma itself. The admission Hb is possibly an inaccurate measure of the true value and patients may be more shocked than first thought. A more liberal resuscitation policy may be warranted.
There were 29 patients with Adolescent Idiopathic Scoliosis and 7 patients with congenital or infantile scoliosis. Z-scores from patients with neuromuscular scoliosis also included, 10 patients with cerebral palsy and 11 with muscular dystrophies (mainly Duchenne MD). There were also 3 patients with Neurofbromatosis and 8 patients with other conditions (miscellaneous). Outcome measures were bone mineral density in patients with different types of scoliosis in form of Z-scores.