Introduction

Total ankle replacement (TAR) is performed for post-traumatic arthritis, inflammatory arthropathy, osteoarthritis and other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1997. In this study, using data from the SAP, we look at trends in the use and outcomes of TAR in Scotland.

Total ankle replacement (TAR) is performed for inflammatory arthropathy, osteoarthritis and other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1998. In this study, we look at trends in the use and outcomes of TAR in Scotland.

We identified patients from the SAP who underwent TAR between 1998 and 2015 with imaging available on the National Picture Archiving and Communication System (PACS). We identified, and examined trends in implant type over the following time periods: 1998–2005; 2006–2010 and 2011–2015. Age, gender, indication, outcomes and trends in implants used for each time period were examined.

There were 499 primary TAR procedures with an overall incidence of 0.5/105 population per year. Eight implants were identified with significant changes in the numbers of each type used over time. The peak incidence of TAR was in the 6th decade and mean age of patients increased from 59 years in 1998–2005, to 65 years in 2011–15 (p<0.0001). The percentage of patients with inflammatory arthropathy was 49% in 1998–2005, compared with 10% in 2011–2015. Arthrodesis and infection rates appeared to be higher during the first time period. The male to female ratio changed over time. The incidence of TAR increased overall during the study period (r= 0.9, p=<0.0001).

This study examines a large number of TARs from an established arthroplasty registry. The rate of TAR has increased significantly in Scotland from 1998 to 2015. Indications and patient age have changed over time and could impact outcomes after ankle replacement.

Introduction

Total ankle replacement (TAR) is performed for post-traumatic arthritis, inflammatory arthropathy, osteoarthritis and a range of other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1997. In this study, using data from the SAP, we examined the annual incidence of TAR between 1997 and 2015. Implant survivorship and the rate of general and joint-specific complications were also analysed.

Magnetic resonance imaging (MRI) continues to become more widely accessible as an investigation, with an increasing number of scans being performed in the outpatient setting for suspected shoulder pathology.

We performed a retrospective review of all shoulder MRI scans performed in an orthopaedic outpatient setting in a district general hospital between October 2010 and October 2011. We also reviewed the medical notes for these patients. 75 MRI Shoulder scans were performed on 74 patients. In 5 cases (7%), no other form of imaging was performed prior to MRI scan. 11 patients (15%) had no provisional diagnosis included in the referral. The nature of referral, indication for MRI and subsequent management of these patients was also examined.

Our findings may support the use of guidelines for requesting MRI scans of the shoulder in outpatients.

Tibiotalocalcaneal (TTC) arthrodesis using a retrograde nail is a common salvage procedure for a range of indications. Previous work has suggested subtalar joint preparation is unnecessary to achieve satisfactory results. We examine the incidence of symptomatic subtalar nonunion following tibiotalocalcaneal fusion in a series of patients, all of whom had full preparation of the subtalar joint, and consider the possible contributing factors.

We performed a retrospective review of all patients who underwent TTC arthrodesis from 2004–2010. All fusions were performed by the same surgeon with full preparation of both tibiotalar and subtalar joints.

61 TTC arthrodeses were performed in 55 patients (mean age = 59 years) using an intramedullary retrograde nail. Mean follow-up was 18 months (6–48 months). Fifty-six ankles (92%) achieved satisfactory union. Five patients (8%) had symptomatic non-union: 4 patients of the subtalar joint - with 3 patients undergoing revision subtalar arthrodesis and 1 patient of the tibiotalar joint. Nine patients required removal of the calcaneal screw (16%) – all had evidence of isolated subtalar nonunion prior to metalwork failure. Eight of these patients achieved asymptomatic union following screw removal.

Subtalar nonunion following TTC fusion has resulted in recent changes to nail design to increase stability across the subtalar joint. Our results demonstrate a favourable overall nonunion rate with isolated subtalar nonunion making up the majority of cases. We also observed a significant rate of distal screw loosening, also associated with subtalar nonunion prior to screw removal, the significance of which merits further investigation.

Isolated talonavicular arthrodesis is a common procedure particularly for posttraumatic arthritis and rheumatoid arthritis. Two surgical approaches are commonly used: the medial and the dorsal approach. It is recognized that access to the lateral aspect of the talonavicular joint can be limited when using the medial approach and it is our experience that using the dorsal approach addresses this issue.

We performed an anatomical study using cadaver specimens, to compare the amount of articular surface that can be accessed, and therefore prepared for arthodesis, by each surgical approach. Medial and dorsal approaches to the talonavicular joint were performed on each of 11 cadaveric specimens (10 fresh frozen, 1 embalmed). Distraction of the joint was performed as used intraoperatively for preparation of articular surfaces during talonavicular arthrodesis. The accessible area of articular surface was marked for each of the two approaches using a previous reported technique3. Disarticulation was performed and the marked surface area was quantified using an immersion digital microscribe, allowing a three dimensional virtual model of the articular surfaces to be assessed.

The median percentage of accessible total talonavicular articular surface for the medial and dorsal approaches was 71% and 92% respectively. This difference was significant (Wilcoxon Signed Ranks Test, p<0.001).

This study provides quantifiable measurements of the articular surface accessible by the medial and dorsal approaches to the talonavicular joint. These data support for the use of the dorsal approach for talonavicular arthrodesis.

Isolated talonavicular arthrodesis is a common procedure particularly for posttraumatic arthritis and rheumatoid arthritis. Two surgical approaches are commonly used: the medial and the dorsal approach. It is recognized that access to the lateral aspect of the talonavicular joint can be limited when using the medial approach and it is our experience that using the dorsal approach addresses this issue.

We performed an anatomical study using cadaver specimens, to compare the amount of articular surface that can be accessed, and therefore prepared for arthodesis, by each surgical approach. Medial and dorsal approaches to the talonavicular joint were performed on each of 11 cadaveric specimens (10 fresh frozen, 1 embalmed). Distraction of the joint was performed as used intraoperatively for preparation of articular surfaces during talonavicular arthrodesis. The accessible area of articular surface was marked for each of the two approaches using a previous reported technique. Disarticulation was performed and the marked surface area was quantified using an immersion digital microscribe, allowing a three dimensional virtual model of the articular surfaces to be assessed.

The median percentage of accessible total talonavicular articular surface for the medial and dorsal approaches was 71% and 92% respectively. This difference was significant (Wilcoxon Signed Ranks Test, p< 0.001).

This study provides quantifiable measurements of the articular surface accessible by the medial and dorsal approaches to the talonavicular joint. These data support for the use of the dorsal approach for talonavicular arthrodesis.

Isolated talonavicular arthrodesis is a common procedure particularly for posttraumatic arthritis and rheumatoid arthritis. Two surgical approaches are commonly used: the medial approach and the dorsal approach. It is recognized that access to the lateral aspect of the talonavicular joint can be limited when using the medial approach and it is our experience that using the dorsal approach addresses this issue. We performed an anatomical study using cadaver specimens, to compare the amount of articular surface that can be accessed, and therefore prepared for arthodesis, by each surgical approach. Medial and dorsal approaches to the talonavicular joint were performed on each of 10 cadaveric specimens. Distraction of the joint was performed as standard for preparation of articular surfaces during talonavicular arthrodesis. The accessible area of articular surface was marked for each of the two approaches.

Disarticulation was performed and the marked surface area was quantified using a digital Microscribe allowing a three dimensional virtual model of the articular surfaces to be assessed.

This study will provide quantifiable measurements of the articular surface accessible by the medial and dorsal approaches to the talonavicular joint.

These data may provide support for the use of the dorsal approach for talonavicular arthrodesis.

A delay in operative intervention for ankle fracture in the presence of blistering at the operative site is generally considered to reduce problems with soft tissue complications including infection. No evidence exists to show an increased rate of complications. Previous work has characterised two types of blisters clear- and blood-filled. It has been suggested that the presence of a blood-filled blister confers a higher risk of wound healing complications compared with a clear-filled blister.

We present a series of patients who underwent surgery for ankle fracture, in the presence of blisters at the operative site, without any change to standard management of the fracture. We also present a review of the literature.

We prospectively followed six patients who underwent early internal fixation (no delay in surgical intervention) of ankle fracture in the presence of blisters at the operative site. In many cases the surgical incisions were made through the blistered skin. No patients had any additional treatment for their blisters. All patients were treated with the same postoperative protocol.

All six patients with both blister types went on to fracture union with no soft tissue complications and no cases of infection.

This initial observational study supports the treatment of ankle fractures with early internal fixation in the presence of soft tissue blisters at the operative site. It is possible that the stabilisation of underlying skeleton results in better healing of the skin and other soft tissues which is a concept often employed in the management of open fractures. We plan to carry out further prospective work on a larger number of patients as part of a randomized trial to confirm this finding.

The study looked at early outcomes of 55 patients who underwent open reduction and internal fixation of distal radius fracture with a single variable angle volar locking plate (Variax, Stryker), by a single surgeon (GS), between May 2007 and December 2008.

A retrospective review of notes and radiographs was performed. Twenty-nine women and 26 men were included. The mean age was 52 years. Mean follow up time was 3 months. The dominant wrist was involved in 38 patients. The mechanism of injury was of low energy in 38 patients and of high energy in 17 patients. All patients had comminuted fractures and 52 patients had intraarticular fractures. Seven patients underwent intraoperative carpal tunnel decompression.

At latest follow up, active wrist motion averaged 37° extension, 40° flexion, 70° pronation, and 56° supination. Grip strength averaged 64% and pinch grip 77% of the contralateral wrist. Postoperative complications included one flexor pollicis longus rupture, one malunion and three patients with loosening of screws. There was a higher rate of complications seen in patients with high energy injuries.

These early results suggest that volar plating with a variable angle plate is an effective treatment option, especially for complex intraarticular distal radius fractures. A medium term outcomes study of a larger number of patients is planned.

Lumbar Spinal Canal Stenosis is a common condition in the ageing population. In Spinal decompression surgery a balance needs to be struck between the need to decompress the neural elements in the spinal canal and the risk of worsening the segmental instability that often coexists in this condition. Traditionally decompression has been supplemented with rigid stabilization e.g. fusion, which is irreversible. Recently semi-rigid or ‘soft’ stabilization philosophies have evolved. The Wallis Device is a second generation interspinous distraction/stabilization implant designed to achieve ‘soft’ segmental stabilization. In addition to stabilising the decompressed segment, it also provides a ‘block’ to full segmental extension, helping to maintain spinal canal dimensions even in the erect position.

We followed up and assessed outcomes in 50 patients (25 spinal decompression + Wallis implant and 25 spinal decompression alone). The two arms of the study were matched for gender, age and level of lumbar decompression. A single surgeon was involved in each case and carried out a standard procedure of fenestration and medial facetectomy. Outcomes were assessed during clinical follow-up as well as by telephone, and included the VAS, the Oswestry Disability Index (ODI) and the EQ5D Health Domain.

Early results suggest decreased incidence of recurrent symptoms and global improvement in all parameters measured, in those subjects that underwent Spinal decompression with Wallis stabilisation.

Aim

Over the last 15 years there has been a series of publications reporting the beneficial effects of elbow arthrolysis, with considerable variation in operative technique and post-operative management. Many advocate the use of passive stretching techniques in the early post-operative period if range of motion fails to improve satisfactorily. The purpose of this study was to assess our results of open elbow arthrolysis in patients who did not receive any passive stretching after discharge from hospital.