Aim

To evaluate the outcome and complications of pubic symphysis plating in the stabilisation of traumatic anterior pelvic ring injuries.

We present our experience of lower limb reconstruction for patients with obvious defects in the tibia, by bone transport using a stacked Taylor Spatial Frame.

A retrospective review of 40 patients treated between 2003 and 2009. There were 19 cases of infected non union, 9 cases of acute bone loss following fracture, 6 cases of chronic osteomyelitis, 4 cases of aseptic non union, 1 case of neurofibromatosis and 1 case of a loose and infected total ankle replacement.

Twenty-eight out of the 40 patients reviewed have completed their treatment. Of these 28 patients, bony union was achieved in 23 patients, of whom 22 were assessed at discharge to have regained good to excellent limb function, a functional assessment was not available for review in the remaining patient.

In 5 patients, docking site union failed, 3 of whom then underwent below knee amputation. Two patients required treatment with an intramedullary nail following frame treatment to achieve consolidated union of the docking site.

Anatomic sagittal and coronal alignment was achieved in 19 out of 23 patients.

The mean bone regenerate was 53.3 mm (range: 15-180mm), with a mean healing index of 9.2 days/mm (range: 4.4-25 days/mm)

The majority of patients experienced at least one complication, these included pin site and soft tissue infections, refracture, nerve palsy and joint stiffness. Surgical stimulation of the docking site was required in 12 of the 28 patients to promote union.

The use of a stacked Taylor Spatial Frame system is effective for restoring bone length and limb function in patients with bone loss following complex trauma and orthopaedic cases. The computer assisted nature of the spatial frame allows for predictable bone regenerate, minimal residual deformity and accurate bone docking

Currently there is no standard quantitative methodology for the description of Hill-Sachs defects (HSD), the size of which is important in planning surgical treatment for patients with anterior shoulder instability. The main purpose was to develop a simple imaging measurement to improve communication regarding HSDs. The secondary goal was to determine, using this new measurement, whether there was a significant difference in the size of HSDs in patients who underwent a Weber osteotomy (more invasive surgical intervention for those failing Bankart repair) compared with patients who underwent clinically successful arthroscopic Bankart repairs (the first surgical intervention for anterior shoulder instability).

HSD volume was calculated with newly developed methodology using computed tomography in ten patients who required eleven Weber osteotomies and using magnetic resonance imaging in twenty-two patients who had clinically successful arthroscopic Bankart repairs. Within the Weber cohort, regression analysis was performed to determine correlation between HSD volume and each of height, maximum depth, and width. Student's t-test analysis was used to compare HSD volume between the Weber and Bankart cohorts.

In the Weber cohort, there is a statistically significant correlation between the HSD Volume Ratio and the HSD Maximum Depth Ratio (R²=0.83). The t-test comparison of mean HSD Volumes showed statistically significant (p<0.0015) larger HSD's in the Weber cohort than the Bankart cohort.

HSD depth is a radiological indicator for HSD volume. This simple measurement may facilitate orthopaedic pre-operative planning for patients with severe recurrent anterior shoulder instability. In this preliminary study, patients who had Weber osteotomies after failed Bankart repairs had statistically significantly larger HSDs than patients with clinically successful Bankart repairs.

Introduction

Sacro-coccygeal chordomas pose a difficult diagnostic and therapeutic problem due to late presentation, large size, soft-tisue extension, difficulties in obtaining adequate resection margins, higher local recurrence rate and uncertain effectiveness of adjuvant treatment. We present a series of 21 patients of sacral chordomas obtained from Scottish Bone Tumour Registry to analyse predictors of local control and survival.

Middle-aged female patients with painful hip arthritis often have high expectations, are physically active and are more likely to have underlying anatomical abnormalities such as DDH. Large hard bearing total hip replacement (THR) offer the possibilities of reduced wear and risk of dislocation.

The patients in this series all had surgery in the private sector and were operated on by one surgeon. They were selected for a hard bearing THR on the basis of age, health and expectations. Large bearing metal-on-metal (MOM) THR became possible in 2003, with ceramic-on-ceramic (COC) bearings used in patients with allergies to metal. There were 90 patients in the MOM group and 92 patients in the COC group. The mean age was 60 and the commonest diagnosis was osteoarthritis in both groups.

In the MOM group there were 8 complications: 2 deep infections, 1 death from PE, and 5 severe soft tissue reactions (pseudotumour). In the COC group there were 2 complications: 1 deep infection and 1 patient with intermittent squeaking.

The patients in this study were closely matched in terms of age and lifestyles. All of them were operated on by a single high volume specialist hip surgeon. The results suggest a high risk of failure in female patients who have had MOM THR. Most of the failures had described discomfort in the hip for many months before revision surgery. All of the failures were associated with a cemented CPT stem. The surgeon no longer uses MOM bearings in female patients because of the unacceptably high failure rate compared to COC bearings.

COC bearings appear to offer the active middle-aged female patient consistently good results and a low risk of failure at least in the short to medium term.

Functional Ultrasound Elastography (FUSE) of Tendo Achilles is an ultrasound technique utilising controlled, measurable movement of the foot to non-invasively evaluate TA elastic and load-deformation properties. The study purpose is to assess Achilles tendons, paratenon and bursa mechanical properties in healthy volunteers and establish a clinical outcome tool for TA treatment.

We studied 40 Achilles tendons in healthy volunteers using our novel Elastography method, which we developed in the University of Oxford. US scan device (Z.one, Zonare Medical System Inc., USA, 8.5 MHz) with and without the Oxford isometric dynamic foot and ankle mover were used. Tendon insertion, midportion and musculotendinous junction were examined during lateral movement and axial compression/decompression modes. B mode and elasticity images were derived from the raw ultrasound radio frequency data. The anatomical structures mechanical properties were evaluated by a semi-quantitative score of different colours representing stiff tissue (blue) to more soft tissue (green, yellow, red).

The Achilles tendons showed mainly a hard structured pattern on sonoelastography. Compression/decompression modes are best used to demonstrate axial softening, while longitudinal displacement is best used to assess load transfer. The average strain along the tendon was 2% (range 0-6%). The overall correlation (?) between real-time sonoelastography and ultrasound findings was < 0.3. However, the correlation (?) between FUSE UEI and US findings was 1.0

Our findings show that FUSE seems to be a sensitive method for assessment of TA mechanical properties. The B mode and elasticity images must be viewed simultaneously. Elasticity and stiffness measurement may offer an invaluable tool to guide TA rupture and tendonopathy treatment and rehabilitation protocol.

This prospective longitudinal study compared the results of isolated endoscopic ACL reconstruction utilising 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over 15-years with respect to reinjury, clinical outcomes and osteoarthritis.

Ninty consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation, radiographic evaluation, KT1000, Lysholm Knee Score, kneeling pain, and clinical outcomes.

Subjects who received the PT graft had significantly worse outcomes compared to those who received the HT graft at 15 years for the variables of radiologically detectable osteoarthritis (p=0.03), motion loss (p=0.01), single leg hop test (p=0.002), participation in strenuous activity (p=0.05), and kneeling pain (p=0.04). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.31). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.07). ACL graft rupture was associated with non-ideal tunnel position (odds ratio 5.0) and males (odds ratio 3.2). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03), and was associated with age < 18 years (odds ratio 4.1) and the patellar tendon graft (odds ratio 2.6). Radiologically detectable osteoarthritis at 15 years was associated with the PT graft (odds ratio 2.3).

Significant differences have developed in the groups at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, extension loss and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.