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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_19 | Pages 14 - 14
1 Nov 2016
Lever C Bosman H Robinson A
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Introduction

Patients with neglected rupture of the Achilles tendon typically present with weakness and reduced function rather than pain. Shortening of the musculotendinous unit and atrophy of the muscle belly in chronic rupture potentially leads to poorer recovery following tendon transfer. Few papers have looked at the outcomes of FHL reconstruction specifically in neglected TA rupture. Of those that have none report functional outcomes following a transtendinous repair.

Methods

Twenty patients with irreparable unilateral tendoachilles ruptures treated with transtendinous FHL reconstruction between 2003 and 2011 were reviewed. Achilles Tendon Rupture Score (ATRS), AOFAS hindfoot score, Tegner score and SF12 were recorded. Standard isokinetic assessment of ankle plantarflexion was performed with a Cybex dynamometer. Great toe flexion strength was tested clinically.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 58 - 58
1 Sep 2012
Lever C Bing A Hill S Laing P Makwana N
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Introduction

Forefoot deformities are common in the rheumatoid population and lead to abnormal loading, plantar callosities and metatarsalgia. First MTP joint arthrodesis with lesser toe Stainsby procedures has become a popular method of reconstructing the rheumatoid forefoot but there is little data that reviews the clinical or biomechanical results of combining the two procedures.

Materials & Methods

A prospective observational study was set up to review 10 rheumatoid patients (20 feet) undergoing bilateral first MTP joint arthrodesis via a medial approach with Stainsby procedures to all lesser toes via curved incisions with resection of two thirds of the proximal phalanx, repositioning of plantar fat pad, extensor to flexor interposition and temporary stabilisation with k wires. Clinical scoring and dynamic pedobarograph pressure measurements were taken pre operatively and at one year post surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 369 - 370
1 Jul 2010
Kanwar R Lever C Bache C
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Aim: To audit the impact of emergency hip ultrasound in the management of suspected hip septic arthritis.

Methods and Results: Case series – Review of 13 consecutive patients who presented with acute hip pain, where clinical examination and inflammatory markers, highly suspicious of Septic arthritis.

Emergency ultrasound was only available in 9 patients.

Only 5 (38%) of these 13 patients had septic arthritis.

Septic arthritis group.

– Emergency ultrasound unavailable in 2 patents. They proceeded straight to arthrotomy yielding pus.

– 3 had a preoperative ultrasound which confirmed the hip joint had an effusion.

“Non Septic Arthritis of Hip” (8 patients).

– In 2 patients emergency ultrasound unavailable. They underwent emergency arthrotomy with negative findings of pus.

– 1 actually had septic arthritis of knee.

– 6 patients did have emergency ultrasound which showed no effusion. Emergency arthrotomy was cancelled.

– They proceeded to MRI of Hip. MRI revealed pathology close to but not involving the hip:

Pelvic osteomyelitis,

Psoas abscess,

Gluteal abscess secondary to small bowel fistula

Cellulitis of medial thigh

Femoral Epiphysis osteomyelitis

and inflammation of tendon secondary to line insertion.

Inflammation of rectus femoris tendon (secondary to central line insertion). Conclusion: Use of ultrasound avoided unnecessary arthrotomy in 6 patients (48%).

If ultrasound was available in all cases, then 8 (63%) patients would have avoided an unnecessary arthrotomy.

Out of hours urgent hip ultrasound may be difficult to request. However our recent experience leads us to propose that if available ultrasound should be performed in all suspected case of hip septic arthritis prior to surgical drainage.

Pathology in the vicinity of the hip can often masquerade convincingly as a septic hip joint.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 497 - 497
1 Aug 2008
Simmons D Lever C Moorehead J Butcher CK
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Aim: One of the issues of metatarsophalangeal joint (MTPJ) replacements is that they do not restore full range of movement (RO M). However, full RO M is not needed for functional walking. The aim of this study was to measure the difference between the functional and maximum ROM of the first metatarsophalangeal joint.

Materials & Method: The functional and maximum ROM of 32 MTPJs in 16 normal adults were measured with a video imaging system. The system first measured the ROM as the subject walked past the camera. It then measured the ROM as standing maximum extension tests were performed.

Results: During functional walking tests the mean ROM was 37.9 degrees (SD 12.2). During maximum standing extension tests the mean ROM was 64.9 degrees (SD 11.3). Therefore the functional walking ROM was only 58% of the maximum standing extension ROM, with a mean difference of 27 degrees. A paired t-test comparison showed P< 0.0001.

Discussion: MTPJ arthroplasty has previously been criticised because it does not restore full RO M. However, the results of this study suggest that the functional movements required in normal gait are significantly less than what can be maximally achieved in clinical standing extension tests. Therefore arthroplasty can be a suitable treatment if it can provide an adequate functional RO M.

Conclusion: The results of this study show that the functional range of movement required for walking is only 58% of the maximum extension ROM of the first MTP joint. Therefore, MTP joint replacements do not need to restore maximum extension, as normal gait can be achieved without this.