Diabetes has been associated with greater risk of complications and prolonged postoperative recovery following ankle trauma. Our cohort study reviewed the operative management and outcomes of ankle fractures in diabetic adults relative to non-diabetic adults from Jan 2016–2019. Non-diabetic controls were frequency age-matched 2:1. 34 of 572 ankle fracture presentations were in diabetic patients, 32% managed non-operatively compared to 29% of the matched non-diabetic cohort. The distribution in Lauge-Hansen fracture pattern was comparable between cohorts. Mean length of follow-up was significantly longer for diabetics (26 weeks) compared to non-diabetics (16 weeks). Post-operative wound complications (superficial wound infection, breakdown, dehiscence) occurred in 48% of the operated diabetic ankles, compared to 5% in non-diabetics (RR 8.1, 95% CI 2.5–26.4). Reoperation (RR 4.3, 95% CI 2.5–26.4, Poorly controlled diabetes is associated with substantially greater complication rates following ankle fracture than those with well controlled or normal blood sugar; high HbA1c > 69mmol/mol is a significant predictor of complicated follow-up. Locally we recommend management strategies that are influenced by the fracture pattern stability and the presence or absence of complicated or poorly managed diabetes.
We would like to present this service evaluation of Taylor Spatial Frame use within a busy limb reconstruction unit. We present a cohort of 60 patients representing a year of work from January 2011 to January 2012 with a breakdown of coding data. Included are details of operative episodes, length of stay, outpatient follow up including software programming episodes, strut changes and general frame care from our specialist nurses. We have produced a comparison of cost to HRG coding tarifs with an audit of coding errors and cost implications of these corrections. Also included is a breakdown of comparison data from patients undergoing frame assisted deformity correction and internal fixation, Computer Hexapod Assisted Orthopaedic Surgery. Exact and careful coding of these procedures is required considering their relatively high cost.
Lower limb mal-alignment due to deformity is a significant cause of early degenerative change and dysfunction. Standard techniques are available to determine the centre of rotation of angulation (CORA) and extent of the majority of deformities, however distal femoral deformity is difficult to assess because of the difference between anatomic and mechanical axes. We found the described technique involving constructing a line perpendicular to a line from the tip of the greater trochanter to the centre of the femoral head inaccurate, particularly if the trochanter is abnormal. We devised a novel technique which accurately determines the CORA and extent of distal femoral deformity, allowing accurate correction. Using standard leg alignment views of the normal femur, the distal femoral metaphysis and joint line are stylized as a block. A line bisecting the axis of the proximal femur is then extended distally to intersect the joint. The angle (Θ) between the joint and the proximal femoral axis and the position (p) where the extended proximal femoral axis intersects the joint line are calculated. These measurements can then be reproduced on the abnormal distal femur in order to calculate the CORA and extent of the deformity, permitting accurate correction. We examined the utility and reproducibility of the new method using 100 normal femora. Θ = 81 ± sd 2.5. As expected, Θ correlated with femoral length (r=0.74). P (expressed as the percentage of the distance from the lateral edge of the joint block to the intersection) = 61% ± sd 8%. P was not correlated with Θ. Intra-and inter-observer errors for these measurements are within acceptable limits and observations of 30-paired normal femora demonstrate similar values for Θ and p on the two sides. We have found this technique to be universally applicable and reliable in a variety of distal femoral deformities.
Lower limb mal-alignment due to deformity is a significant cause of early degenerative change and limb dysfunction. Standard techniques are available to determine the centre of rotation of angulation (CORA) and extent of the majority of deformities, however distal femoral deformity is difficult to assess because of the difference between the anatomic and mechanical axes. We have found the described technique involving constructing a line perpendicular to a line from the tip of the greater trochanter to the centre of the femoral head inaccurate, particularly if the trochanter is abnormal. We have devised a novel technique which accurately determines the CORA and extent of distal femoral deformity, allowing accurate correction. Using standard leg alignment views of the normal femur, the distal femoral metaphysis and joint line are stylised as a block. A line bisecting the axis of the proximal femur is then extended distally to intersect the joint. The angle (𝛉) between the joint and the proximal femoral axis and the position (p) where the extended proximal femoral axis intersects the joint line are calculated. These measurements can then be reproduced on the abnormal distal femur in order to calculate the CORA and extent of the deformity, permitting accurate correction. We have examined the utility and reproducibility of the new method using one hundred normal femurs. Θ=81+/− sd 2.5°. As expected, 𝛉 correlated with femoral length (r=0.74). P (expressed as the percentage of the distal from the medial edge of the joint block to the intersection) = 61% +/− sd 8%. P was not correlated with 𝛉. Intra-and inter-observer errors for these measurements are within acceptable limits and observations of twenty paired normal femora demonstrate similar values for 𝛉 and p on the two sides. We have employed this technique in a variety of distal femoral deformities, including vitamin D resistant rickets, growth arrest, fibula hemimelia, post-traumatic deformity and Ellis-van Creveld syndrome. We find the system universally applicable and reliable.
