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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_7 | Pages 9 - 9
8 May 2024
Widnall J Tonge X Jackson G Platt S
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Background

Venous Thrombo-Embolism is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers, frequently for long time periods. To our knowledge there is no literature stating the prevalence of VTE in patients undergoing TCC. We perceive that neuropathic patients with active charcot have other risk factors for VTE which would predispose them to this condition and would mandate the use of prophylaxis. We report a retrospective case series assessing the prevalence of VTE in the patients being treated with TCCs.

Methods

Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_2 | Pages 23 - 23
10 Feb 2023
Silva A Walsh T Gray J Platt S
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Swelling following an ankle fracture is commonly believed to preclude surgical fixation, delaying operative treatment to allow the swelling to subside. This is in an attempt to achieve better soft tissue outcomes. We aim to identify whether pre-operative ankle swelling influences postoperative wound complications following ankle fracture surgery.

This is a prospective cohort study of 80 patients presenting to a tertiary referral centre with operatively managed malleolar ankle fractures.

Ankle swelling was measured visually and then quantitatively using the validated ‘Figure-of-eight’ technique. Follow-up was standardised at 2, 6, and 12 weeks post-operatively. Wound complications, patient co-morbidities, operative time, surgeon experience, and hospital stay duration were recorded.

The complication rate was 8.75% (n=7), with 1 deep infection requiring operative intervention and all others resolving with oral antibiotics and wound cares. There was no significant difference in wound complication rates associated with quantitative ankle swelling (p=0.755), visual assessment of ankle swelling (p=0.647), or time to operative intervention (p=0.270).

Increasing age (p=0.006) and female gender (p=0.049) had a significantly greater probability of wound complications. However, BMI, smoking status, level of the operating surgeon, and tourniquet time were not significantly different.

Visual assessment of ankle swelling had a poor to moderate correlation to ‘Figure-of-eight’ ankle swelling measurements ICC=0.507 (0.325- 0.653).

Neither ankle swelling nor time to surgery correlates with an increased risk of postoperative wound complication in surgically treated malleolar ankle fractures. Increasing patient age and female gender had a significantly greater probability of wound infection, irrespective of swelling. Visual assessment of ankle swelling is unreliable for quantifying true ankle swelling.

Operative intervention at any time after an ankle fracture, irrespective of swelling, is safe and showed no better or worse soft tissue outcomes than those delayed for swelling.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_13 | Pages 11 - 11
1 Jun 2016
Howard N Fazakerley SB Widnall J Harvey D Platt S Jackson G
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We aim to demonstrate the value of deep tissue biopsies to guide antimicrobial treatment of diabetic ulcers. Some recent studies have advocated the role of superficial swabs to guide antibiotic treatment in comparison to deep tissue biopsies previously perceived as the gold standard of microbiology diagnosis. We performed a retrospective analysis of microbiology culture results of patients with infected diabetic ulcers comparing superficial versus deep biopsy microbiology results.

Forty-one diabetic ulcers in 41 patients were included. The mean numbers of isolates from soft tissue and bone biopsies were 2.1 and 1.8 respectively. 39/41 combined soft tissue and bone biopsies were culture positive. The most prevalent organism seen in deep samples was Staphylococcus aureus (14) followed by anaerobes (9), and enterococcus (9). In superficial swab cultures 21 patients (51%) cultured non-specific, mixed skin flora and enteric species. The remaining 20 patients cultured Staphylococcus aureus (11), Streptococcus (6), Pseudomonas (2) and anaerobes (6).

Three superficial swabs matched deep tissue biopsy cultures. 16 deep biopsies grew organisms seen none specifically in superficial swab cultures with 22 deep tissue biopsies cultures growing organisms not seen on superficial swab with 8 being anaerobes.

We have shown that in 54% of cases, deep tissue cultures isolated organisms that were not grown by superficial swab cultures. We highlight the importance of deep tissue biopsies to guide effective treatment.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 33 - 33
1 Nov 2014
Brookes-Fazakerley S Howard N Harvey D Platt S Jackson G
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Introduction:

Diabetic ulcer superficial swab cultures have a low specificity for guiding antibiotic treatment. Some studies have recently re-assessed and advocated the role of superficial swabs. We have performed an analysis of microbiology results in patients with infected diabetic ulcers to further appraise the need for using deep tissue cultures as a guide for antimicrobial treatment.

Methods:

We reviewed 23 consecutive diabetic patients in 2013. All patients underwent investigation and treatment by the Orthopaedic department for deep, intractable diabetic ulceration. Microbiology culture results from superficial swabs were compared to deep tissue and bone biopsies.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 22 - 22
1 Jan 2014
Cowan C Ahluwalia R Howard N Hennessy M Platt S
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Informed consent is integral to good-practice. It protects the patient and offers proof of discussion and interaction between the surgeon and the patient. We compare efficacy of last clinic consent, specialised consent clinic with or without provision of patient specific literature.

Group A patients underwent written consent at their last outpatient clinic and conformation of consent on the morning of surgery. Group B underwent consent in designated pre-admission clinic in the week prior to surgery. Group (C) attended the same preadmission clinic and were provided with a surgeon dictated written explanation of their surgery and particular risks. This included a explanation of the procedure, complications, risks and rewards in layman's terms, aimed at patients with a reading age of 14 years, with advice concerning alternative procedures and the consequences of taking no action. The risks are graded: common, less common and rare.

All patients undertook a pre-surgery questionnaire on the morning of surgery by an independent observer prior to any contact with the surgical team. Questions focused on their planed procedure, post-operative instructions and possible complications in order to assess the recall of the consent process. A VAS-scale was added to assess overall satisfaction. Statistical analysis was undertaken by a T-test.

In total 162-patients were assessed, the response rate was 68.5% (n=111). In-group A (n=16) 18.8% patients remembered 3 relevant complications, 56.2% recalled their post-operative considerations their overall satisfaction was 4/10. In-group B (n=57) 45.5% remembered three complications, 63.7% recalled their postoperative considerations and had a patient satisfaction of 5/10. In-group C (n=38) 48.3% remembered three complications, and 70.7% recalled postoperative considerations, the overall satisfaction improved to 6/10.

We observed that the consent process is improved by the use of routine pre-operative consent clinics; however the addition of patient specific literature is observed to further improve recall and satisfaction.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 13 - 13
1 Jan 2013
Williams G Widnall J Evans P Platt S
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Introduction

Literature in respect to the MRI appearances of surgically confirmed spring ligament pathology is sparse. The authors conducted a retrospective review of MRI examinations comprising 13 patients with surgically proven spring ligament abnormality.

Methods

Records for operations performed for planovalgus foot deformity with operation notes confirming presence of spring ligament abnormality were obtained for patients treated 2010–11. Of 32 procedures 13 patients (3 male, 10 female) mean age 48.5 (range, 21–86 years) underwent preoperative MRI scanning using a standard musculoskeletal protocol on a T1.5 unit. Scans were retrospectively reviewed by one of the senior authors and consultant musculoskeletal radiologist for pathological findings.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 16 - 16
1 Jan 2013
Mahmood A Shivarathre D Platt S Hennessy M
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Background

Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency.

Methods

We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 57 - 57
1 May 2012
Mahmood A Shivarathre D Platt S Hennessy M
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Background

Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency.

Methods

We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 56 - 56
1 May 2012
Fursdon T Platt S
Full Access

Injuries to the lateral ligamentous complex of the ankle are common. The most commonly injured ligament is the anterior talofibular ligament (ATFL) followed by the calcaneofibular ligament (CFL). The posterior talofibular ligament (PTFL) is less commonly injured. There are few studies reporting the incidence of PTFL injury and less data available which describes the significance of this injury. We aim to establish an incidence of PTFL injury and allude to the possible significance of such an injury.

Methods

A retrospective review of patient notes and magnetic resonance (MR) scans dating from September 2007 to present day was undertaken. Patients complaining of acute or chronic ankle pain, swelling, and instability were included in the study. Exclusion criteria consisted of patients that had undergone previous surgery to the ankle. Routine MR was performed on all patients with oblique axial, coronal and sagittal views taken.

Results

312 patients were included in the study. The incidence of PTFL injury was 10.9%. The PTFL never ruptured in isolation. In 12.3% of patients the PTFL had ruptured with the ATFL and in 28.6% of patients it had ruptured with the CFL. Osteochondral defects were also present in the majority of patients with PTFL failure (57.1%).


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 310 - 311
1 Jul 2011
Shivarathre D Chandran P Ralte P Platt S
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Introduction: Controversy exists in the surgical treatment of unstable ankle fractures in the very elderly age group of over 80 years. Operative fixation in these cases is challenging and the postoperative mortality and morbidity has discouraged surgical intervention in this population. However, the literature regarding the prognosis of surgery in this elderly group is very limited. The purpose of our study was to describe the results of 92 patients aged above 80 years, who underwent operative fixation for unstable ankle fractures.

Methods: 92 consecutive patients aged above eighty years of age had open reduction and internal fixation for unstable ankle fractures during the period of January 1998 – August 2007. The data was collected retrospectively from the case records and radiographs. A standard postoperative rehabilitation programme was followed. The complications were noted and the risk factors for poor prognosis were analysed.

Results: There were 80 women and 12 men in the study. The average age was 85.2 (Range 80.1 – 95.1 yrs). The minimum duration of follow up was 9 months. The superficial wound infection rate was 7% (6 cases) and the deep infection rate was 4.6% (4 cases). The 30 day postoperative mortality was 5.4 % (5 cases). 86 % (75 out of 87 cases) were able to return back to their pre injury mobility at the last follow-up. Diabetes, dementia, peripheral vascular disease and smoking were found to be statistically significant risk factors associated with wound complications. Patient with 2 or more risk factors is 5 times more likely to have wound infection.

Conclusion: The results of operative fixation of unstable ankle fractures are very encouraging with majority of patients returning to pre injury mobility status.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 590 - 591
1 Oct 2010
Shivarathre D Chandran P Platt S
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Introduction: Operative fixation of unstable ankle fractures is a well recognised form of management. However controversy exists in the surgical treatment of unstable ankle fractures in the very elderly age group of over 80 years. Operative fixation in these cases is challenging and the postoperative mortality and morbidity has discouraged surgical intervention in this population. However, the literature regarding the prognosis of surgery in this elderly group is very limited. The purpose of our study was to describe the results of 85 patients aged above 80 years, who underwent operative fixation for unstable ankle fractures.

Methods: 92 consecutive patients aged above eighty years of age had open reduction and internal fixation for unstable ankle fractures during the period of January 1998 – August 2007. The data was collected retrospectively from the case records and radiographs. The mechanism of injury, fracture pattern, and medical co morbidities were recorded. A standard postoperative rehabilitation programme was followed. 5 patients were excluded as complete medical records were unavailable. The clinical and radiological outcomes following surgery were recorded and analysed in detail. The complications were noted and the risk factors for poor prognosis were analysed.

Results: There were 71 women and 16 men in the study. The most common fracture pattern was pronation external rotation type. The average age was 85.2 (Range 80.1 – 95.1 yrs). The minimum duration of follow up was 9 months. The superficial wound infection rate was 5.7% (5 cases) which settled with oral antibiotic treatment for 1–2 weeks. The deep infection rate was 4.6% (4 cases) which required surgical debridement and implant removal. The 30 day postoperative mortality was 4.6 % (4 cases). Most patients demonstrated radiological fracture union with medial malleolus possessing slightly a higher risk of non union. 88.1 % (74 out of 84 cases) were able to return back to their pre injury mobility at the last follow-up. Diabetes and smoking did not statistically influence the outcome of the surgery.

Conclusion: The results of operative fixation of unstable ankle fractures are very encouraging with good functional recovery and return to pre injury mobility status in most cases. The surgical fixation is technically challenging and careful attention must be given to the osteopenia and soft tissue factors.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 242 - 242
1 Mar 2010
Shivarathre DG Chandran P Platt S
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Introduction: Operative fixation of unstable ankle fractures is a well-recognised form of management. However controversy exists in the surgical treatment of unstable ankle fractures in the elderly age group, over 80 years. Operative fixation in these cases is challenging and the postoperative mortality and morbidity has discouraged surgical intervention. The literature regarding the prognosis of surgery in this elderly group is limited. The purpose of this study is to document the results of operative fixation of unstable ankle fractures in patients aged over 80 years of age.

Methods: Ninety-two consecutive patients aged above 80 underwent open reduction and internal fixation of unstable ankle fractures during the period of January 1998 to August 2007. Five patients’ case records were unavailable for the study and they were therefore excluded. The data was collected retrospectively from the case records and radiographs. The clinical and radiological outcomes following surgery were recorded and analysed in detail. The complications were noted and the risk factors for poor prognosis were analysed

Results: The average age was 85.2 (range 80.1 – 95.1 yrs). The minimum duration of follow up was nine months. The superficial wound infection rate was 5.7% (5 cases). The deep infection rate was 4.6% (4 cases), three required surgical debridement. The 30-day postoperative mortality was 4.6 % (4 cases). 88.1 % (74 out of 84 cases) were able to return to their preinjury mobility at the last follow-up. Diabetes and smoking did not statistically influence the outcome of the surgery.

Conclusion: The results of operative fixation of unstable ankle fractures in this age group are encouraging with good functional recovery and return to preinjury mobility status in most cases.