header advert
Results 1 - 4 of 4
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_7 | Pages 11 - 11
1 May 2015
Punwar S Fick D Khan R
Full Access

We identified 26 tibial tubercle osteotomies (TTOs) performed in 23 revision knee arthroplasties between 2009 and 2013. Average age at last operation was 66 (33–92). Mean follow-up period was 14 months (3–33).

Eleven TTOs were performed in 10 knees for single stage revisions and 15 TTOs were performed in 13 knees for 2 stage revisions in the setting of deep infection. In this infected subset 11 patients had a TTO performed at the first stage. This osteotomy was left unfixed to avoid leaving metalwork in a potentially contaminated wound, reopened, and then definitively secured with screws at the second stage. Our technique involves fashioning a long 7×1cm tibial tuberosity osteotomy without a proximal step-cut.

All osteotomies united with no fractures. Minor proximal migration was noted in one case associated with screw loosening. There was no proximal migration noted in the 2 stage cases where the osteotomy had been left initially unfixed. There were no extensor lags.

We conclude that TTO is a safe and reproducible procedure when adequate exposure cannot be obtained in revision knee arthroplasty. In 2 stage revisions sequential osteotomies does not decrease union rates and leaving the osteotomy unfixed after the first stage does not cause any issues.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_7 | Pages 12 - 12
1 May 2015
Huijbregts H Punwar S McMurray D Sorensen E Fick D Khan R
Full Access

Eligible patients were randomly allocated to PMI or standard intramedullary jigs. Smith and Nephew's patient specific cutting blocks (Visionaire) were used for PMI. Postoperative component positioning was investigated using the ‘Perth CT protocol’. Deviation of more than 3° from the recommended position was regarded as an outlier. Exact Mann-Whitney U test was used to compare component positioning and difference in proportion of outliers was calculated using Chi Squared analysis.

Fifty-five knees were enrolled in the standard instrumentation group and fifty-two knees in the PMI group.

Coronal femoral alignment was 0.7 ± 1.9° (standard) vs 0.5 ± 1.6° (PMI) (P=0.33). Outliers 9.4% vs 7.4% (P=0.71). Coronal tibial alignment was 0.4 ± 1.5° (standard) vs 0.6 ± 1.4° (PMI) (P=0.56). Outliers 1.9% vs 1.9% (P=0.99). Sagittal femoral alignment was 0.6 ± 1.5° (standard) vs 1.3 ± 1.9° (PMI) (P=0.07). Outliers 3.8% vs 13.2% (P=0.09). Tibial slope was 1.7 ± 1.9 ° (standard) vs 1.8 ± 2.7° (PMI) (P=0.88). Outliers 13.2% vs 24.1% (P=0.15). External rotation of femoral component was 0.6 ± 1.4° (standard) vs 0.2 ± 1.8° (PMI) (P=0.14). Outliers: 3.8% vs 5.6% (P=0.66).

Compared to standard intramedullary jigs, patient matched instrumentation does not improve component positioning or reduce alignment outliers.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 129 - 129
1 Sep 2012
Punwar S Robinson P Blewitt N
Full Access

Aim

The present study aimed to assess the accuracy of preoperative departmental ultrasound scans in identifying rotator cuff tears at our institution.

Methods

Preoperative ultrasound scan reports were obtained from 64 consecutive patients who subsequently underwent arthroscopic subacromial decompression and/or rotator cuff repair. Data was collected retrospectively using our 2010 database. The ultrasound reports were compared with the arthroscopic findings. The presence or absence of partial and full thickness rotator cuff tears was recorded.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 50 - 50
1 Jan 2011
Punwar S Sidwell I Williams J
Full Access

In February 2007 an Electronic Emergency Board was introduced into the Orthopaedic Department at Musgrove Park Hospital. The aims of this system were to replace the often disorganized handwritten trauma white-board and improve multidisciplinary communication.

The electronic board can be accessed from any computer terminal in the hospital and a large plasma screen is kept permanently on display in the orthopaedic theatre corridor. Emergency admissions are added by the on-call registrar before the morning trauma meeting and during the day the board is managed by our Trauma Coordinator.

We performed an informal survey of orthopaedic trauma departments in the South West region to ascertain current practices for organizing the trauma workload.

In summary we have introduced an electronic system for the organising and recording of all our trauma cases. We have found this system extremely beneficial to the smooth running of the orthopaedic trauma service.