The assessment of the accuracy of reduction of the ankle syndesmosis has traditionally been made using plain radiographic measurements. Recent studies have shown that computerized tomography (CT) scan is more sensitive than radiographs in detecting diastasis. The ethos has now therefore shifted towards CT scan assessment of the syndesmosis. There is however no validated method to scan the syndesmosis and measure it on the CT scans. This exposes the patient to significant radiation risk and also to anxiety from inappropriate interpretation from these scans. The objectives of this research project are to investigate the current practice of CT scanning the syndesmosis at a University Hospital and to devise a new CT protocol to reduce radiation exposure to patients and to assist surgeons in interpreting the observations. Research Ethics Committee approval was obtained. Current practice was evaluated. A new 5 cut CT protocol was devised. Starting at the level of the distal tibial plafond, 5 cuts were made proximally 0.5 cm apart. Accuracy of the syndesmosis reduction was assessed just above the distal tibial plafond. Both the injured and the normal sides were scanned 12 weeks post surgery. The normal side served as a control.Introduction
Methods
Assess patient compliance with self-administration of subcutaneous low-molecular-weight-heparin (enoxaparin) injections for 14 days following knee replacement surgery. Consecutive patients undergoing knee replacement surgery during a 4-month period were identified from a database. All patients had been taught to self administer enoxaparin injections during their in patient stay and asked to self administer the remaining injections after discharge if feasible. Patients were then sent questionnaires designed to assess compliance.Objective
Methods
Patellofemoral replacement is an established intervention in selected patients with severe isolated patellofemoral osteoarthritis. FPV (Wright Medical, UK) is a third generation patellofemoral arthroplasty implant and is the second most used after AVON in National Joint Registry for England and Wales. Reports of survivorship and functional of this implant are scarce in literature. Evaluation of functional outcome and survivorship following FPV patellofemoral arthroplasty.Background
Aim
Injury to the syndesmosis occurs in approximately 10% of all patients with ankle fractures. Anatomic restoration of the syndesmosis is the only significant predictor of functional outcome. Several techniques of syndesmosis fixation are currently used such as cortical screws, bioabsorbable screws and more recently introduced suture-button fixation. No single technique has been shown to be superior to the others. The objective of this research project is to investigate whether treatment with a tightrope (suture-button fixation) gives superior results than the use of a cortical screw in the treatment of acute syndesmotic ankle injuries with regards to function, pain, satisfaction and return to normal activities. Research Ethics Committee approval was obtained. 40 patients with syndesmotic ankle injuries associated with diastasis were prospectively recruited, 20 in each group. Patients were randomized to one of the 2 groups. At 12 weeks, American Orthopaedic Foot and Ankle Society (AOFAS) scores and a computerized tomography (CT) scan of both the ankles was obtained. At 1 year, AOFAS scores and satisfaction was assessed. 32 patients have been recruited so far, 20 in the tightrope group and 12 in the cortical screw group. Mean AOFAS scores at 3 months post-op were 90.67 in the Tightrope group and 84 in the screw group. The difference was not significant (p= 0.096). CT scans revealed that the quality of syndesmosis reduction was equally good with both the techniques. Metalwork prominence was common with both the devices. Both the devices achieved good reduction of the syndesmosis. Our CT scan protocol has insignificant radiation risk and allows more accurate assessment of the syndesmosis. Early clinical results do not show a significant difference in the functional outcome with the use of either device. Long-term (1 year) follow-up has been planned.Discussion and Conclusion
We audited all patients who underwent Foot and Ankle surgery at the University Hospital of Wales over one financial year (April 2007 – March 2008). Patients were identified from the hospital OPCS-4 coding system and all scheduled and unscheduled visits to hospital investigated. Both trauma and elective patients were included. Patients were followed up for a mean period of 9 months (Range 1–14 months) following surgery. The records for 1052 patients were evaluated. Of these, 77% were elective cases and 23% were trauma related. Overall about 10 % of our foot and ankle patients (100/1052) either attended the A&
E Department or had an unplanned clinic visit at some stage of their follow up. Three quarters of these patients were admitted to hospital (median stay 1 day, range 1–51 days). Twenty five patients (24 A&
E; 1 medical) simply re-attended, but were not admitted. The majority of these (58%) had plaster-related problems (8\24) or superficial wound infections (6/24). The remaining patients presented with pain around the operated area, and were discharged after investigation. One patient presented to the physicians 44 days after excision of a Morton’s neuroma with a DVT. Seventy five patients (7%) were re-admitted to hospital. Two were admitted under the physicians: one with a pulmonary embolus (30 days post ORIF ankle) and one following a cardiac arrest (20 days post ORIF ankle). Out of the remainder 34 patients had planned removal of metalwork, 9 patients had metalwork removed because of infection and 21 patients had soft-tissue infection requiring antibiotics or debridement. Overall, 9 patients underwent revision surgery (0.85%). The overall infection and thromboembolic rate was 3.42 %(6 A&
E + 30 T&
O/1052) and 0.28% (1A&
E + 2 medical/1052) respectively.
Anatomical variation of Lisfranc mortise has been implicated in the susceptibility of Lisfranc fracture-dislocation. We investigated whether the variations in the dimensions of second metatarsal base makes the joint vulnerable to fracture dislocation.
