Purpose: The treatment of large osteochondral lesions of the talus (OLT) remains a challenge. Fresh Osteo-chondral Allograft is a method that has been used for the treatment of larger lesions, with the advantage of transplanting living cartilage that is biologically attached to the subchondral bone. The purpose of this clinical series is to prospectively review the clinical and radiographic outcomes of patients that have undergone a Fresh Osteochondral Allograft.

Method: Between January 2003 and January 2007, 17 feet in 8 male and 8 female patients at a mean age of 35.8 (15–53) years underwent fresh osteochondral talar allo-grafting by a single surgeon. Data was prospectively collected, including preoperative and postoperative AOFAS, AOS, AAOS foot & ankle worksheets and SF-36 scores. Statistical analysis consisted of one tailed student T-test with alpha set a 5%. All patients were followed up clinically and radiographically by x-ray and CT scan.

Results: Average follow up was 3.2 (0.9–6.2) years. All scoring systems showed significant improvement postoperatively, except for AAOS shoe comfort scores, and the Mental Component Summary of the SF-36 questionnaire. The AOFAS score improved significantly (p=0.0001) from a mean score of 53.4 (30–71) to 86.3 (72–96). AOS pain scores improved significantly (p=0.0053) from a mean score of 45.4 (8.7–72.2) to 24.1 (4.2–58.9). AOS disability score improved significantly (p=0.0013) from a mean of 53.8 (7.8–77.3) to 25.9 (6.6 – 62.5). The AAOS foot & ankle core scale (standardized mean) improved significantly (p=0.0015) from a mean of 52.3 (21–81) to 80.1 (56–99). The AAOS foot & ankle core scale (normative score) improved significantly (p=0.0016) from a mean of 16.9 (−9 to 40) to 39.5 (20–55). The SF-36 Physical Component Summary improved significantly from a mean of 34.9 (24.2–43.8) to 47.3 (36.6–59.8). There was successful osseous graft incorporation in 16/17 feet (94%) verified on CT scan. Of the 16 grafts which had successfully incorporated, radiographic follow up showed 4/16 feet (25%) had signs of progressive OA and 3/16 feet (19%) had developed new osteolysis around the graft.

Conclusion: Although patients’ functional outcome can be substantially improved with the use of fresh osteochondral allografts the early radiographic findings are of concern with 43% demonstrating progression of arthritis or osteolysis of the graft during the process of graft incorporation.

Introduction: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation.

We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels.

Methods: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients.

Results: At presentation this group had a mean age of 30.7 yrs (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metal-ware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 min, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days).

Questionnaires were returned by 29 of 34 patients at a mean of 3 years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 wks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia.

Discussion: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow up and no major complication was encountered.

INTRODUCTION: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation.

We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels.

METHODS: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients.

RESULTS: At presentation this group had a mean age of 30.7 years (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metalware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 minutes, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days).

Questionnaires were returned by 29 of 34 patients at a mean of three years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 weeks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia.

DISCUSSION: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow-up and no major complication was encountered.

Aim: To study the results of a percutaneous suture technique for the management of acute ruptures of the Achilles’ tendon.

Method: Ten patients with acute Achilles’ tendon rupture were entered into the study. We utilised a percutaneous surgical technique and functional post-operative regime described in the current literature.

Results: All were recreational sports people with an average age of 42.9 years. At an average follow-up of six months there were no re-ruptures, no wound complications, no sural nerve injuries, and no episodes of deep vein thrombosis. No patient had any discomfort during normal walking. In comparison to the uninjured side, there was still a mild reduction in calf circumference but minimal deficits in endurance, strength or range of motion.

Conclusions: The technique was easily performed and overall the treatment appeared to have very high patient acceptance and low morbidity. The well described benefits of early mobilisation were evident.