Background

Symptomatic flexion deformity of proximal interpahalangeal joint (PIPJ) is one of the most common foot deformities and usually treated with arthrodesis. In general, percutaneous K-wires are used to stabilize the joint after excision of cartilage. K-wires projecting out of the toe need special care and can occasionally be dislodged accidentally. Furthermore issues such as cellulitis, pin tract infections, rarely osteomyelitis and need for removal make alternative fixation methods desirable. Smart toe is an intra-osseous titanium memory implant, which is stored frozen. It expands on insertion and does not require removal.

PURPOSE: The success of treatment for mucous cysts of the distal interphalangeal joints of the fingers has been widely variable. The aim of this study was to evaluate the results of surgical treatment of these cysts at our hand unit.

METHODS: Eighty one cysts were treated, with a mean follow up of 18 months(6–24 months). Thirty-one patients (25%) had nail ridging or deformity at presentation. All patients had surgical excision and joint debridement through a dorsal approach.

RESULTS: All patients who underwent surgery had evidence of osteoarthritis with osteophytosis at the time of surgery. No recurrences were noted. Nail ridging resolved after surgery in 55 (67%) digits; the remaining digits had partial improvement or persistent ridging. Five (6%) infections occurred and were treated successfully with antibiotics(4 cases) or debridement,(1 case).6 patients had increased stiffness of the joint and occasional pain or swelling noted in 8 (9.8%) cases.

CONCLUSIONS: Contrary to the published literature, the recurrence rate following excision and joint debridement is very low. Although some patients have decreased range of motion, pain is usually relieved. Some residual sypmtoms might be related to the underlying arthritic process rather than a complication of treatment.

Objectives: Minimally invasive hip arthroplasty (MIHA) has become a trend in last few years. The orthopaedic literature is deficient in well designed scientific studies to support the idea that MIHA provides superior outcomes compared with Total Hip Arthroplasty(THA) performed through standard incisions. We have attempted a comprehensive quantitative review of the published literature to assess the methodology of those studies and reported surgical outcomes.

Methods: We conducted a comprehensive literature search of different online databases. All relevant articles in peer-reviewed journals were retrieved except those not mentioning outcomes, case reports, review of literature and letters to editors. Two independent authors analyzed these articles for year of publication, type of study, patient numbers, surgical method, follow-up, complications and patient satisfaction. Each article was also graded using a validated methodology score; Coleman’s Ten Criteria to assess the quality of study.

Results: 38 studies met our inclusion criteria which contained a total of 6434 hip arthroplasties.78.5% (4031) of these were MIHAs. There was significantly less intra-operative blood loss with MIS technique. However no significant difference was noted between the two groups with respect to operating time, the mean length of hospital stay, pain score, dislocation and revision rates, neurological injury and incidence of peri-operative fracture. In addition the patient characteristics and surgeon experience had a significant effect on outcome. Scores were predominantly low for quality of the studies with patient numbers, follow up time and validated outcome measures being the weakest areas.

Conclusion: Minimally invasive hip arthroplasty is clearly in its infancy and continually evolving with new techniques and instruments being developed to treat a broader range of patients. At the present time there is still a lack of quality evidence to advocate its expansion. The better designed studies in fact suggest that it should perhaps be limited further to recognised expert centres. The complication rates and learning curve may be altered by changes in training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing the outcomes of these two procedures.

Background Open reduction and internal fixation for displaced intra-articular fractures of the calcaneum has become an established method of treatment. A recent randomised, controlled trial has questioned the benefits of surgery, in particular, pain relief.

Method We reviewed the cases undertaken in our department, complications which have arisen, and their treatment. We have devised a management plan in conjunction with the department of plastic surgery to minimise the effect of these complications. There were 124 procedures carried out over a 12-year period, 116 unilateral and 4 bilateral in 120 patients (106 males and 14 females, age range 18–66). Two further patients were included who had had surgery in another hospital and had been referred to our plastic surgery unit with significant wound complications.

The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted.

Results There were five major wound complications, three from our unit and two from another hospital. Infection was present in three cases. Four healed uneventfully but one of the infected group subsequently had a below knee amputation for refractory infection. Minor wound breakdown was more common. There was no association with haematoma or drainage but wound breakdown occurred more frequently in patients who smoked. Neurological complications were infrequent and temporary.

Conclusion This study confirmed that there is a significant morbidity associated with the surgical management of these fractures, although the vast majority of patients’ wounds healed uneventfully. With a sensible management plan, which involves working in conjunction with plastic surgeons, even major soft tissue complications may be addressed.

Introduction We report a modified technique using peroneus brevis for reconstruction of the anterior talofibular and calcaneo-fibular ligaments in the ankle for chronic instability.

Method The surgery was carried out using a double drill-hole in the distal fibula with either a complete or partial tendon graft. An examination under anaesthetic with ankle arthroscopy has been utilised to confirm the clinical diagnosis and assess the articular surfaces. In appropriate cases a translational os calcis osteotomy is added to correct varus hindfoot deformity.

Forty-five procedures were carried out over a 10-year period. The patients were retrospectively assessed with a case note review, and an updated clinical evaluation. The assessment focussed on pain, stability and impact on daily living.

Results Our results compare favourably with existing techniques for lateral ligament reconstruction, with most patients being satisfied with the improvement in pain relief and stability. These will be discussed in detail. Complications included superficial wound infections and sensory neurological symptoms. There were two failures following surgery both of which were associated with a high body mass index and joint laxity.

Conclusion This procedure provides anatomical reconstruction, is technically undemanding and gives adequate pain relief, stability and return to sporting activity. With careful patient selection, including treatment of intra-articular pathology and hindfoot deformity, it is a useful alternative to the methods currently available.