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Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_8 | Pages 13 - 13
1 Jun 2015
Ramakrishna S Leslie D Vijayaraghavan J Clarke H
Full Access

Corail implants have shown to give good results in elective total hip replacements (THR) and in hemi-arthroplasties. Pre-operative planning to identify the correct size of the Corail implant is vital for good post-operative outcomes. An undersized implant can lead to subsidence. The aim of the study was to review the incidence of subsidence. Post-operative radiographs of trauma patients (n=39) and elective (n=45) patients who had Corail femoral implants were reviewed. The implant-to-canal (I:C) ratio were calculated at the given 50% and 70% levels of the Corail implant. Follow up radiographs were reviewed to identify subsidence. The average age of patients was 80.3 years (range 66–93 years) in hemi-arthroplasties and 61 years (range 18–88) in elective THRs. The implant to canal (I:C) ratio at the 50% and 70% levels in trauma patients were 0.77 (range 0.54 – 0.97) and 0.81 (range 0.59 – 0.94) respectively. In elective patients, the ratios at the 50% and 70% marks were 0.77 (range 0.57 – 0.98) and 0.81 (0.56 – 0.95). One case of subsidence was seen in a collarless implant and I:C ratios at 50% and 70% were 0.57 and 0.56. A larger study is required to determine the reliability of this novel ‘implant:canal’ ratio to predict incidence.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_9 | Pages 4 - 4
1 May 2014
Ramakrishna S Lupton C HAND C Stapley S
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The use of external fixation in the management of long bone fractures has long been recognised.

The aim of this study was to compare 3 differing constructs of Hoffman-2 and Hoffman-3 External Fixator systems to assess which potentially withstood the greatest load.

Three different constructs (2, 3 and 4-bar) of Hoffman 2 and 3 External Fixation systems were tested. A UHMWPE tube was utilised as a bone substitute to construct a biomechanically reproducible model which could be tested on an MTS testing jig. Each construct was loaded to 3, 5, 8, 12 and 15mm of displacement at the fracture gap. Each construct was cyclically loaded 200 times for each test and repeated 5 times.

The results demonstrate that the Hoffman-3 configurations withstood a load of at least twice that of the Hoffman 2 configurations across all displacements. Using a 2-way ANOVA test at all displacements the 2-bar configuration withstood greater load than the 3 bar (P<0.0001). With Hoffman 2 the 2-bar configuration withstood a greater load than the 4 bar diamond configuration.

These results demonstrate that Hoffman-3 External Fixation Device has a greater axial loading capacity than its Hoffman-2 predecessor.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXII | Pages 26 - 26
1 Jul 2012
Ramakrishna S Moras P Jowett A Hodkinson S Lasrado I Hand C
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We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hind-foot problems - the Portsmouth experience with the Ilizarov ring fixator.

11 patients underwent ankle and hind-foot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR).

All patients had undergone multiple previous surgeries, which had failed. There were 8 males and 3 females in this group. Average age of the patients was 58 (43 years – 77 years) Mean follow up was 36 months (7 – 60 months). Mean frame time was 24 weeks (15 – 36 weeks). BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores - EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hind-foot nail. All patients were satisfied with their overall improvement in pain and function.

We conclude that this is an effective salvage technique for complex ankle and hind-foot problems in patients with impaired healing potential, insufficient bone stock and progressive deformity.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 383 - 383
1 Jul 2010
Ramakrishna S Ahuja S
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Introduction: Spinal surgical procedures are associated with significant morbidity. It is vital the patients are aware of the potential complications and the implications. The General Medical Council published guidelines regarding consent in June 2008.

Aim: To examine the adequacy for consenting for spinal surgical procedures and focussing on documentation of serious risks.

Methods: Case notes of seventy consecutive patients who had undergone spinal surgery were retrospectively reviewed. The consent forms were examined for documented procedures, complications, grade of the consenting member and timing of the consent.

Results: The documented procedure on the consent form and the operation sheet matched in all seventy cases (100%). Consent was taken by the consultant in 50% of the patients, 30% were consented by middle grade doctors and 20% were consented by the junior doctor. The consenting person was present at the procedure in 63% of the cases. Sixty percent (60%) of the patients were consented in the pre-admission clinic, 23% were consented on the day before the procedure and 17% were consented on the day of the procedure. Common and serious complications such as infection (84%), bleeding (76%), pain (67%), bladder and bowel problems (84%), paralysis (70%) and nerve root damage (67%) were clearly documented.

Conclusion: Two-thirds of the patients are given adequate information to obtain informed consent in the pre-admission clinic. Majority of the patients are aware of the common and the serious risks associated prior to the procedure.

Interests: None

Ethics approval: None