Total elbow arthroplasty (TEA) has been shown to be a treatment option for elderly patients with complex distal humeral fractures and osteoporotic bone. The published results have often included rheumatoid patients who traditionally would be expected to do well from elbow arthroplasty. Only short-term results have been published using this technique in
Aim: Stainsby and Briggs described a procedure for the correction of þxed claw toes. We studied the results of the Stainsby procedure in
Aims. Plate and screw fixation has been the standard treatment for painful conditions of the wrist in
We performed posterior fixation with a Hartshill-Ransford contoured loop in 43 patients with instability at the craniocervical junction. No external bracing was used. Fifteen patients had congenital malformations, ten had tumours, seven had 'bone-softening' conditions (such as osteogenesis imperfecta), five had suffered complicated fractures, three had occipito-C1-C2 hypermobility due to lax ligaments and three had severe degenerative spondylosis with pseudotumours of the transverse ligament. Twenty-nine patients had transoral decompression of the cord before fixation. In most cases, cancellous bone grafts taken from the iliac crest were used to induce fusion; in nine very ill patients, no bone graft was used. In the whole series there was no instance of construct failure, broken wire or laminar fracture. The best results were achieved in patients with tumours or bone-softening conditions. No patient with normal neurology deteriorated after surgery but seven had worse neurological deficits after operation than before. Neck stiffness caused half the patients to change their lifestyle.
Aims. To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. Methods. A total of 40 patients suffering from
Aims. We review our experience of Coonrad-Morrey total elbow arthroplasty
(TEA) for fractures of the distal humerus in
Total elbow arthroplasty (TEA) has been shown to be a treatment option for elderly patients with complex distal humeral fractures and osteoporotic bone. The published results have often included rheumatoid patients who traditionally would be expected to do well from elbow arthroplasty. Only short-term results have been published using this technique in
Claw toes are treated by a variety of soft tissue and bony proceduresbased on the severity of the deformity. We evaluated the results of Stainsby procedure for claw toes. This is a retrospective analysis of the results of Stainsby procedure for claw toes of the foot done by a single surgeon over a 10 year period. All patients who had claw toes,secondary to Rheumatoid and Non rheumatoid causes and treated by this procedure were included in the study. All the patients operated between Jan 1995 -Dec 2004 and who had minimum follow-up of 6 months after surgery were included in the study. Follow up evaluation was by clinical examination, review of case notes and telephone conversation. 42 patients underwent this procedure of which 38 were available for evaluation. Average follow-up was 43.5 months (6–110months). 26 rheumatoid and 21
Claw toes are treated by a variety of soft tissue and bony proceduresbased on the severity of the deformity. We evaluated the results of Stainsby procedure for claw toes. This is a retrospective analysis of the results of Stainsby procedure for claw toes of the foot done by a single surgeon over a 10 year period. All patients who had claw toes, secondary to Rheumatoid and Non rheumatoid causes and treated by this procedure were included in the study. All the patients operated between Jan 1995 -Dec 2004 and who had minimum follow-up of 6 months after surgery were included in the study. Follow up evaluation was by clinical examination, review of case notes and telephone conversation. 42 patients underwent this procedure of which 38 were available for evaluation. Average follow-up was 43.5 months (6–110months). 26 rheumatoid and 21
Introduction: The literature regarding the functional outcome following C1–C2 surgeries for
The February 2023 Wrist & Hand Roundup360 looks at: ‘Self-care’ protocol for minimally displaced distal radius fractures; Treatment strategies for acute Seymour fractures in children and adolescents: including crushed open fractures; Routinely collected outcomes of proximal row carpectomy; Moving minor hand surgeries in the office-based procedure room: a population-based trend analysis; A comparison between robotic-assisted scaphoid screw fixation and a freehand technique for acute scaphoid fracture: a randomized, controlled trial; Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger; Two modern total wrist arthroplasties: a randomized comparison; Triangular fibrocartilage complex suture repair reliable even in ulnar styloid nonunion.
We performed distal chevron osteotomy of the second, third, or fourth metatarsal for painful plantar callosities in 19
Introduction We report the experience of a district general hospital foot and ankle service, in performing a modified excision arthroplasty and tendon transfer to the metatarsophalangeal (MTP) joints of the lesser toes in both rheumatoid and
Introduction: Deep infection continues to be the first most important early complication in knee arthroplasty. It is usual to apply standard prophylaxis to all patients, but it is not usual to use special measures in those of them who present a higher risk. Moreover, sometimes these patients are even not identified. Purpose: To analyse statistically significant risk factors for deep infection in patients with a knee arthroplasty. Patients and Methods:. Design: Case-control study. Observational and retrospective comparison of incidence or prevalence of all risk factors described in the literature. These factors have been classified according to the period of risk in: epidemiologic; pre, intra and postoperative; and distant infections. Case series: 32 consecutive patients with a deeply infected knee arthroplasty operated in the same Department of a University General Hospital. Control series: 100 randomly selected patients, operated in the same hospital and period of time, with no deep infection in their knee arthroplasty along follow-up. Pearson was used for comparison of qualitative variables and ANOVA for quantitative ones. Results: The following risk factors were significantly more frequent (p<
0.05) in the patients with an infected knee arthroplasty:. Preoperative conditions: previous surgery in the same knee (25% vs 9%), chronic therapy with glucocorticoids (19% vs 4%), immunosuppressive treatments (16% vs 3%), and
Pre-revision detection of infection in failed total joint replacements (TJR) is essential to allow appropriate management planning. Unfortunately, low-grade infection is often difficult to detect. The use of molecular biology may offer increased sensitivity in this setting. We have analysed the use of the Polymerase Chain Reaction (PCR) to diagnose infection in pre-operative aspirates in a group of patients undergoing revision arthroplasty. We prospectively tested 50 aspirates in 50 patients with failed TJR (34 hips and 16 knees). Antibiotics were omitted for 2 weeks prior to aspiration. The aspirate was sent for microbiological culture in aerobic and anaerobic conditions. An aliquot was retained for PCR analysis which involved DNA extraction then amplification of an 882 base pair segment of the Universal 16S RNA gene. In 33 patients who subsequently underwent revision arthroplasty multiple specimens were taken from around the joint for microbiological and histological examination and the presence or absence of pus was noted. The patient was deemed to be infected if one of these criteria was found: 2 or more intra-operative cultures positive for the same organism; an acute inflammatory response on histology; pus in the joint at revision . 1. . PCR was positive in 29 cases. Aspiration microbiology was positive in 13 cases. Of the 33 cases revised, 15 patients were deemed to be infected using the previously established criteria, described above. Compared to preoperative aspiration microbiology PCR had a sensitivity of 92% and specificity of 54%. Compared to the published criteria for infection, PCR was 93% sensitive and 61% specific. If rheumatoid cases are excluded the specificity improves to 71%. It was concluded that PCR has the ability to amplify very small amounts of target DNA. The apparently high false positive rate compared to aspiration microbiology may indicate that PCR is picking up DNA from contaminating or non-viable organisms (treated or phagocytosed), giving poor specificity. However, microbiology is known to have poor sensitivity on pre-operative aspiration samples, and some of the microbiology results may be false negative. Compared to the criteria for infection after revision our results for PCR are more encouraging, especially for
The February 2014 Wrist &
Hand Roundup360 looks at: simple debridement and ulnar-sided wrist pain; needle fasciotomy or collagenase injection; joint replacement in osteoarthritic knuckles; the Mannerfelt arthrodesis; scaphoid union rates with conservative treatment; the benefits of atorvastatin for muscle re-innervation after sciatic nerve transection; and complications of trapeziectomy.
Little is known about the long-term outcome of
mobile-bearing total ankle replacement (TAR) in the treatment of end-stage
arthritis of the ankle, and in particular for patients with inflammatory
joint disease. The aim of this study was to assess the minimum ten-year
outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent
surgery between 1988 and 1999. No patients were lost to follow-up.
At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients
(39 TARs) had died and the original TAR remained Cite this article:
The Motec cementless modular metal-on-metal ball-and-socket
wrist arthroplasty was implanted in 16 wrists with scaphoid nonunion
advanced collapse (SNAC; grades 3 or 4) and 14 wrists with scapholunate
advanced collapse (SLAC) in 30 patients (20 men) with severe (grades
3 or 4) post-traumatic osteoarthritis of the wrist. The mean age of
the patients was 52 years (31 to 71). All prostheses integrated
well radiologically. At a mean follow-up of 3.2 years (1.1 to 6.1)
no luxation or implant breakage occurred. Two wrists were converted
to an arthrodesis for persistent pain. Loosening occurred in one
further wrist at five years post-operatively. The remainder demonstrated close
bone–implant contact. The clinical results were good, with markedly
decreased Disabilities of the Arm Shoulder and Hand (DASH) and pain
scores, and increased movement and grip strength. No patient used
analgesics and most had returned to work. Good short-term function was achieved using this wrist arthroplasty
in a high-demand group of patients with post-traumatic osteoarthritis.
In a prospective randomised study 31 patients were allocated to either arthrodesis or Mayo resection of the first metatarsophalangeal joint as part of a total reconstruction of the rheumatoid forefoot. Of these, 29 were re-examined after a mean of 72 months (57 to 80), the Foot Function Index was scored and any deformity measured. Load distribution was analysed using a Fscan mat in 14 cases, and time and distance were measured in 12 of these patients using a 3D Motion system. We found excellent patient satisfaction and a significant, lasting reduction of the Foot Function Index, with no statistically significant differences between the groups. There were no significant differences in recurrence of the deformity, the need for special shoes, gait velocity, step length, plantar moment, mean pressure or the position of the centre of force under the forefoot. The cadence was higher and the stance phase shorter in the fusion group. These results suggest that a Mayo resection may be an equally good option for managing the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot.