The condition known as delta phalanx (or longitudinally bracketed epiphysis) is a rare congenital anomaly first described in 1964. The deformity consists of a triangular bone with an epiphysis running along the shortened side of the phalanx in a proximal to distal direction, making longitudinal growth of the digit impossible. Isolated hallux varus congenitus due to a delta phalanx of the proximal
Aims. Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. Methods. Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding
Aims. The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Method. Patients admitted to hospital with an open fracture (excluding
This annotation reviews current concepts on the three most common surgical approaches used for proximal interphalangeal joint arthroplasty: dorsal, volar, and lateral. Advantages and disadvantages of each are highlighted, and the outcomes are discussed. Cite this article:
The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults. Phase 1 consisted of steps to identify potential outcome domains through systematic review of published studies, and exploration of the patient perspective through qualitative research, consisting of 25 semi-structured interviews and five focus groups. Phase 2 involved key stakeholder groups (patients, hand surgeons, and hand therapists) prioritizing the outcome domains via a three-round international Delphi survey, with a final consensus meeting to agree the final core outcome set.Aims
Methods
This study estimated trends in incidence of open fractures and the adherence to clinical standards for open fracture care in England. Longitudinal data collected by the Trauma Audit and Research Network were used to identify 38,347 patients with open fractures, and a subgroup of 12,170 with severe open fractures of the tibia, between 2008 and 2019 in England. Incidence rates per 100,000 person-years and 95% confidence intervals were calculated. Clinical care was compared with the British Orthopaedic Association Standards for Trauma and National Major Trauma Centre audit standards.Aims
Methods
The Trauma Triage clinic (TTC) is a Virtual Fracture clinic which permits the direct discharge of simple, isolated fractures from the Emergency Department (ED), with consultant review of the clinical notes and radiographs. This study details the outcomes of patients with such injuries over a four-year period. All TTC records between January 2014 and December 2017 were collated from a prospective database. Fractures of the radial head, little finger metacarpal, fifth metatarsal, toe
The objective of this study was to investigate how a new customizable light-curable osteosynthesis method (AdFix) compared to traditional metal hardware when loaded in torsion in an ovine phalanx model. Twenty-one ovine proximal
Introduction. Enchondromas located in the phalangeal bones may be more cellular than non-digital locations necessitating clinical and radiological correlation to determine diagnosis. Atypical enchondromas have increased cellularity and atypia relative to simple enchondromas but no evidence of permeation. Chondrosarcomas of the
Purpose of the study: Duplication of the thumb is the most common congenital anomaly of the first ray. The characteristic feature of type IV is the diversity of the clinical forms and the presence of certain complex forms particularly difficult to treat (Hung IVD). We propose a new procedure for reconstruction of IVD type thumb duplication. Material and method: This new procedure was used for thumb reconstruction in two boys with type IVD thumb duplication. Mean age at surgery was 10 months. Surgical technique. The future incisions were traced with a central skin resection removing the most hypoplastic nail entirely (generally the radial nail). At the bone level, a longitudinal osteotomy of the proximal
Suture anchors have changed the practice of repair of tendons in modern Orthopaedics. The purpose of the study was to identify the ideal suture anchor length for anchoring flexor digitorum profundus tendon to the distal phalanx. We dissected 395 distal
1. A seven-generation family is described which presented an autosomal dominant hereditary disorder characterised by brachydactyly, hypoplastic nails from the index to the little fingers, normal toe nails, absent middle
Normal digital flexion relies on flexor tendon pulleys to transmit linear muscular force to angular digital motion. Despite the critical role these pulleys play, there is a growing trend among surgeons to partially sacrifice or “vent” them during flexor tendon repair to improve surgical exposure. Although this new practice is reported to improve outcomes after flexor tendon repair, there is concern for the long-term effects of bowstringing, reduced finger range of motion (ROM) and altered tendon biomechanics. The objective of this study was to examine the effects of the application of a thermoplastic ring, acting as an “external” pulley, on flexor tendon biomechanics and finger ROM. We hypothesized that the application of an external thermoplastic ring would produce a centripetal force over the tendon to reduce bowstringing, improve finger ROM, and restore tendon loads following pulley venting. Twelve digits comprised of the index, long, and ring fingers from four cadaveric specimens were tested using a novel in-vitro active finger motion simulator. Servo-motors were used to generate motion. Loads induced by flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP), and joint range of motion were measured with each sequential sectioning of the A2, A3, and A4 flexor pulley, in comparison to a native healthy finger condition. At each finger condition, A2 and A4 external thermoplastic pulley rings were applied over the proximal phalanx and middle phalanx, respectively, to recreate A2 and A4 function. Results were recorded and analyzed using a one way repeated-measures ANOVA. Following venting of the A2, A3 and A4 pulley, proximal interphalangeal joint (PIPJ) ROM significantly decreased by 17.02 ± 8.42 degrees and distal interphalangeal joint (DIPJ) range of motion decreased by 17.25 ± 8.68 degrees compared to intact pulleys. Application of the external rings restored range of motion to within 8.14 ± 8.17 degrees at the PIPJ and to within 7.72 ± 8.95 degrees at the DIPJ. Similarly, pulley venting resulted in a 36% reduction in FDS load and 50% in FDP load compared to intact pulleys. Following application of the external rings, loads were almost restored to normal at 7% reduction for FDS load and 13% reduction for FDP load. Venting of flexor tendon pulleys significantly alters flexor tendon biomechanics and digit range of motion. The application of thermoplastic rings acting as external pulleys over the proximal and middle
Fractures of metacarpals and
1. A review of intra-articular and peri-articular fractures of the
Introduction: During the design of minimally invasive surgeries (MIS) carried out on the third toe of the foot, it is important to know the position of the nutrient foramen in the third metatarsal shaft and/or proximal phalanx to prevent complications such as avascular necrosis or delays in consolidation further to corrective osteotomies carried out to treat certain conditions that affect the third toe in toe-to-hand surgical transposition. Our aim was to determine the location of the main nutrient foramen of the third metatarsal and/or proximal
Introduction: Dorsally angulated metaphyseal fractures of the proximal
We treated 35 brachymetatarsal rays of 18 feet in 12 patients by one-stage lengthening with interpositional bone grafts or by gradual lengthening with callotasis combined with shortening of the adjacent metatarsals and
Extensor tendon attachment to the dorsum of the proximal phalanx may fully extend the finger metacarpal phalangeal joint (MPJ). 15 fresh-frozen cadaveric hands were axially loaded in the line of pull to the extensor digitorum comunis of the index, middle, ring and small finger at the level just proximal to the MPJ. We measured force of extension at the MP joint in 3 groups: 1) native specimen, 2) extensor tendon release at the proximal interphalangeal (PIP) joint with release of lumbricals/lateral bands, 3) extensor tendon release at the PIP joint and dorsal proximal phalanx and lumbrical/lateral band release. Degree change of extension was calculated using arctan function with height change of the distal aspect of the proximal phalanx, and the length of the proximal phalanx. We used Student T-test to determine significant decrease in the extension of the
The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture following hand injuries in different paediatric age groups attending a hand unit. Three hundred and sixty children (237 boys and 123 girls) under 16 years of age who presented with hand injuries between 1st April 2000 and 30th September 2000 were included in the study. Bony injuries accounted for 65.5% (236 injuries), 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children/year. Incidence was low in toddlers (34/100,000), more than doubled in pre-school children (73/100,000) and steeply increased to around 20 fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and pre-school children. Crushing was the most common cause of hand injury (64%) and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the
The metabolic variations between the cartilage of osteoarthritis (OA) and Kashin-Beck disease (KBD) remain largely unknown. Our study aimed to address this by conducting a comparative analysis of the metabolic profiles present in the cartilage of KBD and OA. Cartilage samples from patients with KBD (n = 10) and patients with OA (n = 10) were collected during total knee arthroplasty surgery. An untargeted metabolomics approach using liquid chromatography coupled with mass spectrometry (LC-MS) was conducted to investigate the metabolomics profiles of KBD and OA. LC-MS raw data files were converted into mzXML format and then processed by the XCMS, CAMERA, and metaX toolbox implemented with R software. The online Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to annotate the metabolites by matching the exact molecular mass data of samples with those from the database.Aims
Methods
The August 2023 Foot & Ankle Roundup360 looks at: Achilles tendon rupture: surgery or conservative treatment for the high-demand patient?; First ray amputation in diabetic patients; Survival of ankle arthroplasty in the UK; First metatarsophalangeal joint fusion and flat foot correction; Intra-articular corticosteroid injections with or without hyaluronic acid in the management of subtalar osteoarthritis; Factors associated with nonunion of post-traumatic subtalar arthrodesis; The Mayo Prosthetic Joint Infection Risk Score for total ankle arthroplasty.
In the Netherlands, general practitioners (GPs) can request radiographs. After a radiologically diagnosed fracture, patients are immediately referred to the emergency department (ED). Since 2020, the Máxima Medical Centre has implemented a new care pathway for minor trauma patients, referring them immediately to the traumatology outpatient clinic (OC) instead of the ED. We investigated whether this altered care pathway leads to a reduction in healthcare consumption and concomitant costs. In this retrospective cohort study, patients were included if a radiologist diagnosed a fracture on a radiograph requested by the GP from August to October 2019 (control group) or August to October 2020 (research group), on weekdays between 8.30 am and 4.00 pm. The study compared various outcomes between groups, including the length of the initial hospital visit, frequency of hospital visits and medical procedures, extent of imaging, and healthcare expenses.Aims
Methods
Previous studies have suggested that selenium as a trace element is involved in bone health, but findings related to the specific effect of selenium on bone health remain inconclusive. Thus, we performed a meta-analysis by including all the relevant studies to elucidate the association between selenium status (dietary intake or serum selenium) and bone health indicators (bone mineral density (BMD), osteoporosis (OP), or fracture). PubMed, Embase, and Cochrane Library were systematically searched to retrieve relevant articles published before 15 November 2022. Studies focusing on the correlation between selenium and BMD, OP, or fracture were included. Effect sizes included regression coefficient (β), weighted mean difference (WMD), and odds ratio (OR). According to heterogeneity, the fixed-effect or random-effect model was used to assess the association between selenium and bone health.Aims
Methods
1. Four cases of epidermal cysts of the terminal
1. Delta phalanx is a rare congenital abnormality not to be confused with other forms of angular deformity of the
A minority of cases of osteopetrosis show in addition syndactyly and distal phalangeal anomalies. The seven cases that have been reported with this combination have had an unusual degree of density and thickening of the skull vault, face and mandible, and of the shafts of the metacarpals, metatarsals, proximal
1. Rotational deformity of a finger caused by malunion of a phalangeal fracture has been corrected by metacarpal osteotomy. 2. Because of the anatomical arrangement of the metacarpo-phalangeal joint this method gives good control of the distal
Open fractures are uncommon in the UK sporting population, however because of their morbidity then are a significant patient group. Currently there is very little in the literature describing the epidemiology of open fracture in sport. We describe the epidemiology of sport related open fractures from one centre's adult patient population. Retrospective analysis of a prospectively collected database recording all sport related open fracture s over a 15 year period in a standard population. Over the 15 year period, there were 85 fractures in 84 patients. The mean age was 29.2 years (range 15–67). 70 (83%) were male and fourteen female (17%). The six most common sports were football (n=19, 22%), rugby (n=9, 11%), cycling (n=8, 9%), hockey (n=8, 9%); horse riding (n=6, 7%) and skiing (n=6, 7%). The top five anatomical locations were fingers
We report a case of multicentric massive osteolysis. A 52-year-old woman presented with a three-year history of progressive deformities of the hands. She had osteolytic lesions of the metacarpals and metatarsals, and resorption of the terminal
EH of bone is a rare vascular neoplasm, subtype of hemangioendothelioma, characterized by mesenchimal cells that have an epithelioid endothelial appearance. There are different kinds of EH: the benign epithelioid hemangioma, and the malignant epithelioid angiosarcoma. This tumors can occurs in soft tissue, lung, liver and bones and often are multicentric. EH generally involve the bone of the spine and lower limb and is very rare in the upper limb and the hands. The main symptom is pain; pathological fracture may occur in aggressive lesions. Radiographically the EH is a ostelytic lesion with variable peripheral sclerosis, cortical destruction and periosteal new bone. Treatment of EH is curettage and local adjuvants in benign lesion, en bloc resection in the low-grade forms and wide or radical surgery in the high-grade forms. Radiation therapy is suggest in inoperable situations. In the present report we describe the clinical features, the oncological treatment and the reconstructive solutions of two cases of EH of the hand treated in the Orthopedic Oncological Center of Gaetano Pini Institute of Milan. Both cases had multiple locations in the carpus, metacarpus and
1. A new piece of equipment, the quantitative colour television image analyser, has been introduced as providing a superior method for measuring bone density. 2. This method produces not only a numerical result but also a pattern of density distribution in the form of a seven colour contour map. 3. The changes in twenty rheumatoid hands at an interval of one year have been measured. The metacarpals and proximal
1. Bone changes in the haemoglobinopathies are caused by either (a) chronic haemolysis with marrow hyperplasia, or (b) infarction, when Hb S is present in the red cells in amounts sufficient to allow sickling (and therefore vascular occlusion) in vivo. 2. Marrow hyperplasia produces osteoporosis, widening of the medulla, and thinning of the cortex; it may lead to spontaneous fractures and disturbances of growth. Enlargement of the foramina of the nutrient arteries may be seen especially in the
The purpose of this study was to retrospectively review the outcomes of percutaneous flexor tenotomies of diabetic claw toes with ulcers or pending ulcers. A retrospective chart review between January 1999 and June 2005 was performed to identify those patients that had undergone a percutaneous flexor tenotomy for diabetic claw toe deformities. Thirty-four toes in fourteen patients were identified. Twenty-four toes had ulcerations at the terminal aspect and three of these had radiographic evidence of osteomyelitis of the terminal
1. Frostbite in a child may be severe enough to destroy the cartilage cells of the epiphysial plate of a digit, and produce clinical deformity. 2. Both the direct effect of the freezing itself and the vascular changes secondary to such frostbite appear to cause necrosis of the growing epiphysis with destruction of the epiphysis and disappearance of the epiphysial line or plate. The disappearance of the epiphysial plate is obvious, but whether the epiphysis itself is actually destroyed and disappears or simply fuses with the metaphysis is a question now being studied. 3. It is suggested that the deformities may be helped by interphalangeal fusion of severely involved joints in the position of function, and
1. In a series of seventy-one patients with wringer injuries of the hand three basic types of lesion were observed: a) denuding of part of or the entire hand, usually accompanied by avulsion of the distal
Introduction. Hand tumors are usually rare and there is not much literature about series of cases. We have studied a series of 110 cases. Hand tumors do consists of both benign and malignant cases. Methods. We studied series of 110 cases at Karnataka Institute of Medical Sciences, Hubli and Mysore Medical College & Research Institute, Mysore. We retrospectively reviewed the records of 110 patients who underwent double ray amputations at our center over few years: few had amputations of the fourth and fifth rays and others amputation of the second and third rays. Mean age at surgery was 34 years (range, 10–45 years), and minimum follow up was 64 months (mean, 98 months; range, 64–136 months). Some patients had high-grade soft tissue sarcomas of the hand, synovial sarcomas, malignant peripheral nerve sheath tumors, and undifferentiated sarcoma. No patients had detectable metastases at surgery. Results. All patients were completely disease-free at latest follow up. One patient was alive with lung metastases detected 32 months after surgery. No patients developed local tumor recurrence. Functional assessment showed a mean Musculoskeletal Tumor Society score of 24 (range, 19–28) and mean grip strength 24% of the contra lateral side (range, 17%–35%). Conclusions. The majority of osseous tumors of the hand are benign. The surgeon who evaluates and treats osseous tumors of the hand has to be familiar with limb anatomy, tumor biology, various presentations of the tumors and the range of treatment possibilities and their limitations. Lesions in the hand more often present earlier in their course than those at other sites, just because they are more likely to superficial and easily noticed. Ganglion cyst is the most frequently encountered comprising 50–70% of benign tumors of hand. Enchondroma was the next common benign bone tumour followed by osteoid osteoma, osteoblastoma, aneurismal bone cyst, giant cell tumor, epidermoid cyst, and osteochondroma. Although malignant neoplasms in the hand that arise from tissues other than the skin are very rare, the hand may be the site of distant breast, lung, kidney, esophagus, or colon adenocarcinoma metastases, most of which have a predilection for the distal
Summary Statement. An alternative way to assess three dimensional skin motion artefacts of kinematic models is presented and applied to a novel kinematic foot model. Largest skin motion is measured in the tarsal region. Introduction. Motion capture systems are being used in daily clinical practise for gait analysis. Last decade several kinematic foot models have been presented to gain more insight in joint movement in various foot pathologies. No method is known to directly measure bone movement in a clinical setting. Current golden standard is based on measurement of motion of skin markers and translation to joint kinematics. Rigid body assumptions and skin motion artefacts can seriously influence the outcome of this approach and rigorous validation is required before clinical application is feasible. Validation of kinematic models is currently done via comparison with bone pin studies. However, these studies can only assess major bones in a highly invasive way; another problem is the non-synchronous measurement of skin markers and bone pins. Recently the Glasgow Maastricht kinematic foot model, which comprises all 26 foot segments, has been presented. To validate the model we propose a novel non-invasive method for the assessment of skin motion artefact, involving loaded CT data. Patients & Methods. 25 subjects (healthy and pathological feet) have undertaken CT scans. These CT-scans have been obtained in 1 unloaded and 3 varying loading conditions. CT-slices are 3D reconstructed and segmented. The principal axes of the segmented bones were derived from the surface points of the bones. These principal axes are used to compute bone orientation. Subsequently, coordinate systems of bones in the different loading conditions were matched. Markers were translated and rotated to orientations of their corresponding bones. Maximal distance between markers is calculated per subject to asses the influence of skin motion. Results. Preliminary results of 9 subjects show largest positional differences for markers associated with the cuneiform lateralis (5.7 ± 3.2 mm) and cuneiform intermedium (7.7 ± 3.7 mm). Smallest positional differences are found on the hallux proximalis (0.9 ± 0.34mm). Spatial resolution is too small to accurately calculate orientation of smaller bones, therefor distal
We performed one-stage lengthening using intercalary autogenous bone graft in 34 metatarsals and seven proximal
Purpose. A review of the role of external fixators in paediatric trauma at The Royal London Hospital Trauma and Orthopaedic Department. Methods. Retrospective study between 2004 and 2010 reviewing traumatic bone injuries that required initial management with an external fixator. Information was collected through the patients' medical documents and radiographs. Results. In total twenty-seven patients (15 male:12 female, mean age 11, age range 7-15) were initially treated with external fixators over the six year period. The injured bones included 18 tibias, 5 femurs, 2 humeri, 2 radius/ulna, 2
A 14-year-old girl with a congenitally deformed and shortened right leg and foot is described. The patient could not bear weight on the deformed limb and had to hop on the left leg. The deformed foot faced backwards and had nine toes. The right leg was shorter than the left by 26 centimetres. Radiologically, the lower end of the right femur was ill-developed and there was no knee joint. There were two fibulae and the tibia and the patella were absent. A through-knee disarticulation was done and a prosthesis fitted later. The amputated leg and foot were dissected. Many of the muscles in the leg and foot were duplicated. There were two calcanei, one talus, one navicular, two cuboids and four cuneiforms. Ther were nine metatarsals, and all the toes had three
Objectives: Nowadays estimating paediatric bone age is done using methods based on standards from the 50’s and 70’s. These methods are often difficult to perform, they require experience in the analysis of multiple bones and are based on subjective measures. Many times, the age calculated stands within a wide range of age interval. We investigate a new method based on AP foot X-rays. Material and Methods: 971 radiographs taken from 220 paediatric patients (0–18 years old) were analyzed. 34 different ratios were designed by measuring ossification centres of the bones of the first and second foot rays. These ratios were statistically studied searching for the relation with variables as gender, laterality, foot pathology and forefoot formulae. Finally, regression lines and curves from each ratio were calculated as well as their correlation with chronological age. Results: The best suited correlations are obtained with the ratios calculated from the epiphysis of the proximal
Malunion of digital fractures can be difficult to correct especially for rotational phalangeal malunion. We describe the simple closed corrective technique. Materials/Methods: Patients whose phalangeal fractures were treated closed (mobilised or POP +/− K wires) and malunited, typically with mal-rotation. The technique is performed under LA. The bone is cut by percutaneous passage of a 1.1 mm K wire multiple times until the bone is fractured. The malunion is corrected and held with one longitudinal 1.1 mm K wire. The osteotomies are supported for 6 weeks in POP/splint and the wire(s) removed. Results: 11 patients with 12 post fracture malunion–All metaphyseal osteotomies healed within 6 weeks with correction of malrotation and no significant angular deformity. The one diaphyseal osteotomy united late healing only partially (inadequately) corrected and requires revision. Apart from the malunion there were no major complications albeit short-term PIP joint stiffness. Conclusion: This is a safe and reliable technique that avoids most of the complications of more challenging open techniques in the
Introduction: In clinical practice The Cascade sign is widely used to assess the rotational deformity of the fingers associated with metacarpal and phalangeal fractures. We carried out a scientific study on thirty volunteers to evaluate the validity or otherwise of this standard sign. Material and Methods: Metal pointers were attached to the dorsum of the fingers, flexed at MCP and PIP joints. These pointers represented the mid longitudinal axis of the
Aim. Assess the oncological and clinical outcomes associated with intralesional curettage, phenol and bone grafting of the lesions. Method. A retrospective study was performed using data from the Leiden University Medical Center. Ninety patients with low grade central chondrosarcoma of long bones and small tubular bones were treated using phenol and ethanol as adjuvant therapy after intralesional curettage. Standard clinical follow-up contained regular visits to the orthopaedic department, physical examination and radiological follow-up with plain X-rays and dynamic Gadolineum-enhanced MRI scans. Results. Between 1994 and 2005 thirty-three males and fifty-seven females with a mean age of 47 years (range 5.6-73.1) were treated in our clinic. Mean follow-up 6.5 years (range 0.2-14.1). Location of chondrosarcoma. Femur (43%), humerus (32%), tibia (10%), fibula (6%), metacarpalia (4%), radius (2%), ulna (1%), phalanx (1%). Average tumour volume of all lesions, including metacarpals and
Enchondromatosis is a non-hereditary disease, characterised by the presence of multiple enchondromas. While Ollier Disease is typified by multiple enchondromas, in Maffucci Syndrome they are combined with haemangioma. Due to the rarity of these diseases, systematic studies on clinical behaviour providing information how to treat patients are lacking. This study intends to answer the following questions: What are predictive factors for developing chondrosarcoma? When is extensive surgery necessary? How often patients die due to dedifferentiation or metastasis?. Twelve institutes in eight countries participated in this descriptive retrospective EMSOS-study. 118 Patients with Ollier Disease and 15 patients with Maffucci Syndrome were included. Unilateral localization of disease was found in 60% of Ollier patients and 40% of patients with Maffucci Syndrome. One of the predictive factors for developing chondrosarcoma is the location of the enchondromas; the risk increases especially when enchondromas are located in the scapula (33%), humerus (18%), pelvis (26%) or femur (15%). For the
Nineteen chondrosarcomas are reported arising in proximal
We retrospectively reviewed 27 patients who underwent an uncemented total Moje ceramic arthroplasty of hallux rigidus. Out of 33 patients who had the above procedure, 27 were available for review. Clinical and functional outcome were assessed using the American orthopaedic foot and ankle society (AOFAS) fore-foot score, and the SF-36 health assessment score. All patients had an antero-posterior and a lateral weight bearing radiograph. The primary pathology was oesteo-arthritis (Hallux Rigidus). All procedures were performed by the senior author or under his supervision. All patients were female with an average age at surgery of 52.6 years (range 45.8–64.7). The average follow up was 39.5 months (range 14–46). The average post-operative AOFAS forefoot score was 80/100 (range 40–100). The average subscore for pain was 29.39/40 (range 10–40). Twenty five patients 92.5% were satisfied with the outcome, and 22 (81%) were able to wear high heel foot wear. The functional outcome as assessed using the SF-36 health score was compatible with an age matched population. The alignments of component were measured in relation to the shaft of the metatarsal and to the proximal
We retrospectively reviewed 27 patients who underwent an uncemented total Moje ceramic arthroplasty of hallux rigidus. Out of 33 patients who had the above procedure, 27 were available for review. Clinical and functional outcome were assessed using the American orthopaedic foot and ankle society (AOFAS) fore-foot score, and the SF-36 health assessment score. All patients had an anteroposterior and a lateral weight bearing radiograph. The primary pathology was oesteo-arthritis (Hallux Rigidus). All procedures were performed by the senior author or under his supervision. All patients were female with an average age at surgery of 52.6 years (range 45.8–64.7). The average follow up was 39.5 months (range 14–46). The average post-operative AOFAS forefoot score was 80/100 (range 40–100). The average subscore for pain was 29.39/40 (range 10–40). Twenty five patients 92.5% were satisfied with the outcome, and 22 (81%) were able to wear high heel foot wear. The functional outcome as assessed using the SF-36 health score was compatible with an age matched population. The alignments of component were measured in relation to the shaft of the metatarsal and to the proximal
Aims: Thirty-three patients with condylar fractures of the middle and proximal
Eight children developed osteochondroma (OS) at a mean of 88 months, after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n=2) of autologous (n=6) transplantation for either acute leukemia (n=6) or neuroblastoma (n=2) after a conditioning regimen including total body irradiation (n=7) or a combination of Busulfan and Cyclophosphamide.Multiple OS were indentified in seven patients and a solitary OS in one. Locations included: clavicle (2), ribs (2), superior iliac epiphysis (1), metaphy-sis of the distal femur (2), distal (2) and proximal (1) tibia, proximal humerus (1), distal radii (3), scapula (3), proximal metaphysis of the proximal
Introduction and Objectives: The technique modified by Regnauld makes it possible to correct the MTP angle and the DASA, shorten the first
Introduction and Aims: The hypothesis that ‘utilisation of gradual distraction and soft tissue correction by external fixation improves outcomes in hand and wrist deformity’ was analysed in 29 extremities in 24 patients, to define the indications for gradual soft tissue correction of congenital and acquired deformity and distraction osteogenesis in hypoplastic digits. Method: This retrospective review of 29 extremities in 24 patients evaluated the role of monolateral external fixators with uniplanar (n=20) and multiplanar (n=9) correction capability (Orthofix, International). Evaluation included an assessment of complications, patient satisfaction, functional outcome, and impact on health-related quality of life. Results: The devices were successfully used to correct radial longitudinal deficiency of the radius (radial club hand) (n=9); digital hypoplasia (n=15) and wrist flexion contracture secondary to spasticity (n=5). There were no significant complications related to the devices. Pin track irritation and drainage occurred in two of 108 pins. One pin became loose and needed to be replaced, and one fixator required two intraoperative adjustments. Multiplanar fixators used for correction of radial club hands and wrist flexion contracture improved soft tissue position in allowing secondary bony procedures and/or tendon transfers. Distraction osteogenesis of metacarpals and
Material: This work presents the treatment of 114 patients (125 feet), aged 9 – 53 years for:. - 82 short feet due to congenital metatarsal hypoplasia,. - 3 first toe stumps (P1),. - 32 post-trauma and post-surgery cases including two after resection of the metatarsal heads. The cosmetic defect was the principal complaint in most patients (95 women), as well as complications related to wearing shoes. Pain in the forefoot resulted from biomechanical conflicts between the toes and the metatarals. Methods: An oblique or transverse osteotomy for lengthening was performed on the base of the metatarsals and the
It has been known for well over a century that the corresponding ossification centres of the hand tend to appear before those of the foot (Mall 1906), although even now the range of variability remains poorly defined. Presumably a similar asynchrony also obtains for chondrification, although precise timing is more difficult here than for ossification. Accordingly, it is tempting with respect to this syndrome to relate fusions restricted to the
Aims Although chondrosarcomas (CSs) display true malignant features, including local recurrence (LR) and metastases, their behaviour in the hands and feet is thought to differ from that in other parts of the axial and appendicular skeleton by having a lower metastatic potential. The purpose of this study was to investigate the disease-specific and surgical factors that affect the local and systemic prognosis of CS of the hands and feet. A multicentre retrospective study was carried out at two tertiary sarcoma centres. A database search identified all patients with a CS treated between January 1995 and January 2018. There were 810 CSs of which 76 (9.4%) were located in the fingers, toes, metacarpals, and metatarsal bones. The median age of the study population was 55 years (36 to 68) with a median follow-up of 52 months (22 to 87) months. Overall, 70% of the tumours were in the hand (n = 54) and 30% in the foot (n = 22). Predictors for LR were margin (p = 0.011), anatomical location (p = 0.017), and method of surgical management (p = 0.003). Anatomical location (p = 0.026), histological grade between 1 and 3 (p = 0.004) or 2 and 3 (p = 0.016), and surgical management (p = 0.001) were significant factors for LR-free survival. Disease-specific survival was affected by histological grade (p < 0.001), but not by LR (p = 0.397).Methods
Results
The Kramer osteotomy for hallux valgus deformity was described in 1990 and has been performed by the senior author in our unit since 1999. The procedure involves a wedge excision of bone and lateral displacement of the first metatarsal head. The osteotomy is splinted by a K-wire passed medially to the
In this report we present the results of the primary suture of the flexor tendons in zone II, in 198 patients who were operated in our department between 1998 and the first months of 2001. 142 were male from 16 to 65 years old and 56 were female between 14 to 60 years old. Children below 14 years old are not included in this report. The majority of patients in this review reported an accident during dancing and late night activities. Patients with complex injuries such as fractures of
Introduction: Osteomyelitis and septic arthritis (SA) below the elbow are severe conditions affecting the function and viability of the hand. Factors predisposing to these conditions and parameters affecting prognosis are emphasized. Material and Methods: In a 4 years period, 16 patients with SA (4) or osteomyelitis (12) were treated in a University Orthopaedic Department providing care to a rural population of 1.000.000, Nine had history of trauma in unhygienic environment, 3 had immunodeficiency and in 4 osteomyelitis was iatrogenic [previous fixation of fractures (3) and vein catheterization (1)]. SA was located in the wrist (2) and thumb joints (2) and osteomyelitis involved the radius (3), ulna (1), metacarpals (3) and
We report preliminary results from the first, multicenter prospective study designed to define the incidence of symptomatic (Venous Thromboembolism) VTE in patients with isolated leg fractures distal to the knee. Eight hundred and twenty-six enrolled patients have completed three months of follow up. By three months, only seven patients had sustained a symptomatic VTE with no fatal PE. Symptomatic and fatal VTE were infrequent complications after isolated leg fractures distal to the knee without thromboprophylaxis. Routine thromboprophylaxis may not be warranted in isolated leg fractures distal to the knee. To report results from the first, multicenter prospective study designed to define the incidence of symptomatic Venous Thromboembolism (VTE) in patients with isolated leg fractures distal to the knee. Symptomatic and fatal VTE are infrequent complications after isolated leg fractures distal to the knee without thromboprophylaxis. Routine thromboprophylaxis may not be warranted in isolated leg fractures distal to the knee. From August 2002 to April 2004, one thousand eight hundred and eight consecutive patients with isolated leg fractures distal to the knee were screened for entry at five hospitals in Ontario. Patients with major trauma, active cancer and previous VTE were excluded. Thromboprophylaxis was not allowed. Patients were followed prospectively for three months, with telephone calls at fourteen days, six weeks and three months. Suspected DVT and PE were investigated in a standardized manner. Eight hundred and twenty-six enrolled patients have completed three months of follow up. The mean age was forty-five years (range sixteen to ninety-three) and 59.5% of this cohort was female. 99% of these fractures were unilateral and 97% were closed. Fractures included: fibula (38%), metatarsal (29%),
Fourteen cases of pigmented villonodular synovitis (PVNS) of the foot and ankle (between January 1957 and December 1999) accrued from Scottish bone tumor registry are presented with an average follow-up of 4.6 years aimed to analyse the clinical, radiological and histopathological features in order to investigate the clinical behaviour of PVNS in the foot and ankle, and to determine the factors influencing recurrence. The mean age was 26.4 years (range, 8 to 52 years). There were eight females and six males. The mean delay in presentation was 10.3 months. The anatomical sites were foot
Giant Cell Tumour of the Tendon Sheath is a benign tumour of synovial origin most frequently affecting the upper limb. Up to 11% exhibit radiographic evidence of cortical erosion and intra-osseous expansion. In the upper limb recurrence rates of between 10–50% following excision have been reported. However, GCT-TS is rarely described in the foot and ankle and its behaviour is ill understood. 17 cases of this rarely described tumour in the foot and ankle are presented, describing their clinical presentation, histopathology, treatment and outcome. Analysis of all cases of histopathologically proven GCT-TS of the foot and ankle from the Oxford Tumour Registry, was conducted between the periods of January 1984 to December 1999. 22 cases were identified of which 17 cases had adequate records to allow analysis of patient demographics, duration of symptoms, preoperative investigations, presumed diagnosis, precise site of origin, post operative complications and recurrence rates. The mean age of presentation was 28 (8–53). 10 cases were female and 7 male. 76% cases occurred in the foot, all of which arose adjacent to the
We conducted a prospective review of patients treated specifically for phalangeal fractures over a period of 6 months. Data was sourced from patient records, Emergency Dept records and theatre records. X-rays were reviewed by the senior authors using the AGFA IMPAX Web1000 v5.1 System. A total of 654 patients presented to our hospital during the study. Of these, 257 (39%) patients were referred to the plastics and hand surgical team on-call. Remaining 397 (61%) patients were seen and treated at the local accident and emergency. Our review identified a patient group of 75 out of 654 (11.5%) patients who required operation. Mechanism of injury: Direct impact: n=60 (80%), Hyperextension n=11 (15%), Hyper-flexion injury n=4 (5%). Mode of injury: sports related, commonly rugby or football: 23 (31%) patients, crush injury 13 (17%), road traffic accident 10 (13%), punching either wall or a fellow human being in 10 (13%), fall 8 (11%), circular saw related injury in 8 (11%). The average patient age for a phalangeal fracture was 37.3 years. 47 (63%) patients were in the age group 20–40 years. The mean age for a phalangeal fracture in males was 35.9 (16–75) years and 42.2 (23–70) years in females. The gender distribution of these patients reveals that 58/75 (77%) patients were males. This indicates that males were at an increased relative risk of 3.4 for sustaining a hand fractures than females. The fractures were studied with respect to their complexity, digit(s) involved, phalanx and the site on the phalanx, pattern of fracture and finally the involvement of the MCP or the IP joints. Our study revealed that fifty-two (69%) of the fractures were closed while twenty-three (31%) were open. Injuries to the distal
There is little data regarding the epidemiology of childhood injury in Ireland. This is difficult to obtain retrospectively. The aim of this study was to prospectively evaluate paediatric trauma referrals to our department, describe their epidemiology, and identify potentially preventable injuries in children. Our unit at the National Childrens Hospital is located in a growing suburban area in South Dublin. Injury surveillance was conducted on orthopaedic referrals by distributing a form to parents of children attending fracture clinics or admitted acutely for surgery. Parents were asked for demographic information, and a brief description of the injury in terms of location, mechanism and circumstance of injury. Diagnosis was completed by the attending doctor and data was transferred to a computerised database. We analyzed data from the 397 referrals in the first month of this study. The mean age of injury was 9.1 years and the male: female ratio was 1.3:1. The peak hour of injury was 7 – 8 pm. Only 33% of injuries occured during the weekend. 62% of injuries were due to falls, usually form the standing position. The most common location for injury was in or about the home (39%), and other notable locations were school (16%) and sportsfield (14%). 61% of falls greater than 1 metre occurred at home, mostly from walls and childrens slides. 20% of injuries occurred while participating in organized sport, including Gaelic football, soccer and hurling. Injuries occuring during unsupervised sport were more likely to need surgery. Domestic ‘bouncing castles’ and trampolines, increasingly popular in our area, were a notable cause of significant trauma to the upper limb. 7% of injuries occurred by falling from a bicycle, but vehicular road traffic accident was an uncommon cause of injury. 263 children had confirmed fractures, other injuries consisting largely of sprains to the ankle, elbow and wrist. Predictably, the bones most commonly fractured were the radius (41%),
The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures. We reviewed clinical records of a single surgical practice from its entire 2014 calendar year. In total, 71 patients (121 surgical feet) qualified for the study with a mean follow-up of 20.3 months (SD 6.2). We measured their metatarsus adductus angle with the Sgarlato’s method (SMAA), and the intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) with Hardy’s mid axial method. We also assessed their American Orthopaedic Foot & Ankle Society (AOFAS) clinical scale score, and photographic and pedobarographic images for clinical function results.Aims
Methods
Tenosynovial giant cell tumour (TGCT) is one of the most common soft-tissue tumours of the foot and ankle and can behave in a locally aggressive manner. Tumour control can be difficult, despite the various methods of treatment available. Since treatment guidelines are lacking, the aim of this study was to review the multidisciplinary management by presenting the largest series of TGCT of the foot and ankle to date from two specialized sarcoma centres. The Oxford Tumour Registry and the Leiden University Medical Centre Sarcoma Registry were retrospectively reviewed for patients with histologically proven foot and ankle TGCT diagnosed between January 2002 and August 2019.Aims
Methods
Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article:
Our aim was to develop and validate nomograms that would predict the cumulative incidence of sarcoma-specific death (CISSD) and disease progression (CIDP) in patients with localized high-grade primary central and dedifferentiated chondrosarcoma. The study population consisted of 391 patients from two international sarcoma centres (development cohort) who had undergone definitive surgery for a localized high-grade (histological grade II or III) conventional primary central chondrosarcoma or dedifferentiated chondrosarcoma. Disease progression captured the first event of either metastasis or local recurrence. An independent cohort of 221 patients from three additional hospitals was used for external validation. Two nomograms were internally and externally validated for discrimination (c-index) and calibration plot.Aims
Methods
Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity.Aims
Methods
Introduction: Recent in vivo studies of flexor tendon midsubstance healing have indicated that during the first 10 days after injury and repair there is no increase in ultimate tensile force. In contrast, there is an increase of approximately 170% in the rigidity (stiffness) of the repair site and a decrease of more than 45% in the repair-site strain at 20 N force. The basis for the increase in rigidity during the early stages of tendon healing is not known, but may be due to either biological or mechanical factors. In particular, cyclic loading of the tendon repair site during post-operative rehabilitation may have a mechanical conditioning effect that increases the stiffness of the repair site independent of repair-site healing. Our objective was to determine whether or not cyclic loading of repaired flexor tendons causes an in increase in repair-site rigidity and whether or not this increase depends on the level of applied force. We simulated 10 days of passive motion rehabilitation by applying 6000 loading cycles to repaired flexor tendons ex vivo at force levels generated during passive motion rehabilitation. We then evaluated the tensile mechanical properties. We hypothesized that cyclic loading causes an increase in repair-site rigidity and a decrease in repair-site strain. Materials and Methods Forty-eight flexor digitorum profundus (FDP) tendons with attached distal
The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery. We conducted a systematic review of MEDLINE and the CEA Registry to identify CEAs that were conducted on or after 1 January 1997, that studied a procedure pertaining to the field of hand and upper extremity surgery, that were clinical studies, and that reported outcomes in terms of quality-adjusted life-years. We identified a total of 33 studies that met our inclusion criteria. The quality of these studies was assessed using the Quality of Health Economic Analysis (QHES) scale.Aims
Materials and Methods
Fractures in patients aged ≥ 65 years constitute
an increasing burden on health and social care and are associated with
a high morbidity and mortality. There is little accurate information
about the epidemiology of fractures in the elderly. We have analysed
prospectively collected data on 4786 in- and out-patients who presented
with a fracture over two one-year periods. Analysis shows that there
are six patterns of the incidence of fractures in patients aged ≥ 65
years. In males six types of fracture increase in incidence after
the age of 65 years and 11 types increase in females aged over 65
years. Five types of fracture decrease in incidence after the age
of 65 years. Multiple fractures increase in incidence in both males
and females aged ≥ 65 years, as do fractures related to falls. Analysis of the incidence of fractures, together with life expectancy,
shows that the probability of males and females aged ≥ 65 years
having a fracture during the rest of their life is 18.5% and 52.0%,
respectively. The equivalent figures for males and females aged ≥ 80
years are 13.3% and 34.8%, respectively. Cite this article:
To determine whether an early return to sport in professional
Australian Rules Football players after fixation of a non-thumb
metacarpal fracture was safe and effective. A total of 16 patients with a mean age of 25 years (19 to 30)
identified as having a non-thumb metacarpal fracture underwent open
reduction and internal plate and screw fixation. We compared the
players’ professional performance statistics before and after the
injury to determine whether there was any deterioration in their
post-operative performance.Aims
Patients and Methods
We analysed the clinical and radiological outcomes
of a new surgical technique for the treatment of heterozygote post-axial
metatarsal-type foot synpolydactyly with HOX-D13 genetic mutations
with a mean follow-up of 30.9 months (24 to 42). A total of 57 feet
in 36 patients (mean age 6.8 years (2 to 16)) were treated with
this new technique, which transfers the distal part of the duplicated
fourth metatarsal to the proximal part of the fifth metatarsal.
Clinical and radiological assessments were undertaken pre- and post-operatively
and any complications were recorded. Final outcomes were evaluated
according to the methods described by Phelps and Grogan. Forefoot width
was reduced and the lengths of the all reconstructed toes were maintained
after surgery. Union was achieved for all the metatarsal osteotomies
without any angular deformities. Outcomes at the final assessment
were excellent in 51 feet (89%) and good in six (11%). This newly
described surgical technique provides for painless, comfortable
shoe-wearing after a single, easy-to-perform operation with good
clinical, radiological and functional outcomes. Cite this article:
Paediatric fractures are common and can cause
significant morbidity. Socioeconomic deprivation is associated with an
increased incidence of fractures in both adults and children, but
little is known about the epidemiology of paediatric fractures.
In this study we investigated the effect of social deprivation on
the epidemiology of paediatric fractures. We compiled a prospective database of all fractures in children
aged <
16 years presenting to the study centre. Demographics,
type of fracture, mode of injury and postcode were recorded. Socioeconomic
status quintiles were assigned for each child using the Scottish
Index for Multiple Deprivation (SIMD). We found a correlation between increasing deprivation and the
incidence of fractures (r = 1.00, p <
0.001). In the most deprived
group the incidence was 2420/100 000/yr, which diminished to 1775/100
000/yr in the least deprived group. The most deprived children were more likely to suffer a fracture
as a result of a fall (odds ratio (OR) = 1.5, p <
0.0001), blunt
trauma (OR = 1.5, p = 0.026) or a road traffic accident (OR = 2.7,
p <
0.0001) than the least deprived. These findings have important implications for public health
and preventative measures. Cite this article:
We report the use of the distal radius and ulna (DRU) classification
for the prediction of peak growth (PG) and growth cessation (GC)
in 777 patients with idiopathic scoliosis. We compare this classification
with other commonly used parameters of maturity. The following data were extracted from the patients’ records
and radiographs: chronological age, body height (BH), arm span (AS),
date of menarche, Risser sign, DRU grade and status of the phalangeal
and metacarpal physes. The mean rates of growth were recorded according
to each parameter of maturity. PG was defined as the summit of the curve
and GC as the plateau in deceleration of growth. The rates of growth
at PG and GC were used for analysis using receiver operating characteristic
(ROC) curves to determine the strength and cutoff values of the
parameters of growth.Aims
Patients and Methods
To determine the pattern of mutations of the A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the Objectives
Patients and Methods
A relationship between social deprivation and the incidence of fracture in adolescents has not previously been shown. We have used a complete fracture database to identify adolescents who sustained fractures in 2000. The 2001 Scottish census was used to obtain age-specific population and deprivation data according to the Carstairs score. Regression analysis determined the relationship between the incidence of fractures and social deprivation. We analysed 1574 adolescents with fractures (1083 male, 491 female). The incidence of fractures in this group was 21.8 per thousand (31.0 male, 13.1 female). Social deprivation predicted the incidence in adolescent males and females. The incidence of fractures of the proximal upper limb and distal radius in females was overwhelmingly influenced by socioeconomic factors. Males of 15 to 20 years of age were more likely to sustain fractures of the hand and carpus if they lived in economically depressed neighbourhoods.
A prospective series of 32 cases with tuberculosis of the hand and wrist is presented. The mean age of the patients was 23.9 years (3 to 65), 12 had bony disease and 20 primarily soft-tissue involvement. The metacarpal of the little finger was the most commonly involved bone. Pain and swelling were the usual presenting features and discharging sinuses were seen in three cases. All patients were given anti-tubercular chemotherapy with four drugs. Operative treatment in the form of open or arthroscopic debridement, or incision and drainage of abscesses, was performed in those cases where no response was seen after eight weeks of ATT. Hand function was evaluated by the modified score of Green and O’Brien. The mean was 58.3 (25 to 80) before treatment and 90.5 (80 to 95) at the end. The mean follow-up was for 22.4 months (6 to 43). Conservative treatment was successful in 24 patients (75%). Eight who did not respond to chemotherapy within eight weeks required surgery. Although tuberculosis of hand has a varied presentation, the majority of lesions respond to conservative treatment.
Giant cell tumours (GCTs) of the small bones
of the hands and feet are rare. Small case series have been published but
there is no consensus about ideal treatment. We performed a systematic
review, initially screening 775 titles, and included 12 papers comprising
91 patients with GCT of the small bones of the hands and feet. The
rate of recurrence across these publications was found to be 72%
(18 of 25) in those treated with isolated curettage, 13% (2 of 15)
in those treated with curettage plus adjuvants, 15% (6 of 41) in
those treated by resection and 10% (1 of 10) in those treated by
amputation. We then retrospectively analysed 30 patients treated for GCT
of the small bones of the hands and feet between 1987 and 2010 in
five specialised centres. The primary treatment was curettage in
six, curettage with adjuvants (phenol or liquid nitrogen with or
without polymethylmethacrylate (PMMA)) in 18 and resection in six.
We evaluated the rate of complications and recurrence as well as
the factors that influenced their functional outcome. At a mean follow-up of 7.9 years (2 to 26) the rate of recurrence
was 50% (n = 3) in those patients treated with isolated curettage,
22% (n = 4) in those treated with curettage plus adjuvants and 17%
(n = 1) in those treated with resection (p = 0.404). The only complication
was pain in one patient, which resolved after surgical removal of remnants
of PMMA. We could not identify any individual factors associated
with a higher rate of complications or recurrence. The mean post-operative
Musculoskeletal Tumor Society scores were slightly higher after
intra-lesional treatment including isolated curettage and curettage
plus adjuvants (29 (20 to 30)) compared with resection (25 (15 to
30)) (p = 0.091). Repeated curettage with adjuvants eventually resulted
in the cure for all patients and is therefore a reasonable treatment
for both primary and recurrent GCT of the small bones of the hands
and feet. Cite this article:
The management of children’s fractures has evolved
as a result of better health education, changes in lifestyle, improved
implant technology and the changing expectations of society. This
review focuses on the changes seen in paediatric fractures, including
epidemiology, the increasing problems of obesity, the mechanisms
of injury, non-accidental injuries and litigation. We also examine
the changes in the management of fractures at three specific sites:
the supracondylar humerus, femoral shaft and forearm. There has
been an increasing trend towards surgical stabilisation of these
fractures. The reasons for this are multifactorial, including societal
expectations of a perfect result and reduced hospital stay. Reduced hospital
stay is beneficial to the social, educational and psychological
needs of the child and beneficial to society as a whole, due to
reduced costs. Cite this article:
The December 2014 Oncology Roundup360 looks at: metaphyseal and diaphyseal osteosarcoma subtly different beasts; sports and endoprosthetic reconstruction of the knee; is curettage without tissue diagnosis sensible in cartilaginous tumours?; autoclaved autograft in bone tumour reconstruction; vascularised graft a step too far in bone defects?; interdigitated neoadjuvant chemoradiotherapy in high-grade sarcoma; predicting life expectancy in patients with painful metastasis; and osteolytic lesions of the hands and feet.
In this case report a four-year-old girl with ulnar dimelia is described. She had six digits without mirror symmetry in her right hand. The first pre-axial digit was excised and true pollicisation performed for the second pre-axial digit. The arterial anatomy was abnormal but there was not symmetrical development of the arterial tree.
We hypothesised that the use of pulsed electromagnetic
field (PEMF) bone growth stimulation in acute scaphoid fractures
would significantly shorten the time to union and reduce the number
of nonunions in a randomised, double-blind, placebo-controlled multicentre
trial. A total of 102 patients (78 male, 24 female; mean age 35
years (18 to 77)) from five different medical centres with a unilateral
undisplaced acute scaphoid fracture were randomly allocated to PEMF
(n = 51) or placebo (n = 51) and assessed with regard to functional
and radiological outcomes (multiplanar reconstructed CT scans) at
6, 9, 12, 24 and 52 weeks. The overall time to clinical and radiological healing
did not differ significantly between the active PEMF group and the
placebo group. We concluded that the addition of PEMF bone growth
stimulation to the conservative treatment of acute scaphoid fractures
does not accelerate bone healing. Cite this article:
Proximal osteotomies for forefoot deformity in patients with rheumatoid arthritis have hitherto not been described. We evaluated combination joint-preserving surgery involving three different proximal osteotomies for such deformities. A total of 30 patients (39 feet) with a mean age of 55.6 years (45 to 67) underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of the second to fourth metatarsals and a fifth-ray osteotomy. The mean follow-up was 36 months (24 to 68). The mean foot function index scores for pain, disability and activity subscales were 18, 23, and 16 respectively. The mean Japanese Society for Surgery of the Foot score improved significantly from 52.2 (41 to 68) to 89.6 (78 to 97). Post-operatively, 14 patients had forefoot stiffness, but had no disability. Most patients reported highly satisfactory walking ability. Residual deformity and callosities were absent. The mean hallux valgus and intermetatarsal angles decreased from 47.0° (20° to 67°) to 9.0° (2° to 23°) and from 14.1° (9° to 20°) to 4.6° (1° to 10°), respectively. Four patients had further surgery including removal of hardware in three and a fifth-ray osteotomy in one. With good peri-operative medical management of rheumatoid arthritis, surgical repositioning of the metatarsophalangeal joint by metatarsal shortening and consequent relaxing of surrounding soft tissues can be successful. In early to intermediate stages of the disease, it can be performed in preference to joint-sacrificing procedures.
We carried out a retrospective study to assess the clinical results of lengthening the fourth metatarsal in brachymetatarsia in 153 feet of 106 patients (100 female, six males) using three different surgical techniques. In one group lengthening was performed by one-stage intercalary bone grafting secured by an intramedullary Kirschner-wire (45 feet, 35 patients). In the second group lengthening was obtained gradually using a mini-external fixator after performing an osteotomy with a saw (59 feet, 39 patients) and in the third group lengthening was achieved in a gradual manner using a mini-external fixator after undertaking an osteotomy using osteotome through pre-drilled holes (49 feet, 32 patients). The mean age of the patients was 26.3 years (13 to 48). Pre-operatively, the fourth ray of the bone-graft group was longer than that of other two groups (p <
0.000). The clinical outcome was compared in the three groups. The mean follow-up was 22 months (7 to 55). At final follow-up, the mean lengthening in the bone-graft group was 13.9 mm (3.5 to 23.0, 27.1%) which was less than that obtained in the saw group with a mean of 17.8 mm (7.0 to 33.0, 29.9%) and in the pre-drilled osteotome group with a mean of 16.8 mm (6.5 to 28.0, 29.4%, p = 0.001). However, the mean time required for retention of the fixation in the bone-graft group was the shortest of the three groups. Patients were dissatisfied with the result for five feet (11.1%) in the bone-graft group, eight (13.6%) in the saw group and none in the pre-drilled osteotomy group (p <
0.000). The saw group included eight feet with failure of bone formation after surgery. Additional operations were performed in 20 feet because of stiffness (n = 7, all groups), failure of bone formation (n = 4, saw group), skin maceration (n = 4, bone-graft group), malunion (n = 4, bone-graft and saw groups) and breakage of the external fixator (n = 1, saw group). We conclude that the gradual lengthening by distraction osteogenesis after osteotomy using an osteotome produces the most reliable results for the treatment of fourth brachymetatarsia.
Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.
The use of pulsed electromagnetic fields (PEMF)
to stimulate bone growth has been recommended as an alternative to
the surgical treatment of ununited scaphoid fractures, but has never
been examined in acute fractures. We hypothesised that the use of
PEMF in acute scaphoid fractures would accelerate the time to union
by 30% in a randomised, double-blind, placebo-controlled, multicentre
trial. A total of 53 patients in three different medical centres
with a unilateral undisplaced acute scaphoid fracture were randomly
assigned to receive either treatment with PEMF (n = 24) or a placebo
(n = 29). The clinical and radiological outcomes were assessed at
four, six, nine, 12, 24 and 52 weeks. A log-rank analysis showed that neither time to clinical and
radiological union nor the functional outcome differed significantly
between the groups. The clinical assessment of union indicated that
at six weeks tenderness in the anatomic snuffbox (p = 0.03) as well
as tenderness on longitudinal compression of the scaphoid (p = 0.008) differed
significantly in favour of the placebo group. We conclude that stimulation of bone growth by PEMF has no additional
value in the conservative treatment of acute scaphoid fractures.
We describe 22 cases of bizarre parosteal osteochondromatous proliferation, or Nora’s lesion. These are surface-based osteocartilaginous lesions typically affecting the hands and feet. All patients were identified from the records of a regional bone tumour unit and were treated between 1985 and 2009. Nine lesions involved the metacarpals, seven the metatarsals, one originated from a sesamoid bone of the foot and five from long bones (radius, ulna, tibia, and femur in two). The mean age of the patients was 31.8 years (6 to 66), with 14 men and eight women. Diagnosis was based on the radiological and histological features. The initial surgical treatment was excision in 21 cases and amputation of a toe in one. The mean follow-up was for 32 months (12 to 162). Recurrence occurred in six patients (27.3%), with a mean time to recurrence of 49 months (10 to 120). Two of the eight patients with complete resection margins developed a recurrence (25.0%), compared with four of 14 with a marginal or incomplete resection (28.6%). Given the potential surgical morbidity inherent in resection, our data suggest that there may be a role for a relatively tissue-conserving approach to the excision of these lesions.