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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 32 - 32
1 May 2021
Heylen J Rossiter D Khaleel A Elliott D
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Introduction

Pilon fractures are complex, high-energy, intra-articular fractures of the distal tibia. Achieving good outcomes is challenging due to fracture complexity and extensive soft tissue damage.

The purpose of this study was to determine the long-term functional and clinical outcomes of definitive management with fine wire Ilizarov fixation for closed pilon fractures.

Materials and Methods

185 patients treated over a 14-year period (2004–2018) were included. All patients had Ilizarov frames applied to restore mechanical axis and fine wires to control periarticular fragments. CT scans were performed post operatively to confirm satisfactory restoration of the articular surface. All frames were dynamized prior to removal.

Patients' functional outcome was assessed using the validated Chertsey Outcome Score for Trauma (“COST”). Review of clinical notes and imaging was used to determine complications and time to union.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 1 - 1
1 May 2021
Rossiter D Roberts J Heylen J Harb Z Elliott D
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Introduction

Ashford and St Peter's Hospital (ASPH) is a district general hospital in Chertsey, Surrey. It is a tertiary referral unit offering a circular frame service to manage complex trauma patients in the South East of England.

This study analyses the patient pathway in 66 consecutive tertiary referrals from 2015–2020. All patients were managed with an Ilizarov frame for either a tibial plateau fracture or pilon fracture.

Materials and Methods

The patient journey of 66 consecutive tertiary referrals for tibial plateau and pilon fractures were analysed. The following data was captured: patient demographics; type of injury; referring centre; date of injury; date of referral; date of arrival at ASPH; date of surgery and date of discharge. Using this data we aimed to identify areas of the pathway that can be improved.

In addition, the 66 patients were split into two groups of 33 patients. 33 patients were referred via an electronic referral platform and 33 patients were referred verbally prior to the implementation of the electronic referral platform. The groups were compared to see the impact of an electronic referral platform on the patient's journey.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_10 | Pages 10 - 10
1 Jul 2014
Keightley A Nawaz S Elliott D Khaleel A
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The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures.

Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements.

We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of movement of 117 degrees.

Patients undergoing Ilizarov treatment for high energy tibial plateau fractures achieve successful results long term. Definitive treatment should be decided with respect to fracture pattern and the soft tissue envelope. The management aim should be to achieve anatomical reduction and stable fixation to enable early mobilization. Our study confirms the good functional outcomes and low morbidity that can be achieved in high energy fractures treated with Ilizarov fixation.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_8 | Pages 6 - 6
1 Feb 2013
Granville-Chapman J Nawaz S Trompeter A Newman K Elliott D
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Intramedullary nailing of tibial fractures is commonplace and freehand techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radio-lucent bolster. This requires the imaging C-arm to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement; reaming and nail insertion are all performed well above most surgeons' shoulder height. If instead the leg is hung over the edge of the table, the assistant must crouch and hold the leg until the nail is passed beyond the fracture.

We describe a method of nailing which is easier both for the surgeons and the (often inexperienced) radiographer and present a series of 87 consecutive cases managed with this technique.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_2 | Pages 3 - 3
1 Jan 2013
Wright B Gibbs J Elliott D
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Standard Ilizarov technique uses the tensioned olive wires to provide interfragmentary compression in the acute fracture setting and in non-union surgery. In osteopenic metaphyseal bone this can lead to the olive “cutting through” the thin attenuated cortex reducing compression and stability.

We describe a technique placing a percutaneous 3 hole Synthes Mini-fragment plate against the outer cortex of the bone fragment. An olive wire is then placed through each of the outer two holes and through the bone fragment. The construct is then tensioned. This stops the olive cutting into the bone and allows increased compression which is particularly important in non-union surgery.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 157 - 157
1 Jan 2013
Nawaz S Keightley A Elliott D Newman K Khaleel A
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Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation.

124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of motion or IOWA scores. There were comparable functional outcomes and complication rates between both groups.

In summary patients with high energy tibial plateau fracture treated with internal or external fixation, have a good chance of achieving satisfactory long term knee function.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 309 - 309
1 Jul 2011
Phadnis J Trompeter A Gallagher K Wan E Elliott D Newman K
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Aim: To assess mid to long-term functional and symptomatic outcome after internal fixation of the distal radius.

Methods: All patients operated upon between June 2004 and October 2007 were retrospectively assessed using the ‘Disabilities of arm, shoulder and hand’ (DASH, range 0–100), and Mayo wrist (range 0–100) functional scoring systems. Fractures were classified according to the AO system. All patients were treated in one unit by the same group of surgeons using standard accepted techniques. Revision operations and patients treated at greater than four weeks after injury were excluded. Radiographic analysis of time to union was also performed.

Results: 201 patients underwent surgical fixation of which, 183 patients were contactable for follow up (9% loss). Only these patients were included in the study. Mean age was 62.5 years. Mean follow up time was 30 months. Mean time to surgery was eight days. 74% had good/excellent Mayo and 75% good/excellent DASH scores. 2% of patients had a poor outcome with both scores. 28 % reported no functional or symptomatic deficit. There was a 14% overall complication rate (6% major). Mean time to union was 8.39 weeks. Time to union increased with advancing AO grade. There was no significant difference in scores with regard to postoperative immobilisation, time to surgery, time to follow up, patient age, surgeon grade or fracture type.

Conclusion: This is one of the largest series of its type and the results compare favourably with other published operative and non-operative treatment modalities. This is a safe, reproducible technique with excellent functional outcome and is recommended as the treatment of choice when surgery is indicated for these fractures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 371 - 371
1 Jul 2011
Tilkeridis K Khaleel A Kotzamitelos D Hadzigiannakis A Elliott D Simonis RB
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We treated 60 patients with type III Pilon fractures (Ruedi and Allgower Classification) between 1996 and 2005. The fractures were distracted and then fixed with an Ilizarov circular ring fixator, without the use of open surgery. No internal fixation was used for the tibia or fibula. No bone grafting was performed.

The average time from injury to frame application was four days. The patient stayed ib frame for a mean time of 15 weeks. No second operative procedure was needed. All cases united in good alignment.

The patients were reviewed from ten years to nine months after frame removal. Four separate evaluations were performed (functional, objective, radiological and an SF-36). The function and the range of movement were better than the radiological assessment suggested.

This method of treatment gives better results with fewer complications than open surgery with internal fixation


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 173 - 174
1 Mar 2006
Ridgeway S Bhatnagar P Kharendesh P Gibbs J Newman K Khaleel A Elliott D
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Aim: To describe a radiographic biomechanical classification of tibial plateau fractures which dictates treatment. To compare the intra- and interobserver reliability and reproducibility of this, the Chertsey (C1-3) classification, and the Schatzker (SK1-6) classification.

Method: This classification system has been used at this institution for 8 years by the orthopaedic trauma consultants and consists of C1 – valgus fractures, C2 – Varus fractures and C3 axial fractures. Our treatment regime is based on this classification and results presented in a sperate study. These consultants were excluded from the study on reliability and reproducibility. 2 Orthopaedic consultants, 2 orthopaedic registrars and 2 radiologists were selected randomly to classify 30 sets of AP and Lateral radiographs, of randomly selected patients treated in this institution with tibial plateau fractures, consisting of 9 SK1-3/C1, 8 SK4/C2 and 13 SK5,6/C3 fractures, and again with the same radiographs in a random order 1 month later. Radiographs of fractures treated conservatively were excluded. Statistical analysis included Kappa concordance according to Landis and Koch, and the Mann-Whitney U test.

Results: The Schatzker system was only moderately reliable (K=0.66), and the Chertsey classification system significantly more reliable (K=0.82) (p=0.03) with regards to interobserver reliability. Excellent reproducibility (intra-observer reliability) was seen amongst all observers. The consultant orthopaedic surgeons were significantly more reliable than the radiologists, but not the orthopaedic registrars. No particular fracture type in any classification proved to be significantly more difficult to classify.

Conclusion: We present a classification used in our institution based on plain radiographs, which depicts investigations and treatment. The Chertsey classification is significantly more reliable between observers than the Schatzker classification and is reproducible.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_I | Pages 77 - 77
1 Jan 2004
Mellor S Khaleel A Edwards A Gibb P Elliott D Pool R
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We have reviewed the intermediate term results of 56 out of 61 consecutive Wagner revision stems implanted without bone graft. After a mean of 5 years (range 4 to 7 years) 49 out of 56 hips were graded as excellent or good based on the Harris Hip Score. The clinical result was not related to the degree of femoral bone defect prior to revision.

49 Out of 56 hips were seen to subside, but this did not affect the hip score at final review. The mean subsidence was 4.8mm (range 0 – 19mm).Only one stem showed continued subsidence after 12 months post-operatively, and this stem achieved a stable position by 24 months. All osteotomies of the femur united with reconstitution of the femoral bone stock. There was a low incidence of complications; one stem showed catastrophic subsidence within 48 hours of surgery, requiring re-revision to a larger Wagner stem. There was one sciatic nerve palsy. 3 hips dislocated on one occasion in the early post-operative period, but were stable at latest follow-up.

In conclusion, the Wagner stem can bypass major proximal femoral bony defects and achieve initial axial and rotational stability in intact diaphyseal bone. Subsequent stem subsidence does not affect clinical outcome, and proximal femoral bony reconstitution is achieved without the need for bone grafting.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 249 - 249
1 Mar 2003
Bishop T Molloy S Solan M Elliott D Newman K
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Traditionally, immobilisation following achilles tendon rupture has been for 10 to 12 weeks.

We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to pursue the accelerated rehabilitation.

This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks.

There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Cost savings were also made through use of a single removable orthosis rather than sequential casts.

We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 244 - 244
1 Mar 2003
Bishop T Molloy S Solan M Elliott D Newman K
Full Access

Traditionally, immobilisation following Achilles tendon rupture has been for 10 to 12 weeks.

We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to persue the accelerated rehabilitation.

This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks.

There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Costs savings were also made through use of a single removable orthosis rather than sequential casts.

We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis.


The Journal of Bone & Joint Surgery British Volume
Vol. 72-B, Issue 5 | Pages 925 - 925
1 Sep 1990
Elliott D