Abstract

Ankle arthrodesis is the gold standard for treatment of end stage ankle arthritis. We analysed the data of 124 Ankle Arthrodesis (Open Ankle Arthrodesis (OAA) −27; Arthroscopic Ankle Arthrodesis (AAA)- 97) performed between January 2005 and December 2015 by fellowship trained foot and ankle surgeons in a single institution. Based on preoperative deformity (AAA- 28 degree valgus to 26 degrees varus; OAA- 41 degree valgus to 28 degree varus), they were subdivided into 2 groups based upon deformity more than 15 degrees. Union rates, time to union, length of hospital stay and patient related factors like smoking, alcoholism, diabetes, BMI were assessed.

Mean age of patients was 60 years (Range 20 to 82 years)(Male:Female-87:32). Overall fusion rate was 93% in AAA and 89% in OAA (p=0.4). On sub group analysis of influence of preoperative deformity, there was no difference in union rates of AAA versus OAA. 7 patients in AAA and 3 in OAA required further procedures. Average time to union was 13.7 in AAA and 12.5 weeks in OAA (p=0.3). Average hospital stay was 2.6 days in AAA and 3.8 days in OAA (p=0.003). Smoking, alcoholism, Diabetes, BMI did not have any correlation with union rates. Although both AAA and OAA showed good union rates, hospital stay was significantly shorter in AAA. A larger deformity did not adversely affect union rates in AAA. Time to union was higher in AAA though it was statistically insignificant. Lifestyle risk factors did not have cumulative effect on union.

We conclude that AAA is a reproducible method of treating end stage tibiotalar arthritis irrespective of preoperative deformity and patient related factors.

Clinical success of total knee arthroplasty is correlated with correct orientation of the components. Controversy remains in the orthopaedic community as to whether the intramedullary or extramedullary tibial alignment guide is more accurate in the tibial cut.

Is there any difference between intramedullary and extramedullary jigs to achieve better accuracy of the tibial components in total knee replacements?

A retrospective study done on 100 patients during the time period 2007 to 2010. The 100 knee replacements were done by the same surgeon, where 50 patients had the intramedullary tibial alignment guide and the other 50 had the extramedullary one. The tibiofemoral angle was measured pre-operatively as well as post operatively, the tibial alignment angle was measured post operatively then the results were statistically analysed using the SPSS.

There was no significant difference between both groups regarding the tibial alignment angles. Both techniques proved accurate in producing an acceptable post operative tibial component alignment angle. We recommend orthopaedic surgeons choose either technique knowing that accuracy levels are similar.

The debate between intramedullary and extramedullary tibial cutting jigs/guides/ devices continues and most orthopaedic surgeons will use their preferred technique and will continue to achieve good post operative results as we have found in our centre. Our study is rare due to the fact we have a single surgeon performing both techniques, therefore controlling for any surgical experience or operating technique differences.

Background

Short term results of silastic implant of first MTPJ are successful. However reservations exist regarding long term results. The aim of this study is to evaluate long term outcome of silastic implant prosthesis in treatment of hallus rigidus.

We reviewed 108 feet in 83 patients who were operated on between 1988 and 2003. Mean age at operation = 55(SD 8.1). Mean follow up = 8.31 years (SD 3.3). Patients were assessed using the American Orthopaedic Foot and Ankle Scoring system (AOFAS). Passive and active arc of motion were measured. To assess patients' satisfaction they are asked if they would repeat the procedure and also using a visual analogue scale (VAS) to express their overall satisfaction with the outcome. All the patients had anteroposterior and oblique views. Radiographs were assessed for loosening and osteolysis.

Purpose: To test a novel Patient Education and Physician Alerting (PEPA) intervention that seeks to improve the proportion of correct diagnosis and management of osteoporosis in older adults who have sustained a recent hip fracture secondary to a fall.

Methods: Design: Six-month randomized controlled trial. Participants were randomized either to the PEPA group (intervention) or the usual-care group (control). Participants and Setting: Forty-eight men and women aged 60 years and older who were admitted to Vancouver General Hospital for a fall-related hip fracture.|Measurements: The Diagnosis and Management Questionnaire (DMQ) was administered to all participants to determine the rate of investigation and treatment of osteoporosis. The responses were validated in part by physician report obtained for one half of the participants. Statistical Analyses: We compared the difference between the two experimental groups in the proportion of individuals who received bisphosphonate therapy within 6 months after their hip fracture using the chi-square test. The alpha level was set at P < 0.05. |

Results: To date, thirty-three of the 48 participants have completed this 6-month randomized controlled trial. Among these 33 participants, we found a significant difference between the two groups in the proportion of individuals who received bisphosphonate therapy after their hip fracture (p < 0.001). In the PEPA group, 70% (14 out of 20) were put on bisphosphonate therapy within 6 months after experiencing a fragility hip fracture. In contrast, 0% (0 out of 13) were put on bisphos-phonate therapy within 6 months after experiencing a fragility hip fracture in the usual-care group. Of the 78 individuals who were eligible for this study, 48 agreed to participate.

Conclusions: Currently, there is an established care gap for patients who sustain a fragility fracture. This cohort of individuals who fractured their hip did not receive guideline care unless recommended by the PEPA intervention letters sent to the participant delivered to the family physician. Patients who sustain a low-trauma hip fracture and are “at risk” for osteoporosis and do not receive recommended “best practice” care.

Funding : Commerical funding

Funding Parties : Aventis Pharmaceuticals

Osteoporosis investigation following a low-trauma fracture is often missed. The aim of this study was to (i) measure the current rate of osteoporosis investigation and (ii) to test a simple intervention that seeks to increase patient awareness and physician alerting following these sentinel events. Our study showed that 92% of the intervention group was investigated compared to 18% of the control group. This study suggests that a simple inexpensive intervention can increase the rate of osteoporosis investigation in an at risk population.

National guidelines (1–3) emphasize that low-trauma fractures should prompt to investigate for osteoporosis but more than 80% of “at risk” people are not investigated.

To measure the rate of diagnosis of osteoporosis when patients with low-trauma wrist fractures obtain usual care compared to a patient education and physician alerting intervention.

This is a prospective, controlled trial of patient education and physician alert following a distal radius fracture. Participants in the intervention group received four-parts: (i) an information sheet, (ii) a letter from the treating orthopedic surgeon to the patient’s family physician signaling the recent low-trauma fracture (iii) a follow-up reminder call to return to the family doctor for assessment and (iv) a fax to the family physician suggesting assessment and management of osteoporosis. The control group received usual care of the fracture and no specific information about osteoporosis. All participants were telephoned at 6 months to assess investigation status.

Fifty-one participants > 50 yrs. with a fragility wrist fracture were enrolled: 92% of the Intervention participants were investigated for osteoporosis by the family physician compared to 18% of the Control group. This is a significant difference (p ≤ 0.01).

This study suggests that a simple inexpensive intervention by the surgeon can increase the rate of osteoporosis investigation in an at risk population.

Orthopedic surgeons can contribute to the care of osteoporosis by readily adopting simple clinical actions which will make patients more likely to be investigated for osteoporosis.