In the adolescent population, operative management of hallux-valgus is controversial. Operations may be less successful than in adults and post-operative recurrence is more common before full skeletal maturity. This study assesses the radiographic, functional and qualitative outcomes of surgical Hallux Valgus correction in adolescents. Three independent reviewers retrospectively analysed pre and post-operative radiological markers of hallux valgus severity for 44 operations on patients age 13–18. The patient cohort were also asked the Manchester-Oxford foot questionnaire (MOXFQ) to assess functional outcome via telephone interview and patient notes were reviewed for any evidence of complications.Background
Methods
Application of RSA in supine and standing positions allows pelvic fracture stability to be measured more accurately than current techniques. RSA may enable a better understanding of these injuries. The in vivo stability of the pelvic ring after fracture stabilisation remains unknown. Plain radiographs have a low accuracy in diagnosing loss of fracture reduction over time. Radiostereometric analysis (RSA) is an accurate imaging measurement method that has previously been applied to measure the healing of other fractures. This pilot study investigated the potential application of RSA in supine and standing positions to measure pelvic fracture stability over time and under weightbearing load.Summary
Introduction
A number of studies suggest revision of unicompartmental knee replacement (UKR) to total knee replacement (TKR) is straightforward. We hypothesise that this is not always the case in terms of complexity, cost and clinical outcome. We identified 23 consecutive patients revised from UKR to TKR by 2 consultant surgeons (2005–2008). These were matched by age, sex and comorbidity to a cohort of primary TKRs (42 patients) performed during the same period. Data were collected regarding demographics, cost (surgical time & implants) and 1 & 5-year follow-up of clinical outcome (OKS) and outpatients attended. There was no statistically significant difference in cost of implants for revision UKR to TKR vs. primary TKR (p=0.08), however operative time was significantly higher in the revision group. One year mean OKS was significantly higher in the primary TKR group (mean 30 vs. 23 p=0.03), but 5-year follow up showed no significant difference (mean OKS 27 vs. 32 p=0.20). The revision group had statistically significantly greater number of follow-up appointments (mean 6 Vs. 2 p<0.0001). Revision of UKR to TKR is not a universally straightforward procedure, carrying significant overall cost implications. Clinical outcomes, although significantly different at 1 year are almost the same at 5 years.
Menisci performs multiple functions in the knee.'These depend largely on the structural integrity of the meniscus. Arthroscopic partial menisectomy is the treatment of choice for meniscal tears in adults. There is conflicting evidence about the progression of degenerative changes in the medial or lateral compartment of the knee following menisectomy. The aim of our study was to demonstrate the subjective, objective and radiographic outcome of arthroscopic partial lateral menisectomy in the intermediate term and to identify any association between age, sex, activity level, the type of meniscal tear, pre operative articular surface damage and the amount of meniscus resected on the outcome.Introduction
Aim
Classical AO teaching recommends that a syndesmosis screw should be inserted at 25 to 30 degree angle to the coronal plane of the ankle. In practice accurately judging the 25/30 degree angle can be difficult, and there are several reports based on post operative CT scans demonstrating that a significant minority of patients have poorly operatively reduced syndesmotic injuries. The CT scans of 200 normal ankles in one hundred individuals which had been performed as part a CT angiogram were retrospectively examined. The centroid of the fibula and tibia in the axial plane 15mm proximal to the talar dome was calculated. Since a force vector between the centroid of the fibula and the tibia in the axial plane should not displace the fibula relative to the tibia, a line connecting the two centroids was therefore postulated to be the ideal syndesmosis line, and also the optimum position in which to place a compression clamp after reducing the syndesmosis. Where this ideal line passed through the lateral border of the fibula, and through the medial malleolus was then noted. The ideal syndesmosis line was shown to pass through the fibula with in 2mm of the lateral cortical apex of the fibula, and the anterior half of the medial malleolus in 100% of the ankles studied. The results support the concept that in the operatively reduced syndesmosis, the anterior half of the medial malleolus can be used as a reliable guide for aiming the syndesmosis drill hole, provided that the fibular entry point is at or adjacent the lateral fibular apex. The corollary of these findings is that a screw inserted through a plate on the standard antero-lateral border of the fibula, or a plate in the anti-glide position posteriorly, cannot lie in the centroidal axis of the ankle.
To determine differences in fracture stability and functional outcome between synthetic bone graft and allograft/autograft with internal fixation of tibia plateau metaphyseal defects. Between 2007- 2008, 84 consecutive cases of internal fixation of tibia plateaux were identified from our theater logbook. 29 patients required additional autologous, allogenic bone graft, or synthetic bone graft substitute to ensure fracture stability. 5 patients were excluded due to lost to follow up leaving a cohort of 24 patients. Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (6 male and 8 female). Allograft/autograft were utilised in the remaining 10 patients (6 male and 4 female). All 24 patients had closed fractures, classified using the AO and Schatzker classification. Roentograms at presentation, post-operatively and regular follow-up till 12 months were analysed for maintenance of reduction, early and late subsidence of the articular surface. Functional outcomes such as knee range of movement and WOMAC Knee scores were compared between groups.Objective
Patient & Methods
Fractures of the distal third of the adult tibia pose a management problem. Conservative treatment often results in delayed and non-union, mal union or sub optimal functional results in terms of joint motion. Closed reduction and intramedullary fixation may not be possible where the fracture line traverses or lies distal to the level of the locking screws and open reduction and internal fixation at this level has a high soft tissue complication rate. Percutaneous plating provides a safe and minimally invasive procedure for fixation of these fractures. In our unit, over an eighteen month period from September 1999 to March 2001, fourteen patients (ten male and four female) with an average age of forty five (range sixteen to sixty nine years) with fractures of the distal third of the tibia underwent percutaneous plating. Thirteen cases were isolated limb injuries and one occurred in a polytrauma patient with bilateral lower limb injuries. Eight were A1.2, four A1.3 and two B1.3 fractures according to the OTA classification. Only one injury was compound. All patients had a general anaesthetic and antibiotic prophylaxis. The procedure was carried out under tourniquet control and fluoroscopy. Except for the polytrauma patient, all procedures were carried out within seventy two hours of the injury. All fractures were reduced closed and fixed percutaneously with either a semi tubular or DCP plate. The average tourniquet time was 50 minutes. A below knee plaster slab was used in the initial postoperative period and patients were mobilised non weight bearing in a below knee cast at forty eight hours. Patients were followed up in the out patients at two weeks for suture removal and cast change. The average period of non weight bearing was ten weeks. There were no cases of wound infection and union was achieved in all cases with an average time to union of fourteen weeks. After union, three patients underwent a further procedure to remove symptomatic metalwork. On clinical review, all patients had an excellent range of knee and ankle motion. One patient with an associated subtalar dislocation developed marked stiffness at that joint. Percutaneous plating is a quick and relatively easy way of achieving biological fixation of distal tibial fractures. In our study, there was a very low complication rate with predictable union and excellent functional results.
