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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 33 - 33
1 Apr 2013
Eyre J Gudipati S Chami G Monkhouse R
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Background

Lisfranc/midfoot injuries are complex injuries with a reported incidence of 1 in 55000 in literature and frequently overlooked. But, recently they are becoming more commonly diagnosed with advent of CT scan and examination under anaesthesias (EUA) for suspicion fractures. Here we present a case series results of a single surgeons experience over the last 6 years.

Methods

Retrospective review of 68 patients treated by a single surgeon over the last 6 years. Injuries were diagnosed on plain Xrays, clinic examination. Any suspicious injury were further assessed by a CT scan, all injuries were confirmed by EUA and treated with open reduction and internal fixation within 4 weeks of injury. Post-operative immobilisation in full cast for 6 weeks then a removal boot with non-weight bearing for a total of 3months. They were followed up regularly initially at 3, 6 and 12months. At final review the following data was collected: clinical examination, plain x-ray looking for: late deformity, signs of OA in Lisfranc joint, Auto fusion rate, rate of metal work failure. The x-rays findings were correlated with: (1) type of fixation. (2) The following scores: FAOS, AOFAS-M, specially designed new foot and ankle score.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 71 - 71
1 Sep 2012
Gudipati S Sunderamoorthy D Hannant G Monkhouse R
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Lisfranc injuries are not the common injuries of foot and ankle but there has been an increase in the incidence of these injuries due to road traffic accidents and fall from heights. We wish to present our retrospective case series of the operative management of the Lisfranc injuries by our senior author.

We retrospectively reviewed 68 patients with Lisfranc injuries who were managed operatively by the senior author over the last six years. The case note and the radiographs including the CT scans were reviewed. All of them were treated with open reduction and internal fixation within three weeks of injury. The male: female ratio was 43:25. 37 right: 31 left sided injuries. The average age was 40.6 years (range 16 – 81 years). The most common mechanism of injury was fall from steps at home followed by motor bike accident. They average follow-up was 19.5 months and they were assessed both clinically and radiographically at each follow-up.

The k wires were removed at an average of six weeks. 96% were pain free and fully weight bearing after six months. Two patients had lateral scar tenderness. Majority of them returned to normal activities at an average of 12 months. Two patients had initial wound complications which were treated successfully with oral antibiotics. None of them had degenerative changes.

Our results of early open reduction and internal fixation were comparable to the published literature.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 364 - 364
1 May 2009
Farndon MA Monkhouse R
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Introduction: In 2005, 88 patients (19M/69 F, mean age 55) initially referred by their GP to a Consultant Orthopaedic Surgeon were seen by an Operative Podiatrist as a waiting list initiative. The mean delay between GP referral and clinic appointment was 632 days. The majority of patients were listed for a surgical procedure. The podiatrist left the Trust before any listed surgery was performed. The cohort was subsequently reviewed by a Consultant Orthopaedic Surgeon prior to surgical intervention, creating a unique opportunity to compare podiatric and orthopaedic input in one patient group

Materials & Methods: Casenotes and clinic correspondence were identified by merging clinic datasets & retrieved in 86/88 cases. Medical records and documentation of peripheral vascular status were examined as a standard of care. Correlation of surgical decision making was examined qualitatively

Results: Circulatory status was found to be documented in 0/58 (0%) records available for patients seen by the podiatrist and 70/74 (95%) seen by the orthopaedic surgeon respectively. Vascular investigation or referral was initiated by the orthopaedic surgeon in 8 patients listed for surgery by the podiatrist. The listed procedure was postponed or cancelled by the orthopaedic surgeon in a further 11 patients (5 medically unfit for listed surgery, 4 treated conservatively & 2 unable to obtain valid consent). No written or dictated contemporaneous records were made for 23/88 (26%) of index podiatric consultations. Clinically significant drug history was documented by the podiatrist in 1/13 (8%) cases recorded by the orthopaedic surgeon

Discussion: Reasonable correlation was observed between proposed surgical interventions for forefoot problems. Poor correlation was observed for mid- and/or hind foot problems. Avoidable adverse outcomes might have been anticipated in 19/88 (22%) patients listed for surgery by the Operative Podiatrist

Conclusion: The employment of unsupervised non-medical surgical practitioners in hospital based orthopaedic practice is not appropriate.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 5 | Pages 774 - 775
1 Jul 2002
FARAJ AA MONKHOUSE R