Advertisement for orthosearch.org.uk
Results 1 - 20 of 69
Results per page:
Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 16 - 16
1 Jun 2023
Wright J Messner J McMahon S Johnson L Foster P Fernandes J Chhina H Klassen A Cooper A
Full Access

Introduction

LIMB-Q Kids is a new patient-reported outcome measure (PROM) for children with Lower limb differences (LLDs). The objective is to conduct an international field test study.

Materials & Methods

A mixed method multiphase approach was used to develop LIMB-Q Kids. In phase one, a systematic review was conducted to identify concepts from existing PROMs used in research with children with LLDs. A preliminary conceptual framework derived from the systematic review informed an international qualitative study. The data from qualitative interviews were used to form the LIMB-Q Kids, which was further refined through multiple rounds of cognitive debriefing interviews with children. Input was obtained from parents and healthcare professionals from Australia, Canada, Ethiopia, India, UK, and the USA. LIMB-Q Kids was translated and culturally adapted into multiple languages.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 28 - 28
1 Jun 2023
Musielak B Green N Giles S Madan S Fernandes J
Full Access

Introduction

Intramedullary lengthening devices have been in use in older children with closed /open growth plates with good success. This study aims to present the early experience of the FITBONE nail since withdrawal of the PRECICE nail.

Materials & Methods

Retrospective analysis of both antegrade and retrograde techniques were utilized. Only patients where union was achieved and full weight bearing commenced were included. The complication rate, length gained, distraction index, weight bearing index (WBI) as well as mechanical axes were analysed.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 14 - 14
1 Apr 2022
Dorman S Fernandes J
Full Access

Introduction

Acquired chronic radial head (RH) dislocations present a significant surgical challenge. Co-existing deformity, length discrepancy and RH dysplasia, in multiply operated patients often preclude acute correction. This study reports the clinical and radiological outcomes in children, treated with circular frames for gradual RH reduction.

Materials and Methods

Patient cohort from a prospective database was reviewed to identity all circular frames for RH dislocations between 2000–2021. Patient demographics, clinical range and radiographic parameters were recorded.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 40 - 40
1 Apr 2022
Hafez M Nicolaou N Dixon S Obasohan P Giles S Madan S Fernandes J Offiah A
Full Access

Introduction

Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation

Materials and Methods

Patients: Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11–17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 35 - 35
1 Apr 2022
See CC Al-Naser S Fernandes J Nicolaou N Giles S
Full Access

Introduction

Metabolic bone disease encompasses disorders of bone mineralization, abnormal matrix formation or deposition and alteration in osteoblastic and osteoclastic activity. In the paediatric cohort, patients with metabolic bone disease present with pain, fractures and deformities. The aim was to evaluate the use of lateral entry rigid intramedullary nailing in lower limbs in children and adolescents.

Materials and Methods

Retrospective review was performed for an 11-year period. Lower limb rigid intramedullary nailing was performed in 27 patients with a total of 63 segments (57 femora, 6 tibiae). Majority of patients had underlying diagnoses of osteogenesis imperfecta or fibrous dysplasia (including McCune Albright disease). Mean age at surgery was 14 years. Indications for surgery included acute fractures, prophylactic stabilisation, previous nonunion and malunion, deformity correction and lengthening via distraction osteogenesis.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 38 - 38
1 Apr 2022
Gangadharan S Giles S Fernandes J
Full Access

Introduction

Fibula contributes to weight bearing and serves as a lateral buttress to the talus. Fibular shortening leads to ankle valgus, distal tibial epiphyseal wedging and ankle instability. Trauma, infection and skeletal dyplasias are the common causes of fibular shortening in children. Aim was to review this cohort who underwent fibular lengthening and ankle reconstruction

Materials and Methods

Retrospective review from a prospective database of clinical and radiographic data of all children who underwent fibular lengthening for correction of ankle valgus. Distraction osteogenesis with external fixator was performed for all cases.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 26 - 26
1 Apr 2022
Parnami V Shah V Ranmuthuge S Giles S Fernandes J
Full Access

Introduction

To evaluate the results of correction of knee deformities based on deformity analysis in Achondroplasia, the commonest skeletal dysplasia as some have concomitant ligamentous deformities

Materials and Methods

Retrospective study from a prospective database (2007–2020) of achondroplasts who underwent growth modulation. Analysis of medical records with objective measurement of mechanical axis radiographs was done (Traumacad). Satisfactory alignment was defined as neutral to slightly varus (0–15 mm MAD) so that the MCL/LCL laxity is not revealed.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 41 - 41
1 Apr 2022
Hafez M Nicolaou N Offiah A Giles S Madan S Dixon S Fernandes J
Full Access

Introduction

The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails.

Materials and Methods

Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time)


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 49 - 49
1 May 2021
Gigi R Kurien B Giles S Fernandes J
Full Access

Introduction

The purpose of our study was to retrospectively analyze our patients who were treated for FH and PFFD by means of guided growth temporary Hemiepiphysiodesis.

We sought to determine the effectiveness of the procedure, as well as its success rates, complications, and rebound phenomena.

Materials and Methods

We retrospectively reviewed the medical records and all routine preoperative and post operative long standing radiograph of all the FH and PFFD patients that were operated in our institute using guided growth hemiepiphysiodesis technique of distal femur or proximal tibia between 2007 to 2017.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 55 - 55
1 May 2021
Hafez M Giles S Fernandes J
Full Access

Introduction

This is a report of the outcome of management of congenital pseudoarthrosis of the tibia (CPT) at skeletal maturity.

Materials and Methods

Retrospective study.

Inclusion criteria:

CPT Crawford IV

Skeletally maturity.

Availability of radiographs and medical records.

Outcome: union rate, healing time, residual deformities, ablation and refracture.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 17 - 17
1 May 2021
Widnall J Madan S Giles S Fernandes J
Full Access

Introduction

Recurrence in CTEV is not uncommon and as the child becomes older the foot in question is often stiffer and less amenable to the more traditional serial casting Ponseti method. Treatment of these recurrent CTEV feet with external fixators has been previously documented. We aim to present the Sheffield technique of an external circular frame with adjunctive hindfoot and midfoot osteotomies to correct relapsed CTEV and their associated Roye (outcome) scores.

Materials and Methods

Retrospective analysis of patient records from 1999 to 2019 were performed for those undergoing frame correction of CTEV. Patients were included if there was adjunctive foot osteotomies in the setting of CTEV frame correction and willingness to partake in retrospective Roye outcome scoring. The Roye score was sent out in the mail to parents asking for scoring of the current level of symptoms.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 29 - 29
1 May 2021
Rouse B Giles S Fernandes J
Full Access

Introduction

We have previously published limb lengthening using external fixation in pathological bone diseases. We would like to report a case series of femoral lengthening using the PRECICE system in a similar pathological group especially looking at it's feasibility and complications.

Materials and Methods

This is a case series of four patients, two patients with osteogenesis imperfecta and two with Ollier's disease, who underwent femoral lengthening via distraction osteogenesis using the PRECICE intramedullary nail system. It was a retrospective study from a prospective database from clinical records and radiographs.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 28 - 28
1 May 2021
Rouse B Merchant A Gogi N Widnall J Fernandes J
Full Access

Introduction

Low dose technology of an EOS scanner allows mechanical axis radiographs to be produced using a continuously moving x-ray emitting a thin beam to form a single image which includes all three joints, without the need for stitching. The aim of this study was to identify necessary improvements to enable effective interpretation of the radiographs, and to assess whether the quality of the radiographs varied by production method compared to a previous audit of CR and DR radiographs.

Materials and Methods

8 domains were identified based on a previous audit using the acronym MECHANIC each defining the qualities required for a radiograph to meet the criteria. 100 mechanical axis radiographs produced using conventional and digital methods were analysed in the original study to assess how many radiographs met the described criteria. The same criteria were amended and used to assess 123 different mechanical axis radiographs in the follow up study following the introduction of the EOS scanner, in which 77 were produced using EOS and 46 were produced using conventional and digital methods.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_6 | Pages 141 - 141
1 Jul 2020
Delisle J Benderdour M Benoit B Giroux M Laflamme GY Nguyen H Ranger P Shi Q Vallières F Fernandes J
Full Access

Total Knee Arthroplasty (TKA) patients may present with effusion, pain, stiffness and functional impairment. A positive metal hypersensitivity (positive LTT) may be an indication for a revision surgery with a custom-made implant devoid of any hypersensitivity-related metal or an implant with the least possible ion content of the metal hypersensitivity, if no custom-made is available. The purpose of the current study is to assess the prevalence of metal hypersensitivity in subjects requiring a primary TKA and assess their early functional outcomes.

We are recruiting 660 subjects admitted for TKA. Subjects are randomly assigned to 2 groups: oxidized zirconium implant group or cobalt-chrome implant group. Functional outcomes and quality of life (QoL) are measured pre operatively, 3, 6 and 12 months post operatively with WHOQOL-BREF (domain1-Physical Health, domain 2- Psychological, domain 3- Social relationships, domain 4-Environment), KSS, KOOS and pain Visual Analog Scale (VAS). LTT and metal ions are evaluated pre operatively and 12 months post-surgery.

One hundred-sixty patients, 98 women, were enrolled in the study. Mean age was 65.6±8.9. Mean follow up (FU) was 7.1±3.8 months. Eighty-one (50.6%) were randomised in the cobalt-chrome group. Infection rate was 1.9%, one patient required debridement. Three patients (1.9%) presented with contracture at three months FU. At 12 months, WHOQOL-BREF domain 1, 2 and 4 improved significantly (p0,05).

Overall, all 160 patients improved their functional outcomes and QoL. At 12 months, VAS scores decreased from 7±2.06 at baseline to 1.95±2.79. Furthermore, the high prevalence of positive LTT (27/65) do not seem to affect early functional outcomes and QoL on patients that may have received a potential implant with hypersensitivity (18/27).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_13 | Pages 14 - 14
1 Jun 2017
Ferguson DO Fernandes J
Full Access

Background

Chronic acquired radial head dislocations pose a complex problem in terms of surgical decision making, especially if surgery has already previously failed. There are several underlying causes that should be investigated, including previous trauma resulting in a missed Monteggia fracture.

Aim

To review the clinical and radiological outcomes for children up to 18 years of age, with a radial head dislocation treated with circular frame surgery.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 54 - 54
1 Dec 2016
Yin D Jun J Delisle J Banica A Senay A Laflamme G Ranger P Fernandes J
Full Access

Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet and closed-suction drains on blood loss as well as knee function in TKA.

A prospective clinical trial was conducted on 111 patients admitted for TKA. Subjects were divided into three groups based on duration of tourniquet use (T+: whole-course tourniquet, T-: cementation only tourniquet) and usage of closed-suction drain (D+: drain use, D-: no drain). Thirty-six subjects were included in group T+D+, 42 in T-D+ and 33 in T-D-. Data from study population was analysed for pre and post-operative hemoglobin level (Hb), perioperative and total blood loss, blood transfusion rates, knee range of motion (ROM), and pain level assessment. Direct and indirect costs associated to nursing time and drains were calculated. Results are presented in mean ± SD.

No statistically significant differences were observed among the three groups (T+D+, T-D+ and T-D-) concerning total blood lost (calculated using Gross' formula), Hb levels over the first six postoperative weeks, blood transfusion rates and intra-articular hematomas. Intraoperative bleeding was significantly reduced in T+ subjects compared to T- subjects (100 ± 88 mL vs. 279 ± 235 mL respectively, p < 0.001), yet length of surgery was unaffected by the different tourniquet inflation strategies. Hidden blood loss was lower in D+ subjects compared to D- subjects (1161 ± 554 mL vs. 1667 ± 554 mL respectively, p < 0.001), but it was compensated by the blood loss in the drains. Early post operative ROM (flexion: 79.1 ± 14.8°, extension: −5.0 ± 6.7°) was superior in group T-D- compared to group T+D+ (flexion: 71.9 ± 17.1°, p = 0.071°; extension: −9.9 ± 6.4°, p = 0.004). Nevertheless, ROM six weeks postoperative was not statistically different between groups (flexion: 114.0 ± 13.3°, extension: 0.4 ± 5.2°). Patient-reported postoperative pain was also similar in all groups. Nursing time dedicated to drain management was 30 min/patient (330h total for 660 patients/year). Total costs related to drains were $31.92CAD/patient ($21,067CAD total for 660 patients/year).

Our results suggest that whole-course tourniquet and closed-suction drain use in TKA do not yield beneficial results in total blood loss, blood transfusion rates, complication rates and knee rehabilitation. Their clinical relevance in TKA is questionable. Moreover, nursing time and costs related to drains should have been allocated elsewhere in patient care.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 77 - 77
1 Dec 2016
Bellemare M Delisle J Troyanov Y Perreault S Senay A Banica A Beaumont P Giroux M Jodoin A Laflamme G Leduc S MacThiong J Malo M Maurais G Nguyen H Parent S Ranger P Rouleau D Fernandes J
Full Access

Treat to target is the use of a physiologic marker as a monitor of effectiveness or compliance to an intervention. A recent example has been the progressive use of CTX-1 (Marker of osteoclastic activity) as a surrogate of bone resorptive activity in osteoporosis treatment. CTX-1 levels were demonstrated to be inversely related to drug efficacy in the suppression of bone resorption. As far as fragility fractures are concerned, no reference value of CTX-1 for any index fracture sites was found in the literature. In order to prevent subsequent fractures, efforts to better manage this chronic disease are to be explored. The main objective of this study was to compare and validate the use of serum CTX-1 to the perceived compliance to treatment.

Five hundred and forty three patients (men and women) 40 years of age or older who had been treated for a fragility fracture were enrolled. The purpose of this study was to correlate the measurement of CTX-1 with the perceived compliance to treatment of patients at the time of fracture and at six, 12 and 18 months after initiation of treatment. Our secondary objectives were to evaluate two different CTX-1 suppression target levels (CTX-1< 0.3 ng/mL and CTX-1<0.2 ng/mL), to determine CTX-1 values according to fracture sites, and to explore the profile of patients with subsequent fractures.

Considering index fractures, compliant patients under treatment at baseline had lower CTX-1 levels than non-compliant patients (p=0.052). Patients who were compliant to treatment at six, 12 and 18 months also had lower CTX-1 levels than non-compliant patients (p=0.000). When index fractures were divided into fracture sites, regardless of CTX-1 suppression target level (i.e. CTX-1< 0.3 or 0.2 ng/mL), significant CTX-1 suppression was observed in non-hip and non-vertebral (NHNV) fractures at six, 12 and 18 months (p0.05). No clinically relevant difference was observed between the profile of patients with and without subsequent fractures.

The correlation between serum CTX-1 at the time of fracture and at six, 12, 18 months and the perceived compliance to treatment was validated for NHNV fractures supporting the concept of the available treatments and their effects on bone remodeling for this type of fracture. The correlation was not validated for hip neither for vertebral fracture. There was no correlation between CTX-1 levels and subsequent fracture risk.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_21 | Pages 53 - 53
1 Dec 2016
Senay A Benderdour M Laflamme G Ranger P Shi Q Delisle J Fernandes J
Full Access

Total joint arthroplasty has proven to be efficient to relieve pain and regain mobility. In fact, most patients undergoing a total knee arthroplasty (TKA) are satisfied with their surgery (80 to 90%), yet 4 to 7% still complain of unexplainable pain and stiffness. Several authors have proposed that reactivity to the implant could explain this phenomenon. Still, no strong evidence supports this theory as of today. We aimed to determine the prevalence of metal and cement hypersensitivity in a cohort of patients with unexplained pain and stiffness after TKA.

We retrieved data for a group of patients presenting unexplained pain and stiffness. We excluded all other potential known causes of pain. All patients were tested with a Lymphocyte Transformation Test from whole blood taps. We analysed data of hypersensitivity to metals (alloy particles of titanium and cobalt, aluminum, cobalt, nickel, zirconium, vanadium, molybdenum, cobalt, chromium and iron) and PMMA cement (bone cement monomer and particles).

Fifty-three patients underwent a LTT for unexplained pain and stiffness after total knee arthroplasty between May 2012 and May 2015. The cohort consisted of 26 men and 27 women with a mean age of 66.3(±8.0) years. Six patients had no hypersensitivity (11.3%), leaving 88.7% of the cohort with hypersensitivity to metal and/or cement. Almost half the cohort of patients tested for PMMA was hypersensitive to cement (44.0%). The most common metal hypersensitivity was nickel (69.8%). Twelve patients presented sensitivity to only one metal (22.6%), whereas 35 patients were hypersensitive to more than one metal (66.0%). Eleven patients had revision surgery with a hypoallergenic prosthesis. Patients reported a significant diminution of pain as well as better knee function compared to preoperative status as early as 6 weeks postop, although some reported residual stiffness.

The results of this study suggest that metal and/or cement hypersensitivity could play a role in cases of total knee arthroplasty with unexplained pain and stiffness. Randomised controlled clinical trials on the subject will be initiated by our team to further investigate this phenomenon.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_20 | Pages 92 - 92
1 Nov 2016
Larose G Planckaert C Ranger P Lacelle M Fuentes A Bédard D Fernandes J Nguyen H Grimard G Hagemeister N
Full Access

Total knee arthroplasty (TKA) is recognised as an effective treatment for end-staged knee osteoarthritis. Up to 20% of these patients is unfortunately unsatisfied due to anterior knee pain from unknown origin (Bourne and al. 2010). The aim of this study is to compare knee 3D kinematics during gait of patients with anterior knee pain after TKA to an asymptomatic TKA group. Our hypothesis is that the painful TKA group would exhibit known kinematics characteristics during gait that increase patellofemoral (PF) stresses (i.e. dynamic flexion contracture, valgus alignment, valgus collapse or a quick internal tibial rotation movement) compared to the TKA asymptomatic group.

Thirty-eight patients (45 knees) were recruited 12–24 months post-surgery done by one of three experienced orthopaedic surgeons (31 unilateral TKA and seven bilateral TKA, all using the same knee implant). Patients were divided according to their KOOS pain score (with a cut-off at 6/20 to be included in the painful group). The KOOS questionnaire was also used to assess activities of daily living, symptoms, sports and quality of life. A complete clinical and radiological work up was done on the painful group to exclude those with known explanation for pain (i.e. loosening, malrotation, infection and clinical instability). 3D knee kinematics during treadmill walking was captured and computed using the KneeKGTM system.

For the painful and asymptomatic groups, demographic results show respectively: age of 64.4 ± 7.6 and 69.8 ± 8.3 years, BMI of 31.9 ± 5.0 and 28.1 ± 3.6 kg.m−2, speed of 1.8 ± 0.6 and 1.67 ± 0.5 miles/h., and 50% of women in each group. Only age and BMI showed to be statistically different between groups. The painful TKA group exhibited a valgus alignment when walking (at initial contact and during stance, p<0.001). No significant difference has been put forward for the flexion/extension and internal/external tibial rotation.

Since a higher valgus alignment increases the Q angle, which lateralise the patella and increases PF stresses, results provide new insight on origin of symptoms. Conservative treatments for PF pain syndrome have shown to address the valgus alignment and improve symptoms, therefore the next step will be to assess the impact on pain level and alignment during gait of a personalised conservative management for the painful TKA group. Additionally, a study assessing the change in the radiological and dynamic alignment from pre to post surgery could bring valuable insight on the impact of surgical procedure on anterior knee pain.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_15 | Pages 11 - 11
1 Sep 2016
Al-Naser S Nicolaou N Giles S Fernandes J
Full Access

The aim of the study was to review the effectiveness of rigid IM nailing in stabilisation and deformity correction of lower limb long bones in adolescents with metabolic bone disease which to our knowledge has not been studied before.

Medical records and radiographs were retrospectively reviewed looking at indications, deformity correction, number of osteotomies-if needed, bone healing, time to healing and incidence of complications.

Between Aug 2010 and Mar 2015 fifteen patients (24 segments) had rigid IM nailing. Ten patients had Osteogenesis Imperfecta, four with McCune Albright syndrome and one with hypophosphatemic rickets. 22 femora and two tibiae were IM nailed. The mean age of the patients was 13.1 (9.6–16.75 years). Eleven out 24 segments were previously rodded. Eight segments were for acute fractures. 13 bones had significant deformities requiring corrective osteotomies. One patient had previous fracture non union.

All patients were allowed to partial weight bear immediately postoperatively and were fully mobile six weeks following surgery. Mean follow up was 24 months (3–51 months) post-operatively. All deformities were corrected. All fractures and osteotomies radiologically united.

Mean radiological union time was 5.5 months (6 weeks – 11 months). Patients with acute fractures had mean radiological union time of 4 months. Patients who had osteotomies had a mean radiological union time of 7.1 months. The patient with previous non union had BMP at the same time and radiologically healed in 10 months. Two patients had persistent bisphosphonate osteotomy lines but were asymptomatic. One patient had removal of a prominent distal locking screw and one had persistent Trendelenburg gait.

Rigid intramedullary nailing is effective in stabilisation and deformity correction of long bones in adolescent patients with brittle bone disease. The technique has a low complication rate. We recommend the use of this technique in paediatric limb reconstruction in managing metabolic bone conditions.