Large osteochondral lesions (OCLs) of the shoulder
of the talus cannot always be treated by traditional osteochondral
autograft techniques because of their size, articular geometry and
loss of an articular buttress. We hypothesised that they could be
treated by transplantation of a vascularised corticoperiosteal graft
from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of
a consecutive series of 14 patients (five women, nine men; mean
age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised
bone graft. Clinical outcome was assessed using a visual analogue
scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society
(AOFAS) hindfoot score. Radiological follow-up used plain radiographs
and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain
had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and
the mean AOFAS hindfoot score had increased from 65 (41 to 70) to
81 (54 to 92) (p = 0.003). Radiologically, the talar contour had
been successfully reconstructed with stable incorporation of the
vascularised corticoperiosteal graft in all patients. Joint degeneration
was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a
vascularised corticoperiosteal graft taken from the medial condyle
of the femur was found to be a safe, reliable method of restoring
the contour of the talus in the early to mid-term. Cite this article:
MRI signal changes are commonly found with myelopathy. The clinical significance of these signal changes in myelopathic patients remains debated. The purpose of this study was to perform a meta-analysis of the data to determine the effect of MRI signal change on pre-operative and post-operative Japanese Orthopaedic Association (JOA) scores and on recovery rate following surgery. A comprehensive review of the literature was performed to identify all published studies that provided data on the presence of MRI signal change as well as JOA scores in patients with cervical spondylotic myelopathy. Data was tabulated and JOA scores were normalised to the 17-point scale. T-tests were performed to determine if there were significant differences between pre-operative and post-operative JOA scores in patients with or without MRI signal change. The recovery rate was calculated for all patients undergoing surgery. T-tests were performed to determine if significant differences occurred in recovery rate in patients with or without MRI signal change.Introduction
Methods
The objective of this meta-analysis was to compare the effects of early and delayed surgery on the risk of mortality, common post-operative complications, and length of hospital stay among elderly hip fracture patients. We searched MEDLINE and EMBASE for relevant prospective studies evaluating surgical delay in patients undergoing surgery for hip fractures published in all languages between 1966 and 2008. Two reviewers independently assessed methodological quality and extracted relevant data.Purpose
Methods
