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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 64 - 64
1 Sep 2012
Mukhopadhyay S Metcalfe A Guha A Mohanty K Hemmadi S Lyons K O'Doherty D
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Introduction

Previous studies have demonstrated the need of accurate reduction of ankle syndesmosis. Measurement of syndesmosis is difficult on plain radiographs. Recently, a difference of 2mm in anterior and posterior measurements at incisura of the inferior tibio-fibular joint on CT has been described as a measure of malreduction (depicted as ‘G’ for ease of description). Our practice changed towards routine post operative bilateral CT following syndesmosis fixation to assess the reduction and identify potential problems at an early stage. The aim of this primarily radiological study was to determine if the use of bilateral cross sectional imaging brings additional benefit above the more conventional practice of unilateral imaging.

Method

Between 2007 and 2009, nineteen patients with ankle fractures involving the syndesmosis were included in the study group who had bilateral CT post operatively. The values of ‘G’ and the mean diastasis (MD) were calculated, representing the average measurement between the fibula and the anterior and posterior incisura.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 103 - 103
1 Jul 2012
Zourelidis C Mukhopadhyay S Kotwal R Williams R
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In recent years tribological development of knee replacement impants has beeen introduced with several benefits. However, concomitant problems were noticed following widespread use.

High-flexion total knee replacement (PFC RPF DePuy) has been developed with a view to improve flexion and the design is expected to have a better patello-femoral biomechanics. However, high secondary patella resurfacing rate has been noticed in the current series.

We have retrospectively reviewed 119 knees in 96 patients who underwent RPF knee replacement with selective patellar resurfacing from 2006 to 2010 by the senior author. 71 were performed without primary resurfacing while 48 in knees patella was resurfaced primarily due to significant symptomatic arthritic changes. Majority were females (57 versus 39 males). Average follow-up period was 37 (12-62) months.

Twelve (16.9%) knees were subjected to secondary resurfacing due to continuing anterior knee pain. Average time from primary total knee replacement to secondary resurfacing was 18 months (8-35). Most of the patients were satisfied following the secondary resurfacing.

Mean Oxford Knee Score in the group where the patella was resurfaced primarily was 33.1 (9-48), in the group where the patella was not resurfaced 32.8 (11-47), in the secondary resurfacing group 31.8 (14-43) and in the revision group 20.5 (16-25).

RPF knee replacements in our series have a considerably higher rate of secondary patellar resurfacing as compared with published literature. We recommend primary patellar resurfacing of all RPF knee replacements to avoid this problem. Further analysis of the prosthetic design would be beneficial in relation to clinical outcome.

No of patients-96

Total no of knee-118

Av age-66.5

Females-57

Males-39

Patella not resurfaced- 73

Resurfaced-45

Revised-10(13.7%)

Revision to TKR (TC3) for different reason-3(2.54%)

Average time from primary to secondary resurfacing-


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 21 - 21
1 May 2012
Kalra S Sprot H Mukhopadhyay S Subramanian K Robertson A
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Abstract

Displaced mid-shaft clavicle fractures have traditionally been treated non-operatively. New evidence supports the use of operative treatment with better functional results although with some risk of adverse complications. The patient's opinion in choosing one or the other option of treatment is important especially when a new therapeutic philosophy is introduced.

We aimed to obtain the patients' preference based on their opinion of various possible outcomes of each treatment method. A clinical decision tree was constructed based on probabilities for various outcomes from the current literature. We used clinical decision analysis based on Bayesian logic. A similar clinical decision analysis was done for a cohort of orthopaedic surgeons.

We interviewed 20 patients to obtain their health preferences on a numerical rating scale for each of the six possible outcomes for the conservative and operative treatments. Similar health preferences were obtained from 20 orthopaedic surgeons.

The cohort of patients were young (age range: 13 – 21, mean: 16 years) males involved in active sport. The results of the decision analysis demonstrated a strong preference for operative management in this cohort of patients (combined probability of 0.81 for operative treatment versus 0.61 for non-operative).

The cohort of orthopaedic surgeons were either career orthopaedic trainees or qualified orthopaedic surgeons with an age range of 28 – 41 years (mean age: 35 years). The results of the decision analysis demonstrated a weak preference for operative management in this cohort of surgeons (combined probability of 0.84 for operative treatment versus 0.77 for non-operative management).

Overall the young active patient is eight times more likely to prefer operative treatment over non-operative management compared to the well informed orthopaedic surgeon. Patient education is the key to a better informed patient who can make a balanced decision. Clinical decision analysis can be a useful tool in this process.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 24 - 24
1 May 2012
Khurana A Zafar S Abdul W Mukhopadhyay S Mohanty K
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Background and Objective

Patients undergoing hip fracture surgery have a high peri-operative mortality rate. We performed a retrospective study to ascertain if there is any relation between postoperative haemoglobin (Hb) decrease and cardiac related events following the surgery.

Methodology

We carried out a retrospective study in this University Hospital's trauma unit. All patients operated for fracture neck of femur (hemiarthroplasty and DHS – Dynamic Hip Screw) between July 2006 and August 2008 were included in the study.

Electronic records from the trauma unit, pathology portal, operating theatre and blood bank were obtained to identify the pre-operative and post-operative Hb levels, amount of blood transfused and Troponin T (TnT) level.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 96 - 96
1 Apr 2012
Mukhopadhyay S Batra S Kamath S Mukherjee K Ahuja S
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Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study.

224 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006-2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently.

Among 224 patients 13 (5.8%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11-40). 84.6% (n=11) patients were female and 15.3% patients were male. There was varying severity of curve patterns. We have noted two lumbar/thoraco-lumbar curves (Lenke 5), King Type I-6, King Type II-2 and three King Type III curves. All scoliotic deformities were non-structural. Bilateral pars defect was noted in nine (69%) patients.

Previous studies (Fisk et al, 1978; Mau H 1981) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Sairyo et al.). Our study reveals the incidence of pars defect in AIS to be 5.8 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 97 - 97
1 Apr 2012
Mukhopadhyay S Batra S Ahuja S
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In major procedures like scoliosis surgery, parents are often asked to sign the consent on behalf of children because of the pretext that minor may have limited understanding and judgement about the procedure. Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons.

We audited our practice in the department to collect information on the current consent practices involving the minor patients undergoing scoliosis surgery.

We also have conducted a questionnaire survey of the various spinal units in UK to assess their practice in this regard.

Forty-two consent forms (28 patients; multiple procedures in some patients) and case notes of patients between 12 and 16 years undergoing scoliosis surgery were reviewed. We have contacted 12 spinal deformity correction units and 11 spinal trauma units across UK over telephone to assess the current consenting practice as well.

9.5% (n=4) patients signed there own consent forms. Except in one case explanation of risks were documented in detail. Except two units (18%) offering the minor patient to sign their consent, parents are usually asked to sign consent on their behalf in majority (10/12) units. Seven out of the twelve spinal units use standard NHS or department of health consent forms. Few units have their own consent form with some alterations or additions.

There is no specific age when a child becomes competent to consent to treatment: It depends both on the child and on the seriousness and complexity of the treatment being proposed. However, it is still good practice to encourage competent children to more involved along with their families in decision-making.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 95 - 95
1 Apr 2012
Guha A Mukhopadhyay S Ahuja S
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Our study aims to evaluate the efficacy of Wallis implant in management of discogenic back pain.

We have prospectively studied thirty patients between 2006 and 2007. Average age of patients was 40.8 years. Average follow-up period 20.6 months (9-28). Main inclusion criteria includes failure of conservative management of low back pain due to degenerative disc disease, preservation of 50% of the disc height and positive discographic features. In majority of the patients the implant was put in at the level of L4-L5.

Pre-op and post op SF36 and Oswestry Disability Index (ODI) scores were assessed during clinic follow-up and by telephonic interview. Mean SF36 score improved from thirty-seven (8.3 – 54.3) to 51.4. Mean ODI improved from forty-three (20-60) to 26.5(2-60) (p = 0.026). Complications including superficial infection occurred in one patient, deep infection in one patient, erosion of spinous process in one and displacement of the implant in one case. Three (10%) patients had revision surgery due to various reasons.

Wallis interspinous dynamic stabilization system could be used as a soft stabilisation device avoiding fusion and short-term results are promising. In selected group of discogenic low back pain patients it is a useful interim procedure. Long-term follow-up of our series is ongoing.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 490 - 490
1 Nov 2011
Mukhopadhyay S Batra S Kamath S Mukherjee K Ahuja S
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Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study.

Methods: 229 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006–2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently.

Results: Among 229 patients 18 (7.86%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11–40). Male -5 (27.7%), female- 13(72.2%). There was varying severity of curve patterns, major thoracic curve-10, major lumbar curve-4, mild thoracic curve-3 and mild lumbar curve in one. Bilateral pars defect was noted in 14 (77.8%) patients.

Discussion: Previous studies (Fisk et al, 1978; Mau H 1977) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Sairyo et al, 2009). Our study reveals the incidence of pars defect in AIS to be 7.86 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies.

Conflicts of Interest: none

Source of Funding: none


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 312 - 312
1 Jul 2011
Guha A Mukhopadhyay S Reddy M Thomas R
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Background: The bunionette is a lateral prominence of the fifth metatarsal head. It is usually caused by a wide intermetatarsal angle (IMA) between the 4th and 5th metatarsals with associated varus of the metatarsophalangeal (MTP) joint. Increased pressure placed on the head of the 5th metatarsal results in pain and plantar callus formation. Failure of conservative treatment warrants bony corrective surgery. Various distal, shaft and basal osteotomies have been described in the literature.

Methods: We have used a ‘reverse’ scarf osteotomy in 12 cases (10F: 2M) with a mean follow-up of 12 months (range 5–22 months). All patients filled up a Foot Function Index (FFI) questionnaire pre-operatively and a repeat questionnaire at the latest follow-up. All angles were measured on a weight bearing AP radiograph of the foot. Post-operatively we mobilised the patients immediately using a heel bearing shoe. All osteotomies healed sufficiently at 6 weeks to allow unprotected weight bearing. Full weight bearing was allowed after clinical and radiological union was achieved.

Results: Pre-op mean IMA was 13.1 degrees (range: 10.4–18 degrees) and mean 5th MTP angle was 19.9 degrees (range 12.7–25.5 degrees). Pre-op mean FFI was 34.2 (range 14–71.3). Post operatively, mean IMA was 7.27 degrees (range: 2.0–11.5 degrees); mean 5th MTP angle was 6.36 degrees (range: 2.8–9.0 degrees) and post-operative mean FFI was 5 (range 0–16.7). All except one patient were pleased with the cosmetic correction obtained. One patient did not like the scar but her foot was asymptomatic and her FFI improved from 27 to 0. All patients would undergo the same procedure on the other foot if required and would recommend the same to a friend.

Conclusion: ‘Reverse’ Scarf osteotomy in the correction of bunionette deformity offers promising results in the short term. Further longterm follow-up would help to establish the benefits of this procedure.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 427 - 428
1 Jul 2010
Mukhopadhyay S Batra S Kamath S Ahuja S
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Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study.

Methods: 229 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006–2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently.

Result

Among 229 patients 18 (7.86%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11–40). Male-5 (26.3%), female- 4(73.6%). Majority of the patients with were females (72.2%). There was varying severity of curve patterns, major thoracic curve-10, major lumbar curve-4, mild thoracic curve-3 and mild lumbar curve in one. Bilateral pars defect was noted in 14 (77.7%) patients.

Discussion

Previous studies (Fisk et al, 1978; Mau H 1977) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Jon R. Davids et al, 2004). Our study reveals the incidence of pars defect in AIS to be 7.86 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies.