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Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 7 - 7
1 Jun 2017
Calder P Shaw S Roberts A Tennant S Sedki I Hanspal R Eastwood D
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Purpose

This study compares outcomes in patients with complete congenital fibula absence, associated with severe lower limb deformity, treated with an amputation protocol to those using an extension prosthesis.

Method

32 patients were identified. 9 patients (2M: 7F, median age at presentation of 22 yrs) utilized an extension prosthesis. 23 patients (16M: 7F, median age at presentation of 10 months) underwent 25 amputations during childhood: only two underwent tibial kyphus correction to facilitate prosthetic wear.

Mobility was assessed using the SIGAM and K scores. Quality of life was assessed using the PedsQL inventory questionnaire; pain by a verbal severity score. Patients undergoing amputation were further subdivided by age, below and above 2 yrs at the time of surgery.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_13 | Pages 8 - 8
1 Jun 2017
Calder P Shaw S Roberts A Tennant S Sedki I Hanspal R Eastwood D
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Purpose

This study compares outcomes in patients with complete congenital fibula absence treated with an amputation protocol to those using an extension prosthesis.

Introduction

Complete fibula absence presents with significant lower limb deformity. Parental counselling regarding management is paramount in achieving the optimum functional outcome. Amputation offers a single surgical event with minimal complications and potential excellent functional outcome.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_8 | Pages 108 - 108
1 Apr 2017
Bhattacharjee A Freeman R Roberts A Kiely N
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Methods

A retrospective review of 80 patients with unilateral slipped capital femoral epiphysis from 1998–2012 was undertaken to determine the outcome of the unaffected hip. All patients were treated with either prophylactic single Richards screw fixation or observation of the uninvolved hip and were followed up for at least 12 months. The unaffected hip of 44 patients (mean age 12.6 years, range 9–17) had simultaneous prophylactic fixation and 36 patients (mean age 13.4 years, range 9–17.4) were managed with observation.

Results

Sequential slip of the unaffected hip was noted in 10 patients (28 per cent) in the observation group and only in 1 patient (2 per cent) in the group managed with prophylactic fixation. A Fisher's exact test showed significantly high incidence of sequential slip in unaffected hips when managed with regular observation (p-value 0.002). Only 3 cases had symptomatic hardware on the unaffected side after prophylactic fixation with one requiring revision of the metal work; one had superficial wound infection treated with antibiotics. No cases had AVN or chondrolysis.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 342 - 342
1 Jul 2014
Sun Y Roberts A Haines N Ruffolo M Mauerhan D Hanley E
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Summary

PCA-III, a phosphocitrate analog, acts not only as a potent calcification inhibitor but also as a protective agent for extracellular matrices. PCA-III has potential as a disease-modifying drug in the treatment of primary osteoarthritis and posttraumatic osteoarthritis in humans.

Introduction

Phosphocitrate (PC) inhibits the development of primary osteoarthritis (OA) in Hartley guineas pigs but not menisectomy-induced OA in rabbits (1). We sought to examine the molecular mechanisms underlying the disease-modifying activity of PC, and evaluate the effect of PCA-III, a PC analog (PCA), on the development of primary and secondary OA.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_1 | Pages 14 - 14
1 Jan 2014
Roberts A
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Purpose:

To examine the feasibility of surgical outcome measures for a children's orthopaedic surgeon when compared with other specialties.

Methods & Results:

Details of procedure codes for 2726 inpatient episodes were used to examine the distribution of procedures and the breadth of diagnoses dealt with by a variety of orthopaedic sub-specialists. The author's practice included 199 surgical cases and was compared with two arthroplasty surgeons (n=971); a spinal surgeon (n=256); a foot and ankle surgeon (n=341) and an upper limb surgeon (n=393).

Arthroplasty surgeons can report 50% of their outcomes as primary knee or hip replacements the index procedure for the author is metalwork removal (14.5%). My upper limb colleague could be judged on 25% of his cases (carpal tunnel decompression) and my spinal surgical colleague on 20% of his cases (primary posterior decompression of spinal cord). Only my foot and ankle colleague compared in terms of diversity with 9% of his cases consisting of first metatarsal osteotomy and the next 9% consisting of 1st MTPJ arthrodesis.

The proportion of multiple procedures also varies between sub-specialists with 66% of my cases being multiple compared with 38% for the arthroplasty surgeons and 42% for the upper limb surgeons. Foot and ankle has a high rate of multiple procedures (62%) and the spinal surgeons code different procedures at each level in the spine giving the high rates of multiple procedures.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_8 | Pages 3 - 3
1 Feb 2013
Roberts A Quayle J Krishnasamy P Houghton J
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CECS is an exercised induced condition that causes pain, typically in the lower limbs, and is relieved by rest. It is often seen in military personnel significantly restricting their duties. Conservative treatment is rarely successful and patients often require surgical decompression by fasciotomy or fasciectomy.

All IMP (intramuscular pressure) tests (n=286) carried out between December 2007 and October 2010 on patients with suspected CECS in the anterior compartment of the lower leg were reviewed. The treatment and outcomes of those referred for surgery were analysed. Pre- and post-surgery military medical grading for leg function was extracted from the medical records system. Independent t-tests compared differences between patients that had surgery or did not. The Wilcoxon signed-rank test compared grades before and after surgery.

According to the diagnostic criterion, 80% of patients undergoing IMP testing had CECS. Of these, 179 (68%) patients underwent surgery, 17 (9%) of these were for recurrent symptoms. Almost all decompressions were bilateral (95%). The majority of operations (121) were fasciectomies of the anterior compartment only and were performed by 2 surgeons. The remaining operations (58) were performed by 6 surgeons and were fasciotomies of both anterior and lateral compartments. The mean time from testing to surgery was 24 (median 11) weeks. There were 23 (13%) complications other than recurrence including 16 wound infections, 6 seromas and 1 haematoma. Pre- and post-surgery grading was available for 67% of patients. These patients had significantly better leg function after surgery (Z=−3.67, p<0.001). Of these, 47% improved, 38% showed no improvement and 15% had a poorer outcome had. Those who had a fasciectomy were significantly more likely to improve than those who had a fasciotomy (p=0.023, rho=−1.96).

Our results demonstrate that patients generally improve lower limb function following surgical decompression. However, 53% showed no improvement or deteriorated in their medical grading. In addition, there is a high diagnosis rate for CECS following IMP measurement. This may reflect the poor validity of the diagnostic criterion or this could be due to good clinical selection for testing. Furthermore, fasciectomy shows a greater correlation with improved outcome than fasciotomy. There is a need to develop more accurate diagnostic criteria and to evaluate the benefits of standardising surgical technique.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 72 - 72
1 Jul 2012
Metcalfe A Stewart C Postans N Barlow D Whatling G Holt C Roberts A
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Introduction

Patients with knee osteoarthritis frequently complain that they develop pain in other joints due to over-loading during gait. However, there have been no previous studies examining the effect of knee arthritis on the other weight bearing joints. The aim of this study was to examine the loading of the hips and contra-lateral knee during gait in a cohort of patients pre- and post knee replacement.

Methods

Twenty patients with single joint osteoarthritis awaiting knee replacement and 20 healthy volunteers were recruited. Gait analysis during level gait and at self selected speed was performed using a 12 camera Vicon motion analysis system. The ground reaction force was collected using EMG electrodes attached to the medial and lateral hamstrings and quadriceps bilaterally. Patients were invited to return 12 months post-operatively. Data was analysed using the Vicon plug-in-gait model and statistical testing was performed with SPSS v16.0 using ANCOVA to account for gait speed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXV | Pages 8 - 8
1 Jul 2012
Gilbert R Gallacher P Roberts A
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Purpose of Study

A description of a procedure to stabilize symptomatic complete discoid menisci with medium term results.

Methods and Results

Children with mechanical symptoms of lateral meniscal instability were assessed by MRI scan. In those with a lateral discoid meniscus an arthroscopic examination was performed to identify the presence of tears and confirm the radiological diagnosis. No incomplete or Wrisberg variant types were encountered. An antero-lateral arthrotomy was performed. The anterior horn of the meniscus was mobilized and traction sutures inserted. Flexion and extension of the knee whilst traction was applied led to delivery of the anterior horn into the wound. After confirmation of position with image intensifier a groove was fashioned in the anterior aspect of the cartilaginous portion of the proximal tibial epiphysis. Typically three titanium bone anchors with non absorbable sutures were placed in the base of the groove. The anterior horn of the meniscus was drawn into the groove and anchored with sutures. Active range of motion exercises were encouraged but a canvas knee immobilizer was employed whilst walking for the first six weeks.

Four boys and three girls underwent meniscopexy performed at a mean age of 9.4 years (range 5.7 to 12.4 years). Follow up was at a mean of 4.9 years. At last follow up no patient reported symptoms of locking or pain. No patient has required revision surgery but one girl had a subsequent meniscopexy procedure on the opposite knee. Five of the children have had Lysholm scores performed at last follow up averaging 93.5 (80 to 100 points).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 41 - 41
1 May 2012
Metcalfe A Stewart C Postans N Dodds A Smith H Holt C Roberts A
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Introduction

Patients with knee osteoarthritis (OA) often tell us that they put extra load on the joints of the opposite leg as they walk. Multiple joint OA is common and has previously been related to gait changes due to hip OA (Shakoor et al 2002). The aim of this study was to determine whether patients with medial compartment knee OA have abnormal biomechanics of the unaffected knee and both hips during normal level gait.

Methods

Twenty patients (11 male, 9 female), with severe medial compartment knee OA and no other joint pain were recruited. The control group comprised 20 adults without musculoskeletal pain. Patients were reviewed, x-rays were examined and WOMAC and Oxford knee scores were completed. A 12 camera Vicon (Vicon, Oxford) system was used to collect kinematic data (100Hz) on level walking and the ground reaction force was recorded using three AMTI force plates (1000Hz). Surface electrodes were placed over medial and lateral quadriceps and hamstrings bilaterally to record EMG data (1000Hz). Kinematics and kinetics were calculated using the Vicon ‘plug-in-gait’ model. A co-contraction index was calculated for the EMG signals on each side of the knee, representing the magnitude of the combined readings relative to their maximum contraction during the gait cycle. Statistical comparisons were performed using t-tests with Bonferroni's correction for two variables and ANOVA for more than two variables (SPSS v16).


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 38 - 38
1 Jan 2011
Qureshi A Roberts A
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The purpose of this study was to assess the Interobserver Reliability of the Sauvegrain Skeletal Age Assessment.

Elbow radiographs requested to exclude injury were anonymised. Sixteen examinations were assessed by ten independent orthopaedic specialist registrars or consultants. The Sauvegrain method as modified by Dimeglio was used to score the radiographs. The observations made were then assessed for interobserver reliability by means of a multiple observer Kappa score and the total scores by intra-class correlation coefficient.

Kappa scores for the components of the score were 0.403 for the lateral condyle; 0.492 for the trochlea; 0.354 for the proximal radius and 0.508 for the olecranon. Adding item scores to produce a modified Sauvegrain score had an intraclass reliability of 0.858 (95% CI 0.758 to 0.935).

Methods of identifying skeletal maturation and predicting future growth generally depend on the use of an atlas of hand radiographs. Difficulties with poor interobserver reliability associated with these methods has led to a move towards assessments that do not depend upon bone age estimations. Unfortunately plans based on ratios of growth or average patterns produce errors when unusual types of growth disturbance are present. We conclude that use of a scoring system for maturation assessed by elbow radiographs offers a significant advantage when substituted into the straight line method of growth prediction. The Sauvegrain method as modified by Dimeglio1 has demonstrated an excellent level of inter observer reliability. We have used Sauvegrain scores to improve the accuracy of timing when using the Mosely straight line method.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 8 | Pages 1184 - 1184
1 Aug 2010
Roberts A


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 215 - 215
1 May 2009
Qureshi AA Roberts A
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Aim: To assess the Interobserver Reliability of the Sauvegrain Skeletal Age Assessment

Methods and Results: Elbow radiographs requested to exclude injury were anonymised. Sixteen examinations were assessed by ten independent orthopaedic specialist registrars or consultants. The Sauvegrain method as modified by Dimeglio was used to score the radiographs. The observations made were then assessed for interobserver reliability by means of a multiple observer Kappa score and the total scores by intra-class correlation coefficient.

Kappa scores for the components of the score were 0.403 for the lateral condyle; 0.492 for the trochlea; 0.354 for the proximal radius and 0.508 for the olecranon. Adding item scores to produce a modified Sauvegrain score had an intra-class reliability of 0.858 (95% CI 0.758 to 0.935).

Conclusions: Methods of identifying skeletal maturation and predicting future growth generally depend on the use of an atlas of hand radiographs. Difficulties with poor interobserver reliability associated with these methods have led to a move towards assessments that do not depend upon bone age estimations. Unfortunately plans based on ratios of growth or average patterns produce errors when unusual types of growth disturbance are present. We conclude that use of a scoring system for maturation assessed by elbow radiographs offers a significant advantage when substituted into the straight-line method of growth prediction. The Sauvegrain method as modified by Dimeglio1 has demonstrated an excellent level of interobserver reliability. We have used Sauvegrain scores to improve the accuracy of timing when using the Mosely straight-line method3.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 520 - 520
1 Aug 2008
Sewry C Roberts A Patrick J
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Purpose of study: To describe the histological effects of botulinum toxin on gastrocnemius muscle affected by cerebral palsy.

Method: Samples of gastrocnemius were obtained at the time of surgery. Ethical committee approval had been obtained for the study. Details of timing and doses of botulinum toxin previously administered to the muscle were recorded. A variety of immunohistochemical tests were employed to identify any changes in the muscle. Alterations in the distribution of myosin isoforms were identified with antibodies for fast, slow and neonatal myosin. The presence of persistent denervation was inferred from fibres deficient in neuronal nitric oxide synthase (nNOS). Mitochondrial abnormalities were assessed with an NADH stain and the presence of chronic atrophic fibres (nuclear clumps) noted.

Results: Our first case had received 3 botulinum injections over a period of 5 years, the last one 3 years prior to biopsy. Histology showed pronounced abnormalities with a wide variation in fibre size, areas of myofibrillar disruption and 50% of fibres co-expressing fast and slow myosin. Other samples showed less change but showed more frequent nuclear clumps than controls, indicating chronic atrophy and more hybrid fibres than controls, but always less than 10%. Treated muscles also showed a small, variable number of atrophic fibres without nNOS. Treated samples showed no apparent fibre type grouping, a feature associated with collateral sprouting of peripheral nerves following denervation.

Conclusions: Moderate doses of botulinum toxin appear to produce an alteration in muscle histology apparent several years afterwards. No correlation could be found between the timing of the previous injection or the dose of botulinum toxin injected and the severity of the changes. Botulinum toxin remains a valuable aid in the management of spastic muscle. However consideration should be given to other methods of treatment if an effective non surgical alternative exists.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 225 - 225
1 Sep 2005
Hopcroft R Hynd D Willis C Manning P Roberts A Lowne R Wallace W
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Introduction: Legislation driven & technology aided reductions in mortality have been documented over the past 10 years for road traffic accidents (RTAs). However many authors have noted an increasing morbidity as a result of serious lower limb injuries. In collaboration with the Transport Research Laboratory (TRL) a 2 stage research programme has been carried out on fresh frozen PHMS lower limbs. This programme, has culminated in a specific series of PMHS tests to reproduce the most disabling lower limb injuries seen in real world accident data. The authors aimed to establish force thresholds for failure (fracture) of the calcaneus, talus and tibial plafond in frontal and frontal offset RTAs. This data is considered essential to support new pan-European legislation for better lower limb protection structures in new motor vehicles which is currently under discussion.

Methods: A 5m bungee driven sled test facility capable of creating a validated and repeatable dynamic crash pulse was used to subject 15 PMHS lower limb specimens to, axial impact loading. The pulse was modelled on the accelerometer toe-pan recordings from a full-scale automotive crash test in frontal impact. To represent brake pedal intrusion at an impact velocity of up to 14ms−1, a staggered double impact, delaying application of axial loading was used. Impact loading was achieved via a modelled brake pedal to the mid-foot. All specimens were preloaded through the Achilles tendon and by knee extension to simulate the plantar flexing response seen in the foot & ankle in driving simulator studies. Delaying the application of axial loading after the initial impact and sled deceleration effectively imparts momentum into the specimen, further preloading the foot and ankle and thus increasing pre-impact bracing. Transducer data were recorded using high frequency (20 & 100 KHz) capture systems (K-Trader and Prosig). High-speed cinematography enabled additional kinematic analysis. Each specimen was tested once only. Specimens were selected at random for five impact severity groups. All specimens underwent pre impact BMD evaluation using protocols previously designed for this type of work. Post impact analysis included X-rays and necropsy.

Results: The specimens used varied in BMD and age similar to specimens used in other centres for similar testing. In the 15 final test specimens 8 calcaneal fractures were generated, one with an additional talar neck fracture. Seven specimens did not sustain injury. Measured BMD did not appear to be a useful predictor of load to failure. Peak axial forces ranged from 5KN up to 14kN. Toe pan and foot accelerations up to 200g were generated.

Discussion: This test method appears to predispose the calcaneus to injury. It failed to create either a Pilon fracture or an isolated talus fracture. Previous research investigating axial impact loading have applied a direct impact with varing levels of pre-load. They resulted in a range of injuries and suggested pre-loading reduced injury thresholds for talar and tibial injuries. This has not been our experience.

Conclusions: This data is invaluable, enabling thresholds for legislative car crash testing to be authoritatively stated and incorporated into national and international standards.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_I | Pages 69 - 69
1 Mar 2005
Roberts A Patrick J Jaffray D Stewart C Cole G
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Introduction: Selective dorsal rhizotomy has been used extensively in Europe and North America in the management of spasticity secondary to cerebral palsy. Permanent reduction in lower limb spasticity has been observed with consequent improvements in gait parameters. A decade ago a rhizotomy programme was established in Oswestry to utilise the technique for a carefully monitored group of children with cerebral palsy diplegia.

Methods: Using stringent selection criteria, twenty children underwent selective lumbar dorsal rhizotomy with follow up by means of gait analysis. A permanent reduction in spasticity has been observed with a significant improvement in almost all parameters. We report the need for further bony and soft tissue surgery and our complications. There has been weight gain in the majority of cases. There has been no major spinal deformity.

Conclusion: As a result of our review of the results in the first twenty cerebral palsy diplegic patients we have modified our selection criteria. Exclusion criteria include weakness, not enough spasticity or poor control.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_I | Pages 40 - 40
1 Mar 2005
Hart W Goude W Roberts A Richardson J Evans G
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Aim: A retrospective review of the triple pelvic osteotomies performed between 1988 and 2002 identifying the factors that may predict a favourable outcome from surgery.

Method: A case note and x-ray review identifying various parameters that influence outcome.

Results: 30 osteotomies in 26 patients have been studied. 3male and 27 female patients have been identified. All patients were symptomatic prior to surgery complaining of pain and reduced exercise tolerance. Following surgery 21 patients were satisfied with their outcome and 9 patients had poor results.

The average age of patients with a good outcome was 20.9 years. The average age of patients with a poor outcome was 30.9 years.

There was no correlation between the correction of either the Sharp angle or the centre-edge angle and outcome. Sphericity of the head was unrelated to outcome. Obesity was associated with a poorer outcome in older patients.

Conclusion: Triple pelvic osteotomy provides a reliable method of improving symptoms in younger patients with dysplastic hips. An increased rate of failure should be expected in patients over thirty years of age.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_IV | Pages 468 - 468
1 Apr 2004
Bartlett R Roberts A Wong J
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Introduction The aim of the study was to investigate the incidence, in Australia, of popliteal artery injury during knee surgery; to assess the distance from the popliteal artery to the posterior tibia in flexion and extension; and to investigate the influence of major trauma or surgery on the anatomy.

Methods A questionnaire was sent to Australian members of the ANZ Society of Vascular Surgeons. Duplex ultrasound studies were obtained through the Vascular Laboratory University of Melbourne. Studies in extension and 90° of flexion assessed the distance from the popliteal artery to the posterior tibia. Twelve persons with normal knees were assessed bilaterally. Eight patients with a posterior cruciate ligament deficient knee were assessed bilaterally. Seventy vascular surgeons responded documenting 115 popliteal artery injuries occurring during knee surgery. There were 69 lacerations, 27 thromboses, 13 AV fistula and 19 false aneurysms. In 12 normal people (24 knees) the popliteal artery was 5.5 mm (2.9 to 9.9) from the tibia in extension and 5.7 mm (2.9 to 10.0) in 90° of flexion. In ten of 24 knees the artery moved closer in flexion. In the eight posterior cruciate ligament deficient knees the artery was 4.7 mm (2.7 to 6.9) from the tibia in extension and 3.8 mm (2.6 to 4.5) at 90° of flexion. In all eight PCL knees the artery moved closer in flexion. In normal knees the popliteal artery may move closer to the tibia in flexion, the average distance being about 5.5 mm.

Conclusions The popliteal artery is closer to the knee joint following trauma or surgery and specifically closer in flex-ion than in extension. Risks of injury are significant.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 195 - 195
1 Feb 2004
Roberts A
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Aim: To assess the T-L plasty as a treatment of the overriding fifth toe.

Materials and Methods: 12 cases of T-L plasty undertaken for an overriding fifth toe were reviewed ( Mean age 9.8 years). The operation entails a T-shaped dorsal and plantar incision over the fourth to fifth web space. Extensive tenotomy and dorsal capsulotomy of the little metatarsophalangeal joint is undertaken. The corner of the lateral dorsal flap is advanced along the longitudinal limb of the ‘T’ and the incision is converted to an L-shaped wound. This transposition is reversed in the plantar aspect. The correction is stable without the need for K-wire fixation.

Results: 11 patients were satisfied with the correction. In 4 of the cases, the external rotation of the overriding fifth toe was not corrected. There was one failure. However, he had previously had 2 Butler procedures. The scar was acceptable.

Conclusion: The Freund is an alternative method for correction of an overriding fifth toe.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 172 - 172
1 Feb 2003
Allami M Mann C Bagga T Roberts A
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Routine metalwork removal, in asymptomatic patients, remains a controversial issue in our daily practice. Current literature emphasized the potential hazards of implant removal and the financial implications encountered from these procedures. However, there is little literature guidance and no published research on current practice.

To estimate the current state of practice of orthopaedic surgeons in the United Kingdom regarding implant removal for limb trauma in asymptomatic patients, an analysis of the postal questionnaire replies of 36% (500 out of 1390) of randomly selected UK orthopaedic consultants was performed by two independent observers.

47.4% replies were received. A total of 205 (41%) were found to be suitable for analysis. The most significant results of our study I: 92% of orthopaedic surgeons stated that they do not routinely remove metalwork in asymptomatic skeletally mature patients. II: 60% of trauma surgeons stated that they do routinely remove metalwork in patients aged 16 years and under, while only 12% of trauma surgeons do routinely remove metalwork in the age group between 16–35 years. III: 87% of the practising surgeons indicated that they believe it is reasonable to leave metalwork in for 10 years or more. IV: Only 7% of practising trauma surgeons replied to this questionnaire have departmental or unit policy.

No policy is needed for metalwork removal, as most of the orthopaedic surgeons were complying with literature guidance supporting the potential risks associated with implant removal, in spite of the limited number of departmental or units’ policies on implant removal and the paucity of the literature documenting the current practice. However, there is a discrepancy among trauma surgeons in relation to metalwork removal between patient age groups. This indicates guidelines would be helpful to guide the surgeon for the best practice. This is important from a medico-legal standpoint because surgeons are being criticised for not achieving satisfactory results in negligence cases.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 136 - 136
1 Jul 2002
Roberts A
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Aim: To study of the results of the first 100 Miller-Galante, unicompartmental knee replacements performed by one surgeon over the period from May 1990 to November 1996, with particular reference to the failure mechanisms.

Method: A cohort of 100 patients has been followed up prospectively on a biennial basis. They have been assessed using the Nottingham Knee Proforma of Tew & Waugh. An up-dated review was carried out of the cases for the preparation of this presentation.

Results:

Alive, knee functioning satisfactorily – 57

Dead, knee functioning satisfactorily – 21

Lost to follow up – 10

Significant symptoms, not revised – 2

Infection – 1 case not requiring revision

Revised – 9

Due for revision – 1

Of the 32 patients over the age of 74 at the time of replacement none have required revision (18 still alive).

Reasons for revision:

6 developed degeneration in another compartment

2 had unexplained pain

1 developed loosening of the tibial component (19 components found to be well fixed to bone at revision)

1 developed significant wear and is due for revision

Conclusions: This prosthesis remains a surgical option for treatment of unicompartmental knee osteoarthrosis. As judged on survival it appears to be superior to high tibial osteotome (HTO) but it appears to be inferior to total knee replacement (TKR). It is easier to revise than failed HTO or TKR. Careful patient selection is obviously required.