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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 21 - 21
1 Jan 2014
Ribee H Bhalla A Patel A Johnson B Leah J Bailey A Chapman C Bing A Hill S Laing P Makwana N Thomason K Marquis C
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Introduction:

Plantar Fasciitis is an extremely common and challenging problem that presents itself to foot and ankle practitioners. Many different treatment modalities are available for this condition, with little proven benefit. ECSWT was approved for use by the FDA for the treatment of chronic proximal plantar fasciitis in 2002 and NICE published guidance in 2009 recommending its use in refractory cases.

Methods:

Patients who diagnosed with ultrasound scan, and for whom other treatments were unsuccessful, underwent treatment on an outpatient basis. They had three 4–5 minute sessions, once a week. A Spectrum machine was used delivering 10 Hz waves in 500 preset pulses at 2 bar pressure, followed by 2000 preset pulses at 2.5 bar pressure. Pre- and 3 month post-treatment pain levels were recorded using a 10 point Visual Analogue Scale.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 69 - 69
1 May 2012
Thomason K Paton J Trimble K Metcalfe J Marsden J
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Introduction

Shoes with a rocker sole are commonly prescribed following forefoot surgery to redistribute pressure towards the heel. By shifting the body weight backwards, does the rocker shoe adversely effect balance and so disturb normal muscle activity? This study investigated the effects of the Darco post-operative shoe, and the impact of a contralateral shoe raise, on forefoot pressure, posture and balance.

Materials and Methods

Fourteen healthy volunteers were investigated (age 36 ±10.8 yrs 11 females) either wearing (1) left Darco shoe and right standard shoe with/without a 5cm temporary shoe raise (Algeos Ltd) (2) two standard shoes. Postural sway was measured while standing with eyes open/closed and on/off a foam block. Dynamic balance was measured while stepping forwards/backwards and walking. Measurements of foot pressure (TECSKAN Inc USA), 3D body motion (Codamotion, UK) and surface electromyography of lower limb muscles were taken. Results were analysed using a repeated measures ANOVA.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 26 - 26
1 Apr 2012
Clarke A Thomason K Emran I Badge R Hutton M Chan D
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Patients with solitary spinal metastases from Renal Cell Carcinoma (RCC) have better prognosis and survival rates compared to other spinal metastatic disease. Adjuvant therapy has been proven ineffective. Selected patients can be treated with Total En bloc Spondylectomy (TES) for solitary intra-osseous metastasis in the thoracolumbar spine secondary to renal cell carcinoma.

Five patients with solitary vertebral metastasis secondary to RCC underwent TES for radical resection of the spinal pathology after pre-operative embolisation. The procedure involves en bloc laminectomy and corpectomy with posterior instrumented fusion and anterior instrumentation with cage reconstruction following the spondylectomy. All patients were fully staged pre-operatively and assessed according to the Tokuhashi scoring system.

Recurrence of spinal metastasis and radiological failure of reconstruction

All patients demonstrated full neurological recovery and reported significant pain relief. One patient died at 11 months post-op due to a recurrence of the primary. The other four are well at 24, 45, 52 and 66 months post-op without evidence of recurrence in the spine. There were no major surgical complications.

Careful patient selection is required to justify this procedure. The indication is limited to solitary intra-osseous lesions where complete resection of the tumour is possible. The main advantage of this treatment is that it affords significant pain relief and restores spinal stability whilst minimizing local recurrence.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 2 - 2
1 Jan 2011
Thomason K Van Der Walt P
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Orthopaedic surgery accounts for about 10% of red cell transfusions used in hospital. In view of the recognized risks and decreasing availability of donor blood, every effort should be made to minimize inappropriate transfusions.

Methods: Data was collected on the number of patients prescribed blood transfusion after primary total hip and knee replacement at the North Devon District Hospital. It involved 211 patients in 2004, 599 patients in 2005 and 812 patients in ‘06/’07. The effect of withdrawing the use of drains and instigating local infiltration of the wound with diluted adrenaline on transfusion rates was monitored and the results compared against the national average.

Results: The transfusion rates for hip arthroplasty came down from 15.2% in 2004 to 8.8% in 2007 and for knee arthroplasty from 12.2% in 1004 to 5.3% in 2007.

Conclusion: Our current transfusion rates are well below the national average, without the use of cell savers. We wish to discuss the factors which might affect transfusion rates and share our experience after introducing a simple, inexpensive, safe and effective post-operative blood transfusion policy. The respective contributions of drains and infiltration will be emphasized.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 69 - 69
1 Mar 2010
Clarke A Thomason K Badge R Emran I Chan D
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Introduction: Patients with solitary spinal metastases from Renal Cell Carcinoma (RCC) have better prognosis and show longer survival rates compared to other spinal metastatic disease. Adjuvant control by chemotherapy and hormonal therapy has been proven ineffective to treat this relatively radio resistant tumour, which can often present with both back pain and neurological deficit. Selected patients can be treated with Total En bloc Spondylectomy (TES) for solitary intra-osseous metastasis in the thoracolumbar spine secondary to renal cell carcinoma.

Methods: Four patients with solitary vertebral metastasis secondary to RCC underwent TES for radical resection of the spinal pathology after pre-operative embolisation. The procedure involves en bloc laminectomy and corpectomy with posterior instrumented fusion and anterior instrumentation with cage reconstruction following the spondylectomy. All patients were fully staged pre-operatively and assessed according to the Tokuhashi scoring system to determine predictive life expectancy.

Results: All patients demonstrated full neurological recovery and reported significant pain relief. One patient died at 11 months post-op due to a recurrence of the primary in the nephrectomy bed. The other three are alive and well at 33, 40 and 54 months post-op with no radiological evidence of tumour recurrence in the spine. There were no major surgical complications.

Discussion: Careful patient selection is required to justify this procedure. The indication is best limited to solitary intra-osseous lesions where complete resection of the tumour is possible. The main advantage of this treatment is that it affords significant pain relief and restores spinal stability whilst minimizing local recurrence.

Conclusion: TES can improve symptomatic control of isolated solitary spinal metastases of the thoracolumbar spine in Renal Cell Carcinoma.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 390 - 390
1 Sep 2009
Thomason K
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Sixteen observers measured eight anatomic parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System (PACS) software and repeated the measurements two weeks later. Inter and intra observer variability for each parameter was calculated using intraclass correlation coefficients (ICC) and tolerance limits (TL). Highest inter-observer agreement was demonstrated in dorsal tilt (ICC 0.858; TL ± 14.2°) with poor agreement on the size of the gap and step. When compared with the results of a similar study published 10 years ago looking at observer variability in x-ray measurement of healed distal radial fractures, the reliability of computerized measurements is not significantly different to those achieved by manual techniques (dorsal tilt inter-observer TL on PACS ± 16° compared with TL ± 15° using ruler and protractor). These results suggest the current guidelines in the literature for acceptable radiological reduction limits based on < 10° change in palmar tilt, < 2mm radial shortening, < 5° change in radial angle and < 1–2mm articular step for acute distal radius fractures cannot be reliably measured


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 524 - 524
1 Aug 2008
Thomason K Badge R Emran IM Chan D
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Study Design: Descriptive case series.

Objective: To report on the outcome of 4 patients treated with Total En bloc Spondylectomy (TES) for solitary intra-osseous metastasis in the thoracolumbar spine secondary to hypernephroma.

Summary of background data: Patients with solitary spinal metastases from renal cell carcinoma (RCC) have better prognosis and show longer survival rates as compared to other spinal metastatic disease. Adjuvant control by chemotherapy and hormonal therapy has been proven ineffective to treat this relatively radioresistant tumour, which can often present with both back pain and neurological deficit.

Methods: Four patients with solitary vertebral metastasis secondary to RCC underwent TES for radical resection of the spinal pathology. The procedure involves en bloc laminectomy and corpectomy with posterior instrumented fusion and anterior instrumentation with cage reconstruction following the spondylectomy. All patients were fully staged pre-operatively and assessed according to the Tokuhashi scoring system to determine predictive life expectancy. 3 of the 4 had pre-operative embolization and all had radical resection of the primary tumour.

Results: All patients reported significant pain relief and demonstrated neurological improvement. One patient died at 11 months post-op due to a recurrence of the primary in the nephrectomy bed. 3 were alive and well at 18, 26 and 39 months post-op with no radiological evidence of tumour recurrence. There were no major surgical complications.

Conclusions: Careful patient selection is required to justify this procedure. The indication is best limited to solitary intra-osseous lesions where complete resection of the tumour is possible. The main advantage of this treatment is that it affords significant pain relief and restores spinal stability whilst minimizing local recurrence.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 7 | Pages 885 - 888
1 Jul 2008
Thomason K Eyres KS

Salvage of a failed total ankle replacement is technically challenging and although a revision procedure may be desirable, a large amount of bone loss or infection may preclude this. Arthrodesis can be difficult to achieve and is usually associated with considerable shortening of the limb.

We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50).