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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_7 | Pages 2 - 2
8 May 2024
Cruickshank J Eyre J
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Introduction

Large osteochondral defects (OCD) of the talus present a difficult management conundrum. We present a series of Maioregen xenograft patches applied through an open approach, early lessons from the technique and good early outcomes, in patients who are otherwise looking at ankle salvage techniques.

Results

16 patients underwent open patch procedures, performed by a single surgeon, over a 30 month period. 12 males, and 4 females with age at presentation from 21–48. The majority were young, male, in physical employment with active sporting interest. MoxFQ, and E5QD were collected preop, 3, 6, 12 month postoperatively. There were significant improvements in ROM, pain, and scores in the cohort. 3 cases returned to Theatre, 1 for a concern about late infection, which settled with good outcome, and a further 2 with metalwork / adhesions.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 33 - 33
1 Apr 2013
Eyre J Gudipati S Chami G Monkhouse R
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Background

Lisfranc/midfoot injuries are complex injuries with a reported incidence of 1 in 55000 in literature and frequently overlooked. But, recently they are becoming more commonly diagnosed with advent of CT scan and examination under anaesthesias (EUA) for suspicion fractures. Here we present a case series results of a single surgeons experience over the last 6 years.

Methods

Retrospective review of 68 patients treated by a single surgeon over the last 6 years. Injuries were diagnosed on plain Xrays, clinic examination. Any suspicious injury were further assessed by a CT scan, all injuries were confirmed by EUA and treated with open reduction and internal fixation within 4 weeks of injury. Post-operative immobilisation in full cast for 6 weeks then a removal boot with non-weight bearing for a total of 3months. They were followed up regularly initially at 3, 6 and 12months. At final review the following data was collected: clinical examination, plain x-ray looking for: late deformity, signs of OA in Lisfranc joint, Auto fusion rate, rate of metal work failure. The x-rays findings were correlated with: (1) type of fixation. (2) The following scores: FAOS, AOFAS-M, specially designed new foot and ankle score.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 38 - 38
1 Apr 2013
Chami G Eyre J Harris N
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Introduction

Stress fractures in the foot are common; the common practice is to look for any factor in the history or for any foot deformity that could cause the fracture. Once found, it is common to treat the fractures without further investigations. The aim of this study is to assess if we are missing any underlying metabolic disorder associated with such injury.

Materials and methods

We studied 34 sequential cases referred for chronic foot pain. Stress fractures were confirmed either by classic x-ray's features or MRI. Clinical examination and further tests were performed for Vitamin D levels, Thyroid function, PTH, DEXA scan, Biochemical and bone profile. All stress fractures were treated conservatively.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 146 - 146
1 May 2011
Eyre J Green N Budgen S
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Introduction: Hallux Rigidus(HR) is a progressive arthritic process of the first MTP joint that causes pain, stiffness and uncomfortable enlargement of the joint, thus resulting in significant morbidity.

Current treatment options include cheilectomy, resection arthroplasty, distal osteotomies (eg Moberg) or arthrodesis (Gold standard). Resurfacing of the metatarsal head, and concurrent joint release allow successful treatment of all stages of Hallux Rigidus, also offering the advantages of maintenance of metatarsal length, and movement.

Method: Patients with stage II-IV hallux rigidus, who had failed conservative management, had good bone stock, no previous signs of osteomyelitis and neurovascularly intact status were offered this new procedure. All procedures were performed by the senior author, in a single centre. The HemiCap® MTP prosthesis was implanted using a dorsal approach to the 1st MTPJ. The joint was decompressed and dorsal / lateral bone shaping performed to maximise movement. Pre op and post op scoring at 6 weeks, 3, 6 and 12 months were recorded using AOFAS forefoot, NPS and SF12 scores.

Results: 36 First metatarsal head resurfacing procedures were performed on 32 patients. Follow up ranges from 6 weeks to 18 months. Pre op scores averages were AOFAS 22.06 (8–52), SF12 35.55 (14–61.3) and NPS 8.03 (4–10). At 12 months, these average scores had improved significantly to AOFAS 82.57 (55–95) SF12 56.01 (27.5–63.4) and pain scores 0.69 (0–4). There was significant improvement of 60 points on the AOFAS forefoot score, 20 points on the SF12 scoring system, and significant decrease in pain scores of 7.34.

Discussion: Initial results of MTPJ resurfacing are encouraging. This technique provides an advantage over cheilectomy which is of limited use in late stage rigidus, and over resection arthroplasty which shortens the 1st MT and risks transfer metatarsalgia. In our practice metatarsal head resurfacing is providing a useful alternative to fusion in active patients who require movement of the MTPJ. Should patients not tolerate the procedure well, the added advantage is easy conversion to the gold standard of fusion. We continue to follow these patients and add further subjects to this study.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 77 - 78
1 Mar 2009
Eyre J Jeavons R Branfoot T Dennison M Royston S Britten S
Full Access

Aims: To investigate adequacy of temporary ex-fix in grade III open fractures of the tibia, prior to definitive treatment by Flap & Frame at 2 UK trauma centres.

Methods: Between 2000 and 2006 all open fractures of the tibia treated by the Ilizarov Method at our two institutions were entered onto the Flap & Frame database. The database was searched for all temporary external fixators placed prior to definitive Ilizarov fixation. Data collected – ex-fix type, whether revision was necessary, reasons for revision.

Results:

97 grade III open fractures in 95 patients

64 required temporary spanning ex-fix: 23 applied at trauma centre/41 at DGH

14/64 ex-fixes required revision (prior to definitive Ilizarov): poor plastics access(6)/instability(2)/both(6)

All 14 revised had been applied in a DGH, i.e. 14/41 DGH ex-fix needed revision (34%)

Ex fixes revised after application at trauma centre vs. DGH = 0/23 vs. 14/41, p< 0.01 ×2

Revision of Hoffman hybrid vs. monolateral ex fix = 4/4 vs. 10/60 p< 0.001 ×2

Non modular system (Orthofix) vs. modular systems (Hoffman II/AO) = 7/17 vs. 0/39 p< 0.001

Discussion: Recently Naique and Pearse showed a revision rate of skeletal fixation of 48% in grade IIIb open fractures referred to their tertiary centre. In our series 34% of temporary external fixators needed revision. Modular systems such as Hoffman II and AO required no revision, irrespective of whether they were applied at trauma centre or DGH.

All Hoffman hybrids needed revision, due to both instability and plastics access. Significantly more non modular (Orthofix) ex-fixes required revision compared to modular (Hoffmann II/AO), due to poor plastics access.

Conclusion: We recommend modular external fixation systems such as Hoffman II or AO if problems of temporary external fixation of open tibial fractures are to be avoided. Hybrid temporary external fixation should be abandoned as temporary fixation in such an injury