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The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1362 - 1368
1 Dec 2022
Rashid F Mahmood A Hawkes DH Harrison WJ

Aims

Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era.

Methods

A multicentre observational study was carried out at 19 NHS Trusts in England. The study period for the data collection was 1 February 2021 until 28 February 2022, with mortality tracing until 28 March 2022. Data collection included demographic details, data points to calculate the Nottingham Hip Fracture Score, COVID-19 status, 30-day mortality, and vaccination status.


Bone & Joint 360
Vol. 10, Issue 5 | Pages 4 - 5
1 Oct 2021
Graham SM Harrison WJ Laubscher M Maqungo S


The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 782 - 787
3 Apr 2021
Mahmood A Rashid F Limb R Cash T Nagy MT Zreik N Reddy G Jaly I As-Sultany M Chan YTC Wilson G Harrison WJ

Aims

Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined.

Methods

This multicentre observational study included 1,633 patients who sustained a hip fracture across nine hospital trusts in North West England. Data were collected for three months from March 2020 and for the same period in 2019. Patients were matched by Nottingham Hip Fracture Score (NHFS), hospital, and fracture type. We looked at the mortality outcomes of COVID-19 positive and COVID-19 negative patients sustaining a hip fracture. We also looked to see if vitamin D levels had an impact on mortality.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_14 | Pages 1 - 1
1 Aug 2017
Hillier D Hawkes D Kenyon P Harrison WJ
Full Access

Background

The Fracture Fixation Assessment Tool score (FFATs) was developed as an objective evaluation of post-operative fracture fixation radiographs as a means of appraisal and education. The tool has proven validity, simple to use and based upon AO principles of fracture fixation. This study has been designed to assess how FFATs changes throughout the training program in the UK.

Methods

The local trauma database of a district general hospital, with trauma unit status was used to identify cases. Although FFATs is designed to apply to any fracture fixation, Weber B ankle fractures were selected as common injuries, which constitute indicative cases in T&O training. Grade of the primary surgeon and supervision level were both stratified. The initial and intraoperative radiographs were anonymised and presented to the assessor who had been blinded to the identity and grade of the surgeon, for scoring using FFATs.


The Bone & Joint Journal
Vol. 96-B, Issue 4 | Pages 462 - 466
1 Apr 2014
Graham SM Lubega N Mkandawire N Harrison WJ

We report the short-term follow-up, functional outcome and incidence of early and late infection after total hip replacement (THR) in a group of HIV-positive patients who do not suffer from haemophilia or have a history of intravenous drug use. A total of 29 patients underwent 43 THRs, with a mean follow-up of three years and six months (five months to eight years and two months). There were ten women and 19 men, with a mean age of 47 years and seven months (21 years to 59 years and five months). No early (< 6 weeks) or late (> 6 weeks) complications occurred following their THR. The mean pre-operative Harris hip score (HHS) was 27 (6 to 56) and the mean post-operative HHS was 86 (73 to 91), giving a mean improvement of 59 points (p = < 0.05, Student’s t-test). No revision procedures had been undertaken in any of the patients, and none had any symptoms consistent with aseptic loosening. This study demonstrates that it is safe to perform THR in HIV-positive patients, with good short-term functional outcomes and no apparent increase in the risk of early infection.

Cite this article: Bone Joint J 2014; 96-B:462–6.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 5 - 5
1 Feb 2013
Stevenson A Stolbrink M Moffatt D Harrison WJ Cashman J
Full Access

We present our experience of treating 57 cases of bone defects associated with chronic osteomyelitis (COM) and a new algorithm for their treatment.

A retrospective analysis of our operation database revealed 377 patients treated for COM (2002–2010). 76 (20%) had bone defects, of these 57 had notes and x-rays available.

Data was collected on: age, sex, type/extent of bone involved, number/type of procedures, and length of stay. The tibia was most commonly affected (63%), followed by the femur (21%). Infection control procedures included debridement, drilling and sequestrectomy. Long-term antibiotics were seldom used. Prerequisites to reconstruction surgery were; fully healed skin, absence of sequestrae on x-ray and no antibiotics for 2-months. Decision on the method of treatment of defect was made depending on; age, defect size, viability of periosteum and physes, condition of soft tissues and coexisting deformity.

Initial treatment was; plaster stabilisation (15), frame stabilisation (6), free fibula structural bone grafts (9), ipsilateral vascularised fibula graft (7), non-structural cancellous bone graft (8), bone transport (8) and amputation (4).

43 (75%) patients were successfully treated with initial strategy. Initial treatment therefore failed in 14 (25%) patients. Successful treatment subsequently used was; structural bone grafting (6), non-structural bone grafting (4), bone transport (3) and Rush Rod stabilisation (1).

Little is known about osteomyelitis-induced bone defects, which cause massive morbidity in developing countries. Our novel research shows that these can be treated successfully, often by relatively simple methods. In the absence of ongoing infection, non-vascularised bone grafting techniques are often successful. Bone transport or vascularised grafting are more reliable but more complex solutions.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1265 - 1270
1 Sep 2012
Bates J Mkandawire N Harrison WJ

We report a prospective single-blind controlled study of the incidence of early wound infection after internal fixation for trauma in 609 patients, of whom 132 were HIV-positive. Wounds were assessed for healing using the ASEPSIS score. There was no significant difference in the rate of infection between HIV-positive and HIV-negative patients undergoing clean surgery (4.2% vs 6%, respectively; p = 0.65). HIV-positive patients did not receive additional antibiotic prophylaxis or antiretroviral therapy as part of their management. The difference in the rate of infection between HIV-positive and HIV-negative patients with an open fracture or other contamination was not significant (33% vs 15%, respectively; p = 0.064). There was no relationship between CD4 count and infection rate. HIV status did not significantly influence the number of secondary surgical procedures (p = 0.183) or the likelihood of developing chronic osteomyelitis (p = 0.131). Although previous contamination from the time of injury was a risk factor for infection in mal- and nonunions, it was not significantly increased in HIV-positive patients (p = 0.144).

We conclude that clean implant surgery in HIV-positive patients is safe, with no need for additional prophylaxis.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 8 | Pages 1005 - 1010
1 Aug 2011
Jones HW Beckles VLL Akinola B Stevenson AJ Harrison WJ

From a global point of view, chronic haematogenous osteomyelitis in children remains a major cause of musculoskeletal morbidity. We have reviewed the literature with the aim of estimating the scale of the problem and summarising the existing research, including that from our institution. We have highlighted areas where well-conducted research might improve our understanding of this condition and its treatment.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 3 | Pages 404 - 408
1 Mar 2011
Harnett P Freeman R Harrison WJ Brown LC Beckles V

We conducted a prospective randomised controlled trial to compare the standard Ponseti plaster method with an accelerated method for the treatment of idiopathic congenital talipes equinovarus. The standard weekly plaster-change method was accelerated to three times per week. We hypothesised that both methods would be equally effective in achieving correction. A total of 40 consecutive patients (61 feet) were entered into the trial. The initial median Pirani score was 5.5 (95% confidence interval 4.5 to 6.0) in the accelerated group and 5.0 (95% confidence interval 4.0 to 5.0) in the standard control group. The scores decreased by an average 4.5 in the accelerated group and 4.0 in the control group. There was no significant difference in the final Pirani score between the two groups (chi-squared test, p = 0.308). The median number of treatment days in plaster was 16 in the accelerated group and 42 in the control group (p < 0.001). Of the 19 patients in the accelerated group, three required plaster treatment for more than 21 days and were then assigned to the standard control method. Of the 40 patients, 36 were followed for a minimum of six months.

These results suggest that comparable outcomes can be achieved with an accelerated Ponseti method. The ability to complete all necessary manipulations within a three-week period facilitates treatment where patients have to travel long distances.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 8 | Pages 1138 - 1143
1 Aug 2010
Beckles VLL Jones HW Harrison WJ

We present a retrospective review of 167 patients aged 18 years and under who were treated for chronic haematogenous osteomyelitis at our elective orthopaedic hospital in Malawi over a period of four years. The median age at presentation was eight years (1 to 18). There were 239 hospital admissions for treatment during the period of the study. In 117 patients one admission was necessary, in 35 two, and in 15 more than two.

A surgical strategy of infection control followed by reconstruction and stabilisation was employed, based on the Beit CURE radiological classification of chronic haematogenous osteomyelitis as a guide to treatment. At a minimum follow-up of one year after the end of the study none of the patients had returned to our hospital with recurrent infection.

A total of 350 operations were performed on the 167 patients. This represented 6.7% of all children’s operations performed in our hospital during this period. One operation only was required in 110 patients and none required more than three. Below-knee amputation was performed in two patients with chronic calcaneal osteomyelitis as the best surgical option for function. The most common organism cultured from operative specimens was Staphylococcus aureus, and the tibia was the bone most commonly affected. Polyostotic osteomyelitis occurred in four patients. We believe this is the largest reported series of patients treated for chronic haematogenous osteomyelitis.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 3 | Pages 341 - 343
1 Mar 2009
Lubega N Mkandawire NC Sibande GC Norrish AR Harrison WJ

In Africa the amount of joint replacement surgery is increasing, but the indications for operation and the age of the patients are considerably different from those in the developed world. New centres with variable standards of care and training of the surgeons are performing these procedures and it is important that a proper audit of this work is undertaken.

In Malawi, we have pioneered a Registry which includes all joint replacements that have been carried out in the country. The data gathered include the age, gender, indication for operation, the prosthesis used, the surgical approach, the use of bone graft, the type of cement, pressurising systems and the thromboprophylaxis used. All patients have their clinical scores recorded pre-operatively and then after three and six months and at one year. Before operation all patients are counselled and on consent their HIV status is established allowing analysis of the effect of HIV on successful joint replacement.

To date, 73 total hip replacements (THRs) have been carried out in 58 patients by four surgeons in four different hospitals. The most common indications for THR were avascular necrosis (35 hips) and osteoarthritis (22 hips). The information concerning 20 total knee replacements has also been added to the Registry.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 521 - 522
1 Aug 2008
Norrish AR Bates JHJ Harrison WJ
Full Access

Purpose of study: Long bone chronic osteomyelitis may result in limb length discrepancy by shortening of the affected bone when the physis is damaged. Little is known about the rates of overgrowth of infected long bones. This study documents the relative rates of overgrowth and undergrowth in a large series of chronic osteomyelitis patients.

Methods: Forty-two consecutive patients presenting to our unit with chronic osteomyelitis of a long bone were included. There were no exclusion criteria. The mean age at presentation was 10.3 years. The mean duration of symptoms was 18.2 months prior to presentation. For 37 (88%) of patients the cause of osteomyelitis was haematogenous.

Results: Three (7%) patients had shortening of the long bone compared to the unaffected side (average 2.5cm), whilst 13 (31%) patients had overgrowth of the affected bone (average overgrowth 2.2cm). The tibia was most commonly affected (20/42, 48%), followed by the femur (8/42, 19%) and the humerus (6/42, 14%). The average proportion of long bone involved on X-ray was 59%. At least one physis was affected in 8/42 (12%) patients (2 had undergrowth, 1 overgrowth).

Conclusions: This large prospective series of patients shows the effect of osteomyelitis on the growth of long bones, in particular an overgrowth rate of 31%. The mechanism for this is probably related to the duration of symptoms. In areas of the world with poor access to health care, there is consequently a prolonged period of increased blood supply as a result of inflammation.

This increased blood supply may make overgrowth limb length discrepancy more likely than undergrowth.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 6 | Pages 790 - 793
1 Jun 2007
Norrish AR Lewis CP Harrison WJ

Patients infected with HIV presenting with an open fracture of a long bone are difficult to manage. There is an unacceptably high rate of post-operative infection after internal fixation. There are no published data on the use of external fixation in such patients. We compared the rates of pin-track infection in HIV-positive and HIV-negative patients presenting with an open fracture. There were 47 patients with 50 external fixators, 13 of whom were HIV-positive (15 fixators).

There were significantly more pin-track infections requiring pharmaceutical or surgical intervention (Checketts grade 2 or greater) in the HIV-positive group (t-test, p = 0.001). The overall rate of severe pin-track infection in the HIV-positive patients requiring removal of the external-fixator pins was 7%. This contrasts with other published data which have shown higher rates of wound infection if open fractures are treated by internal fixation.

We recommend the use of external fixation for the treatment of open fractures in HIV-positive patients.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 9 | Pages 1178 - 1181
1 Sep 2005
Harrison WJ


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 1 | Pages 10 - 11
1 Jan 2005
Lavy CBD Mkandawire N Harrison WJ


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 248 - 248
1 Mar 2003
Loughead JM Harrison WJ
Full Access

Concern over long term outcomes in patients with silastic metatarsophalangeal implants prompted an assessment of such patients. We reviewed 21 single-stemmed silastic metatarsophalangeal arthroplasties in 18 patients with a mean follow-up of 18 years and 9 months. Eight operations were performed for hallux valgus, and 13 for hallux rigidus. Patients were assessed by clinical scoring, patient satisfaction, and radiographic grading. Patients treated for hallux rigidus achieved higher clinical scores than those treated for hallux valgus. This difference was statistically significant (p < 0.02). There was no correlation between radiographic appearance and clinical score, patient satisfaction, or time since implantation. Long-term changes to the bone stock did not cause clinical detriment, and in no case was late revision surgery necessary.

There has been widespread concern regarding silicone synovitis associated with early clinical detriment, together with progressive erosive bony changes seen with these implants. In our very long term review outcomes were surprisingly good, particularly in the surgical treatment of hallux rigidus in the over fifty age group.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 108 - 108
1 Feb 2003
Harrison WJ Lewis CP Lavy CBD
Full Access

25 cases of closed fractures around the distal femoral growth plate were analysed prospectively over a one-year period. There were 22 males and 3 females. Mean age was 16 years (range 7 to 22).

According to the classification of Salter and Harris there were 6 cases (24%) of type 1 fracture, 12 (48%) type 2 fractures, 3 (12%) type 3, and 4 (16%) type 4. Mechanism of injury was football in 13 (59%), simple fall in 4 (18%), crush in 2 (9%), RTA in 2 (9%), and fall from height in 1 (5%); in 3, the mechanism was not recorded. The average time from injury to hospital admission was 5 days (range 0 to 17 days).

Management was conservative in 4 and operative in 21. The medial parapatellar approach was used in 16. Post-surgically plaster cylinders were used for a mean of 3 weeks (range 0 to 6 weeks). No patient received physiotherapy.

In the operative cases, sepsis was observed in 1 case (5%). This was a crash injury with a skin ulcer that became septic postoperatively and later required knee fusion.

Of the remaining 20 operative cases, 17 cases were reviewed, 4 to one year, 9 to six months, and 4 to three months. There were no cases of deformity, nor wound complications. Those reviewed at one year had an excellent range of movement averaging 0 to 117 degrees (range 0–100 to 0–140). At six months the average range of movement was 1–98 degrees (range 5–70 to 0–140) and at three months 2–62 degrees (range 10–50 to 0–95).

In conclusion, we believe that these difficult fractures should usually be managed operatively where expertise allows. Preliminary results suggest that the medial parapatellar approach provides excellent access but may inhibit initial rehabilitation.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 103 - 103
1 Feb 2003
Harrison WJ Lewis CP Lavy CBD
Full Access

A prospective study was undertaken of wound healing in HIV positive patients undergoing orthopaedic implant surgery. 175 implant operations were assessed. 40 operations (23%) were in HIV positive individuals. Wounds were scored using the Asepsis scoring system.

Closed fractures in HIV positive patients had 1 (3. 5%) major infection. No correlation was seen between CD4 count and risk of wound infection.

With regards to early wound sepsis, implant surgery can be undertaken safely in HIV positive individuals with closed injuries regardless of CD4 count. The risk of wound sepsis rises dramatically in implant surgery for HIV positive patients with open fractures.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 6 | Pages 802 - 806
1 Aug 2002
Harrison WJ Lewis CP Lavy CBD

We performed a prospective, blind, controlled study on wound infection after implant surgery involving 41 procedures in patients infected with the human immunodeficiency virus (HIV) and 141 in HIV-negative patients. The patients were staged clinically and the CD4 cell count determined. Wound infection was assessed using the asepsis wound score. A risk category was allocated to account for presurgical contamination.

In HIV-positive patients, with no preoperative contamination, the incidence of wound infection (3.5%) was comparable with that of the HIV-negative group (5%; p = 0.396). The CD4 cell count did not affect the incidence of infection (r = 0.16). When there was preoperative contamination, the incidence of infection in HIV-positive patients increased markedly (42%) compared with that in HIV-negative patients (11%; p = 0.084).

Our results show that when no contamination has occurred implant surgery may be undertaken safely in HIV-positive patients.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 5 | Pages 732 - 734
1 Jul 2002
Lewis CP Lavy CBD Harrison WJ

The atlas of Greulich and Pyle for skeletal maturity and epiphyseal closure is widely used in many countries to assess skeletal age and to plan orthopaedic surgery. The data used to compile the atlas were collected from institutionalised American children in the 1950s.

In order to determine whether the atlas was relevant to subSaharan Africa, we compared skeletal age, according to the atlas, with chronological age in 139 skeletally immature Malawian children and young adults with an age range from 1 year 11 months to 28 years 5 months. The height and weight of each patient were also measured in order to calculate the body mass index.

The skeletal age of 119 patients (85.6%) was lower than the chronological age. The mean difference was 20.0 ± 24.1 months (t-test, p = 0.0049), and the greatest difference 100 months. The atlas is thus inaccurate for this group of children.

The body mass index in 131 patients was below the normal range of 20 to 25 kg/m2.

The reasons for the low skeletal age in this group of children are discussed. Poor nutrition and chronic diseases such as malaria and diarrhoea which are endemic in Malawi are likely to be contributing factors. We did not find any correlation between the reduction in body mass index in our patients and the degree of retardation of skeletal age.