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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_7 | Pages 9 - 9
8 May 2024
Widnall J Tonge X Jackson G Platt S
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Background. Venous Thrombo-Embolism is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers, frequently for long time periods. To our knowledge there is no literature stating the prevalence of VTE in patients undergoing TCC. We perceive that neuropathic patients with active charcot have other risk factors for VTE which would predispose them to this condition and would mandate the use of prophylaxis. We report a retrospective case series assessing the prevalence of VTE in the patients being treated with TCCs. Methods. Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events. Results. There were 143 TCC episodes in 104 patients. Average age at cast application was 55 years. Time in cast averaged 45 days (range 5 days – 8 months, median 35 days). 3 out of 4 patients had neuropathy as a consequence of diabetes. One TCC related VTE (0.7% of casting episodes) was documented. This was a proximal DVT confirmed on USS 9 days following cast removal. No patient received VTE prophylaxis while in TCC. Conclusion. Despite these complex patients having a multitude of co-morbidities the prevalence of VTE in the TCC setting remains similar to that of the general population. This may be due to the fact that TCCs permit weight bearing. This case series suggests that, while all patients should be individually VTE risk assessed as for any lower limb immobilization, chemical thromboprophylaxis is not routinely indicated in the context of TCCs


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 14 - 14
4 Jun 2024
Liaw F O'Connor H McLaughlin N Townshend D
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Introduction. Following publication of the Ankle Injury Management (AIM) trial in 2016 which compared the management of ankle fractures with open reduction and internal fixation (ORIF) versus closed contact casting (CCC), we looked at how the results of this study have been adopted into practice in a trauma unit in the United Kingdom. Methods. Institutional approval granted to identify eligible patients from a trauma database. 143 patients over 60 years with an unstable ankle fracture between 2017 and 2019 (1 year following publication of the AIM trial) were included. Open fractures, and patients with insulin-dependent diabetes or peripheral vessel disease were excluded (as per AIM criteria). Radiographs were reviewed for malunion and non-union. Clinical notes were reviewed for adverse events. Minimum follow up was 24 months. Results. Of the 143 patients, 42 patients (29.4%) received a moulded cast with a return to theatre rate of 21.4%, malunion rate of 30.1%, and infection or wound problem rate of 4.8%. When the exact phrase “close contact cast” was specified in 21 patients (14.7%), there was a 19.0% return to theatre rate, 28.6% malunion rate, and a 4.8% infection or wound problem rate. 101 patients (70.6%) had ORIF with a return to theatre rate of 10.9%, malunion rate of 5.0%, and infection or wound problem rate of 13.9%. Discussion. Our results show a high rate of complication with cast management of unstable ankle fractures in this older population. This was improved where CCC was specified, but remains higher even than those published in the AIM trial. Whilst there is certainly a role for CCC in carefully selected patients, we would advise caution in the widespread adoption of a close contact casting technique


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_7 | Pages 19 - 19
8 May 2024
Begkas D Michelarakis J Mirtsios H Kondylis A Apergis H Benakis L Pentazos P
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Background. Treatment of arthrogrypotic clubfoot (AC) presents a challenging problem. Over time many different methods have been proposed, with variable rates of success, recurrence and other complications. In this study we describe our 20-year experience in treatment of AC. Materials and methods. Between 1996 and 2016, 165 AC in 90 children (51 males and 39 females) were treated in our department. Their mean age was 7.6 years (3 months-16 years). Ponseti casting and Achilles tendon release (PCATR) was performed on 38 children (68 feet) and soft tissue release and casting (STRC) on 35 children (67 feet). The remaining 17 children (30 feet) underwent wide soft tissue release and correction using the Ilizarov method (STRIL). The results of each subgroup were graded according to clinical (pain, foot appearance, residual deformities, walking and standing status and shoe modifications) and radiological (anteroposterior and lateral talocalcanear angles, the angle between longitudinal axes of talus and the first metatarsal and the position of talus in the lateral view) criteria. Results. The average follow up was 6.4 (2–10) years. Results were excellent (plantigrade, painless, properly loaded feet, without deformities, adapted to common shoes) in 56 PCATR group feet, 59 STRC group feet and 23 STRIL group feet. Good results (required orthopaedic shoes) were obtained in 10 PCATR group feet, 6 STRC group feet and 7 STRIL group feet. Fair results (residual temporary pain and/or mild deformity) presented 2 PCATR group feet and 1 STRC group foot, while bad results (reoccurrence of clubfoot) were found in 1 STRC group foot. Conclusions. On the basis of our 20-year clinical experience we believe that pediatric AC can be successfully treated with PCATR in the age of less than 1 year old (y.o), with STRC between 1–5 y.o. and with STRIL in children over the age of 5 y.o


The Bone & Joint Journal
Vol. 101-B, Issue 6 | Pages 691 - 694
1 Jun 2019
Tonge XN Widnall JC Jackson G Platt S

Aims. To our knowledge, there is currently no information available about the rate of venous thromboembolism (VTE) or recommendations regarding chemoprophylaxis for patients whose lower limb is immobilized in a plaster cast. We report a retrospective case series assessing the rate of symptomatic VTE in patients treated with a lower limb cast. Given the complex, heterogeneous nature of this group of patients, with many risk factors for VTE, we hypothesized that the rate of VTE would be higher than in the general population. Patients and Methods. Patients treated with a lower limb cast between 2006 and 2018 were identified using plaster room records. Their electronic records and radiological reports were reviewed for details about their cast, past medical history, and any VTE recorded in our hospital within a year of casting. Results. There were 136 episodes of casting in 100 patients. The mean age was 55 years (22 to 91). The mean time in a cast was 45 days (five days to eight months). A total of 76 patients had neuropathy secondary to diabetes. No patient received chemical thromboprophylaxis while in a cast. One VTE (0.7% of casting episodes) was documented. This was confirmed by Doppler scan nine days after removing the cast. Conclusion. The frequency of VTE was higher than that of the general population (0.05%); this is most likely attributable to our patients’ apparent increase in VTE risk as suggested by The National Institute for Health and Care Excellence (NICE). These findings suggest that thromboprophylaxis is not routinely indicated in patients who undergo immobilization of the lower limb in a cast, although the risks of VTE should be assessed. While the cast itself does not pose an increased risk, other pathologies, such as active cancer, mean that each individual case needs to be considered on their merit. Cite this article: Bone Joint J 2019;101-B:691–694


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 16 - 16
4 Jun 2024
Kozhikunnath A Garg P Coll A Robinson AH
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Introduction. Total contact casting (TCC) is one of the most commonly utilized modalities in the management of diabetic feet. We undertook a retrospective review to determine the prevalence of symptomatic VTE events in patients treated in a weight bearing TCC in our diabetic foot unit, and to formulate guidelines for VTE prophylaxis. Methods. Electronic records were reviewed to identify all patients treated in a TCC between 2014 and 2021. Data collection included patient demographics, comorbidities, period of immobilization in TCC, the incidence of VTE events, and any VTE prophylaxis prescribed during their period in TCC. Results. 549 patients were identified who had at least one episode of TCC. Mean age was 67 years (range 28 to 94 years) and the mean duration in cast was 10.2 weeks (range 0.3–46 weeks). Only 6 patients (1.1%) were prescribed chemical thrombo-prophylaxis during their period in TCC. Mean body mass index (BMI) for these patients was 32.3 (Range 18.4–58.9). Other significant comorbidities: 81% (n-444) of patients had associated cardio-vascular comorbidities; 54 % (n-296) had renal comorbidities including 22% (n-121) having had dialysis and 4.2% (n-23) with renal transplants. Eight of the 549 patients (1.5%) had suffered a VTE event of which only 2 (0.36%) were during the period of immobilization in TCC. One was a symptomatic DVT (0.18%) and the another was an asymptomatic (incidental) finding of pulmonary embolism (PE). There was no mortality related to the VTE episodes. Conclusion. NICE guidelines state that one should “Consider pharmacological VTE prophylaxis for patients with lower limb immobilization”. Our study finds that patients treated in a weight bearing TCC do not require routine pharmacological VTE prophylaxis, in spite of an extended period of lower limb immobilization and significant medical comorbidities


Bone & Joint Open
Vol. 3, Issue 10 | Pages 841 - 849
27 Oct 2022
Knight R Keene DJ Dutton SJ Handley R Willett K

Aims

The rationale for exacting restoration of skeletal anatomy after unstable ankle fracture is to improve outcomes by reducing complications from malunion; however, current definitions of malunion lack confirmatory clinical evidence.

Methods

Radiological (absolute radiological measurements aided by computer software) and clinical (clinical interpretation of radiographs) definitions of malunion were compared within the Ankle Injury Management (AIM) trial cohort, including people aged ≥ 60 years with an unstable ankle fracture. Linear regressions were used to explore the relationship between radiological malunion (RM) at six months and changes in function at three years. Function was assessed with the Olerud-Molander Ankle Score (OMAS), with a minimal clinically important difference set as six points, as per the AIM trial. Piecewise linear models were used to investigate new radiological thresholds which better explain symptom impact on ankle function.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 23 - 23
1 May 2012
Saltzman C
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Clubfoot deformity is the most common congenital musculoskeletal disorder (1). Approximately one in one thousand people are born with at least one clubfoot; between 150,000 and 200,000 babies are born with a clubfoot each year (2). Eighty percent of these cases occur in developing countries, and the majority is left untreated. When infants are treated with a non-invasive casting technique pioneered by Ignacio Ponseti M.D., they generally can be “cured” with relative ease. In the United States, 97% of patients given this treatment can walk successfully and are able to live normal lives (3). The Ponseti Method requires several plaster casts but either no or minimal surgery, can be taught fairly easily not only to doctors but also to healthcare workers, nurses, and other people who have some knowledge and training in healthcare. Also, it requires plaster casting, making it an inexpensive treatment. Dr. Ignacio Ponseti first performed his non-invasive treatment in 1949, but didn't publish his results until 1963. Two more papers, published in 1979 and 1995 described the long-term outcomes of treatment. In 1996 Oxford Press published a book detailing his approach. Although the treatment has always had high success rates, a lack of publicity prevented it from becoming more widely used until the late 1990s. Its basic mechanism consists of a series of plaster casts and manipulations that gradually reshape the foot around a fixed talus to obtain correction. Generally, between five and seven casts are required. The casts extend from the toes to the upper thigh and hold the knees at a right angle. One of the most important aspects of this method is timing: infants can be given treatment starting at seven days old and ideally should begin treatment before reaching eight months of age. Brazil, Uganda, Malawi and Chile now have official national programs, which are sponsored by each country's Ministries of Health, in which clinics in each country treat clubfoot disorder using the Ponseti Method. China set up a national program in 2005, but with a population of 1.3 billion people, it will take several years to complete the training. The prevalence of the Ponseti Method varies in the sixty other countries with healthcare workers trained in the treatment. This talk will review the principles of treatment and focus on results of recurrence after initial treatment with the Ponseti Method


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_21 | Pages 8 - 8
1 Dec 2017
Konarski A Kamel SA Pillai A
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Introduction. The conservative management of stable Weber B fibula fractures remains variable. We thought that the current trend in our institution poses an unnecessary burden on fracture clinics. Methods. We reviewed patients referred with Weber B ankle fractures over an 18 month period. Our inclusion criteria were non-diabetic adults, with isolated stable Weber B fractures. Fractures were deemed stable if they had no evidence of talar shift on initial radiographs (< 5mm medial clear space and < 1mm variation between superior and medial clear spaces). Exclusion criteria were unstable fractures on radiographs, or no local follow-up. Management was reviewed from case notes and radiographs. Primary outcome was the stability of the fracture by the end of treatment. Secondary measures were duration of treatment, number of follow up appointments and radiographs, and complications. Results. 182 cases were reviewed. 82 were excluded leaving 100 patients for follow-up. Mean age was 53 (18–99). Mean number of outpatient appointments was 2.63 (1–6), follow up radiographs was 2.34 (0–6). 74 were treated in a walking boot and 15 in a walking cast for a mean of 6 weeks (4–9) and allowed to full weight-bear. 10 were kept non weight-bearing in a cast for 6 weeks and 1 was partially weight-bearing. Mean follow-up time was 7.3 weeks (1–30). No fractures displaced and one patient developed an ulcer from a cast. Conclusion. Our study suggests that in isolated Weber B fractures, with no radiographic instability on initial presentation, further displacement is unlikely. We propose that these injuries can be treated safely in a removable boot with full weight-bearing for 6 weeks then clinical and radiologic assessment if required. Casting or restricted weight-bearing does not confer any additional advantage. We question the necessity and rationale behind weekly clinical and radiological follow-up for such cases


Bone & Joint Open
Vol. 3, Issue 6 | Pages 455 - 462
6 Jun 2022
Nwankwo H Mason J Costa ML Parsons N Redmond A Parsons H Haque A Kearney RS

Aims

To compare the cost-utility of removable brace compared with cast in the management of adult patients with ankle fracture.

Methods

A within-trial economic evaluation conducted from the UK NHS and personnel social services (PSS) perspective. Health resources and quality-of-life data were collected as part of the Ankle Injury Rehabilitation (AIR) multicentre, randomized controlled trial over a 12-month period using trial case report forms and patient-completed questionnaires. Cost-utility analysis was estimated in terms of the incremental cost per quality adjusted life year (QALY) gained. Estimate uncertainty was explored by bootstrapping, visualized on the incremental cost-effectiveness ratio plane. Net monetary benefit and probability of cost-effectiveness were evaluated at a range of willingness-to-pay thresholds and visualized graphically.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 5 - 5
1 Dec 2015
Collins R Loizou C Sudlow A Smith G
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Operative and non-operative treatment regimens for Achilles tendon ruptures vary greatly but commonly involve rigid casting or functional bracing. The aim of our study was to investigate the extent of tendon apposition following such treatments. Twelve fresh-frozen, adult below knee lower-extremity cadaveric specimens with intact proximal tibiofibular joints were used. Each was prepared by excising a 10cm × 5cm skin and soft tissue window exposing the Achilles tendon. With the ankle in neutral position, the tendon was transfixed with a 2mm k-wire into the tibia, 8cm from its calcaneal insertion. A typical post-rupture gap was created by excising a 2.5cm portion of tendon between 3.5cm and 6cm from its calcaneal insertion. The specimens were then placed into a low profile walker boot (SideKICK. TM. , Procare) without wedges and a window cut into the back. The distance between the proximal and distal Achilles tendon cut edges was measured and repeated with 1, 2 and 3 (10mm) wedges. Subsequently the specimens were placed into a complete below knee cast in full equinus which was also windowed. The Achilles tendon gap (mean +/− SD) measured: 2.7cm (0.5) with no wedge, 2.3cm (0.4) with 1, 2.0cm (0.4) with 2, 1.5cm (0.4) with 3 wedges and 0.4cm (0.3) in full equinus cast. The choice of treatment had a significant effect on tendon gap (p< 0.0001 – repeated measures ANOVA), and all pairwise comparisons were significantly different (Bonferroni), with all p< 0.001, apart from 0 wedge vs. 1 wedge (p< 0.01) and 1 wedge vs. 2 wedges (p< 0.05). Our results showed that each wedge apposed the tendon edges by approximately 0.5cm with the equinus cast achieving the best apposition. Surgeons should consider this when planning appropriate immobilisation regimes for Achilles tendon ruptures


The Bone & Joint Journal
Vol. 103-B, Issue 6 | Pages 1127 - 1132
1 Jun 2021
Gray J Welck M Cullen NP Singh D

Aims

To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle.

Methods

We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 80 - 80
1 May 2012
Young J Sott A Robertson N Hendry J Jacob J
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Metatarsal fractures are extremely common injuries accounting for 10% of all fractures seen in our accident and emergency departments (3). The vast majority can be treated conservatively. There is no standardised treatment, but it is commahplace to immobilise the foot and ankle joint in a below-knee back-slab, full cast or functional brace for a period of up to 6 weeks, weight-bearing the patient as pain allows. This practice is time-consuming and expensive, not to mention debilitating, and carries a morbidity risk to the patient. We describe a simple, effective and cheap treatment method for metatarsal fracture management using the functional forefoot-offloading shoe (FOS). This is clinically proven to offload pressure on the metatarsals and is commonly used in both elective forefoot surgery and in diabetic patients. Between January and September 2009, we identified 57 patients attending our fracture clinic with new metatarsal fractures. 28 met our inclusion criteria. All patients reported a significant improvement in their pain. At Injury – mean 8.21 out of 10 (range 4-10). After FOS fitting - mean 2.92 out of 10 (range 0-6). The forefoot-offloading shoe is an excellent alternative to plaster casting or functional boot immobilisation, offering high patient satisfaction, an excellent outcome and a considerable cost-saving to the hospital trust


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 62 - 62
1 Sep 2012
Brown J Moonot P Taylor H
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Introduction. The delayed presentation of Achilles tendon rupture is common, and is a difficult problem to manage. A number of surgical techniques have been described to treat this problem. We describe the use of Flexor Hallucis Longus (FHL) transfer to augment the surgical reconstruction of the delayed presentation of achilles tendon rupture. Materials and Methods. Fourteen patients with chronic tendo-Achilles rupture, presenting between April 2008 and December 2010, underwent surgical reconstruction and FHL transfer. Surgery was performed employing standard operative techniques, with shortening of the Achilles tendon and FHL transfer into the calcaneum with a Biotenodesis screw (Arthrex). VISA-A scores were performed preoperatively and six months postoperatively. Complication data was collected by review of the electronic patient record and direct patient questioning. Results. One patient died of an unrelated cause shortly before outcome scoring, and another patient was excluded because casting in the preoperative period prevented accurate scoring, although he achieved a good post-treatment score. Analysis was therefore carried out on twelve patients. Eleven of the twelve patients had significant improvement in their VISA-A score, with a mean improvement in score of 30 (p < 0.05). There were no significant complications in any of the patients. Conclusion. Our results show that FHL transfer in the management of chronic Achilles tendon rupture is a good, safe and reliable technique. There is excellent improvement in the mean VISA-A score, with no significant complications. Our results support the use of FHL tendon transfer for patients with chronic tendo-Achilles rupture


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 52 - 52
1 May 2012
Dalal S Barrie J
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Introduction. Many common fractures are inherently stable, will not displace and do not require plaster casting to achieve union in a good position. Nevertheless, many patients with stable fractures are advised that they need a cast, despite the potential for stiffness, skin problems and thromboembolism. Attempts to challenge this practice often meet the argument that patients prefer a cast for pain relief. We analysed five years of a single consultant's fracture clinic to see how many patients with stable foot and ankle fractures chose a cast after evidence-based counselling. Materials and methods. All patients with stable fractures of the ankle or metatarsals seen between 1st June 2005 and 31st May 2010 were included. Displaced or potentially unstable ankle fractures, Jones fractures and fractures involving the Lisfranc joint were excluded. Patients were advised functional treatment but offered a cast if they wished. Patients were documented prospectively as part of a larger audit, including demographics, diagnosis and treatment in the emergency department and fracture clinic. Results. 93 patients had stable ankle fractures. One (1%) chose a cast, 77 an ankle brace and 14 the RICE regime. One was advised a cast for neurological deformity. 105 patients had fifth metatarsal fractures outside the “non-” zone. 19 (18%) chose casts and 86 followed the RICE regime. 50 patients had other stable metatarsal fractures 15 (30%) chose casts. 86% of patients had casts applied in the emergency department. Discussion. The majority of patients with stable foot and ankle fractures do not wish to wear a cast once they understand it will not affect their outcome. In many cases this decision could have been reached in the emergency department with appropriate guidelines and education, preventing patient inconvenience and possible adverse events. Conclusion. Most patients are happy with evidence-based functional treatment of stable fractures


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 20 - 20
1 Sep 2012
Tong A Bizby O Price N Williams P
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Introduction. The Ponseti regime was introduced in Swansea in 2003 for the treatment of congenital talipes equinovarus (CTEV). The aim of this retrospective cohort study was to compare children treated with this regime with a historical group treated traditionally before then. Materials and Methods. Sixty children (89 feet) were treated with the Ponseti regime between 2003 and 2010. Their notes were compared with notes from 12 children (21 feet) treated between 1995 and 2002. Clinic attendance for serial manipulation and immobilisation (strap/cast) was compared using a two-tailed Mann Whitney U test. Major release surgery was compared using a two-tailed Fisher's Exact test. Results. Children in the historical cohort presented when they were 0–174 days old (median 1 day). They attended 3–35 times (median 22) for serial manipulation and strapping/ plasters. Major release surgery was undertaken on 14 feet (66.7%) when the children were 6–39 months old (median 9 months); 7 had revision surgery. The Ponseti cohort presented when they were 0–73 days old (median 10 days) and attended outpatients 2–19 times (median 7) for serial manipulation and casting. An Achilles tenotomy was undertaken in 54 feet (60.7%) when the children were 45–184 days old (median 71 days) and major release surgery in 17 feet (19.1%) when the children were 10–66 months old (median 21 months). Four children had revision surgery. Discussion. There is a significant reduction in outpatient attendances (Ua = 1313, p = <0.0001) for serial manipulation and reduced rate of release surgery (p = 4.56 × 10. −5. ) since the implementation of the Ponseti regime. The rate of revision surgery in both groups was not significant (p = 0.15), although these samples were small. Conclusion. The Ponseti regime is an effective initial treatment for infants with CTEV compared with traditional treatment. It has decreased the number of clinic attendances and the rate of major release surgery


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1359 - 1363
1 Oct 2018
Chiu Y Chung T Wu C Tsai K Jou I Tu Y Ma C

Aims

This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot.

Patients and Methods

Between January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed.


The Bone & Joint Journal
Vol. 100-B, Issue 2 | Pages 190 - 196
1 Feb 2018
Chraim M Krenn S Alrabai HM Trnka H Bock P

Aims

Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up.

Patients and Methods

We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70).


The Bone & Joint Journal
Vol. 99-B, Issue 1 | Pages 87 - 93
1 Jan 2017
Lawrence JE Nasr P Fountain DM Berman L Robinson AHN

Aims

This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment.

Patients and Methods

All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme.


The Bone & Joint Journal
Vol. 98-B, Issue 6 | Pages 806 - 811
1 Jun 2016
Akimau PI Cawthron KL Dakin WM Chadwick C Blundell CM Davies MB

Aims

The purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast.

Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior.

Patients and Methods

A total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed.


The Bone & Joint Journal
Vol. 97-B, Issue 6 | Pages 809 - 813
1 Jun 2015
Butt DA Hester T Bilal A Edmonds M Kavarthapu V

Charcot neuro-osteoarthropathy (CN) of the midfoot presents a major reconstructive challenge for the foot and ankle surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and recommended for patients who have a deformity of the medial column of the foot due to CN. We present the results from the first nine patients (ten feet) on which we attempted to perform fusion of the medial column using this bolt. Six feet had concurrent hindfoot fusion using a retrograde nail. Satisfactory correction of deformity of the medial column was achieved in all patients. The mean correction of calcaneal pitch was from 6° (-15° to +18°) pre-operatively to 16° (7° to 23°) post-operatively; the mean Meary angle from 26° (3° to 46°) to 1° (1° to 2°); and the mean talometatarsal angle on dorsoplantar radiographs from 27° (1° to 48°) to 1° (1° to 3°).

However, in all but two feet, at least one joint failed to fuse. The bolt migrated in six feet, all of which showed progressive radiographic osteolysis, which was considered to indicate loosening. Four of these feet have undergone a revision procedure, with good radiological evidence of fusion. The medial column bolt provided satisfactory correction of the deformity but failed to provide adequate fixation for fusion in CN deformities in the foot.

In its present form, we cannot recommend the routine use of this bolt.

Cite this article: Bone Joint J 2015; 97-B:809–13