Rupture of the tendo Achillis is a common injury with a rising incidence. Traditionally the key question following this injury has been whether or not to operate. However a contemporary Cochrane review highlighted that the method of rehabilitation may also have an important contribution to the outcome. Since this review, various early weight-bearing rehabilitation protocols have been described. Currently evidence points to the use of early functional rehabilitation, regardless of operative or non-operative management. However, there is no consensus on which exact functional rehabilitation protocol should be used. Future research should be directed towards improving our understanding of how the different rehabilitative components interact in the tendo Achillis as it heals.

Midfoot arthrodesis is the conventional surgical intervention for midfoot arthritis. Arthrodesis aims to stabilise, realign and fuse the affected joints, providing patients with improved pain and function. Current research neglects the measurement of patient reported outcomes. This study aimed to investigate objective, and patient reported outcomes of midfoot arthrodesis. The secondary aim was to identify variables predicting the development of non-union. An automated search of online patient records identified 108 eligible patients (117 feet). The rates of union, re-operations, and complications were calculated using radiographs and medical records. Logistic regression was used to model variables influencing the odds of non-union. All living patients were posted a Manchester Oxford Foot Questionnaire (MOx-FQ), a patient reported outcome assessment. Pre-operative MOx-FQ results were available in a minority of cases. Students t-test was used to compare pre- and post-operative MOx-FQ scores. The rate of union achieved was 74%. The rate of re-operations was 35%. The rate of complications was 14%. Bone grafts and staple fixation independently impacted the odds of non-union. Bone grafts decreased the odds of non-union, whilst staple fixation increased the odds. This finding agrees with the opinion of other researchers. We recommend the use of bone grafts, and the avoidance of fixation with staples. Previous attempts have been made to assess patient outcomes. However, this study is the first to use the MOx-FQ, a validated questionnaire. Therefore, this study establishes a baseline for improvements in patient reported outcomes

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No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA.

Aims

Patients receiving cemented hemiarthroplasties after hip fracture have a significant risk of deep surgical site infection (SSI). Standard UK practice to minimize the risk of SSI includes the use of antibiotic-loaded bone cement with no consensus regarding type, dose, or antibiotic content of the cement. This is the protocol for a randomized clinical trial to investigate the clinical and cost-effectiveness of high dose dual antibiotic-loaded cement in comparison to low dose single antibiotic-loaded cement in patients 60 years and over receiving a cemented hemiarthroplasty for an intracapsular hip fracture.

Cite this article: Bone Joint Open 2020;1-11:706–708.

Aim: To evaluate our results of articulated hip distraction in children with a painful, stiff hip. Materials & Methods: Between 1988 & 2003, 10 children underwent hip distraction and 7 have completed treatment. The diagnoses were varied, though the presentations were those of pain & stiffness of the hip, poor posture and gait. The Orthofix articulated hip device was used in all patients. The outcome assessment was performed by clinical and radiological review. Results: The mean age of the patients was 13.7 years (Range 12–17 years). The primary diagnosis was SUFE- 3, Perthes-4, trauma-1, septic arthritis -1, chemotherapy induced -1. The mean fixator time was 12 weeks (range 10–14 weeks). The follow-up period ranged from 4–183 months. Soft tissue releases and joint debridement were done in 6 and 2 patients respectively. Results were good in one, fair in five and poor in one patient. Patients with non-functional ankylosis gained functional position with some increase in range of motion. Grade 2 pin tract infections were noted in 4 patients. Conclusion: Early results with hip distraction in this difficult, complicated group of patients are promising clinically and radiologically

Aims

The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis.

Objectives: The aim of this study was to determine the outcome of posterior lumbar fusion performed using an intrasegmental pedicle screw device. Design: Prospective Case Series. Subjects: 83 consecutive patients underwent posterior lumbar fusion for the intrasegmental pedicle screw device between October 1998 and November 2001. The mean age was 46.8 (range 17–86) and 46 were male and 37 female. 40 patients had a single intervertebral level fusion, 34 two level and 7 three level. 23 patients had undergone previous spinal surgery and 29 were smokers. Outcome Measures: Fusion status was assessed using radiographs (lateral, AP and in the plain if the intervertebral disc). To be judged as fused, there had to be an absence of metalwork failure, no pedicle screw loosening and fusion at all levels if a multi-level fusion. Patient outcome was assessed by means of a visual analogue scale (VAS) for pain, SF36 health assessment questionnaire, a patient subjective outcome assessment, employment status and analgesic usage. Results: Patients were followed up for a minimum of one year. Fusion was successfully achieved in 80 (96%) patients. The mean VAS reduced by 2.2 points from 8.2 to 5.9 (p=0.007). There was a significant improvement in all the physical component scores of the SF36. The subjective outcome was either excellent or good in 65% of patients. Analgesia usage reduced in 71% of patients. 4 patients underwent further surgery. One patient died in the post operative period. There was no significant difference in the fusion rate in smokers compared to non smokers, or those that had undergone previous spinal surgery. The subjective outcome was either excellent or good in 59% of smokers, but only 37% in those that had undergone previous surgery. Conclusions: We believe that our results demonstrate that the use of an intrasegmental pedicle screw device can facilitate high fusion rates with good clinical outcomes in most patients. The fusion rate does not appear to be effected by smoking, or previous spinal surgery

Objectives: The aim of this study was to determine the outcome of posterior lumbar interbody fusion using an intrasegmental pedicle screw device in a series of patients with symptomatic spondylolisthesis. Design: Prospective Case Series. Subjects: 34 consecutive patients underwent posterior lumbar fusion for symptomatic spondylolisthesis using an intrasegmental pedicle screw device between December 1998 and January 2002. The mean age was 48.6 (range 27–84) and 16 were male and 18 female. 22 patients had a spondylolisthesis at the L5/S1 level, 10 at the L4/5 level, 1 at the L3/4 level, 1 at the L2/3 level. 17 patients had a grade 1 slip, 16 grade 2, and 1 grade 3. 22 patients had a single intervertebral level fused, 10 two levels and 2 three levels. Outcome Measures: Fusion status was assessed using radiographs (lateral, AP and in the plain if the intervertebral disc). To be judged as fused, there had to be an absence of metalwork failure, pedicle screw loosening and fusion at all levels if a multi-level fusion. Patient outcome was assessed by means of a visual analogue scale (VAS) for pain, SF36 health assessment questionnaire, a patient subjective outcome assessment, employment status and analgesic usage. Results: Fusion was successfully achieved in 33 (97%) patients. The mean VAS reduced by 3.2 points from 8.3 to 5.1 (p=0.0001). There was a significant improvement in all the physical component scores of the SF36. The subjective outcome was either excellent or good in 24 (71%) patients. Of the 26 patients working prior to surgery, 20 (77%) returned to work. Analgesia usage reduced in 21 (61%) patients. One patient died in the post operative period. Conclusions: Our study supports the view that good clinical outcomes can be achieved by posterior interbody fusion of symptomatic spondylolisthesis. This particular intrasegmental device enables a safe, simple technique for reduction and fusion of symptomatic spondylolisthesis

Introduction: Since Briggs and Milligan. 1. first described posterior lumbar interbody fusion (PLIF) in 1944, posterior lumbar interbody fusion has been a controversial fusion technique. Reports regarding the safety, efficacy and fusion rates have varied greatly over the years. Modern pedicle screw instrumentation and the use of intervertebral spreaders / implants have provided a powerful technique for the restoration of spinal balance in degenerative deformity. Since 1993, the author has performed over 400 posterior interbody fusions for a wide variety of degenerative, traumatic and neoplastic conditions. A review was undertaken of 362 consecutive patients who were managed with this technique between October 1993 and July 2001. The purpose of this review was to determine the efficacy and safety of the technique and in particular, to attempt to identify those factors, which have contributed to patient outcomes. Methods: The first 86 patients underwent wide posterior decompression with resection of facet joints and interbody grafting using morcellised posterior elements and pedicle screw stabilisation. From February 1995, the interbody graft was supplemented with Carbon wedge shaped spacers bearing serrated upper and lower surfaces (Ramps). From July of 1996 (patient 170), the interbody graft was supplemented with posterior grafting, and from December 2000 with Autologous Growth Factor (AGF) treated graft. Patient pre-operative, operative and post-operative data and complications and follow-up Surgeon Subjective Outcome Assessments (SSOA’s) were acquired prospectively. Questionnaires were administered seeking patient generated follow-up data, including Patient Subjective Outcome Assessment (PSOA). Results: Follow-up data (SSOA ± PSOA) was available on 327 or 91% of patients. The data was for periods greater than 6 months in 64% of patients. PSOA data was available on 31% – mean follow-up time for these patients was 27.7 months (± 25.8). Average age at surgery was 56 years (± 16). Average number of levels operated was 1.5 (± 0.9). Average number of previous surgeries was 0.7 (± 1.0). 286 patients were private and 76 were compensation. 88 patients had no deformity while the remainder had some form of deformity, the most common of which were spondylolisthesis – 156 and scoliosis – 94. Overall, private patients did much better (very good or excellent outcomes) than compensation ones: 76% vs. 57% (p < 0.002). Patients who underwent surgery for conditions associated with deformity did significantly better than those without: 80% vs. 57% (p < 0.01). The outcomes since the introduction of interbody serrated spacers and additional posterior grafting have been significantly improved: for private patients, 86% now vs. 62% (p < 0.002). The introduction of ramps improved the non-union rate from 16.3% in the first 86 patients to 8.3% in the next 84. The addition of posterior grafting improved the non-union rate to 1.0% in the next 198 patients. There have been no non-unions since the introduction of AGF. Serious complications included three deaths, five deep infections, eight early returns to theatre for radiculopathy, four partial and one complete foot drop, four CSF leaks and one pulmonary embolus. Of the patients surveyed, 123/131 or 94% considered the surgery worthwhile and 88% said that they would have it again, if necessary. Discussion: Refinements in technique and improved patient selection have resulted in a significant improvement in clinical outcomes over the last eight years. While technically demanding, this PLIF technique now yields a high fusion rate, the ability to fully correct sagittal and coronal deformity and a high rate of good or excellent clinical outcomes: 86% in private patients

The February 2015 Children’s orthopaedics Roundup³⁶⁰ looks at: Hip dislocation in children with CTEV: two decades of experience; Population-based prevention of DDH in cerebral palsy: 20 years’ experience; Shoulder derotation in congenital plexus palsy; Back pain in the paediatric population: could MRI be the answer?; Intercondylar fracture of the humerus in children; The Dunn osteotomy in SUFE; Radiocapitellar line a myth!; Do ‘flatfooted’ children suffer?

Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition arthroplasty as an alternative to arthrodesis in eight patients with advanced arthritis and retrospectively reviewed their clinical and radiographic outcomes after a mean follow-up of 41 months (13 to 53). The visual analogue scale (VAS) for pain at its worst and at rest, and the patient-rated wrist evaluation score improved significantly after surgery, whereas ranges of movement and grip strength were maintained at the pre-operative levels. Progression of arthritis in the radiocapitate joint was observed in three patients, but their outcomes were not significantly different from those without progression of arthritis.

Proximal row carpectomy with capsular interposition arthroplasty is a reasonable option for the treatment of patients with advanced arthritis of the wrist.

The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many different purposes. This paper describes how they should be used and seeks to clarify areas of confusion.