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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 199 - 199
1 Sep 2012
Giannini S Buda R Cavallo M Ruffilli A Vannini F
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Introduction. Multiple ACL revisions represent an extremely demanding surgery, due to the presence of enlarged or malpositioned tunnels, hardware, injuries to the secondary stabilizers and difficulties in retrieving autologous tendons. An anatomical ACL reconstruction is not always possible. We analyzed the results in a series of patients operated with over the top reconstruction (OTTR) and lateral extra-articular plasty to the Gerdy's tubercle (LP) using Achilles (AT) or tibialis posterior tendon (TPT) allografts. Methods. From 2002 to 2008, twenty-four male athletes with a mean age of 30.8 years were operated. 20 of the patients had two, while four patients had three previous reconstructions. IKDC score and KT evaluation were used at a mean 3.3 years follow-up (2–7 years). Results. The mean IKDC subjective score at follow-up was 81.3. The IKDC objective score rated A or B in 84% of the patients. Of the 20 good results, 17 patients resumed sport activity at the pre-injury level. KT side-to-side difference averaged 3.5 mm in the TPT, versus 3.2 mm in the AT group. No significant differences were noted between the AT and TPT group. Conclusions. Multiple ACL revision surgery is a salvage procedure, with average good results, but not equivalent to primary ACL reconstruction. Patients should be advised that a return to sports may not be feasible. OTTR+LP is an established technique that permits to overcome difficult anatomical situations, with cortical fixation providing good immediate stability and avoiding tunnel fixation and bone grafting. Long tendon grafts as AT and TPT are needed


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 2 | Pages 232 - 237
1 Feb 2006
Saridis A Panagiotopoulos E Tyllianakis M Matzaroglou C Vandoros N Lambiris E

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight.

The mean external fixation time was 309.8 days. According to Paley’s grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.


Aims. The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment. Patients and Methods. Between October 2008 and July 2016, 14 patients with failed osteosynthesis of an atypical subtrochanteric femoral fracture were treated with a blade plate (atypical group). Their mean age was 67.8 years (60 to 74); all were female. During the same period, 21 patients with failed osteosynthesis of a typical subtrochanteric fracture underwent restabilization using a blade plate (typical group). Outcome variables included the time of union, postoperative complications, Harris Hip Score, and Sanders functional rating scale. Results. In the atypical group, union was achieved in 12 patients (85.7%) at a mean of 8.4 months (4 to 12). The mean follow-up was 31.2 months (12 to 92) The plate broke in one patient requiring further stabilization with a longer plate and strut-allograft. Another patient with failure of fixation and varus angulation at the fracture site declined further surgery. In the typical group, union was achieved in 18 patients (85.7%) at a mean of 7.9 months (4 to 12). There was no difference in the mean Harris Hip Score between the two groups (83.1 points vs 86.8 points; p = 0.522) at the time of final follow-up. Sanders functional rating scores were good or excellent in 78.6% of the atypical group and in 81.0% of the typical group. Conclusion. The 95° angled blade plate was shown to be an effective fixation modality for nonunion of atypical subtrochanteric fractures with a high rate of union and functional improvement, comparable to those after fractures not associated with bisphosphonate treatment. Cite this article: Bone Joint J 2018;100-B:1511–17


Bone & Joint Open
Vol. 3, Issue 9 | Pages 710 - 715
5 Sep 2022
Khan SK Tyas B Shenfine A Jameson SS Inman DS Muller SD Reed MR

Aims

Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.

Methods

Patient identifiers for a consecutive cohort treated between 1 January 2003 and 31 December 2011 were linked to radiographs, surgical notes, clinic letters, and mortality data from a national dataset. This allowed charting of their postoperative course, complications, readmissions, returns to theatre, revisions, and deaths. We also identified all postoperative attendances at the Emergency and Outpatient Departments, and recorded any subsequent skeletal injuries.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_5 | Pages 4 - 4
1 May 2015
Laubscher M Mitchell C Timms A Goodier D Calder P
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Background:. Leg length discrepancy related to absence of the femoral head with proximal migration of the femur presents a treatment dilemma. Late sequelae of neonatal hip sepsis and chronic hip dislocation due to developmental dysplasia are the most common causes. Traditional teaching dictates that the hip is stabilised prior to limb lengthening. Reconstructive options alter the shape of the proximal femur which complicates future surgery. Methods:. We retrospectively reviewed 3 cases of femoral lengthening with an ‘unstable’ hip without prior stabilization. The aetiology was neonatal hip sepsis in 2 cases and chronic hip dislocation due to developmental dysplasia in 1 case. Lengthening was performed with the use of a retrograde Precice lengthening nail. Results and Discussion:. The desired length (range 5.5 to 6cm) was achieved in all patients without migration of the proximal femur. In all cases patient satisfaction was high with the lengthening and the ability to abort shoe raises. There was an improvement in gait pattern in all patients. Conclusion:. Femoral lengthening is possible without prior stabilisation of the hip in so called ‘unstable’ hip situations. The proximal femoral anatomy is not further altered and future salvage procedures such as a total hip replacement are not compromised


The Bone & Joint Journal
Vol. 97-B, Issue 7 | Pages 1004 - 1006
1 Jul 2015
Middleton SD McNiven N Griffin EJ Anakwe RE Oliver CW

We define the long-term outcomes and rates of further operative intervention following displaced Bennett’s fractures treated with Kirschner (K-) wire fixation between 1996 and 2009. We retrospectively identified 143 patients (127 men and 16 women) with a mean age at the time of injury of 33.2 years (18 to 75). Electronic records were examined and patients were invited to complete the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a satisfaction questionnaire. The time since injury was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had died, one had developed dementia and 12 patients were lost to follow-up. This left 119 patients available for recruitment. Of these, 57 did not respond, leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow-up. Median satisfaction was 94% (interquartile range 91.5 to 97.5) and the mean DASH score was 3.0 (0 to 38). None of the patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennett’s fractures treated by closed reduction and K-wire fixation show excellent functional results and a high level of patient satisfaction. The rate of infection is low and similar to other surgical procedures with percutaneous K-wires. Cite this article: Bone Joint J 2015;97-B:1004–6


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 5 | Pages 629 - 637
1 May 2008
Forward DP Davis TRC Sithole JS

Fractures of the distal radius occurring in young adults are treated increasingly by open surgical techniques, partly because of concern that failure to restore the alignment of the fracture accurately may cause symptomatic post-traumatic osteoarthritis in future years. We reviewed 106 adults who had sustained a fracture of the distal radius between 1960 and 1968 and who were below the age of 40 years at the time of injury. We carried out a clinical and radiological assessment at a mean follow-up of 38 years (33 to 42). No patient had required a salvage procedure. While there was radiological evidence of post-traumatic osteoarthritis after an intra-articular fracture in 68% of patients (27 of 40), the disabilities of the arm, shoulder and hand (DASH) scores were not different from population norms, and function, as assessed by the Patient Evaluation Measure, was impaired by less than 10%. Ordinal logistic regression analysis showed a significant relationship between narrowing of the joint space and extra-articular malunion (dorsal angulation and radial shortening) as well as intra-articular injury. Multivariate analysis revealed that grip strength had fallen to 89% of that of the uninjured side in the presence of dorsal malunion, but no measure of extra-articular malunion was significantly related to either the Patient Evaluation Measure or DASH scores. While anatomical reduction is the principal aim of treatment, imperfect reduction of these fractures may not result in symptomatic arthritis in the long term, and this should be considered when counselling patients on the risks and benefits of the many treatment options available


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_4 | Pages 5 - 5
1 May 2015
Middleton S McNiven N Griffin E Anakwe R Oliver C
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We define the long-term outcomes and rates of further operative intervention following displaced Bennett's fractures treated with Kirschner (K)-wire fixation. We prospectively identified patients who were treated for displaced Bennett's fractures over a 13 year period between 1996 and 2009. Electronic records for these patients were examined and patients were invited to complete a Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in addition to a patient satisfaction questionnaire. We identified 143 patients with displaced Bennett's fractures treated with K-wire fixation and followed them up at a mean of 13 years. The mean patient age at the time of injury was 33.2 years. At the time of follow up, 11 patients had died and 1 had developed dementia and was unable to respond. 9 patients had no contact details. This left 122 patients available for recruitment. Of these, 60 did not respond leaving a study group of 62 patients. Patients reported excellent functional outcomes and high levels of satisfaction at follow up. Mean satisfaction was 89% and the mean DASH score was 3.2. The infection rate was 3%. None of the 122 patients had undergone salvage procedures and none of the responders had changed occupation or sporting activities. Long-term patient reported outcomes following displaced Bennett's are excellent. Fusion surgery or trapeziectomy was not undertaken for any patient in this series nor did this injury result in sporting or occupational changes. The rate of infection is low and similar to the literature for other surgical procedures with percutaneous K-wires


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_3 | Pages 7 - 7
1 Feb 2014
Davidson E Oliver W White T Keating J
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Tibial plateau fractures are common intraarticular fractures. The principal long-term complication is post-traumatic osteoarthritis (PTOA) with the usual salvage procedure being total knee arthroplasty (TKA). Our aim was to define the incidence of PTOA requiring TKA following tibial plateau fractures and identify the risk factors. We looked at all tibial plateau fractures between 1995 and 2008. There were 888 tibial plateau fractures. 23% were Schatzker I, 25% II, 14% III, 22% IV, 8% V and 8% VI. To date 25 have undergone TKA (2.8%). The mean age of patients at time of fracture was 56 in the overall cohort and 65 in those requiring TKA; this was statistically significant (p=0.04). 4% of females with tibial plateau fractures required TKA in comparison to 2% of males. The Schatzker I fractures were the least likely to require TKA at 1% with the most likely requiring arthroplasty surgery being type III at 6%. Only 1% of the patients treated non-operatively later underwent TKA. The overall incidence of TKA after tibial plateau fractures was 3%. For displaced fractures requiring internal fixation this rose to 4%. Risk factors were increasing age, split depression fractures and female gender. Although tibial plateau fractures are commonly associated with degenerative radiographic changes, we concluded that the incidence of symptomatic OA severe enough to require TKA is low


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_25 | Pages 10 - 10
1 May 2013
Higgs Z Hooper G Kumar C
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Tibiotalocalcaneal (TTC) arthrodesis using a retrograde nail is a common salvage procedure for a range of indications. Previous work has suggested subtalar joint preparation is unnecessary to achieve satisfactory results. We examine the incidence of symptomatic subtalar nonunion following tibiotalocalcaneal fusion in a series of patients, all of whom had full preparation of the subtalar joint, and consider the possible contributing factors. We performed a retrospective review of all patients who underwent TTC arthrodesis from 2004–2010. All fusions were performed by the same surgeon with full preparation of both tibiotalar and subtalar joints. 61 TTC arthrodeses were performed in 55 patients (mean age = 59 years) using an intramedullary retrograde nail. Mean follow-up was 18 months (6–48 months). Fifty-six ankles (92%) achieved satisfactory union. Five patients (8%) had symptomatic non-union: 4 patients of the subtalar joint - with 3 patients undergoing revision subtalar arthrodesis and 1 patient of the tibiotalar joint. Nine patients required removal of the calcaneal screw (16%) – all had evidence of isolated subtalar nonunion prior to metalwork failure. Eight of these patients achieved asymptomatic union following screw removal. Subtalar nonunion following TTC fusion has resulted in recent changes to nail design to increase stability across the subtalar joint. Our results demonstrate a favourable overall nonunion rate with isolated subtalar nonunion making up the majority of cases. We also observed a significant rate of distal screw loosening, also associated with subtalar nonunion prior to screw removal, the significance of which merits further investigation


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 11 | Pages 1487 - 1492
1 Nov 2009
Blakey CM Biant LC Birch R

A series of 26 children was referred to our specialist unit with a ‘pink pulseless hand’ following a supracondylar fracture of the distal humerus after a mean period of three months (4 days to 12 months) except for one referred after almost three years. They were followed up for a mean of 15.5 years (4 to 26). The neurovascular injuries and resulting impairment in function and salvage procedures were recorded. The mean age at presentation was 8.6 years (2 to 12). There were eight girls and 18 boys. Only four of the 26 patients had undergone immediate surgical exploration before referral and three of these four had a satisfactory outcome. In one child the brachial artery had been explored unsuccessfully at 48 hours. As a result 23 of the 26 children presented with established ischaemic contracture of the forearm and hand. Two responded to conservative stretching. In the remaining 21 the antecubital fossa was explored. The aim of surgery was to try to improve the function of the hand and forearm, to assess nerve, vessel and muscle damage, to relieve entrapment and to minimise future disturbance of growth. Based on our results we recommend urgent exploration of the vessels and nerves in a child with a ‘pink pulseless hand’, not relieved by reduction of a supracondylar fracture of the distal humerus and presenting with persistent and increasing pain suggestive of a deepening nerve lesion and critical ischaemia


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 11 | Pages 1499 - 1506
1 Nov 2008
Rammelt S Schneiders W Schikore H Holch M Heineck J Zwipp H

Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion. In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031). We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant relief of pain and improvement in function


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 118 - 118
1 Sep 2012
Leonardsson O Garellick G Kärrholm J Akesson K Rogmark C
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Background. In Sweden approximately 6000 patients yearly sustain displaced femoral neck fractures. During the last decade there has been a shift towards more arthroplasties at the expense of internal fixation. In 2008 approximately 75% of the dislocated femoral neck fractures in Sweden were treated with arthroplasties. Those patients are typically elderly and frail and the vast majority of them receive hemiarthroplasties. In 2005 a national hemiarthroplasty registration was established as part of the Swedish Hip Arthroplasty Register (SHAR). Material & Method. The SHAR aims to register all hemiarthroplasties performed in Sweden, including primary and salvage procedures. Surgical and patient details are recorded and re-operations are registered. Results. 21.346 hemiarthroplasties were recorded from 2005 through 2009. The most common diagnosis, acute fracture of the femoral neck, increased from 91.3 to 94.3 percent during this period. The most commonly used stems (i.e. the Lubinus SP II and the Exeter stems) accounted for 68.3 percent of the implants. In total 743 patients (3,6%) underwent additional surgery and the most common reason for this was dislocation. The strongest risk factors for re-operation and revision (Cox regression analysis) were hemiarthroplasty due to failed internal fixation (rr 2.1, 95%CI 1.7–2.7) and uncemented stem (2.0, CI 1.5–2.6). Even when only modern uncemented implants are analyzed (i.e. exclusion of Austin-Moore) we can still see an increased risk of any re-operation(1.8, CI 1.3–2.5) and re-operation due to periprosthetic fracture (3.8, CI 2.0–7.1). Bipolar hemiarthroplasty heads also increased the risk of re-operation, especially due to dislocation (1.4, CI 1.1–1.8). The most used bipolar head (Variocup) has no increased risk of re-operation compared to all other bipolar heads generally, but an increased risk of re-operation due to dislocation (1.7, CI 1.2–2.4). Anterolateral surgical approach (Gammer and Hardinge) decreased the risk of re-operation due to dislocation (0.63, CI 0,53-0.83). Other risk factors are male gender and age above 75 years. During the period the use of monoblock type implants decreased from 17.8 to 0.9 percent. Use of uncemented implants decreased from 10.4 percent in 2005 to 3.0 percent in 2009 and the number of procedures performed with anterolateral approach increased from 46.7 to 55.9 percent. Conclusion. The SHAR have identified risk factors for re-operation and subsequently some important changes have been seen in choice of implant and fixation. We conclude that the results from the hemiarthroplasty registration have a large impact on the methods and implants chosen by the Swedish orthopaedic surgeons and therefore is an important tool in the continuing effort for improving the patient care


The Bone & Joint Journal
Vol. 101-B, Issue 10 | Pages 1285 - 1291
1 Oct 2019
MacKenzie SA Ng RT Snowden G Powell-Bowns MFR Duckworth AD Scott CEH

Aims

Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment.

Patients and Methods

This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded.


The Bone & Joint Journal
Vol. 100-B, Issue 11 | Pages 1506 - 1510
1 Nov 2018
Parker B Petrou S Masters JPM Achana F Costa ML

Aims

The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an open fracture of the lower limb.

Patients and Methods

A total of 460 patients were recruited from 24 specialist trauma hospitals in the United Kingdom Major Trauma Network. Preference-based health-related quality-of-life outcomes, assessed using the EuroQol EQ-5D-3L and the 6-Item Short-Form Health Survey questionnaire (SF-6D), and economic costs (£, 2014/2015 prices) were measured using participant-completed questionnaires over the 12 months following injury. Descriptive statistics and multivariate regression analysis were used to explore the relationship between deep SSI and health utility scores, quality-adjusted life-years (QALYs), and health and personal social service (PSS) costs.


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1125 - 1131
1 Sep 2017
Rickman M Varghese VD

In the time since Letournel popularised the surgical treatment of acetabular fractures, more than 25 years ago, there have been many changes within the field, related to patients, surgical technique, implants and post-operative care. However, the long-term outcomes appear largely unchanged. Does this represent stasis or have the advances been mitigated by other negative factors? In this article we have attempted to document the recent changes within the surgery of patients with a fracture involving the acetabulum, outline contemporary management, and identify the major problem areas where further research is most needed.

Cite this article: Bone Joint J 2017;99-B:1125–31


We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery.

At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p < 0.001). The functional outcome, as assessed by the Harris Hip score, was better in patients aged < 45 years compared with those aged > 45 years (p < 0.001).

These findings suggest that further fixation using two cannulated compression screws and a vascularised iliac crest bone graft is an effective salvage treatment in patients aged <  45 years, in whom osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.

Cite this article: Bone Joint J 2015; 97-B:988–91.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 11 | Pages 1558 - 1562
1 Nov 2010
Arora R Gabl M Pechlaner S Lutz M

We identified 11 women with a mean age of 74 years (65 to 81) who sustained comminuted distal radial and ulnar fractures and were treated by volar plating and slight shortening of the radius combined with a primary Sauvé-Kapandji procedure.

At a mean of 46 months (16 to 58), union of distal radial fractures and arthrodesis of the distal radioulnar joint was seen in all patients. The mean shortening of the radius was 12 mm (5 to 18) compared to the contralateral side. Flexion and extension of the wrist was a mean of 54° and 50°, respectively, and the mean pronation and supination of the forearm was 82° and 86°, respectively. The final mean disabilities of the arm, shoulder and hand score was 26 points. According to the Green and O’Brien rating system, eight patients had an excellent, two a good and one a fair result.

The good clinical and radiological results, and the minor complications without the need for further operations related to late ulnar-sided wrist pain, justify this procedure in the elderly patient.


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 11 | Pages 1474 - 1479
1 Nov 2006
Magnan B Bortolazzi R Marangon A Marino M Dall’Oca C Bartolozzi P

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders’ type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler’s angle was 6.98° (5.95° to 19.86°), whereas after surgery the mean value was 21.94° (12.58° to 31.30°) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing.

The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 1 | Pages 80 - 88
1 Jan 2007
El-Rosasy MA

We have managed 21 patients with a fracture of the tibia complicated by bone and soft-tissue loss as a result of an open fracture in 10, or following debridement of an infected nonunion in 11, by resection of all the devitalised tissues, acute limb shortening to close the defect, application of an external fixator and metaphyseal osteotomy for re-lengthening. The mean bone loss was 4.7 cm (3 to 11). The mean age of the patients was 28.8 years (12 to 54) and the mean follow-up was 34.8 months (24 to 75).

All the fractures united with a well-aligned limb. The mean duration of treatment for the ten grade-III A+B open fractures (according to the Gustilo-Anderson classification) was 5.7 months (4.5 to 8) and for the nonunions, 7.6 months (5.5 to 12.5). Complications included one refracture, one transient palsy of the peroneal nerve and one equinus contracture of 10°.