Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac
Abstract. Background. Prospective study to compare patient reported outcome measures (PROM) for sacroiliac
Aim. This study assesses the ability of the JS-BACH classification of bone infection to predict clinical and patient-reported outcomes in prosthetic joint infection (PJI). Method. Patients who received surgery for suspected PJI at two specialist bone infection centres within the UK between 2010 and 2015 were classified using the JS-BACH classification into either ‘uncomplicated’, ‘complex’ or ‘limited options’. All patients were classified by two clinicians blinded to outcome, with any discrepancies adjudicated by a third reviewer. At the most recent follow-up, patients were assessed for (i) any episode of recurrence since the index operation and (ii) the status of the joint. A Cox proportional-hazard model assessed significant predictors of recurrence following the index procedure. Patient-reported outcomes included the EuroQol EQ-5D-3L index score and the EQ-visual analogue score (VAS) at 0, 14, 42, 120 and 365 days following the index operation. Results. 220 patients met the inclusion criteria during the study period which included PJI of the knee (n=111), hip (n=102), shoulder (n=4) and elbow (n=3). The median time to final follow-up was 4.7 years (inter-quartile range 2.7 – 6.7 years). Controlling for type of index procedure and site of infection, Cox proportional-hazards ratio of recurrence when being classified as complex versus uncomplicated was 25.2 (95% CI 3.45 – 183.7, p<0.001) and having limited options verses uncomplicated was 59.0 (95% CI 7.93 – 439.1, p<0.001). None of the patients who were classified as ‘uncomplicated’ PJI (0/52) had received either amputation,
Distal interphalangeal
Proximal inter-phalangeal joint . (PIPJ). arthrodesis is a commonly performed procedure as a part of hammer and claw-toe correction. Conventional K-wire stabilisation has the potential disadvantages of infection; violation of DIP joint; external protrusion or the wire and necessity of removal. Newer intra-medullary stabilisation devices are also available, though tend to incur addition costs. We present our technique and results of using a single, buried 1.6 mm K-wire for proximal inter-phalangeal
Aim. Eradication of infection in chronic osteomyelitis requires effective dead space management after debridement. Residual bacteria in biofilm may be resistant to normal levels of systemic antibiotic penetrating bone and will contribute to recurrence of osteomyelitis. This study evaluated a new antibiotic-loaded biocomposite in the eradication of chronic infection from bone defects. Patients and Method. We report a prospective study of 100 patients with Cierny and Mader types III and IV chronic osteomyelitis, in 105 bones. Osteomyelitis followed open fracture or ORIF of closed fractures in 71%. Nine had concomitant septic arthritis. 80% had comorbidities (Cierny-Mader Class B hosts). Ten had infected non-unions. All patients were treated by a multidisciplinary team with a single-stage protocol including; debridement, multiple sampling, culture-specific systemic antibiotics, stabilisation, dead space filling with Cerament G™ and immediate primary skin closure. Stabilisation was required in 21 cases and 5 required
The purpose of this study is to assess the improvement in pain and function of the ankle when arthrodiastasis is used for end stage juvenile idiopathic arthritis [JIA] in the paediatric population. All patients treated with ankle arthrodiastasis, 2009–2013 were studied. Clinical, radiological and survivorship data were examined. The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and Parents (OxAFQ-P), along with the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical rating system for Ankle-Hindfoot were recorded pre-operatively and at 6 months. Eight patients (9 ankles) with severe tibiotalar JIA, refractory to medical management were treated. Average age at surgery was 14.5 years (range 8–19). Average length of arthrodiastasis was 3.5 months. Length of follow-up averaged 13 months (range 5–28 months). All scores showed an improvement at 6 months. OxAFQ-C scores (out of 60) improved on average from 23 to 43. OxAFQ-P scores also improved from19 to 39. The largest improvement was found for the physical subsection. AOFAS Ankle-Hindfoot score (out of 100) averaged 34 pre-op and 74 at 6 months. Pain scored out of 10 decreased from an average of 7.4 to 4.3 at 6 months. All patients and parents were satisfied with the surgery and would have the procedure performed again. Radiological studies demonstrated cartilage regeneration, joint restoration and deformity correction with arthrodiastasis. Survivorship was good (75%) at 36 months, but 2 patients (3 ankles) had subsequent surgery in the adult sector for progression of disease despite initial improvement following arthrodiastasis. This case series demonstrates the efficacy of ankle arthrodiastasis as a surgical option in severe end-stage ankle inflammatory arthritis in paediatric patients in the short to midterm. It improved functional scores and pain scores which should delay the need for more radical
Objective. To assess the long term functional and objective outcomes for 2 stage Dupuytrens contracture correction. Methods. Patients with severe contracture were offered a 2 stage correction. This involved application of external fixator to distract the contracture over the course of 2 weeks and subsequent partial fasciectomy (in primary contractures) and dermofasciectomy with full thickness skin graft (in recurrent contractures). A series of 54 corrections in 47 patients were identified. Of these, 6 were lost to follow-up, 1 deceased. Pre-operative total range of active movement (TRAM), total flexion contracture and PIP flexion contracture, Tubiana grade and DASH/Michigan Hand Scores were recorded and compared to post-operative data. Results. Mean age was 61 (range 43–90), 44 male, 10 females. The average duration of follow-up was 32 months (range 6–96). The mean fixed flexion deformity (FFD) in the PIPJ improved from 84 degrees (range 50–110, SD-12) to 30 degrees (range −5–90, SD-27) (p< 0.0001). Mean total flexion contracture improved from 123 degrees(range 50–210, SD-34) to 46 degrees (range 0–195, SD-50) (p< 0.0001). The mean TRAM improved from 70 degrees (range 10–140, SD-33) to 148 degrees (range 25–135, SD-52) (p< 0.0001). DASH scores improved from 32.0 to 27.6. Michigan hand scores improved from 68 to 76. There was no statistical difference in pre- and post-op hand scores. Complications include CRPS (8%), infection (6%), stiffness (4%), graft failure (4%), neurovascular injury (2%), fracture (4%). Conclusions. Long term follow-up of this two stage technique shows that the correction, range of movement and function is maintained. We consider that the complications rate is acceptable for these very severe deformities where amputation,
Patients with spinal cord injuries have been seen to have increased healing of attendant fractures. This for the main has been a clinical observation with laboratory work confined to rats. While the benefits in relation to quicker fracture healing are obvious, this excessive bone growth (heterotopic ossification) also causes unwanted side effects, such as decreased movement around
Purpose. This study was undertaken to assess the result of total hip arthroplasty (THA) performed for fused hips. Patients and Methods. Twenty nine patients (31 hips), aged 21 to 70 years (average 46 years), underwent THA conversion surgery and were followed for an average of 4.6 years (2.4-12.0 years). There were 23 cases of spontaneous fusion and 8 case of surgical fusion. The causes of
Sacroiliac
Chronic osteomyelitis may recur if dead space management, after
excision of infected bone, is inadequate. This study describes the
results of a strategy for the management of deep bone infection
and evaluates a new antibiotic-loaded biocomposite in the eradication
of infection from bone defects. We report a prospective study of 100 patients with chronic osteomyelitis,
in 105 bones. Osteomyelitis followed injury or surgery in 81 patients.
Nine had concomitant septic arthritis. 80 patients had comorbidities
(Cierny-Mader (C-M) Class B hosts). Ten had infected nonunions. All patients were treated by a multidisciplinary team with a
single-stage protocol including debridement, multiple sampling,
culture-specific systemic antibiotics, stabilisation, dead space
filling with the biocomposite and primary skin closure. Aims
Patients and Methods
Construction of a functional skeleton is accomplished
through co-ordination of the developmental processes of chondrogenesis,
osteogenesis, and synovial joint formation. Infants whose movement Cite this article: