To study the incidence of delayed consolidation of regenerate in children undergoing correction or lengthening of lower limb deformities using an external fixator. Between 2006 and 2011, 150 patients with lower limb deformities (excluding feet) were treated in our unit using external fixators. A retrospective review of our prospective database was carried out to identify patients with poor regenerate formation requiring bone grafting. Patients with acute fractures, pseudarthrosis of the tibia due to neurofibromatosis and those above the age of eighteen were excluded. An independent observer reviewed the medical records and radiographs. Eleven patients with ages ranging from 2 years 5 months to 17 years 5 months (mean average 9 years 9 months) formed the basis of our study – 3 males and 8 females. Factors that were associated with this complication include age greater than twelve years (10 patients), lack of weight bearing (6 patients), previous fixator (5 patients) and smoking (5 patients). The regenerate was deficient in nine tibial segments and two femoral segments. Six of the deficient tibial regenerates were at a proximal site whilst three were distal. There was no significant difference in length gained between these sites (p < 0.5). The mean time to regenerate bone grafting was 7 months. Time to healing following bone grafting was 2.5 months.Purposes of the Study
Methods and Results
The management of non-unions of subtrochanteric femoral fractures with associated implant failure is challenging. This study assessed the outcome of a cohort of patients treated according to the diamond concept. Between 2005–2010 all patients with subtrochanteric aseptic non-unions presented post implant failure (Gamma Nail breakage) were eligible in the absence of severe systemic pathologies and comorbidities. Demographics, initial fracture pattern, method of stabilisation, mode of failure of metal work, time to revision of fixation, complications, time to union, and functional outcome were recorded over a minimum period of follow-up of 12 months. The revision strategy was based on the “diamond concept;” optimising the mechanical and biological environment (revision of fixation, osteoinduction/BMP-7, osteoconduction/RIA harvested graft, and osteogenicity/concentrate of bone marrow aspirate).Background
Methods
Despite interest, the current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively (“study group”). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed (“standard practice group”).Background
Methods
(1) To determine whether any difference exists in AVN risk between surgical reduction [Fish] or pinning-in-situ [PIS] of severe slips. (2) To review the different classifications of SUFE in relation to AVN. 56 children presented with slipped upper femoral epiphysis (SUFE) from 1998 to 2008; 29 males, 27 females; mean age 12.8 years. The Loder & Southwick classifications were used. All slips were treated surgically. The mild and moderate groups were treated with a single pin-in-situ. The severe group had either surgical reduction [Fish femoral neck osteotomy], alternatively a single pin-in-situ, randomised by day of admission. Avascular necrosis of the femoral head (AVN) was the primary outcome measurement.Aim
Materials and Methods
