Aims

Osteofibrous dysplasia (OFD) is a rare benign lesion predominantly affecting the tibia in children. Its potential link to adamantinoma has influenced management. This international case series reviews the presentation of OFD and management approaches to improve our understanding of OFD.

Aim

Spondylodiscitis and vertebral osteomyelitis can lead to long-term sequelae if not diagnosed and treated promptly and appropriately. The Royal National Orthopaedic Hospital (RNOH) has devised a new spinal infection referral system within the UK that allows cases to be discussed in a specialist multi-disciplinary (MDT) forum. National guidelines were devised in 2013 to help guide treatment, which recommends both tissue biopsies from the affected region and a MRI of the entire spine. The aims of this study were to assess the current treatment and referral practices and compare them with the set guidelines. It is hypothesised that a high percentage of patients are started on antibiotics without a biopsy or a positive set of blood cultures, a low percentage of patients are referred without undergoing a MRI of the full spine and that there is a long delay in referral to the MDT.

Introduction

Pedicle subtraction osteotomy is a powerful technique for correcting sagittal imbalance in ankylosing spondylitis. There has been significant perioperative morbidity associated with this technique in the peer review literature. We present the Royal National Orthopaedic Hospital experience with a single surgeon retrospective study that was conducted to evaluate the outcomes in patients who underwent lumbar pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis.

Introduction: Ankle diastasis injury occurs in up to 20% of ankle fractures. Various techniques have been used to treat syndesmosis injuries, but controversy remains and outcome is variable. In light of some recent cases of substandard syndesmosis fixations requiring revision, an audit of our results was undertaken.

Method: Study type: Retrospective audit of radiographs and patient records

Data collection: patients were selected using an orthopaedic database search for operations coded as distal tib/fib ORIF or ankle ORIF.

Study period: 12 months, July 2008 to July 2009 (currently data has been analyzed on the first 6 months only, the remaining 6 months will follow)

Audit questions to be answered: How is ankle diastasis injury being managed? Are we reducing syndesmosis correctly? Should there be a revision to local policy?

Audit standard: Syndesmoses should be adequately reduced and fixation techniques employed should be in accordance with recommendations in standard Orthopaedic reference texts (Rockwood & Green, AO fixation manual 3)

Results: 76 ankle ORIFs in July to December 2008 inclusive. Out of these, 16 had diastasis fixation (21%). 2 of the patients had a syndesmosis width over 6 mm indicating an inadequate reduction of the syndesmosis 1. Both of these required revision surgery. In total 70% of the post operative x-rays showed inadequate syndesmosis fixation or reduction.

Discussion: The single most predictive indicator of a favourable function is accurate reduction of the syndesmosis 2. Substandard fixations are associated with poor long term outcomes. This raises the potential for litigation and the requirement for education and policy change. We have produced policy guidelines for theatre and circulated the information to all surgeons. A further audit will be carried out to assess the effectiveness of this in 6 months time. (The data will be available from this re-audit for presentation at the conference.)

Aim: We evaluated the clinical and radiologic results of patients treated by the minimally invasive technique and plate þxation in accordance with biological þxation principles for femoral fractures. Methods: Biological þxation principles were used in the treatment of 24 patients (18 males, 6 females; mean age 32 years; range 18 to 56 years) with femoral fractures. Fractures were reduced by indirect reduction and the plate was forwarded through distal and proximal incisions over the periosteum without the need for incisions on the fracture line. Fixation of the plates was performed with the use of screws from distal and proximal incisions. The patients were allowed partial and full weight-bearing in a mean of 3.6 and 5 months, respectively. By means of monthly clinical and radiologic examinations, union was assessed by callus formation in the fracture line and painless weight-bearing. In addition, leg length discrepancy, rotation, angulation deformities, and knee and hip range of motions were determined. The mean follow-up was 2 years and 7 months (range 16 months to 4 years and 5 months). Results: The mean union time was 4.6 months (range 4 to 11 months). Except for one patient (4%) with delayed union, all patients achieved union. No infections occurred related to the fracture site. Conclusion: Successful clinical and radiologic results can be obtained by biological methods of þxation in diaphyseal femur fractures with multiple fragments, segment formation, inmultitrauma patients with high Injury Severity Score and compromized pulmonary function, and in those having subtrochanteric or supracondylar fractures associated with high complication rates.