NICE guidelines support the use of total hip replacement (THR) in preference to cemented hemiarthroplasty for the treatment of fit and active elderly patients with a displaced intracapsular neck of femur fracture. We hypothesized that not all patients eligible for a THR received one in our unit. We performed a prospective cohort study including all consecutive hip fracture patients admitted to our unit over a 6 month period. Case notes and data from the National Hip Fracture Database were evaluated. Patients were deemed suitable for a THR if they mobilised outdoors with a maximum of one stick, had an abbreviated mental test score of 8 or greater and had an ASA score of 1 or 2. 256 patients sustained a neck of femur fracture during the study period and 36 met the inclusion criteria. 26 (72%) had cemented hemiarthroplasties and 10 (22%) had a THR. THR rates varied with the day of surgery. At our unit we have a low rate of THR for patients who fulfil the NICE criteria for suitability, however it is around the national average. This could be improved upon by increasing the availability of surgeons who are able to perform THR, especially on weekends.
Previous attempts at small incision hallux valgus surgery have compromised the principles of bunion correction in order to minimise the incision. The Minimally Invasive Chevron/Akin (MICA) is a technique that enables an open modified Chevron/Akin to be done through a 3 mm incision, facilitated by a 2 mm Shannon burr. This is a consecutive case series performed between 2009 and 2012. This includes the learning curve for minimally invasive surgery. All cases were performed by a single surgeon at two different sites, one centre where minimally invasive surgery is available and the other where it is not. The standard procedure in both centres is a modified Chevron osteotomy. Regardless of whether the osteotomy was performed open or minimally invasive two-screw fixation was performed. Retrospective analysis includes the IMA, HVA, M1 length, forefoot width and forefoot: hindfoot ratio. Clinical outcomes include the MOXFQ, AOFAS, and assessment of complications.Background:
Methodology:
The Chevron osteotomy is straightforward, requires less dissection and allows earlier rehabilitation than some other osteotomies. However it is generally perceived as unsuitable for severe deformities even though a 2012 meta-analysis and an earlier RCT failed to show any advantage of the scarf over the chevron. We aim to assess the correctability of severe HV comparing the correction, the clinical outcomes and complications of the Chevron osteotomy with other techniques employed in a consecutive series. We reviewed a series of 92 cases of severe hallux valgus (IMA >17° regardless of the HVA). The follow-up period varied from 1 to 4 years. Pre-operative x-rays and final post-operative weight-bearing x-rays were performed. Outcome scores (MOXFQ and AOFAS), IMA, HVA and foot width were collected. Complications were monitored.Background:
Methodology:
Various angles have been used to grade the severity of hallux valgus deformity. They are useful in surgical planning but do not correlate with symptom severity or improvement. We feel that there is a fundamental mismatch between the width of the forefoot and the width of the hindfoot and that this is more clinically relevant, we describe two techniques for measuring this. We aim to measure the degree of foot narrowing after surgery and moreover how this correlates to the severity of pre- and post operative outcomes. 200 consecutive bunion operations were assessed with weight bearing radiographs. The HVA and IMA were measured according to standard practice. We also assessed forefoot width using two methods we have described. The first is the ‘Forefoot Width’ measured as a perpendicular to the midfoot (a technique we have previously validated). The ‘Foot Ratio’ is calculated as a function of the calcaneal width. Clinical outcomes were assessed using the MOXFQ and AOFAS.Background:
Methods:
