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The Bone & Joint Journal
Vol. 103-B, Issue 10 | Pages 1611 - 1618
1 Oct 2021
Kavarthapu V Budair B

Aims

In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method.

Methods

We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_8 | Pages 41 - 41
1 May 2018
Battaloglu E Budair B Bridgeman P Warner R Baden J Bose D Fenton P
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Introduction

Managing open tibial fractures according to national guidelines is a primary focus for major trauma centres, however pressures of capacity and expertise limit the capability to achieve all of these standards for every patient. Debate remains over the impact of particular aspects of guidance, especially in relation to the timing of surgical interventions. Evaluation of these tenants of care predominantly hinge on trends derived from low level scientific evidence, mainly due to the difficulty in completing high level studies. The aim of this study is to assess the complication rates and the associations with difficulties in achieving the national guidance standards.

Methods

Retrospective analysis of the 2015/2016 cohort of 3B open tibial fractures treated at the Queen Elizabeth Hospital Birmingham. Data collected, through the use of the patient electronic records, cross referenced against hospital coding and trauma injury database, included patient demographics, injury details, clinical interventions, surgical management, complications and time to bony union.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_9 | Pages 59 - 59
1 May 2017
Budair B Pattison G
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Background

Visual representation help make the ever-increasing data more attractive, thought provoking and informative. In the field of surgical training, Procedure Based Assessment is a structured method of assessing surgical performance and skills of trainees in the UK and is a valuable tool for trainers in the Annual Review of Competence Progression. Trainers can view PBA's on the online-based Intercollegiate Surgical Curriculum Programme individually in a long-form format with no visual representation.

Aim

To assess the effect of an originally devised EVR tool of PBA's in the context of ARCP on 10 aspects including speed of assessment, assimilation of data, ease of interpretation and identification of trainees’ weaknesses and strengths.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_2 | Pages 63 - 63
1 Jan 2017
Prakash R Malik S Hussain S Budair B Ranjitkar S Prakash D
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During revision THR, the surgery is often difficult and compromised due to lack of patient's bone especially in the pelvis. Any extra bone in the acetabulum is expected to be of advantage to the patient and the surgeon. The aim of this study was to see if preservation of medial acetabular osteophyte in uncemented total hip replacement had any adverse effect on the prosthesis survival or patient satisfaction.

Conventional acetabular preparation involves reaming down to the true floor. This not only medialises the centre of rotation of the hip but also reduces the acetabular offset. In contrast the main surgeon preserved the acetabular offset by preserving some osteophytic bone between the true floor of the acetabulum and the acetabular cup. This is achieved by reaming the acetabular cavity conservatively while achieving secure primary fixation of the prosthesis. We report the outcome of a single surgeon series of such cases. The endpoint was assessed as the need for revision of the acetabular cup.

A total of 106 consecutive patients were identified who underwent uncemented THR from 2005 to 2010. The medial osteophyte was measured on immediate post-operative x-rays, from the “teardrop” to the nearest point of the acetabular cup, by 3 surgeons (one consultant and 2 registrars). The patients were contacted for a telephone interview and their clinical notes, including x-rays, were reviewed.

Outcome was available for 79 patients. 74 patients were available for follow-up and 5 patients died unrelated to THR. Average follow-up was for 8.3 years (range 5.5–10.8). Average age was 62 years. The average medial osteophyte was 1.98 mm (range 0–14mm). One patient had late infection and one had dislocation. There was not a single failure of the acetabular component. The patient satisfaction was high at 8.8 out of 10.

Preservation of medial osteophyte in the acetabulum whilst doing uncemented THR has the advantage of retaining the patient's own bone stock which can be of great advantage to the surgeon as well as the patient should revision THR be required in future. Our study has shown that this can be achieved without compromising the survival of the prosthesis or the patient satisfaction.

This technique may increase the range of motion of the hip by reducing the risk of bony or soft tissue impingement, and also reduce the risk of dislocation. Furthermore, not recreating the native centre of rotation of the hip does not seem to have any adverse effect for the patients, who are very happy with the outcome. We recommend that whilst doing uncemented THR, the acetabulum should not be reamed to the true floor as has been the conventional teaching, but attempt should be made to preserve some medial osteophyte where possible, at the same ensuring that good primary fixation of the cup is achieved. This is to give the patient and surgeon the advantage of extra available bone should revision surgery be required in the future.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_13 | Pages 63 - 63
1 Mar 2013
Boutefnouchet T Budair B Qadri Q
Full Access

Introduction

Delay, postponing and cancellation of hip fracture surgery leads to unnecessary starvation and adverse effects on patients and resources. Best Practice Tariffs (BPT) have been introduced to incentivise organisation into optimising the overall care for this type of injuries.

Methods

Retrospective observational analysis of all consecutive cases of hip fractures over a period of 18 months; this period spanned the introduction of BPT: 10 months before and 8 months after. Data on delay, postponing and cancellation of surgery were recorded and analysed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 92 - 92
1 Jan 2013
Boutefnouchet T Ashraf M Budair B Porter K Tillman R
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A clinical evaluation of the effect of MRI scan to bring about a change in surgical management of elderly patients who present with hip fracture with no history of trauma or a suspicious looking lesion on x-rays. Many of these patients present with or without history of previous malignancy or bone disorder.

We evaluated that if the delay in treatment within 36 hours as per national guide lines is justified to benefit patients.

Methods

A clinical review of six hundred hip fracture patients where one hundred and four patients who had MRI scan of hip for fracture with either no history of trauma or a fracture with suspected pathological features with or without history of malignancy or bone disorder.

The final outcome of hundred patients who had MRI scans 32 male and 68 female with median age of 65 years. Four patients were excluded as were unable to tolerate the MRI scan.

Statistical analysis software SAS/STAT® was used to conduct data collation and analyses.

A further radiological analysis of MRI scans with positive lesion to the plain X-rays to correlate the finding of a lesion on femoral side on MRI scan to a lesion on acetabular side.

Results

Out of hundred patients who had MRI scan for a suspected metastatic or pathological lesion only 12 showed a metastatic lesion despite the fact 31 had previous history of malignancy, CI 4.03; 101.91, P < 0.0003. No primary lesion detected in any patient.

We also found if the acetabular side was not seen to be involved on pain x-ray, MRI scan did not detect any acetabular lesion, contingency coefficient 0.5632, P < .0001.