To quantify the micro-motion at the fracture gap in a tibial fracture model stabilised with an external fixator. A surrogate model of a tibia and a cadaver leg were fractured and stabilised using a two-ring hexapod external fixator. They were tested initially under static loading and then subjected to vibration.Aim
Method
The management of a significant bony defect following excision
of a diaphyseal atrophic femoral nonunion remains a challenge. We
present the outcomes using a combined technique of acute femoral
shortening, stabilized with a long retrograde intramedullary nail,
accompanied by bifocal osteotomy compression and distraction osteogenesis with
a temporary monolateral fixator. Eight men and two women underwent the ‘rail and nail’ technique
between 2008 and 2016. Proximal locking of the nail and removal
of the external fixator was undertaken once the length of the femur
had been restored and prior to full consolidation of the regenerate.Aims
Patients and Methods
Muscle stiffness and joint contractures are common complications of limb lengthening. Authors have demonstrated less permanent soft tissue complications with intramedullary lengthening than external fixation. Our aim was to evaluate the joint response following intramedullary femoral lengthening and need for physiotherapy and alteration to rate/rhythm of lengthening. A retrospective review of documentation for all femoral Precice nails in our centre inserted between 2012 and 2017. This involved 98 nails (68 antegrade, 30 retrograde) in 88 patients (59 males, 29 females) with a mean age of 32 years (range 12–69 yrs). We excluded cases where there was no documentation regarding Range of Movement (ROM). Bilateral lengthenings were recorded as separate cases. This left 50 antegrade, 16 retrograde cases with hip ROM data and 55 antegrade, 26 retrograde cases with Knee ROM data.Introduction
Method
To review the natural history of posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition. 38 patients with posteromedial bowing of the tibia presenting between 2000–2016 were identified. Mean follow up from presentation was 78 months. Seventeen patients underwent lengthening and deformity correction surgery, whilst 3 further patients are awaiting lengthening and deformity correction procedures.Purpose
Patients and Methods
The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower limb lengthening. To assess macroscopic and microscopic changes to the implants and assess differences following design modification, with identification of potential surgical, implant and patient risk factors. 15 nails were retrieved from 13 patients following lower limb lengthening. Macroscopic and microscopic surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analysed with Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy to identify corrosion.Introduction
Method
The management of a significant bone defect following excision of a diaphyseal atrophic femoral non-union remains a challenge. Traditional bone transport techniques require prolonged use of an external fixator with associated complications. We present our clinical outcomes using a combined technique of acute femoral shortening, stabilised with a deliberately long retrograde intramedullary nail, accompanied by bifocal osteotomy compression and distraction osteogenesis to restore segment length utilising a temporary monolateral fixator. 9 patients underwent the ‘rail and nail’ technique for the management of femoral non-union. Distraction osteogenesis was commenced on the 6th post-operative day. Proximal locking of the nail and removal of the external fixator was performed approximately one month after length had been restored. Full weight bearing and joint rehabilitation was encouraged throughout. Consolidation was defined by the appearance of 3 from 4 cortices of regenerate on radiographs.Introduction
Method
Severe infantile Blount's disease can result in a multiplanar deformity of the proximal tibia with both intra-articular and metaphyseal components. Correction can represent a significant surgical challenge. We describe our results using the Taylor spatial frame for acute tibial hemiplateau elevation combined with gradual metaphyseal correction in patients with severe infantile blounts with an associated physeal bony bar. Eight patients (10 knees) underwent tibial hemiplateau elevation and metaphyseal correction with use of the Taylor Spatial Frame between 2012–2016. We undertook a retrospective case note and radiographic review of all patients to assess clinical and radiographic outcomes. Mean age at the time of surgery of was 11.7 years and mean length of follow up was 16.8 months.Background
Methods
This study compares outcomes in patients with complete congenital fibula absence treated with an amputation protocol to those using an extension prosthesis. Complete fibula absence presents with significant lower limb deformity. Parental counselling regarding management is paramount in achieving the optimum functional outcome. Amputation offers a single surgical event with minimal complications and potential excellent functional outcome.Purpose
Introduction
Several low energy osteotomy techniques are described in the literature but there is limited evidence comparing healing indices. We present a retrospective review of two techniques to evaluate an optimum method. Two cohorts of patients underwent osteotomy of the tibia using a Gigli saw (n=15) or DeBastiani corticotomy (n=12) technique. Indications for surgery included limb lengthening and bone transport for defect reconstruction with a minimal distraction of 2 cm. The patient radiographs were anonymised and the regenerate assessed by the two senior authors who were blinded to the osteotomy type. Bone quality was recorded along the anterior, posterior, medial and lateral cortices, graded 1–5 from absent to full consolidation over time in frame. The time to 3 cortices healed/regenerate length was calculated. The time to consolidation of the anterior, posterior, medial and lateral cortices were compared. The mean 3 cortices index in the Gigli group was 2.0 months/cm and in the DeBastiani group 1.8 months/cm, This was not a significant difference. In both groups anterior bone formation was slower, and in 50% and 33% of the Gigli and DeBastiani groups respectively the anterior cortex did not fully heal by the time of frame removal.Method:
Results:
The Exogen Ultrasound Device is licensed for fracture non-union under NICE guideline MTG-12. Reimbursement is offered if there is no fracture union after 250 days of treatment as per manufacturer guidelines. Quoted healing rates vary between 62% and 100%: we compare our results to these. A retrospective audit of all patients who received Exogen for long bone non-union was undertaken. The indication, duration of treatment, fracture outcome and compliance with the recommended treatment pathway were recorded.Background:
Method:
External fixators are not as well tolerated around the femur when compared to the tibia. Lengthening with an intramedullary device is therefore attractive. We reviewed all cases of femoral lengthening performed at our unit from 2007 to 2014. Cases of non-unions, concurrent deformities, congenital limb deficiencies and lengthening with an unstable hip were excluded. This left 33 cases for review. Healing index, implant tolerance and complications were compared.Background:
Method:
Little is known about the forces carried by the Taylor Spatial Frame (TSF) hexapod fixator. Our aim was to measure the TSF resultant force and how this changed during the consolidation phase. Five patients undergoing correction of tibial deformities were recruited. Measurements were taken at 2, 4, 8 and 12 weeks post-correction during various activities. Instrumented struts incorporating strain gauges measuring axial force were temporarily used each time. Strut forces and lengths were used to determine frame kinetics. The resultant axial fixator forces and moments were calculated relative to sitting. Ground reaction forces (GRF) were measured using the treadmill force plates.Background:
Method:
Leg length discrepancy related to absence of the femoral head with proximal migration of the femur presents a treatment dilemma. Late sequelae of neonatal hip sepsis and chronic hip dislocation due to developmental dysplasia are the most common causes. Traditional teaching dictates that the hip is stabilised prior to limb lengthening. Reconstructive options alter the shape of the proximal femur which complicates future surgery. We retrospectively reviewed 3 cases of femoral lengthening with an ‘unstable’ hip without prior stabilization. The aetiology was neonatal hip sepsis in 2 cases and chronic hip dislocation due to developmental dysplasia in 1 case. Lengthening was performed with the use of a retrograde Precice lengthening nail.Background:
Methods:
Fracture healing is governed by biological and mechanical factors. Circular frames are one method to fix fractures. Recently, the number of frame designs that are available has increased and these different designs may have different effects on the mechanical environment created. The senior author has been concerned by the stability of the construction when a short frame is used. This study examined the stability of different frames and the possible use of additional 7th struts to aid stability. The frame configuration was modified with increasing strut angles from 15° − 70°. Each frame was cyclically tested in compression to 200N. The Taylor Spatial Frame was retested with the addition of a seventh strut.Introduction
Method
