Ankle lateral ligament complex injury is common. Traditional ‘Brostrum’ repair, performed either open or arthroscopically, still has a protracted post-operative period. The ‘Internal Brace’ provides a scaffold for the ligament repair and acts as a ‘check-rein’ preventing further injury.

16 patients with ankle instability and injury to the Anterior-Talo-Fibular-Ligament (ATFL) confirmed on MRI were identified. All had completed a period of conservative treatment. All had symptoms of pain in the region of the ATFL and described a feeling of instability. Surgery was performed under general anaesthetic and regional popliteal block. Anterior ankle arthroscopy demonstrated a positive ‘drive through’ in all cases. The ATFL was absent and in the majority replaced by incompetent scar. Scar tissue was removed from the anterior aspect of the ankle allowing visualisation of the fibula and lateral talar neck. Using the Internal Brace system (Arthrex), a 3.5mm swivel-lock with fibre-tape was placed into the fibula. With the ankle in plantar flexion, to allow appropriate tensioning, the distal end of the fibre-tape was secured to the talar neck, at a 45 degree angle, with a 4.75mm biotenodesis screw. The patient was placed into a moon-boot for 7–10 days and mobilised fully weight-bearing. Pre-op score, using EDQ-5, MOXFQ, AOFAS and visual analogue scores, with post-op PROMS were performed.

All patients reported improvement in their symptoms at 6 week visit. The majority were back to normal activities at 12 weeks. The few that were not, had missed physiotherapy appointments for various reasons. There were no infections and no implant failures.

Arthroscopy allows direct visualisation for accurate placement of the Internal Brace. Post-operatively recovery is expedited due to the stability provided by the ‘Brace’, permitting a more aggressive rehabilitation programme. The greatest potential is arguably for the elite athlete, where an accelerated return to full activity has significant occupational implications.

INTRODUCTION

Intramedullary nail fixation has been used for successful treatment of long bone fracture such as humerus, tibia and femur. We look at the experience of our trauma unit in treating long bone fracture using the AO approved Expert femoral/tibial nail and proximal femoral nail antirotation (PFNA). We look at the union and complication rates in patients treated with AO approved nailing system for pertrochanteric, femoral and tibial shaft fracture.

INTRODUCTION

Warfarin remains the treatment of choice for the majority of patients with venous thromboembolism, atrial fibrillation and valvular heart disease or valve replacement unless contraindicated. Poor management of patients on warfarin often leads to delay in surgery, life threatening bleeding during or after operation and unnecessary delay in discharge from hospitals in United Kingdom.