To determine the outcome of the use of Bone Morphogenetic Protein 7 (BMP7) as a replacement for bone graft in a limb reconstruction unit Retrospective case note and imaging review was performed on a cohort of 71 consecutive patients from October 2009 to October 2012 in whom BMP7 was used to achieve union. The patients were identified from a pharmacy database. Factors analysed included the perceived indication, location in the skeleton, age, comorbidities, type of procedure (non-union, fusion, docking site etc), complications and need for revision surgery.Statement of purpose
Methods
The management of developmental dysplasia of the hip (DDH) requiring open reduction between 12 and 18 months of age is controversial. We compare the outcome of medial approach open reduction (MAOR) versus delayed anterior open reduction with Salter osteotomy in such patients. 17 consecutive patients who underwent MAOR aged 12–20 months were reviewed (mean follow-up of 40 months, range 6–74). This group was compared to 15 controls who underwent anterior reduction and Salter osteotomy aged 18–23 months (mean follow-up of 44 months, range 14–134). 13 of the 17 (76%) MAOR patients required subsequent Salter osteotomy at a mean of 22 months post-reduction, with a further 2 patients under follow-up being likely to require one. Acetabular index improved from 42 (32–50, SD − 5.5) to 16 (7–24, SD − 4.5) in the MOAR group after Salter osteotomy compared to an improvement of 40 (30–53, SD − 6) to 13 (4–24, SD − 5) in the control group (p>0.05). Acetabular index at last follow-up was within normal limits in 15 of 17 (88%) MAOR patients. All patients in the control group had acetabular indices (or centre-edge angles of Wiberg) within the normal range. There was 1 subluxation (7%) in the control group. There were 6 cases (33%) of post-operative avascular necrosis (5 Kalamchi & MacEwen Grade I, 1 Grade 2) in the MAOR group and 6 (40%) in the control group (5 Grade 1, 1 Grade 4). All of the MAOR patients had good or excellent clinical results according to McKay's criteria, compared to 14 out of 15 (93%) controls. This study suggests that MAOR or delayed open reduction and Salter osteotomy is a reasonable treatment for children with DDH presenting between the ages of 12 and 18 months. However, the majority of MAORs are likely to require a subsequent Salter osteotomy.
To assess the long term functional and objective outcomes for 2 stage Dupuytrens contracture correction. Patients with severe contracture were offered a 2 stage correction. This involved application of external fixator to distract the contracture over the course of 2 weeks and subsequent partial fasciectomy (in primary contractures) and dermofasciectomy with full thickness skin graft (in recurrent contractures). A series of 54 corrections in 47 patients were identified. Of these, 6 were lost to follow-up, 1 deceased. Pre-operative total range of active movement (TRAM), total flexion contracture and PIP flexion contracture, Tubiana grade and DASH/Michigan Hand Scores were recorded and compared to post-operative data.Objective
Methods
Distraction Osteogenesis can be complicated by regenerate insufficiency resulting in prolonged implant usage or regenerate failure with malalignment or fracture. Experimental evidence has demonstrated that bisphosphonates may mediate improved local limb BMD and regenerate strength. A prospective series of 14 patients over 5 years. One cohort (Group A) of these cases presented with established regenerate insufficiency leading to consideration for surgical intervention. Patients received a therapeutic regime of intravenous bisphosphonate A further cohort (Group B) of 7 patients was commenced on bisphosphonate therapy at an earlier stage, prior to the regenerate maturation phase.Background
Methods
