Large osteochondral defects (OCD) of the talus present a difficult management conundrum. We present a series of Maioregen xenograft patches applied through an open approach, early lessons from the technique and good early outcomes, in patients who are otherwise looking at ankle salvage techniques. 16 patients underwent open patch procedures, performed by a single surgeon, over a 30 month period. 12 males, and 4 females with age at presentation from 21–48. The majority were young, male, in physical employment with active sporting interest. MoxFQ, and E5QD were collected preop, 3, 6, 12 month postoperatively. There were significant improvements in ROM, pain, and scores in the cohort. 3 cases returned to Theatre, 1 for a concern about late infection, which settled with good outcome, and a further 2 with metalwork / adhesions.Introduction
Results
Primary bone tumours in the elderly population are relatively rare. We reviewed the Leeds regional bone tumour registry between 1990–1999 and found them to constitute only 43 of the 341 (12%) bone tumour cases. Malignant tumours (65%) were more common than benign tumours with primary tumours accounting 92 % and metastatic tumours only 8 % of all the malignancies. Females were more affected than males (55% versus 45 %). Chondrosarcoma was the most frequent tumour, constituting 24% of primary malignant tumours and 18 % of all bone tumours. Chondroma was the most common benign tumour accounting for 50% of all benign tumours, and 11% of all tumours. Survival rate was relatively poor in elderly population with primary malignant tumours. The majority of malignant tumours were in the lower limb (femur 25%, tibia 14 %).The upper limb accounted for 14% and the axial skeleton 5%. Bone tumour registries provide a valuable source of cumulative information about both common and uncommon tumours. Such information could not easily be gathered by personal experience. It is also a very good source of information for research education and service.
We have developed a simple technique for demonstrating the sagittal profile of each rotated level of a scoliotic spine and used it to determine the patterns of lordosis and kyphosis in each of six clinical types of idiopathic scoliosis. The currently accepted classification of scoliosis is inaccurate and a modification is proposed. The three main types of scoliosis were shown to have sagittal profiles distinctly different from each other and from normal. Single structural curves had short lordotic sections at their apices, limited above and below by kyphosis. Double curves showed longer lordotic sections limited only by one area of kyphosis. Lordosis throughout the thoracic and lumbar spine was associated with triple curve patterns. The biomechanical effects of the abnormal sagittal profiles provide a simple explanation for the genesis and progression of the different types of scoliosis, and the recognition of the pattern of the sagittal abnormalities permits treatment to be designed on a sound anatomical basis for individual cases.
