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
Lisfranc/midfoot injuries are complex injuries with a reported incidence of 1 in 55000 in literature and frequently overlooked. But, recently they are becoming more commonly diagnosed with advent of CT scan and examination under anaesthesias (EUA) for suspicion fractures. Here we present a case series results of a single surgeons experience over the last 6 years. Retrospective review of 68 patients treated by a single surgeon over the last 6 years. Injuries were diagnosed on plain Xrays, clinic examination. Any suspicious injury were further assessed by a CT scan, all injuries were confirmed by EUA and treated with open reduction and internal fixation within 4 weeks of injury. Post-operative immobilisation in full cast for 6 weeks then a removal boot with non-weight bearing for a total of 3months. They were followed up regularly initially at 3, 6 and 12months. At final review the following data was collected: clinical examination, plain x-ray looking for: late deformity, signs of OA in Lisfranc joint, Auto fusion rate, rate of metal work failure. The x-rays findings were correlated with: (1) type of fixation. (2) The following scores: FAOS, AOFAS-M, specially designed new foot and ankle score.Background
Methods
Stress fractures in the foot are common; the common practice is to look for any factor in the history or for any foot deformity that could cause the fracture. Once found, it is common to treat the fractures without further investigations. The aim of this study is to assess if we are missing any underlying metabolic disorder associated with such injury. We studied 34 sequential cases referred for chronic foot pain. Stress fractures were confirmed either by classic x-ray's features or MRI. Clinical examination and further tests were performed for Vitamin D levels, Thyroid function, PTH, DEXA scan, Biochemical and bone profile. All stress fractures were treated conservatively.Introduction
Materials and methods
Current treatment options include cheilectomy, resection arthroplasty, distal osteotomies (eg Moberg) or arthrodesis (Gold standard). Resurfacing of the metatarsal head, and concurrent joint release allow successful treatment of all stages of Hallux Rigidus, also offering the advantages of maintenance of metatarsal length, and movement.
97 grade III open fractures in 95 patients 64 required temporary spanning ex-fix: 23 applied at trauma centre/41 at DGH 14/64 ex-fixes required revision (prior to definitive Ilizarov): poor plastics access(6)/instability(2)/both(6) All 14 revised had been applied in a DGH, i.e. 14/41 DGH ex-fix needed revision (34%) Ex fixes revised after application at trauma centre vs. DGH = 0/23 vs. 14/41, p<
0.01 ×2 Revision of Hoffman hybrid vs. monolateral ex fix = 4/4 vs. 10/60 p<
0.001 ×2 Non modular system (Orthofix) vs. modular systems (Hoffman II/AO) = 7/17 vs. 0/39 p<
0.001
All Hoffman hybrids needed revision, due to both instability and plastics access. Significantly more non modular (Orthofix) ex-fixes required revision compared to modular (Hoffmann II/AO), due to poor plastics access.
