Introduction

Intra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures.

The factors affecting patient satisfaction with the outcome following treatment of Tendo-Achilles rupture were assessed. 35 patients were reviewed. 14 were treated non-operatively and 21 by open surgical repair.

Mean follow up was 2 years (range 9 months- 4 years). Evaluation consisted of questionnaire and information from medical records. Mechanism of injury, type and time of injury, co-morbidity and follow-up were noted from the medical records. From the questionnaire, pre injury activities, occupation, post-injury activities and overall satisfaction with their function were collected. The overall satisfaction level was quoted by the patients themselves by grading 10 for excellent recovery and 1 for the poor recovery.

Seventy percent were very satisfied with the outcome of treatment with a mean visual analogue score of 8.4 (7–10). The age, gender and occupation did not have any significant influence on the satisfaction level. The main determinant in the unsatisfied group was reduced post injury leisure activities. This was statistically significant between the two groups at p=0.003. Delay in initiation of treatment had a significant influence, with the group that presented late for treatment being less satisfied with p=0.015. Regression analysis showed that physiotherapy following treatment increased post injury activity and the level of satisfaction with p=0.034.

Reduced post injury leisure activity, delay in initiation of treatment and post treatment physiotherapy had a significant influence on patient satisfaction with outcome. There was no significant difference in the overall outcome between the operative and non-operative group.

The factors affecting patient satisfaction with the outcome following treatment of Tendo-Achilles rupture were assessed. 35 patients were reviewed. 14 were treated non-operatively and 21 by open surgical repair. Mean follow up was 2 years (range 9 months– 4 years). Evaluation consisted of questionnaire and information from medical records. Mechanism of injury, type and time of injury, co-morbidity and follow-up were noted from the medical records. From the questionnaire, pre-injury activities, occupation, post-injury activities and overall satisfaction with their function were collected. The overall satisfaction level was quoted by the patients themselves by grading 10 for excellent recovery and 1 for the poor recovery.

Seventy percent were very satisfied with the outcome of treatment with a mean visual analogue score of 8.4 (7–10). The age, gender and occupation did not have any significant influence on the satisfaction level. The main determinant in the unsatisfied group was reduced post injury leisure activities. This was statistically significant between the two groups at p=0.003. Delay in initiation of treatment had a significant influence, with the group that presented late for treatment being less satisfied with p=0.015. Regression analysis showed that physiotherapy following treatment increased post injury activity and the level of satisfaction with p=0.034.

Reduced post injury leisure activity, delay in initiation of treatment and post treatment physiotherapy had a significant influence on patient satisfaction with outcome. There was no significant difference in the overall outcome between the operative and non-operative group.

There are good evidance that the distal canal restrictor improves pressurisation. Bone block and Hardinge restrictors are among the commonly used restrictors in UK.

During the introduction of cement, the restrictors tend to migrate. The effect may cause significant chane in the size and thickness of the cement mantle. One of the determinents of early dramatic failure is the size of the cement mantle.

In our study, we compared the cement mantle thickness and amount of migration with Bone block restrictor and with Hardinge restrictor. The measurements were done in the standard AP x-ray of the hip taken in the post operative period. All cases were operated by one surgeon. The position of the either of the restrictor were maintained in all cases to 1.5 cm below the tip of the stem. Measurements were made for the cement mantle thickness, the distance between the tip of the stem and restrictor and canal diameter.

One observer who was not involved in the operative procedure evaluated 69 x-rays. Twenty seven cases of bone block restrictor and 42 cases of Hardinge restrictors were used.

At the end of our study, we conclude that both restrictors migrate with pressurisation. The amount of migration with Hardinge restrictor is more than bone block restrictor (21.5mm Vs 14.4mm) which is significant (p-0.007). The amount of migration had not affected the zone-4 cement mantle thickness (p-0.450). With the use of either restrictors, migration was influenced by the canal diameter (p-0.00). Canal diameter did not affect the cement mantle thickness ( p-0.368). We conclude that bone block restrictor is superior in withstanding pressurisation.

Total joint arthroplasty of the first metatarsophalangeal joint is an acceptable modality of treatment for hallux rigidus. We set out to evaluate the early outcome of ceramic/ceramic (MOJE) prosthesis, in the treatment of painful hallux rigidus.

Between March 2000 and June 2002, 13 patients (14 implants) with painful hallux rigidus were treated with ceramic/ceramic (MOJE) prosthesis. The hallux meta-tarsophalangeal-interphalangeal scoring scale, by the American Orthopaedic Foot and Ankle Society, was used to assess these patients, pre-operatively and at follow up. A total score of 100 is possible in a patient with no pain, full range of MTP joint movement and good alignment.

The average follow up was for 12 months. At six months, 12 patients had no pain post operatively. The average AOFAS score pre-operatively was 43.07, compared to 95.28 post-operatively (p= 0.0001). Ten of the patients subjectively described the out come of the procedure as excellent. Two patients described it as satisfactory. One patient with significant hallux valgus pre-operatively, developed subluxation of the prosthesis at 6 months. At revision, the prosthesis was noted to be loose and a distraction arthrodesis was carried out. Pre-operatively, all patients had a combined dorsiflexion and plantarflexion range of between 30 and 74 degrees. Post operatively this was improved to greater than 75 degrees in 10 patients. Seven out of the eight female patients were able to wear fashionable foot shoes with high heels comfortably. Twelve of the patients experienced audible squeaking, which improved after six months. One patient developed a superficial infection, which was treated successfully.

The ceramic/ceramic (MOJE) total arthroplasty gave excellent results in 77% of patients. Patients were happy with the fact that they could continue wearing fashionable shoes. The early outcome is encouraging, with a statistically significant improvement in the AOFAS scoring system.

The subjective functional outcome and factors affecting patient satisfaction were assessed following tendo Achilles injury which was treated either by conservative (42.4%) or surgical (57.6%) methods.

This is a retrospective study on 35 patients treated for tendo Achilles injury at Airedale General Hospital with a mean follow up time of 2 years (range nine months to four years). A questionnaire ascertained pre and post injury leisure time activity level, occupational change and overall satisfaction with treatment. Case-notes were reviewed for mechanism of injury, time of referral to specialist,previous tendon pathologies,treatment details and complications. Fifty-two patients were contacted and 35 responded. The mean age was 52.7 years (range 33 to 90); 27.3% are involved in office work, 27.3% doing manual work, 15.2% doing job which involves standing most of their time (teacher), 27.2% were leading a retired life and remaining were house wives.

Nobody has changed their occupation. Seventy percent were very satisfied with treatment (analogue score 7–10). The remaining patients complained of pain, stiffness and weakness of ankle and they could not fully get back to their previous leisure time activities. Statistically the operative and conservative groups did not show any difference in the level of satisfaction. The age, sex, occupation and level of sports activities undertaken did not have any significant bearing on satisfaction level. Decreased post injury leisure time activities significantly affected the satisfaction score (p=0.003). Sixty percent of subjects took less than six months to reach there pre-injury activity level. Another significant finding was that the group who presented late for treatment (range 15 days to 1.4 years) was less satisfied (p=0.015). There was some evidence (p=0.034) from regression analysis that physiotherapy intervention increased post injury activity and the satisfaction level. There were 2 reruptures in the conservative group but no other major complications.

To conclude, there were no differences in satisfaction following surgical or conservative management. The reduced post injury leisure time activities, delay in treatment and physiotherapy determined the final outcome.

The role of spinal instrumentation in the presence of infection is still controversial, radical debridement of infected vertebrae and disc material may leave the spine unstable despite the use of bone graft, and some form of spinal stabilisation may deem necessary.

We reviewed 27 cases of primary pyogenic spinal infection treated in addition to an appropriate antimicrobial agents, by radical debridement, bone grafting and posterior (22) or anteror (5) spinal instrumentation.

The indication for surgery was the failure of conservative treatment (4), progressive neurological deficit (20) and the lack of diagnosis (3). The infection was caused by pyogenic bacteria (19), Mycobacterium Tuberculosis (6), Candida Albicans (1) Echinococcus granulosus (1).

The mean period of follow-up was 3.8 years (1–12). The infection was eradicated in all our patients, the neurological recovery was full in 19 out of 20 patients with neurological deficits.

Deep wound infection (Three immunocompromised patients, they all responded to repeated wound debridement); implant failure (Two patients, both required revision of fixation), early postoperative death due to nosocomial infection (1).

Spinal instrumentation may be indicated when after debridement and bone grafting, the stability of spine is compromised.