The Cobb Stainsby forefoot arthroplasty for claw and hammer toes combines excision arthroplasty (Stainsby) with extensor tendon transfer to the metatarsal head (Cobb). We present a retrospective, three surgeon case series of 218 toes in 128 patients over four years. Clinical notes were reviewed for all patients and 77 could be contacted for a telephone survey. Follow up ranged from 12–82 months.

All patients presented with pain and shoe wear problems from dislocated metatarsophalangeal joints either from arthritis, hallux valgus, Freiberg's disease or neurological disorders. Ipsilateral foot procedures were performed simultaneously in 24 (30%) patients. Seventy-two patients (94%) were satisfied, 72 (94%) reported pain relief, 55 (71%) were happy with toe control, 61 (79%) were pleased with cosmesis, 59 (77%) returned to normal footwear and 56 (73%) reported unlimited daily activities. Minor complications occurred in 17 (13%) and 3 (2%) developed complex regional pain syndrome. Four (5%) developed recurrent clawing.

The Stainsby procedure permits relocation of the plantar plate under the metatarsal head for cushioned weight-bearing but can create a floppy, unsightly toe. By combining this with the Cobb procedure, our case series demonstrates improved outcomes from either procedure alone with benefits over alternatives such as the Weil's osteotomy.

Oxford Level 4 evidence – retrospective case series.

Diagnosis of complex regional pain syndrome (CRPS) can be challenging. We explore the role of fracture clinic in diagnosis and management with a closed-loop audit of new guidelines.

We retrospectively reviewed patients with CRPS over 3.5 years. We determined the delay from injury to commencement of treatment and monitored symptoms. New guidelines were introduced to fracture clinic in January 2013. The Budapest Criteria aids diagnosis. GAD-7 and PHQ-9 patient questionnaires grade symptoms. Orthopaedic surgeons prescribe nortriptylline or pregabalin, refer to physiotherapy and review patients after six weeks. We re-audited prospectively after implementing these guidelines.

The first audit cycle found 11 patients in 3.5 years. The mean delay to anti-neuropathic medication from injury was 4.7 months. Two patients required psychotherapy, one intravenous pamidronate, three inpatient physiotherapy under nerve blocks and two spinal cord stimulators. After implementing guidelines, there were 14 patients with CRPS in 9 months. All but two patients received anti-neuropathic medication on the day of diagnosis. All patients treated appropriately improved markedly within 4–12 weeks. No patients required escalation of treatment.

Our guidelines increased pick-up rates of CRPS, diagnoses were made earlier and treatment started sooner. Physiotherapy modalities remained varied, however, early anti-neuropathic treatment led to a rapid improvement in all cases.

Introduction:

Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. Arthroscopic excision of calcaneonavicular bars have previously been described as has a technique for excising talocalcaneal bars using an arthroscope to guide an open resection. We describe a purely arthroscopic technique for excising talocalcaneal coalitions. We present a retrospective two-surgeon case series of the first eight patients (nine feet).

Introduction:

In a consecutive series of 71 arthroscopic subtalar arthrodeses performed between 2004 and 2011, 14 also involved arthroscopic decortication of the talonavicular joint (double arthrodesis) and 4 the subtalar, talonavicular and calcaneocuboid joints (triple arthrodeses).

Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. Arthroscopic excision of calcaneonavicular bars have previously been described as has a technique for excising talocalcaneal bars using an arthroscope to guide an open resection. We describe an entirely arthroscopic technique for excising talocalcaneal coalitions and present a retrospective two-surgeon case series of the first eight patients (nine feet).

Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 year to 5.5 years.

Subtalar movements were improved in all feet. Deformity was not always fully corrected but pain and SAFAS scores improved in all patients bar one. They all had a rapid return to good function apart from this same patient who required subsequent fusions. The posterior tibial nerve was damaged in one patient.

Minimal destruction of bone and soft tissues allows early mobilization and minimizes pain. We acknowledge the risk of neurological damage from any operative technique. Patient selection and preoperative planning are crucial. This series from two independent surgeons supports the feasibility and effectiveness of this technique.

We present the results of a bi-centre, retrospective study examining the clinical, functional and radiological outcomes of distal radius fracture fixation with the Aptus locking plates and Tri-Lock® variable angle locking screws. We assessed 61 patients with distal radius fractures with a minimum of six months follow-up. Functional assessment was made using the DASH score. We measured wrist range of movement and grip strength, and reviewed radiographs to assess restoration of anatomy, fracture union and complications. All fractures united within six weeks. Mean ranges of movement and grip strength were only mildly restricted compared to the normal wrist. The mean DASH score was 18.2. Seven patients had screws misplaced outside the distal radius although 3 of these remained asymptomatic. Five other patients developed minor complications. Variable angle locking systems benefit from flexibility of implant positioning and may allow enhanced inter-fragmentary reduction for accurate fixation of intra-articular fractures. However, variable-angle systems may lead to increased rates of screw misplacement.

The purpose of this study was to evaluate and assess the sporting and physical activities of patients who have undergone hip resurfacing. One hundred and seventeen patients who underwent hip resurfacing between 2003–2007 were reviewed.

Demographic data such as age, sex and comorbidities were recorded. University of California and Los Angeles (UCLA) activity level ratings and Oxford hip scores were collected pre-and postoperatively for each patient. The sporting and physical activities of all patients were pre-and post-operatively recorded.

The mean age of patients at surgery was 54 yrs and 56 yrs at review. The mean follow up time was 19 months. Following surgery there was a significant improvement in UCLA activity level scores from 4.4 to 6.8 (Wilcoxon Matched-pairs Signed rank test, p< 0.05). Oxford hip scores significantly improved from 43.4 to 17.7 following surgery. Eighty six patients regularly participated in sport before they became symptomatic with significant hip pain, and 75 regularly participated in sports after surgery. In total 87% of patients successfully returned to their regular sporting and physical activities following surgery. Many patients were returning to high impact sports including football, tennis, cricket and squash.

The published medium-term survivorship of the Birmingham hip has given surgeons increasing confidence to use the prosthesis on a younger generation of patients. Our study has demonstrated that hip resurfacing can allow patients to remain extremely active.

Purpose of study: To compare our practice of paediatric foot and ankle surgery with other hospitals in the UK and to assess the safety and patient satisfaction of day-case procedures on an afternoon list.

Methods and Results: A postal questionnaire was sent to 135 consultant members of BSCOS to identify which foot and ankle operations were being performed as inpatients (“Major surgery”) and day-cases (“Minor surgery”). We received 87 (64%) replies over 3 months. The survey revealed that certain procedures were being performed as a day-case in fewer than 35% of centres in the UK. These included excision of tarsal coalitions, tendon transfers, metatarsal osteotomies and open posterior releases for equinus. These same procedures are performed routinely as day-cases at Birmingham Children’s Hospital.

We focussed on a single surgeon series with a once weekly afternoon operating list. We identified 24 “major operations” on 19 patients that were performed as a day case over 21 months. The parents of each patient were contacted by telephone to complete a satisfaction survey. We demonstrate that there were no problems that should have warranted an inpatient stay.

Conclusions: Most paediatric foot and ankle surgery can be performed satisfactorily as a day case which has obvious cost implications for the NHS. Although this is an accepted practice among adults, the majority of paediatric orthopaedic units are yet to accept this protocol.