In general the life expectancy of population is improving. This is causing to increase case load of peri-prosthesis fractures after joint replacements. We present our results of peri-prosthesis fracture around hip managed by revision arthroplasty. A retrospective analysis of 24 consecutive patients of periprosthetic hip fracture treated with a revision arthroplasty at Major Trauma Centre between February 2021 and January 2022.Abstract
Introduction
Methods
The approach to Intramedullary (IM) fixation of long bone fractures remains a controversial issue. Early reports demonstrated less favourable results of retrograde nailing as compared with antegrade options due to higher non-union rates. The aim of this audit was to evaluate the outcomes of practice within the Trauma and Orthopaedic department with relation to IM nail fixation of diaphyseal femur fractures. The Trauma database between February 2010 and September 2013 was used to identify all femur IM nailing procedures. Picture Archiving and Communication System (PACS) software was used to classify the fractures according to the Muller AO classification. All 3–2 (Diaphyseal femur fractures) were included in the audit. PACS imaging together with outpatient documentation was evaluated for radiological and clinical outcome.Background
Methodology
We review the current state of development of proton therapy and the implications for beam therapy in the management of primary bone tumours The principle of radiotherapy is to deliver a high dose, accurately, to the tumour. Conventional photon and proton therapy irradiates adjacent tissue significantly. This is reduced with intensity modulated proton therapy (IMPT). This has been demonstrably effective in treating tumours refractory to chemotherapy and conventional radiotherapy such as chrondrosarcomas and chordomasStatement of purpose
Introduction
Monitoring of scoliosis is traditionally done with radiographs, which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigated whether the findings from surface topography can be used to monitor scoliosis curves and how much this method affects outcome scores in patients with scoliosis. This study therefore had two subsets: (1) to investigate whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic Cobb angle, providing an alternative non-invasive means of monitoring patients with scoliosis (LA and Cobb subset); and (2) to establish the relationships between the magnitude of the deformity in scoliosis, measured by Cobb angle on radiograph and volumetric asymmetry (VA) with the ISIS2 surface topography, and the patient perception of self-image and mental health, measured with SRS-22 scores (Cobb, VA, and SRS subset). In the LA and Cobb subset, 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55° or less were included in the study. They had clinical assessment, Cobb angle measurement taken from a standard radiograph, and surface topography done on the same day. A comparison of Cobb angle and LA was done. In the Cobb, VA, and SRS subset, 89 untreated patients with scoliosis were included in the study. They had clinical assessment, Cobb angle measurement of radiograph, and surface topography done on the same day along with SRS-22 questionnaires. A comparison correlation of SRS scores for function, pain, self-image, and mental health against Cobb angle and VA was undertaken. All statistical analysis was done with software R.Introduction
Methods
We review the current state of development of proton therapy and the implications for beam therapy in the management of primary bone tumours The principle of radiotherapy is to deliver a high dose, accurately, to the tumour. Conventional photon and proton therapy irradiates adjacent tissue significantly. This is reduced with intensity modulation proton therapy (IMPT). This has been demonstrably effective in treating tumours refractory to chemotherapy and conventional radiotherapy such as chrondrosarcomas and chordomasStatement of purpose
Introduction
Freiberg's infarction poses a challenge to foot and ankle surgeons. Several surgical and non surgical treatment methods are described. We performed a dorsal closing wedge osteotomy, debridement and microfracture of the metatarsal head. Dorsal closing wedge osteotomy helps in bringing the smooth plantar articular surface of the metatarsal head to articulate with the phalangeal articular cartilage whilst offloading the damaged dorsal articular cartilage. Debridement and Microfracture of the metatarsal head helps in regeneration of the damaged cartilaage via subchondral stem cells. Total of 15 patients (12F, 3M) underwent the above surgery between year 2002 and 2008. Mean age was 35yrs (range14-60). All of them had an extraarticular dorsal closing wedge osteotomy fixed with a single screw along with debridement of the joint and mocrofracture of the damaged cartilage. Post operatively heel weight bearing was allowed with a special shoe for 6 weeks. Serial radiological assessments were done to assess healing of the osteotomy and reshaping of metatarsal head. Patients had a mean follow up of 2.5 yrs (Range 1-6). All patients were assessed using subjective patient satisfaction scores (scale 0-10) and AOFAS scores.Introduction
Materials and Methods
To determine if extended scope physiotherapists perform to the same standards as their orthopaedic colleagues with regards to diagnosing knee pathology and making appropriate referrals for arthroscopy. Data was collected prospectively from Aug 2005. Patients were seen in a consultant led orthopaedic clinic by an Extended Scope Physiotherapist (ESP), a registrar or the consultant. All patients placed onto the waiting list for knee arthroscopy were considered for the study. The outpatient diagnosis and demographic data were recorded and compared against the arthroscopy findings. A single consultant surgeon performed the arthroscopies. 300 patients were included in the study (100 in each group). Each group was similar in terms of presenting complaint and demographics. There was no significant difference between the ESP’s and registrars in their ability to diagnose intraarticular pathology (CHI squared test: X 2.031, df 1, p=0.15). When only cruciate and meniscal pathology were considered there was also no significant difference between the ESP’s and the registrars (Fishers test p=0.12 and p=0.22 respectively, 2-tail test) The ESPs performed particularly well in their ability to diagnose cruciate injuries (sensitivity 100%, specificity 100% and PPV 100%). Both ESPs and registrars had high sensitivity but low specificity with regards to diagnosing meniscal pathology suggesting a low threshold for a positive diagnosis and a poor ability to correctly diagnose those patients who did not have a meniscal injury. Of the 300 patients only 9 unnecessary arthroscopies were requested. None were requested by the ESPs. Extended scope physiotherapists perform a useful role in orthopaedic outpatients. They perform as well as orthopaedic registrars with regards to making the correct diagnosis and the selection of patients for arthroscopy.
