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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 28 - 28
1 Jun 2023
Musielak B Green N Giles S Madan S Fernandes J
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Introduction

Intramedullary lengthening devices have been in use in older children with closed /open growth plates with good success. This study aims to present the early experience of the FITBONE nail since withdrawal of the PRECICE nail.

Materials & Methods

Retrospective analysis of both antegrade and retrograde techniques were utilized. Only patients where union was achieved and full weight bearing commenced were included. The complication rate, length gained, distraction index, weight bearing index (WBI) as well as mechanical axes were analysed.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 40 - 40
1 Apr 2022
Hafez M Nicolaou N Dixon S Obasohan P Giles S Madan S Fernandes J Offiah A
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Introduction

Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation

Materials and Methods

Patients: Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11–17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 41 - 41
1 Apr 2022
Hafez M Nicolaou N Offiah A Giles S Madan S Dixon S Fernandes J
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Introduction

The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails.

Materials and Methods

Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time)


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 7 - 7
1 May 2021
Hogg J Madan S
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Introduction

Torsional malalignment syndrome (TMS) is a unique combination of rotational deformities in the lower limb, often leading to severe patellofemoral joint pain and disability. Surgical management of this condition usually consists of two osteotomies in each affected limb, with simultaneous correction of both femoral anteversion and external tibial torsion. However, we believe that a single supratubercular osteotomy followed by tibial derotation with the Taylor Spatial Frame (TSF) can be used to provide a significant improvement in both appearance and function.

Materials and Methods

This is a retrospective case analysis in which we will be reviewing 16 osteotomies performed by one surgeon between 2006 and 2017. The study includes 11 patients with a mean age of 16.7 ± 0.8 years. Pre and post-operatively, patients were fully evaluated through history and physical examination, and CT rotational profiling. Statistical analyses were performed in order to determine whether or not any observed clinical or cosmetic improvements were statistically significant.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 17 - 17
1 May 2021
Widnall J Madan S Giles S Fernandes J
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Introduction

Recurrence in CTEV is not uncommon and as the child becomes older the foot in question is often stiffer and less amenable to the more traditional serial casting Ponseti method. Treatment of these recurrent CTEV feet with external fixators has been previously documented. We aim to present the Sheffield technique of an external circular frame with adjunctive hindfoot and midfoot osteotomies to correct relapsed CTEV and their associated Roye (outcome) scores.

Materials and Methods

Retrospective analysis of patient records from 1999 to 2019 were performed for those undergoing frame correction of CTEV. Patients were included if there was adjunctive foot osteotomies in the setting of CTEV frame correction and willingness to partake in retrospective Roye outcome scoring. The Roye score was sent out in the mail to parents asking for scoring of the current level of symptoms.


Bone & Joint Open
Vol. 1, Issue 11 | Pages 669 - 675
1 Nov 2020
Ward AE Tadross D Wells F Majkowski L Naveed U Jeyapalan R Partridge DG Madan S Blundell CM

Aims

Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients.

Methods

All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 9 - 9
1 Jun 2017
Balakumar B Patel K Madan S
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Purpose

We share our experience in management of failed in-situ pinning in severe unstable Slipped Capital Femoral Epiphysis (SCFE) by surgical dislocation approach.

Method

A retrospective review of hip database from 2006 to 2013 showed 41 children underwent surgical dislocation for SCFE. We identified seven who had severe slip with failed in-situ pinning.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 6 - 6
1 Jun 2017
Balakumar B Pincher B Abouel-Enin S Blackey CM Thiagarajah S Madan S
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Purpose

This study aims to report the radiological corrections achieved and complication profile of Peri-Acetabular Osteotomy (PAO) undertaken through the minimally invasive approach.

Method

106 PAOs were performed in 103 patients, by senior author, using a minimally invasive approach from 2007 to 2015. Pre- and post-operative radiographs were reviewed and the degree of acetabular re-orientation was analysed. Case notes were examined retrospectively to identify haemoglobin levels and complications across two sites.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_11 | Pages 10 - 10
1 Jun 2017
Balakumar B Basheer S Madan S
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Purpose

This report compares midterm results of open neck osteoplasty + neck osteotomy vs arthroscopic osteoplasty for severe Slipped Capital Femoral Epiphysis (SCFE).

Method

Database from 2006 to 2013 identified 22 patients out of 187 operations for SCFE. 12 underwent Open Neck Osteotomy (ONO) and osteoplasty by Ganz surgical dislocation approach. 10 underwent Arthroscopic Osteoplasty (AO). The mean follow-up for the ONO and AO groups were 59 (46 – 70), 36.1 (33 – 46) months respectively.


The Bone & Joint Journal
Vol. 98-B, Issue 1 | Pages 21 - 27
1 Jan 2016
Basheer SZ Cooper AP Maheshwari R Balakumar B Madan S

Slipped capital femoral epiphysis (SCFE) may lead to symptomatic femoroacetabular impingement (FAI). We report our experience of arthroscopic treatment, including osteochondroplasty, for the sequelae of SCFE.

Data were prospectively collected on patients undergoing arthroscopy of the hip for the sequelae of SCFE between March 2007 and February 2013, including demographic data, radiological assessment of the deformity and other factors that may influence outcome, such as the presence of established avascular necrosis. Patients completed the modified Harris hip score (mHHS) and the non-arthritic hip score (NAHS) before and after surgery.

In total, 18 patients with a mean age of 19 years (13 to 42), were included in the study. All patients presented with pain in the hip and mechanical symptoms, and had evidence of FAI (cam or mixed impingement) on plain radiographs.

The patients underwent arthroscopic osteoplasty of the femoral neck. The mean follow-up was 29 months (23 to 56).

The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1) and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p = 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively. Linear regression analysis demonstrated a significant association between poorer outcome scores and increased time to surgery following SCFE (p < 0.05 for all parameters except baseline MHHS).

Symptomatic FAI following (SCFE) may be addressed using arthroscopic techniques, and should be treated promptly to minimise progressive functional impairment and chondrolabral degeneration.

Take home message: Arthroscopy of the hip can be used to treat femoroacetabular impingement successfully following SCFE. However, this should be performed promptly after presentation in order to prevent irreversible progression and poorer clinical outcomes.

Cite this article: Bone Joint J 2016;98-B:21–7.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_9 | Pages 4 - 4
1 Aug 2015
Shepherd J Robinson K Giles S Davies G Madan S Fernandes J Jones S
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The purpose of the study was to investigate the incidence of surgical site infection following elective paediatric orthopaedic surgery.

A pro forma adopted from a pilot study was filled out preoperatively for each elective operation performed during the study period. Each patient was then followed up for six weeks postoperatively to record any SSI that developed. Data collected included patient demographics, type of operation, grade of Surgeon, type of procedure, wound length, skin preparations, use of tourniquet, any antibiotic prophylaxis and length of operation.

This study collated data on 334 operations with 410 procedural sites over a six month period. Infection were recorded in 19 sites equivalent to a SSI rate of 4.63%. None of the patients developed long-term complications.

The mean age of the participants in the study was 11 years (range 0.5 to 17 years), 57% were males and 43% were females.

The infection were detected between 1 and 38 days after surgery. The outcome was not compromised in any of the patients as none of them required long-term treatment. Statistical analysis was undertaken.

The study proves that the surgical site infection after elective paediatric orthopaedic surgery is low and serve as a bases for consenting patients for surgery.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_1 | Pages 5 - 5
1 Jan 2014
Abouel-Enin S Blakey C Cooper T Madan S
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We report the radiological outcomes, and short-term clinical results, of 47 periacetabular osteotomies undertaken through both the traditional bikini incision, and a minimally invasive approach.

47 periacetabular osteotomies have been undertaken in 45 patients, by the senior author, between 2005 and 2013. There were 10 male and 35 female patients. The mean age at operation was 28.2 years. Since 2010 surgery has been performed through a 7-cm skin incision (31 hips), an incision coined as minimally invasive by Søballe et al when they described their trans-sartorial approach for acetabular surgery. Clinical data was collected prospectively; primary outcome measures included the young adult hip score and the hip disability and osteoarthritis outcome score. Pre- and post-operative radiographs were analysed for achieved acetabular reorientation.

At the time of follow-up the median young adult hip score had improved significantly from pre-operative values. Mean scores were 35.4 pre-operatively, and 64.25 post-operatively. Improvement in the anterior and lateral centre-edge angle was 32 and 32.9 degrees respectively through a traditional incision, and 27.1 and 30 degrees through the minimally invasive approach (p>0.05). No major complications occurred in any patient. Four patients complained of lateral cutaneous nerve hypoaesthesia, in two patients there was delayed union of the pubic osteotomy and in one non-union. Two patients have gone on to total hip replacement.

The minimally invasive approach is safe and allows for accurate reorientation of the acetabulum whilst minimizing tissue damage. The scar is cosmetically appealing to patients, especially the predominantly female group treated with this condition. We did not see the evidence of reduced surgical stay that has been reported by other groups utilizing a minimally invasive approach.

Level of evidence: II


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 24 - 24
1 May 2013
Nunn T Pratt E Dickens W Bell M Jones S Madan S Fernandes J
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The Pelvic Support Osteotomy (PSO) or Ilizarov Hip Reconstruction(IHR) is well described for the treatment of septic sequelae of infancy. The purpose of this study was to clinically, functionally and radiographically assess our short-term results of this procedure.

25 patients (16 boys, 9 girls) who had undergone a IHR using the Ilizarov/TSF construct over a period of 10 years for a variety of pathologies were reviewed. The mean age at surgery was 15 years 4 months. The pre-operative diagnoses were SCFE(10), hip sepsis (6), DDH (6) and Perthes (3). All had significant leg length discrepancies, 16 had a painful stiff hip, 6 had a painful mobile hip and 3 had a painless unstable hip. At surgery, a mean measured proximal valgus angle of 51° and a mean extension angle of 15° was achieved. Distal femoral lengthening averaged 4.2 cm and distal varus correction was a mean of 8°. The mean fixator time was 173 days.

At a mean of 2 years and 7 months follow-up the lower-extremity length discrepancy had improved from a mean of 5.6 cm apparent shortening to 2.3 cm. Trendelenberg sign was eliminated in 18/25 cases. Improvements in range of hip movements and gait parameters were observed. Stance time asymmetry, step length asymmetry, pelvic dip and trunk lurch improved significantly. One patient had conversion to a total hip replacement after 7 years, 4 patients required re-do PSO due to remodelling of the proximal osteotomies, two had heterotopic ossification and two had significant knee stiffness due to lack of compliance.

The early results of IHR are encouraging to equalise limb lengths, negate trendelenburg gait, provide a mobile hip with a reasonable axis and the possibility of conversion to THR in the future if needed. Complications need to be anticipated and the effects of remodelling and maintaining adequate knee range of motion must be emphasised.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 17 - 17
1 Feb 2013
Asghar M Madan S Maheshwari R Munoruth A
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Introduction

Taylor Spatial Frame (TSF) has been designed to treat complex tibial, foot and ankle deformities using computer software. We have performed various osteotomies in combination with different soft tissue procedures, with the use of TSF.

Material and Methods

A retrospective study of 20 consecutive patients operated by, senior author SSM, from 2004 onwards who underwent surgical correction of tibia, ankle, midfoot and hind foot including lateral column lengthening, calcaneal and midfoot osteotomies. Demographic details, diagnosis, procedures (including previous operations), length of follow-up, outcome and complications were recorded. Of the 20 patients, 13 were men and 7 women. The mean age was 39 years (range 18 to 70). 5 patients had TSF for malunion or non-union of ankle fractures, malunion of tibia (5), congenital talipes equino-varus(3), acute fracture of ankle (2), one patient each for spina bifida, Poliomyelitis, Charcot-Marie-Tooth disease, equino-varus due to periventricular leuco-encephalopathy and avascular necrosis of the talus. Bilateral TSF for torsional malalignment of tibia (1)


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_11 | Pages 12 - 12
1 Feb 2013
Nunn T Bajaj S Geddes C Wright J Bellamy J Madan S Fernandes J
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Aim

The use of intraoperative cell salvage as a tool for reducing allogenic transfusion has been demonstrated in pelvic osteotomies. The aims of this audit were to identify any problems or complications with cell salvage, reduction in allogenic transfusion and identify procedures that would benefit.

Methods

The use of cell salvage and allogenic transfusions were prospectively recorded over a 27-month period for all those who had major non spinal surgery looking at whether cell-salvage reduced allogenic transfusions and where cell salvage was used it was matched to procedure, diagnosis and age with cases where it was not used over the same time period.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_6 | Pages 12 - 12
1 Feb 2013
Larnert P Madan S Giles S Davies A Jones S Fernandes J
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Aim

To evaluate the influence of arthrodiatasis in the natural history of the stages of the disease radiologically and also the timing of arthrodiatasis.

Materials and methods

44 patients with Perthes' disease that had articulated hip distraction were radiologically evaluated. We assessed these based on Joseph's modified Elizabethtown classification before, during and soon after distraction. Other parameters used were the application of common radiological grading systems and other features.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_3 | Pages 7 - 7
1 Jan 2013
Saldanha K Madan S Fernandes J Jones S
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Aim

To study the results of using recombinant human bone morphogenic protein-2 (rhBMP-2) to achieve bone union in children with complex orthopaedic problems including skeletal dysplasia, congenital limb deficiencies and complex trauma.

Materials & Methods

Between November 2006 to April 2010, rhBMP-2 was used to achieve bone healing in a total of 19 children. The indications were delayed union or non-union in 16 long bones where previous surgeries had failed and 4 posterior spinal fusions. All children had underlying complex orthopaedic problems predisposing them to delayed bone healing. The average age at the time of surgery was 13 years and 8 months (Range: From 4 years to 19 years and 4 months). There were 7 boys and 12 girls.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIV | Pages 17 - 17
1 May 2012
Geddis C Ali R Fernandes J Madan S
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The purpose of this study was to determine the oblique plane deformity in slipped upper femoral epiphysis.

A retrospective radiographic review was undertaken in patients admitted with a slipped upper femoral epiphysis between March 2008 and October 2010. Patients in whom a CT scan had been performed in addition to plain radiographs were assessed further. Angular deformity in the coronal and sagittal planes were measured by the angle formed between the femoral neck and a line perpendicular to the physis on the AP pelvic radiograph and the axial CT scan respectively. The magnitude and direction of the resultant deformity was defined in the oblique plane. Additional demographic data (gender, age, side, procedure and complications) was collected.

Seven girls, average age of 12 (range 10 – 13) and 6 boys, average age of 13 (range 10 – 15) were identified. The slip was bilateral in 2, left sided in 6 and right sided in 5 cases. Two patients were pinned in situ, 8 had surgical dislocation performed to facilitate reduction prior to pinning and 3 patients had secondary procedures performed following in situ pinning. The average angulation in the oblique posteroinferior plane (25 degrees) was less than in the coronal (30 degrees) and the sagittal planes (62 degrees). The average magnitude was 67mm (range 31 – 88).

CT is useful adjunct particularly when a frog legged lateral view is not possible because of pain or the fear of further displacement. Determination of the deformity in the oblique plane may aid in positioning of the screw during in situ pinning and may be helpful in identifying patients in whom pinning maybe difficult.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 405 - 405
1 Jul 2010
Gorva A Mathews T Madan S Giles S Jones S Fernandes J
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Introduction: Plastic deformation of the regenerate bone is a complication noted soon after limb lengthening. However, less is known about the factors responsible for the development of plastic deformation.

Materials and Methods: Retrospective analysis of 35 X-rays of achondroplast children who had limb lengthening were reviewed. The study compared Monofocal Vs Bifocal and Long lengthenings(> 10 cms) Vs modest lengthenings(≤ 10 cms) of tibial lengthening. Other parameters included in study were Bone healing Index, total length gained and sagittal and coronal axial deformities. There were 20 females and 15 males, 21 long lengthenings and 14 modest lengthenings in the study. The joint orientation and diaphyseal angles(antero-posterior and lateral X-ray views) was used for the measurement of plastic deformation of the regenerate bone.

Results: The mean age at operation was 10 years (range; 6–16 years). There were 29 cases of monolateral fixator and 6 of Ilizarov ring fixator, Of which 26 had monofocal lengthening and 9 had bifocal lengthening (34 callotasis and 1 chondrodiastasis). The total average length gained was 10 cms (range; 23–152). The mean bone healing index and external fixation index/time were 41 days and 352 days respectively. Plastic deformation of the regenerate bone was seen in 26 cases in total. 24 out of 29 cases of monolateral fixator (82%) developed plastic deformation. 44%(4/9) of bifocal group and 84%(22/26) of monofocal group showed evidence of plastic deformation. The long lengthenings showed plastic deformation in 85% (18/21) of the cases, whereas only 57%(8/14) of the cases were positive in modest lengthening group. Most of the axial deviation was in the coronal plane in 92% (24/26) and the sagittal plane accounted to only 23%(6/26) requiring surgical correction.

Conclusions: Long lengthenings and monofocal techniques showed more plastic deformation than bifocal and short lengthenings. However, Ilizarov ring fixator with bifocal corticotomy seemed to be promising with less association with the above entity in our recent experience.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 386 - 386
1 Jul 2010
Madan S Leunig M Ganz R
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Introduction: Patients who develop proximal femoral growth arrest present a typical deformity of short femoral neck, high riding greater trochanter, and caput valgum. This is seen usually seen in Perthes, AVN due to treatment of CDH, and sometimes in epiphyseal dysplasia.

Method: We present a series of 34 cases (34 hips) treated at the above institutes. The cases treated in Berne were prior to 2002. Twenty patients were females. There were 24 patients with Perthes, nine with old healed and treated DDH, and one with epipyhseal dysplasia. All had Trendelenburg or delayed Trendelenburg sign. They had an average shortening of 3.5 cms, and their age range was 14 yrs to 64 yrs. Pre-op assessement was done with plain radiographs, CT scan, and or MRI scan.

Results: Their Merle D’Aubigne score improved from 13 (10 to 15) to 17 (15 to 18) at the latest follow up. Twenty four (70%) had good to excellent result. Five have since undergone a total hip replacement, and five have some pain but can do reasonable amount of activity. The follow-up is 6 years (2 to 13 years). There was one trochanteric non-union, but no cases of AVN.

Discussion: We describe the technique of biomechanically improving the moment arm and muscle length with this procedure. This helps the soft tissues to strengthen, improve force vectors in the correct direct in the hip, perhaps improve the longevity of the joint and also prepare the hip soft tissues for future THR.