Ankle fractures are extremely common but unfortunately, over 20% fail to obtain good to excellent recovery. For those requiring surgical fixation, usual-care post-surgery has included six-weeks cast immobilisation and non-weightbearing. Disuse atrophy and joint stiffness are detrimental sequelae of this management. While rehabilitation, starting at two-weeks post-surgery is viewed as safe, the literature contains methodological flaws and a lack of focus on early exercise, perpetuating the controversy over the effectiveness of early exercise interventions. Our objectives were to determine if following operative fixation for Weber B fracture, the physiotherapy intervention, early motion and directed exercise (EMADE), applied in the clinical setting, were superior to Usual-care at 12-weeks (primary outcome) and 24-weeks.Background
Objectives
A number of orthopaedic strategies have been described for limb salvage following periprosethic joint infection (PJI). However, this is often only possible with concomitant soft tissue reconstruction in the form of flap coverage. The purpose of this study was to determine the long-term clinical outcome of patients who underwent pedicled gastrocnemius flap coverage as part of their treatment for knee PJI. We performed a retrospective review of all patients undergoing gastrocnemius muscle transfer with split thickness skin grafting as part of their treatment for knee PJI at a tertiary referral centre between 1994 and 2015. Data recorded included patient characteristics, orthopaedic procedure, microbiology result and antimicrobial management. Outcome measures included flap failure, infection recurrence, amputation, functional outcome (Oxford knee score; OKS) and mortality.Aim
Method
The effects of splintage, suture and excision of the tendon sheath on the healing of incompletely transected flexor tendons in the rabbit have been evaluated separately and in various combinations. When all procedures were done together, repair was accompanied by dense adhesion formation with little evidence of any healing activity by the tendon cells. The experiments indicated that the adhesions were the result not of any one single factor studied but of all three contributing in varying degrees. Suturing produced the most adhesions but synovial sheath excision and immobilisation also contributed. It is suggested that these factors are also responsible for the adhesions which occur after flexor tendon repair in clinical practice.
1. Tendon possesses an active potential for repair and remodelling. 2. Large defects made in the flexor tendons of rabbits showed tenoblastic activity and repair without the formation of adhesions. 3. The failure to show this intrinsic ability for repair in previous studies may have been influenced by adverse factors introduced in order to hold the cut tendon ends together.
1. The features of ganglia of the flexor tendon sheaths of the hand are described. 2. A high incidence in typists is discussed in relation to etiology and pathogenesis. 3. The suggestion is made that needle rupture is the method of choice, with surgical excision in case of recurrence.
