The aim of this study was to determine whether obesity affects pain, surgical and functional outcomes following lumbar spinal fusion for low back pain (LBP).

A systematic literature review and meta-analysis was made of those studies that compared the outcome of lumbar spinal fusion for LBP in obese and non-obese patients. A total of 17 studies were included in the meta-analysis. There was no difference in the pain and functional outcomes. Lumbar spinal fusion in the obese patient resulted in a statistically significantly greater intra-operative blood loss (weighted mean difference: 54.04 ml; 95% confidence interval (CI) 15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio: 1.91; 95% CI 1.68 to 2.18; n = 43858; p < 0.001) and longer duration of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p < 0.001). Obese patients have greater intra-operative blood loss, more complications and longer duration of surgery but pain and functional outcome are similar to non-obese patients. Based on these results, obesity is not a contraindication to lumbar spinal fusion.

Cite this article: Bone Joint J 2015;97-B:1395–1404.

Aim:

To Determine Whether Maximal Rib Prominence Measured On Lateral Radiographs Can Be Used As A Surrogate To Rib Rotation Determined By Surface Tomography (Quantecscanning) In Assessment Of Spinal Rotation.

Aim

To review the results of patients who underwent fixation of complex proximal femur fractures using the Proximal Femur Locking Plates (PFP) and analyse causes of failure of PFP.

Introduction: There is limited literature available looking into circumstances surrounding the development of stress fracture of the medial and lateral malleoli after ankle replacement. We present the preliminary results of a prospective study examining the effect of ankle replacement upon local bone mineral density and the phenomenon of stress shielding.

Aim: To assess the effect of ankle replacement loading of the medial and lateral malleoli, by analysing the BMD of the medial and lateral malleoli before and after Mobility total ankle replacement.

Methodology: Ten consecutive patients undergoing Mobility total ankle replacement for osteoarthritis had pre-operative bone densitometry scans of the ankle, repeated at 6 and 12 months after surgery. The bone mineral density of a 2 cm square area within the medial malleolus and lateral malleolus was measured. The pre-operative and post-operative bone densitometry scans were compared. The relation between the alignment of the tibial component and the bone mineral density of the malleoli was also analysed.

Results: The mean preoperative BMD within the medial malleolus improved from 0.58g/cm2 to mean 6 months postoperative BMD of 0.59g/cm2 and 0.60g/cm2 at 12 months. The mean preoperative BMD within the lateral malleolus decreased from 0.40g/cm2 to a mean 6 months postoperative BMD of 0.34g/cm2. However the BMD over the lateral malleolus increased to 0.36g/cm2 at 12 months. The mean alignment of the tibial component was 88.5° varus (85° varus to 94° valgus). There was no correlation between the alignment of the tibial component and the bone mineral density on the medial malleolus (r = 0.09, p = 0.865).

Conclusion: The absence of stress shielding around the medial malleolus indicates that TAR implanted within the accepted limits for implant alignment, load the medial malleolus. However, there was stress shielding over the lateral malleolus resulting in decreased BMD in the lateral malleolus.

Failed Back Surgery Syndrome (FBSS) refers to having persistent back and/or leg pain after one or more surgical procedures aimed at correcting lumbosacral disease. Different modalities including Epidural injections, Spinal cord stimulation, Anterior/Posterior Lumbar Interbody Fusion (ALIF, PLIF) have been described in the literature with varying outcome. Our aim was to review the functional outcome of patients treated with Posterior Lumbar Interbody Fusion for FBSS since June 2000 to December 2006.

This is a retrospective study of prospectively collected data of 25 patients diagnosed with FBSS and treated with PLIF at University Hospital of North Tees. All patients were requested to fill in the Oswestry Disability Index(ODI), Numerical Rating Scale for Back Pain (NRSBP), Numerical Rating Scale for Leg Pain (NRSLP), SF36 pre and post operatively. The scores were analysed using SPSS software for statistical significance.

There were 12 men and 13 women. Mean age was 47.8 years (range 31–76 years). Mean follow up was 24.8 months (range 4 – 63 months). Four of the 25 patients had Post discectomy syndrome while the rest had post laminectomy syndrome. Most common level of surgery was L5/S1 either as a single level or in combination with other levels above. ODI decreased from a pre-op mean of 55.6(range 20–74.1) to 20.6(range 2–54) while VASBP decreased from 6.9 (range 1–9) to 2.2(range 0–6) (p< 0.05) and VASLP decreased from 6.4 (range 3–10) to 2.2 (range 0–7) (p< 0.05). SF36BP scores improved from a mean 26.7 (range 12–37.1) before the surgery to 45 (range 31–62) (p< 0.05) after surgery. 84% of the patients felt that the outcome of the surgery met their expectation and were satisfied with result.

Our results show that PLIF can be offered as a safe and effective for treatment of FBSS.

There is limited literature available looking into circumstances surrounding the development of stress fracture of the medial and lateral malleoli after ankle replacement. We present the preliminary results of a prospective study examining the effect of ankle replacement upon local bone mineral density and the phenomenon of stress shielding.

We aimed to assess the effect of ankle replacement loading of the medial and lateral malleoli, by analysing the Bone Mineral Density (BMD) of the medial and lateral malleoli before and after Mobility total ankle replacement.

Ten consecutive patients undergoing Mobility total ankle replacement for osteoarthritis had pre-operative bone densitometry scans of the ankle, repeated at 6 months after surgery. The bone mineral density of a 2 cm square area within the medial malleolus and lateral malleolus was measured. The pre-operative and postoperative bone densitometry scans were compared. The relation between the alignment of the tibial component and the bone mineral density of the malleoli was also analysed.

The mean preoperative BMD within the medial malleolus improved from 0.57g/cm2 to mean 6 months postoperative BMD of 0.62g/cm2. The mean preoperative BMD within the lateral malleolus decreased from 0.39g/cm2 to a mean 6 months postoperative of 0.33g/cm2. The mean alignment of the tibial component was 88.50 varus (range 850 varus to 940 valgus). However, there was no correlation between the alignment of the tibial component and the bone mineral density on the medial malleolus (r = 0.09, p = 0.865).

The absence of stress shielding around the medial malleolus indicates that ankle replacements implanted within the accepted limits for implant alignment, load the medial malleolus. However, there was stress shielding over the lateral malleolus resulting in decreased BMD in the lateral malleolus.

Introduction: There is limited literature looking into the circumstances surrounding the development of stress fractures of the medial and lateral malleoli after ankle replacement. We present the preliminary results of a prospective study examining the effect of total ankle replacement (TAR) upon local bone mineral density (BMD) and the phenomenon of stress shielding.

Aim: To assess the effect of TAR loading othe medial and lateral malleoli, by analysing the BMD of the medial and lateral malleoli before and after Mobility TAR.

Methodology: Ten consecutive patients undergoing Mobility total ankle replacement for osteoarthritis had pre-operative bone densitometry scans of the ankle, repeated at 6 and 12 months after surgery. The bone mineral density of a 2 cm square area within the medial and lateral malleoli was measured. The pre-operative and post-operative bone densitometry scans were compared. The relation between the alignment of the tibial component and the bone mineral density of the malleoli was also analysed.

Results: The mean preoperative BMD within the medial malleolus increased from a mean of 0.57g/cm2 to 0.58g/cm2 at six months and 0.60g/cm2 at 12 months postoperatively. The mean preoperative BMD within the lateral malleolus decreased from 0.39g/cm2 to 0.34g/cm2 at six months postoperatively. However the BMD over the lateral malleolus increased to 0.356g/cm2 at 12 months. The mean alignment of the tibial component was 88.50 varus (range 850 varus to 940 valgus). There was no correlation between the alignment of the tibial component and the bone mineral density on the medial malleolus (r = 0.09, p = 0.865).

Conclusion: The absence of stress shielding around the medial malleolus indicates that ankle replacements implanted within the accepted limits for implant alignment, load the medial malleolus. However, there was stress shielding over the lateral malleolus resulting in decreased BMD in the lateral malleolus.

Introduction: There is limited literature available looking into circumstances surrounding the development of stress fracture of the medial and lateral malleoli after ankle replacement. We present the preliminary results of a prospective study examining the effect of ankle replacement upon local bone mineral density and the phenomenon of stress shielding.

Aim: To assess the effect of ankle replacement loading of the medial and lateral malleoli, by analysing the BMD of the medial and lateral malleoli before and after Mobility total ankle replacement.

Methodology: Ten consecutive patients undergoing Mobility total ankle replacement for osteoarthritis had pre-operative bone densitometry scans of the ankle, repeated at 6 months after surgery. The bone mineral density of a 2 cm square area within the medial malleolus and lateral malleolus was measured. The pre-operative and post-operative bone densitometry scans were compared. The relation between the alignment of the tibial component and the bone mineral density of the malleoli was also analysed.

Results: The mean preoperative BMD within the medial malleolus improved from 0.57g/cm2 to mean 6 months postoperative BMD of 0.62g/cm2. The mean preoperative BMD within the lateral malleolus decreased from 0.39g/cm2 to a mean 6 months postoperative BMD of 0.33g/cm2. The mean alignment of the tibial component was 88.50 varus (range 850 varus to 940 valgus). However, there was no correlation between the alignment of the tibial component and the bone mineral density on the medial malleolus (r = 0.09, p = 0.865).

Conclusion: The absence of stress shielding around the medial malleolus indicates that ankle replacements implanted within the accepted limits for implant alignment, load the medial malleolus. However, there was stress shielding over the lateral malleolus resulting in decreased BMD in the lateral malleolus.

Introduction: Lisfranc injuries account for 0.2% of all fractures. Around 20% of these injuries are missed or misdiagnosed leading to long term problems with the foot. Early recognition and treatment of these injuries are crucial in restoring the function of the foot.

Aim: To review the functional outcome of patients following surgery for lisfranc injuries.

Methodology: This is a retrospective review of patients treated surgically for lisfranc injury in our hospital between January 2000 and January 2007. There were 13 patients whose records were reviewed and data including age, mechanism of injury, associated injuries, surgery performed, and peri-operative complications were collected. A telephonic survey was conducted to find out the current functional and employment status. AOFAS mid-foot score was used to evaluate the outcome.

Results: 13 patients were included in the study. Mean age was 31 years at the time of injury. 5 patients were female and 8 male. 10 had injury on the left foot while 3 had on the right. 11 were closed lisfranc injury. 10 patients had isolated lisfranc injury. Seven patients had sustained lisfranc injury following a fall, while three had a road traffic accident. Six patients had a homo-lateral, four had isolated and two had divergent type. Nine patients had trans-articular fixation, seven of whom had open reduction and internal fixation while two had K-wire fixation. Extra-articular fixation was done in four patients. Average AOFAS mid foot scoring was 80 ranging from 47 to 100. Lower scores were related to pain. Nine patients were pain free at follow up and returned to work. Average follow-up period was 32.6 months (range5–77 months)

Conclusion: Two thirds of patients with a Lisfranc fracture dislocation return to work and extra-articular fixation may result in superior outcomes compared with the traditional methods.

Objective: To identify institution specific risk factors for developing MRSA surgical site infection (SSI) and develop an objective mechanism to estimate the probability of MRSA infection in a given patient admitted to the orthopaedic unit.

Design: A cohort study was performed to identify risk factors in all patients who had MRSA infection during admission on the orthopaedic unit between January 2002 and December 2004. Logistic regression was used to model the likelihood of MRSA. A stepwise approach was employed to derive a model. The MRSA prediction tool was developed from the final model.

Results: Of the 11 characteristics included in the logistic regression, the features that strongly predicted a MRSA infection were ASA grade, patient’s residence and reason for admission.

110 had MRSA infection in their surgical wound. 83 of 110 (75.5%) patients were non-elective admissions, of which 49 (60%) were proximal femur fractures. 20% of proximal femur fractures admitted from nursing home and 7.8% from their own homes developed SSI with MRSA. This cohort of SSI with MRSA had an average of 5.7(1–18) previous admissions. 25 (23%) had been previously colonised with MRSA. Majority of them (76%) were between 70–90 years old and were ASA grade 3–4.

Conclusion: Through multivariate modelling technique we were able to identify the most important determinants of patients developing SSI with MRSA in our institute and develop a tool to predict the probability of MRSA in a given patient. This knowledge can be used to guide the use of appropriate prophylactic antibiotic and to take other required measures to avoid the SSI with MRSA.