The purpose of this study is to assess the improvement in pain and function of the ankle when arthrodiastasis is used for end stage juvenile idiopathic arthritis [JIA] in the paediatric population. All patients treated with ankle arthrodiastasis, 2009–2013 were studied. Clinical, radiological and survivorship data were examined. The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and Parents (OxAFQ-P), along with the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical rating system for Ankle-Hindfoot were recorded pre-operatively and at 6 months. Eight patients (9 ankles) with severe tibiotalar JIA, refractory to medical management were treated. Average age at surgery was 14.5 years (range 8–19). Average length of arthrodiastasis was 3.5 months. Length of follow-up averaged 13 months (range 5–28 months). All scores showed an improvement at 6 months. OxAFQ-C scores (out of 60) improved on average from 23 to 43. OxAFQ-P scores also improved from19 to 39. The largest improvement was found for the physical subsection. AOFAS Ankle-Hindfoot score (out of 100) averaged 34 pre-op and 74 at 6 months. Pain scored out of 10 decreased from an average of 7.4 to 4.3 at 6 months. All patients and parents were satisfied with the surgery and would have the procedure performed again. Radiological studies demonstrated cartilage regeneration, joint restoration and deformity correction with arthrodiastasis. Survivorship was good (75%) at 36 months, but 2 patients (3 ankles) had subsequent surgery in the adult sector for progression of disease despite initial improvement following arthrodiastasis. This case series demonstrates the efficacy of ankle arthrodiastasis as a surgical option in severe end-stage ankle inflammatory arthritis in paediatric patients in the short to midterm. It improved functional scores and pain scores which should delay the need for more radical joint fusion or replacement procedures in this challenging surgical condition.
To evaluate patient outcomes in surgically managed ankle fractures with respect to fracture pattern, timing of surgery and length of stay. A retrospective review was undertaken of all patients admitted with an ankle fracture requiring a surgical procedure to our hospital between 1st Jan 2008 – 31st Dec 2008. Patient records were reviewed for baseline demographics and dates of admission, surgery and discharge. Radiographs were examined for fracture pattern and any evidence of dislocation. Patients were grouped into either early surgery (<48hours), or delayed surgery (>48hours). Data was analysed for length of stay (total, pre- and post-operative), time to surgery and factors influencing timing of surgery.AIM
METHOD
54% of meniscal tears were medial, 12% lateral and 10% bilateral. Patients with a lateral tear were significantly younger (45 Vs 51 yrs, p<
0.001). The most common type of medial tear was a flap tear (34%), followed by horizontal cleavage tears [HCT] (18%). The posterior 1/3 is the most common position. Laterally the tear morphology shows HCT comprising 25% and degenerative tears 17%, with the most common position a middle 1/3 tear. Lateral tears are more common in females (p<
0.05) Patients with bucket handle tears were significantly younger (41 Vs 53yrs, p<
0.001) and more likely to have a history of trauma (p<
0.001). Medial joint line tenderness was the most sensitive test (79%) and had the highest positive predictive value (81%). McMurry’s test is the most specific for both medial and lateral tears (90%) but is not sensitive. Medial meniscal tears are more accurately diagnosed clinically than lateral (79% Vs 50%).
The average age of the patients for open decompression (63yrs +/− 11) compared to interspinous device (63yrs +/− 9) was equal. Male to female ratio for Open Vs ID [1.4:1 Vs 1.1:1] did not differ significantly (p = 0.39). The ASA grades were higher for the interspinous device group with an average of 2.5 compared to 2.1 in the open group. The length of anaesthetic was on average shorter for the interspinous devices, which included a higher proportion of 2 level decompressions. The average length of stay on average was identical at 1.3 days, complications were similar [5% Vs 7%] with patient satisfaction higher [81% Vs 68%], although statistically insignificant [p=0.79]
Interspinous device insertion is a less invasive procedure and can be carried out on patients with a higher anaesthetic risk, even being performed under sedation. It should be considered for patients with symptoms of LSS instead of open decompression as there is no effect on length of stay or complication rate and there is a trend toward a decrease in anaesthetic time with improved patient satisfaction in the short term.
We studied the pattern of 99mTc-methylene diphosphonate uptake around uncemented femoral components in 44 asymptomatic hip arthroplasties, performing isotope scans at intervals from 4 to 48 months after operation. We used phase-III images obtained with a high-resolution gamma camera and measured the activity in various zones using a specially designed computer program. The components studied at 4, 6, 9 and 12 months were coated with hydroxyapatite (HA) and those studied at 18, 24, 36 and 48 months were not coated. We found a statistically significant fall in activity between four and six months around HA-coated prostheses in all five femoral periprosthetic zones. After six months activity was relatively uniform, but remained higher than that in normal femoral bone at 48 months in non-coated prostheses. We discuss the application of these patterns in the evaluation of painful cementless hip arthroplasties.