Aim

Our collaborative study aims to demonstrate that acute partial Achilles Tendon Tears (ATTs) are not separate diagnostic entities from full ATTs. and should be thought of as a continuum rather than binary partial or full.

The National Joint Registry (NJR) was established in 2003, and was extended to include ankle arthroplasty on 1^st April 2010, and shoulder and elbow arthroplasty in April 2012.

The aim of this study was to evaluate the uptake of the NJR for ankle arthroplasty over its first 3 years. This is compared to the first 3 years of hip and knee data, and the first year of shoulder and elbow data.

The methods of measuring compliance are also evaluated. NJR compliance is measured by comparing the number of procedures submitted to the NJR, against the number of levies raised through implant sales. This applies to all of the UK, and both independent and NHS providers. However, compliance can also be measured by comparing NJR submissions with data submitted to the Hospital Episode Statistics (HES) database. This only relates to NHS institutions in England.

The NJR ankle data was compared to implant data, and adjusted to compare to HES data, to evaluate the different methods of measuring compliance.

We also compared these figures with the first 3 years for hip and knee arthroplasties and the first year for shoulder and elbow arthroplasties.

Introduction

Lower limb mal-alignment as a result of fracture malunion can result in knee degenerative arthritis or predispose to early arthroplasty failure due to the altered mechanical axis. The choice of corrective osteotomy is often determined by potential complications. Opening wedge osteotomy is associated with poor bone healing especially in adult diaphyseal bone. Distraction osteogenesis enables gradual deformity correction with the gap filled by regenerate bone. Bone formation however is formed less favourably in the diaphysis and metaphyseal osteotomy is advised. We present a consecutive series of adult tibial diaphyseal correction using the Taylor Spatial Frame utilising the method of distraction osteogenesis.

Introduction

Hallux valgus is a common orthopaedic complaint with multiple surgical options. There are many methods available for assessing whether sufficient translation of the first metatarsal can be achieved with a metatarsal translational osteotomy alone. None of the current methods take into account the breadth of the metatarsal. With current PACS technology a radiograph can be zoomed to any size and we postulate that by using the surgeon's thumb (or any suitable digit), as a sizing tool, a safe clinical decision can be made concerning whether a translational metatarsal osteotomy alone will provide sufficient correction.

Introduction

Hallux valgus deformity is a common potentially painful condition. Over 150 orthopaedic procedures have been described to treat hallux valgus and the indication for surgery is pain intractable to nonoperative management.

Although Bohler’s & Gissane’s angles are measured in adult calcaneal fractures, it is not known if such measurements are reliable in children nor how such measurements vary with the age of the child.

The Picture Archiving and Communications System (PACS) databases of 2 London Teaching Hospitals were searched and all children who had a lateral ankle xray taken as part of their attendance to the A& E department were identified. Films were excluded if there was a fracture of the calcaneus or if the film was oblique or of poor quality. Bohler’s and Gissane’s angles were measured using the image viewer software. All patients’ films were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Interclass Correlation Coefficients (ICC) were used to assess the reliability of the measurements.

347 children were identified and after exclusions, 218 films were used for the study. The overall ICC for Bohler’s angle inter-obsever error was 0.91 and for intra-observer error was 0.92, giving excellent correlation. This reliability was maintained across the age groups. Gissane’s angle inter-observer error was very poor and the intra-observer error poor across the age groups, although accuracy did improve as the patients approached maturity.

Further analysis of the Bohler’s angle showed a significant variation in the mean angle with age. Contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values.

We feel that measurement of Gissane’s angle is unreliable in children but measurement of Bohler’s angle is accurate and reproducible. Bohler’s angle varies with age and knowledge of Bohler’s angle variation is important in the evaluation of os calcis fractures in children.

The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler’s and Gissane’s angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Intraclass correlation coefficients were used to assess the reliability of the measurements.

For Bohler’s angle the overall inter-observer reliability, the intraclass correlation coefficient was 0.90 and the intra-observer reliability 0.95, giving excellent agreement. This reliability was maintained across the age groups. For Gissane’s angle, inter- and intra-observer reliability was only fair or poor across most age groups.

Further analysis of the Bohler’s angle showed a significant variation in the mean angle with age. Contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values. The age-related radiologic changes presented here may help in the interpretation of injuries to the hindfoot in children.