Background

There is a lack of information on the independent preoperative predictors of perioperative mortality, including the influence of previous stroke and acute coronary syndromes (myocardial infarction + unstable angina, ACS). Previous studies have grouped variables under the umbrella term “ischaemic heart disease”. In this study, we investigated the influence of vascular risk factors separately.

Background

Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to English NHS hospitals. This is the first study investigating rates of these events following total joint replacement (TJR) on a national scale.

Background

Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to hospital in the English NHS (hospital episode statistics, HES). This is the first study investigating rates of these events following total joint replacement (TJR) on a national scale in the NHS.

Antegrade femoral nailing through the greater trochanter, using nails designed for piriformis entry, is associated with varus and iatrogenic comminution. Nails designed for greater trochanter insertion theoretically reduce these complications, but clinical outcomes comparing these to piriformis entry remain unknown. We compared femoral shaft fracture repair with a nail designed for trochanteric entry to an identical nail without a trochanteric bend inserted through the piriformis fossa.

The trochanteric nail was easier to insert with decreased operative and fluoroscopy time. It resulted in equally high union rates, low complication rates, and functional results similar to conventional nailing through the piriformis fossa.

Trochanteric antegrade nailing of the femur is thought to be advantageous over conventional antegrade nailing due to improved ease of insertion, but is unproven. This study compares results of femoral shaft fracture treatment using a nail designed specifically for trochanteric entry, Trigen TAN, to results using an identical nail without a trochanteric bend inserted through the piriformis fossa, Trigen FAN.

A femoral nail specially designed for trochanteric insertion resulted in equally high union rates, equally low complication rates, and functional results similar to conventional antegrade femoral nailing through the piriformis fossa. As a result of increased ease of insertion, decreased operative time and decreased fluoroscopy time, the greater trochanter entry portal, coupled with an appropriately designed nail, represents a rational alternative for antegrade femoral nailing.

Insertion of a specially designed femoral nail though the trochanter is faster, easier, and requires less fluoroscopy time than conventional antegrade nailing through the piriformis fossa.

Overall, there was < 10° malalignment and no iatrogenic fracture comminution. The average operative time was 21% greater using the FAN nail than using the TAN nail, (p=.08). The average fluoroscopy time was 61% greater for the FAN group than for the TAN group, (p< .05). Trends in functional outcome (Lower Extremity Measure) were similar for both groups.

One hundred and eight patients treated for a femoral shaft fracture were included in this study. Ninety-eight patients were treated with either a Trigen TAN nail (n=38) or Trigen FAN nail (n=53); seventeen patients with insufficient follow-up were excluded from analysis.

Funding:Smith & Nephew, Memphis TN

Introduction and Aims: To assess the efficacy of fibular osteotomy on the rate of arthrodesis at the tibiofibular syndesmosis in patients with Total Ankle Replacement (TAR).

Method: A prospective trial of fibular osteotomy was performed in 16 consecutive TAR (13F/3M), mean age 67 (41–82). All operations were performed by the same surgeon, as described by the inventor of the procedure, Dr. Frank Alvine, MD. After completion of the syndesmotic fusion, the fibula was exposed proximal to the proximal syndesmotic screw. An oblique osteotomy of the fibula was performed. Importantly, the angle of the cut was made such that the proximal fibula was trapped by the distal cut surface. The osteotomy was directed from medial distal to lateral proximal. All cases were followed until radiographic and clinical signs of healing were seen.

Results: Union occurred in all cases, with a mean time to fusion of seven weeks, with six patients achieving union within five weeks. No patient developed pain at the osteotomy site. All osteotomies showed signs of radiographic healing and none of these were symptomatic. There were no neuromas related to this procedure, and no patient experienced sensory changes along the nerve distribution. One patient developed symptomatic prominence of the screw on the medial malleolus and was asypmtomatic after implant removal.

Conclusion: The addition of a fibular osteotomy resulted in a 100% rate of syndesmosis fusion. We postulate that the osteotomy is successful because it removes the micromotion at the syndesmosis, which occurs with loading of the intact fibula. As the fibula only functions as a lateral strut in patients with an Agility total ankle, we felt that the osteotomy would cause minimal if any concerns. Our findings corroborate our hypothesis in that all the fusions were successful and none of the patients experienced secondary problems related to the osteotomy. We would recommend this technique as an adjunct to standard ankle replacement using the Agility system.

Exposure of the prosthesis is one of the problems encountered after arthroplasty of the knee. Eight patients with nine exposed prostheses have been treated by using a gastrocnemius myocutaneous flap to provide cover. This preserved the prosthesis and closed the joint in six of the eight patients.l The factors leading to breakdown of the wound are discussed and the anatomy of the gastrocnemius myocutaneous flap and the operative procedure are described.