Introduction:

Recent published studies have examined the normal dimensions of the syndesmosis on CT. However, previous anatomical studies have shown variations of the articulating facets within the tibialae fibularis and may contribute to the false appearance of increased spacing within the syndesmosis. In this study, we measured and compared anterior and posterior distances of the distal tibiofibular(DTF) syndesmosis on MRI and CT imaging.

Methods:

We identified adult patients who had had both a CT scan and an MRI scan of their ipsilateral ankle to investigate symptoms unrelated to the DTF syndesmosis. The anterior and the posterior DTF dimensions were measured on CT and MRI axial images, at the level of the distal tibial physeal scar. This was taken from anterior tubercle of tibia and from the most anterior aspect of the posterior tibial tubercle to the nearest point of medial aspect of the fibula. The geometrical shapes of the syndesmosis and the anterior tibial tubercle were also recorded.

Aims:

With the advent of standing CT and MRI scans, there is increasing interest in establishing the role and usefulness of these investigations. When ordering a standing investigation, we assume that 100% of body weight is loaded through the limb, but most machines have handlebars for support and some have seats to allow patients the opportunity to sit. The aim of this study was to evaluate the amount of load going through the lower limbs in various positions supported and unsupported, to explore the range and variation in measurements obtained.

Methods:

Following ethics and local IRB approval, 40 healthy volunteers were asked to stand on an electronic weighing scales and be measured for height. They were then asked to stand on an identical electronic weighing scale on the PedCAT standing CT.

Their weight was measured single and double leg stance, with the hands supported and unsupported on the side bars. The subjects were then asked to sit with a single and then both legs on the scale.

Introduction:

Cone Based CT (CBCT) scanning uses a point source and a planar detector with parallel data acquisition and volumetric coverage of the area of interest. The pedCAT (Curvebeam USA) scanner is marketed as a low radiation dose, compact, faster and inexpensive CT scanner that can be used to obtain both non- weightbearing and true 3 dimensional weightbearing views.

Method:

A review of the first 100 CBCT scanning in our unit has been performed to assess ease of scanning, imaging time, radiation dose and value of imaging as opposed to conventional imaging.

Aim:

Ankle sprains are one of the most common sports injuries. Around 10–20 % of the acute ankle sprains may lead to the sequelae of chronic ankle instability. Around 15–35% of the patients have residual pain following successful lateral ligament reconstruction. One of the reasons suggested for the persistent symptoms following lateral ligament reconstruction has been the presence of intra-articular pathology.

Methods and materials:

We performed ankle arthroscopy on all patients undergoing the modified Brostrom repair and compared patients with associated intra-articular pathology to those without any intra-articular pathology.

Introduction:

Unstable ankle fractures are commonly treated with operative fixation. Isolated lateral malleolus fractures (Weber B) are often operated by orthopaedic trainees. Operative fixation of these fractures is included in the index procedures of procedure based assessment (PBA) of intercollegiate Surgical Curriculum Programme (ISCP). Orthopaedic trainees are expected to be competent in this procedure by the end of their training. Fluoroscopic guidance is essential for adequate reduction and safe fixation of these fractures.

Aims:

It is currently unknown if patients are exposed to excess radiation when they are operated by trainees compared to consultant surgeons. It is a common perception that trainees take more time to fix these fractures compared to trained consultants thereby exposing patients to untoward effects of prolonged tourniquet time.

Introduction:

Inadequate reduction and fixation of ankle fractures leads to poor clinical outcomes although there are no well-established criteria to evaluate the quality of surgical fracture fixation of the ankle. The aim of our study was to validate Pettrone's criteria that can be used in the radiological assessment of the quality of ankle fracture fixation that predict the functional outcome.

Methods:

A retrospective study was completed following the operative management of ankle fractures at a University teaching hospital between 1^st January 2009 and 31^st December 2009 were included in the study. Exclusion criteria were paediatric fractures, polytrauma, and fractures involving the tibial plafond. The fracture pattern was classified using the AO classification system. Three independent Foot and Ankle Consultants assessed the quality of surgical ankle fracture fixation using Pettrone's criteria. Approximately one year following the surgery, functional outcome was obtained using Lower Extremity Function Score (LEFS) and a modified American Orthopaedic Foot and Ankle Society score (AOFAS). The Mann-Whitney test was used for the LEFS and AOFAS functional scores. Logistic regression was performed upon age and gender with regards to functional outcome. Given that the Kappa coefficient is a pair wise statistic, the average pair wise agreement for each category of the Pettrone criteria was also determined.

Introduction:

In this cohort study, we present comprehensive injury specific and surgical outcome data from one of the largest reported series of distal tibial pilon fractures, treated in our tertiary referral centre.

Methods:

A series of 76 pilon fractures were retrospectively reviewed from case notes, plain radiographs and computed tomography (CT) imaging. Patient demographics, injury and fracture patterns, methods and timing of fixation and clinical and radiological outcomes were assessed over a mean follow up period of 8.6 months (range 2–30).

Introduction:

In April 2012 National Trauma Networks were introduced in England to optimise the management of major trauma. All patients with an ISS of ≥ 16 should be transferred to the regional Major Trauma Centre (level 1). Our hypothesis was that severe foot and ankle injuries would no longer be managed in Trauma Units (level 2).

Methods:

A retrospective analysis of the epidemiology of severe foot and ankle injuries was performed, analysing the Gloucestershire foot and ankle trauma database, from a Trauma Unit, for a catchment population of 750,000 people. The rate of open fractures, mangled feet and requirements for stabilisation with external fixation were reviewed before and after the introduction. This was compared to the foot and ankle injuries triaged to the regional Major Trauma Centre (MTC) using the TARN database information.

Introduction:

The os-calcis is the most common tarsal bone to fracture. It can lead to a debilitating arthritis and has considerable socio-economic implications.

In the literature there is great debate as to whether operative or non-operative management has a better outcome. Previous smaller case series report improved results from surgery whereas the one randomised trial showed no overall benefit from surgery. However sub-group analysis identified patients that had a better outcome with operative management. Results from the UK heel fracture trial are awaited. We present a 5 year series from a single centre, single surgeon that includes 143 fractures. There are currently no comparable published data.

Methods:

We reviewed 143 intra-articular fractures of the os calcis. All fractures were evaluated using CT scans and classified according to Sanders system. The functional outcome of Sanders type 2 fractures were evaluated using Atkins scoring system. Evaluation took place annually between 2 and 7 years post injury. A comparison was made between type 2 fractures treated operatively and those treated non-operatively.

Introduction:

Calcaneal fractures are rare but debilitating injuries assumed to affect particular demographic sub groups. This study aimed to relate epidemiological factors (age, gender, smoking status and social deprivation scores) to the incidence of calcaneal fractures requiring operative fixation over a 10-year period.

Methods:

Data (age, gender and smoking status) was extracted from a prospective trauma database regarding calcaneal fractures between September 2002 and September 2012. The Rank of Index of Multiple Deprivation (IMD) scores was collated for each patient and data sub-stratified in 20% centiles. 2010 National Census Data was used to formulate patient subgroups and incidences. Resulting data was subjected to statistical analysis through calculation of relative risk (RR) scores with 95% confidence intervals (95% CI).

Introduction:

We report our 10-year experience of post-operative complications of calcaneal fractures treated by internal fixation and attempt to correlate these with previously cited patient risk factors.

Methods:

All calcaneal fractures treated by internal fixation in our Major Trauma Centre between September 2002 and September 2012 were identified. Patient indices (age, gender, smoking status and pre-existing co-morbidities), time to surgery and method of surgery (open reduction and internal fixation (ORIF) versus closed reduction and percutaneous fixation) were recorded. Primary outcome was the incidence of wound infection requiring intravenous antibiotics and/or re-operation. Statistical analysis through Mann-Whitney-Wilcoxon testing and relative risk ratio calculations with 95% Confidence Intervals (CI) was performed.

Introduction:

Open reduction and internal fixation of displaced intra-articular calcaneal fractures is susceptible to a high incidence of wound complications. Displaced fractures create abnormal contact characteristics at the subtalar joint, resulting in poor functional outcome and arthritis. We present the functional outcomes of 32 fractures (Sanders 2 and 3) at an average follow up of two years.

Methods:

Over a 57 month period, 32 fractures (29 patients) underwent this technique in a London level 1 trauma centre. Open fractures were excluded. The previously described technique with sinus tarsi portals was used. Pre and post-operative radiographs and functional outcomes were assessed.

Introduction:

Percutaneous fixation of intraarticular calcaneal fractures adequately restore the subtalar joint with lower soft tissue complications and equivalent short-term results compared to open fixation. However, studies have largely focused on less severe fracture types (Sanders types 2/3). We report our initial experience of this relatively new Mini-open Arthroscopic-assisted Calcaneal Osteosynthesis (MACO) technique for more comminuted calcaneal fractures (Sanders types 3/4).

Methods:

We prospectively studied consecutive patients with intraarticular calcaneal fractures requiring surgical fixation between April 2012 and June 2013. MACO involves initial subtalar arthroscopic debridement, with subsequent fluoroscopic-assisted, mini-open reduction and fixation of depressed fragments using cannulated screws. Outcome scores (Manchester-Oxford Foot(MOXFQ), AOFAS Hindfoot and SF-36 questionnaires) and radiological parameters were recorded with a mean follow-up of 12 months (7–13).

Introduction:

It has been shown that inadequate reduction of the sesamoids can lead to recurrent hallux valgus. It can be difficult however to assess the sesamoid position. We propose a simple method of grading sesamoid position; the sesamoid width ratio. We aim to assess for a difference in ratio between those with and without hallux valgus and subsequent correlation with increased deformity. The new grading system can then be tested for inter-observer reliability.

Methods:

277 (103 normal, 87 preoperative, 87 postoperative) AP weight bearing foot radiographs were analysed for hallux valgus angle (HVA), intermetatarsal angle (IMA), and both medial and lateral sesamoid width (mm). The sesamoid width ratio (SWR; lateral/medial width) was then calculated. Using statistical methods based upon HVA and IMA grading, three groups of increasing hallux valgus severity, in accordance with SWR, were defined; normal ≥1.30, moderate 1.29–0.95 and severe ≤0.94. Sixty images (10 normal, 25 preoperative, 25 postoperative) were then sent on disc to three separate reviewers to assess for inter-observer error.

Background:

Various angles have been used to grade the severity of hallux valgus deformity. They are useful in surgical planning but do not correlate with symptom severity or improvement. We feel that there is a fundamental mismatch between the width of the forefoot and the width of the hindfoot and that this is more clinically relevant, we describe two techniques for measuring this. We aim to measure the degree of foot narrowing after surgery and moreover how this correlates to the severity of pre- and post operative outcomes.

Methods:

200 consecutive bunion operations were assessed with weight bearing radiographs. The HVA and IMA were measured according to standard practice. We also assessed forefoot width using two methods we have described. The first is the ‘Forefoot Width’ measured as a perpendicular to the midfoot (a technique we have previously validated). The ‘Foot Ratio’ is calculated as a function of the calcaneal width. Clinical outcomes were assessed using the MOXFQ and AOFAS.

Background:

The Chevron osteotomy is straightforward, requires less dissection and allows earlier rehabilitation than some other osteotomies. However it is generally perceived as unsuitable for severe deformities even though a 2012 meta-analysis and an earlier RCT failed to show any advantage of the scarf over the chevron. We aim to assess the correctability of severe HV comparing the correction, the clinical outcomes and complications of the Chevron osteotomy with other techniques employed in a consecutive series.

Methodology:

We reviewed a series of 92 cases of severe hallux valgus (IMA >17° regardless of the HVA). The follow-up period varied from 1 to 4 years. Pre-operative x-rays and final post-operative weight-bearing x-rays were performed. Outcome scores (MOXFQ and AOFAS), IMA, HVA and foot width were collected. Complications were monitored.

Background:

Previous attempts at small incision hallux valgus surgery have compromised the principles of bunion correction in order to minimise the incision. The Minimally Invasive Chevron/Akin (MICA) is a technique that enables an open modified Chevron/Akin to be done through a 3 mm incision, facilitated by a 2 mm Shannon burr.

Methodology:

This is a consecutive case series performed between 2009 and 2012. This includes the learning curve for minimally invasive surgery. All cases were performed by a single surgeon at two different sites, one centre where minimally invasive surgery is available and the other where it is not. The standard procedure in both centres is a modified Chevron osteotomy. Regardless of whether the osteotomy was performed open or minimally invasive two-screw fixation was performed. Retrospective analysis includes the IMA, HVA, M1 length, forefoot width and forefoot: hindfoot ratio. Clinical outcomes include the MOXFQ, AOFAS, and assessment of complications.

Introduction:

The dorsal closing wedge calcaneal osteotomy has been described for the treatment of insertional pathology of the tendo-achilles. The aim of this study was to evaluate the efficacy of the technique using outcome measures.

Method:

This was a prospective case series. Patients were included if they had tendo-achilles insertional pathology (calcific tendonitis, bursitis or Haglund's deformity). A short extended lateral approach was used and a 1 cm dorsally based closing wedge osteotomy of the calcaneus performed. Fixation was with 2 staples. Patients were scored pre-operatively and at 6 and 12 months post-operatively using the VISA-A and AOFAS ankle-hindfoot scores. Results were analysed with the paired student t-test.

Introduction:

Peroneal muscle weakness is a common pathology in foot and ankle surgery. Polio, charcot marie tooth disease and spina bifida are associated with varying degrees of peroneal muscle paralysis. Tibialis Posterior, an antagonist of the peroneal muscles, becomes pathologically dominant, causing foot adduction and contributes to cavus foot posture. Refunctioning the peroneus muscles would enhance stability in toe off and resist the deforming force of tibialis posterior. This study determines the feasibility of a novel tendon transfer between peroneus longus and gastrocnemius, thus enabling gastrocnemius to power a paralysed peroneus tendon.

Method:

12 human disarticulated lower limbs were dissected to determine the safety and practicality of a tendon transfer between peroneus longus and gastrocnemius at the junction of the middle and distal thirds of the fibula. The following measurements were made and anatomical relationships quantified at the proposed site of the tendon transfer: The distance of the sural nerve to the palpable posterior border of the fibula; the angular relationship of the peroneus longus tendon to gastrocnemius and the achilles tendon; the surgical field for the proposed tendon transfer was explored to determine the presence of hazards which would prevent the tendon transfer.

Introduction:

Plantar Fasciitis is an extremely common and challenging problem that presents itself to foot and ankle practitioners. Many different treatment modalities are available for this condition, with little proven benefit. ECSWT was approved for use by the FDA for the treatment of chronic proximal plantar fasciitis in 2002 and NICE published guidance in 2009 recommending its use in refractory cases.

Methods:

Patients who diagnosed with ultrasound scan, and for whom other treatments were unsuccessful, underwent treatment on an outpatient basis. They had three 4–5 minute sessions, once a week. A Spectrum machine was used delivering 10 Hz waves in 500 preset pulses at 2 bar pressure, followed by 2000 preset pulses at 2.5 bar pressure. Pre- and 3 month post-treatment pain levels were recorded using a 10 point Visual Analogue Scale.

Introduction:

Historically the incidence of Achilles re-ruptures has been described as around 5% after surgical repair and up to 21% after conservative management. In 2008 we commenced a dedicated Achilles tendon rupture clinic for both conservative and surgically managed patients using new standardised operating procedures (SOP). We have evaluated the impact of this new service, particularly with regard to re-rupture rate.

Materials and methods:

The SOP was stage dependent and included an initial ultrasound examination, functional orthotics with early weight bearing, accelerated exercise and guidelines for the return to work and sport. Evaluation included re-rupture rate, complication rate, and outcome measured by the Achilles Tendon Total Rupture Score (ATRS) and Achilles Tendon Repair Score (AS). A basic cost evaluation was performed to assess any potential savings.

Introduction:

Patient reported outcome measures are becoming more popular in their use. Retrospective scoring is not yet a validated method of data collection but one that could greatly decrease the complexity of research projects. We aim to compare preoperative and retrospective scores in order to assess their correlation and accuracy.

Methods:

36 patients underwent elective foot and ankle surgery. All patients were scored preoperatively using the SF-12 and FFI. Patients then recorded both PROMs retrospectively at the three month follow up (av. 139 days). Results were then analyzed for statistical significance.

Introduction:

Surgeons want to counsel their patients accurately about the risks of rare complications. This is difficult for venous thromboembolism (VTE), as most studies report rates of asymptomatic disease, which may not be clinically relevant. Generic guidelines promote chemoprophylaxis in foot and ankle surgery despite a relative dearth of evidence. We therefore calculated the rate of confirmed, symptomatic deep vein thrombosis and pulmonary embolism, after surgery or trauma to the foot or ankle, in our hospital.

Methods:

In a retrospective cohort design, we scrutinised referrals for venous Doppler ultrasound and computed tomography pulmonary angiography, and found all confirmed deep vein thromboses (DVTs) or pulmonary embolisms (PEs) over an 18 month period from November 2010 to May 2012. These patients were cross-referenced with our orthopaedic database. All adult trauma admissions and fracture clinic attendances were retrieved and divided according to injury. We then identified all adult elective patients using Healthcare Resource Group code data.

Introduction:

The National institute of Health and Clinical Excellence (NICE) guidelines for thromboprophylaxis following lower limb surgery and plastercast immobilisation recommend pharmacological prophylaxis be considered until the cast is removed. These guidelines have been extrapolated from data for hip and knee arthroplasty, and trauma studies. Recent studies have questioned the validity of these guidelines. At Portsmouth, low molecular weight heparin (LMWH) is prescribed for 14 days following surgery in high risk patients. The protocol predates the most recent NICE guidance. We set out to investigate whether this was a safe method of thromboprophylaxis following elective hindfoot surgery.

Methods:

A retrospective audit of all patients undergoing hindfoot surgery between 01/01/10 and 31/12/12 was performed. All patients were immobilised in a POP backslab and prescribed 14 days of LMWH. All patients were reviewed at 2 weeks and converted to a full cast or boot. Immobilisation was continued for between 6 and 12 weeks. A list of all patients who had undergone investigation for deep vein thrombosis at Queen Alexandra hospital from 01/01/10 to 28/03/13 was obtained from the VTE investigation department. The two lists were cross referenced to identify any DVTs occurring following hindfoot surgery and plastercast immobilisation.

Introduction:

NICE guidelines state that every patient should be assessed for their VTE risk on admission to hospital. The aim of this study was to determine whether currently recommended risk assessment tools (Nygaard, Caprini, NICE and Plymouth) can correctly identify the patients at risk.

Methods:

In a consecutive series of over 750 trauma patients treated with cast immobilisation 23 were found to have suffered a VTE. Their notes were retrospectively reviewed to discover how many had been assessed for their VTE risk on admission. Additionally, the 4 most current Risk Assessment Tools were used to retrospectively score the patients for their VTE risk to determine whether they would have been identified as at risk of sVTE, had the RAMs been used at the time. We also identified a matched group of patients in the same cohort who had not suffered a VTE and they were also retrospectively risk assessed.

Introduction:

Techniques devised for 1^st MTPJ arthrodesis have been described since 1979 when Humbert et al published a ‘tongue and trough’ technique. Common contemporary techniques include fixation with single or crossed screws, or dorsal plates and these are suitable for a variety of indications. All three contemporary techniques have demonstrated a wide range of fusion rates. This study reports a comparison of non-union rates of the 1^st metatarsophalangeal joint (MTPJ) with the current Memometal Anchorage™ dorsal plate system and the previous Hallu-fix™ and Charlotte™ systems.

Methods:

Between 01/2009 and 07/2012 174 consecutive 1^st MTPJ fusions were performed for 153 patients (Mean age 62, range 42 to 83) by three surgeons at one University teaching hospital. 40 patients (23%) were male and 132 (77%) female. Patients without available radiographs were excluded from the study. 20 patients received Hallu-fix™ plates, 76 Charlotte™ plates and 76 Memometal Anchorage™. Radiographs of the feet were taken from four weeks postoperatively and reviewed for incomplete bone bridging and increased radiolucency around screws.

Introduction:

Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. Arthroscopic excision of calcaneonavicular bars have previously been described as has a technique for excising talocalcaneal bars using an arthroscope to guide an open resection. We describe a purely arthroscopic technique for excising talocalcaneal coalitions. We present a retrospective two-surgeon case series of the first eight patients (nine feet).

Methods:

Subtalar arthroscopy is performed from two standard sinus tarsi portals with the patient in a saggy lateral position. Coalitions are resected with a barrel burr after soft tissue clearance with arthroscopic shavers. Early postoperative mobilisation and non-steroidal anti-inflammatory drugs prevent recurrence of coalition. Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 to 5.5 years.

Introduction:

In a consecutive series of 71 arthroscopic subtalar arthrodeses performed between 2004 and 2011, 14 also involved arthroscopic decortication of the talonavicular joint (double arthrodesis) and 4 the subtalar, talonavicular and calcaneocuboid joints (triple arthrodeses).

Methods:

We examined complications, union rates in all 18 patients and clinical outcomes in 16 for whom this was the sole procedure.

Introduction:

The National Joint Registry has been capturing data on ankle replacement surgery since April 2010. This currently represents the largest cohort of ankles replacements captured worldwide and is a valuable resource to give us short term outcome of ankle replacement surgery.

Methods:

All the ankle replacements on the NJR were linked to the HES database using deterministic methods. The results were then anonymised. We then looked at Hopital admissions after the ankle replacement had taken place.

Introduction:

The Scandinavian Total Ankle Replacement (STAR) is a three-component, uncemented implant in widespread use throughout Europe. STAR has achieved encouraging results with short and medium term outcome. We present the long term (13–19 year) results of a consecutive series of 200 STAR ankles.

Methods:

Between November 1993 and February 2000, a total of 200 consecutive STARs were carried out in 184 patients. Patients were followed up both clinically and radiologically, until death or failure, with time to decision to revision or fusion as the endpoint. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score.

Introduction:

Total ankle replacement is a recognised treatment for disabling end stage ankle arthritis and an alternative to arthrodesis, although results are not yet comparable to other joint replacements. This has stimulated a constant evolution in design of implants and instrumentation. The Nottingham Foot and Ankle Unit used the STAR until 2005, when it switched to Mobility, due to the perceived advantages of less bone resection, improved instrumentation and potentially less polyethylene insert wear. The aim of this study is to report the unit's results and review the different outcomes between the two ankle replacements used.

Methods:

A retrospective analysis of all total ankle replacements carried out by the foot and ankle unit at Nottingham City Hospital between March 1999 and June 2013. Post operative complications, associated reoperations and revisions were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS), Foot Function Index (FFI), European five dimension quality of life scores (EQ-D5) and patient satisfaction was independently assessed at each follow up visit. Other ankle replacements or those performed elsewhere or with less than 12 month follow up were excluded.

Introduction:

Symptomatic treatment of ankle osteoarthritis (OA) with corticosteroid injections is well established. Hyaluronic acid is also reported as an effective symptomatic treatment for ankle OA but these two treatments have not been compared directly.

Methods:

A prospective randomised controlled trial in patients with symptomatic ankle osteoarthritis. Twenty patients per group were required based on a significance level of 0.05, and a drop out rate of 5%. Patients were blindly allocated to the treatment or control group. Injections were carried out by the clinician in the outpatient department. Treatment group received Ostenil 20 mg and control group received Depomedrone 40 mg (both as single injections). The treatment arm was allocated by computer generated block randomization to match treatment allocation with grade of arthritis. The primary outcome measure was the change in Visual Analogue Scale (VAS) pain score at 6 months. Secondary outcome was the change in AOFAS score at 6 months. Research ethics committee approval was obtained.

Introduction:

Total Ankle Replacement is proving to be a viable option for younger patients with Post Traumatic Osteoarthritis of the Ankle. The aim of our study was to study the clinical and patient reported outcomes between patients of < 60 and > 60 years who underwent TAR.

Method:

Patients who underwent a TAR between March 2006 and May 2009 were invited to take part in the hospital patient registry. They were divided into two groups based on Age (Group A-Age > 60 and Group B-Age < 60). Patient demographics, co-morbidities, Clinical (AOFAS) outcomes, patient reported outcomes (FAOS, SF-36, patient satisfaction) and complications were collected from patients pre-operatively and at 1, 2 and 3 years follow up. Comparisons were made between groups for all outcome measures.

Introduction:

The aim of this study was to assess patients reported fitness to return to work and to driving after ankle replacement.

Method:

Using Hospital Joint Registry, patients who underwent ankle replacement between 2006 and 2011 were invited to take part in the study. Questionnaires were sent to these patients. Participants were asked to report the nature and pattern of their work (full time or part time), time it took to return to work and subsequent nature of work. Participants were also asked about time to return to driving.

Introduction:

There is paucity of literature on Gait analysis following Total Ankle Replacement (TAR). We aimed to study changes to gait after successful Mobility TAR.

Methods:

20 patients who underwent a primary TAR, with a diagnosis of either OA or PTOA were recruited between October 2008 and March 2011. Gait analysis was carried out using the Helen Hayes marker system with VICON 3D opto-electric system pre-operatively, 3, 6 and 12 months post-operatively. Ankle kinematics and spatio-temporal parameters of gait were studied.

Introduction:

Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritic complaints of the ankle. Glazebrook et al proposed a three grade classification of complications to assist prediction of early implant failure. We have compared the experience of a tertiary referral centre in the UK to Glazebrook's proposed system.

Method:

A retrospective review of the Sheffield Foot and Ankle Unit TAR database was performed from 1995 to 2010. All complications were recorded and categorised using Glazebrook's proposed system. Glazebrook described eight main complications of increasing severity. Low grade complications; Post operative bone fracture, Intra-operative bone fracture and wound healing problems were very unlikely to lead to revision. Medium grade complications; technical error and subsidence, lead to failure < 50% of the time. High grade complications; deep infection, aseptic loosening and implant failure lead to revision > 50% of the time.

Introduction:

TTC fusion for the salvage of failed TARs with significant bone loss using a hindfoot nail and femoral head allograft has been reported in a number of small series. We present our experience of this procedure.

Method:

Review of the theatre records from 2006 to July 2011 identified twenty four cases using this technique. The case notes and imaging were retrospectively reviewed.