As hallux valgus (HV) worsens clinical and radiological signs of arthritis develop in metatarsophalangeal joint due to incongruity of joint surfaces. The purpose of this prospective study was to determine if intraoperative mapping of articular erosion of the first metatarsal head, base of the proximal phalanx, and tibial and fibular sesamoids can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity We analysed 50 patients prospectively who underwent surgery between Jan 2009-Jan 2010. Patients with a known history of previous first metatarsophalangeal joint surgical intervention, trauma, or systemic arthritis were excluded from analysis. Preoperative demographics and AOFAS score were recorded. Intraoperative evaluation and quantification of the first metatarsal head, base of the proximal phalanx, and sesamoid articular cartilage erosion was performed. Cartilage wear was documented using International Cartilage Research Society grading.Background
Materials and methods
Absence of rotator cuff allows unbalanced muscle forces of the shoulder to cause vertical migration of the humeral head. The translation of the humerus causes impaction of articular surface against the acromion. The purpose of the study is to assess outcome of Cuff tear arthropathy (CTA) Hemiarthroplasty prosthesis in this group of patients. Retrospective review was undertaken in 42 patients who underwent Global CTA Hemiarthroplasty between Jan 2001-Jan 2009. The mean length of follow up was 6 years.Background
Methods
It is recognised that as the severity of However, few studies specifically document the degenerate changes. The purpose of this study is to determine if intraoperative mapping of articular erosive lesions of the first MTP joint can be correlated to clinical and/or radiographic parameters used during the preoperative assessment of the HV deformity. We prospectively analysed 50 patients who underwent surgery between Jan 2009 & Jan 2010. Patients with a known history of previous first three patients did not have scoring or cartilage wear documentation carried out and were excluded. The mean age was 56 years. The mean Materials & Methods
Results
Syndesmosis injuries are significant injuries and require anatomical reduction. However, stabilisation of these injuries with syndesmosis screws carries specific complications and many surgeons advocate a second operation to remove the screw. Primary Tightrope suture fixation has been shown to be an effective treatment for syndesmotic injuries and avoids the need for a second operation. A retrospective audit identified patients who were treated for syndesmosis injuries over a two year period. Theatre and clinic costs were obtained to compare the cost of syndesmosis fixation using diastasis screws with the estimated cost of primary syndesmosis fixation using a Tightrope suture.Introduction
Materials and Methods
Ankle fractures are common injuries affecting all age groups and constitute a large proportion of the orthopaedic trauma caseload. Frequently a large number of bed days are utilized waiting for swelling to subside and a theatre slot to become available. We audited current practice and then implemented a home therapy program (HTP). If HTP criteria were met then patients with reduced, unstable ankle fractures were taught how to use crutches and allowed home from the emergency department in order to ice and elevate at home. They were then admitted from clinic for surgery the same day and then discharged when safe and comfortable. The purpose of this study was to prospectively compare the local management of surgically stabilised ankle fractures before and after instigating a home therapy program. 43 consecutive patients met our inclusion criteria and underwent surgical fixation of unstable ankle fractures over a three month period (February to April 2008.) The average length of hospital stay was 8 days (1–18), 4.5 days pre-operatively and 3.5 days post operatively. Forty-eight patients underwent surgical fixation of unstable ankle fractures over a four month period (November 2008 to February 2009.) Twenty-one met the home therapy criteria. The average length of hospital stay was reduced to three days, 1.6 days pre-operatively and 1.3 days post operatively. Additionally a patient survey revealed high levels of satisfaction with the HTP. The home therapy program has effectively reduced hospital stay both pre and post-operatively. Patients mobilising at home pre-operatively mobilise earlier post-operatively and are discharged home earlier. Over the three-month period of HTP, 131 bed days were saved which equates to a saving of £30,000.
Survivors of meningococcal septicaemia often develop progressive skeletal deformity secondary to physeal damage at multiple sites, particularly in the lower limb. Distal tibial physeal arrest typically occurs with sparing of the distal fibular physis leading to a rapidly progressive varus ankle deformity. There is no previous literature reporting this ankle deformity following meningococcal septicaemia. We report the management of this deformity in 13 ankles in 10 consecutive patients 36 months after meningococcal septicaemia. Plain radiographs and MRI were used to define the deformity and the extent of growth plate involvement. The Taylor Spatial Frame (TSF) with a distal tibial metaphyseal osteotomy was used to restore the distal tibio-fibular joint. Distal fibular epiphysiodesis was performed in all ankles at the initial procedure. Distal tibial epiphysiodesis was performed at the time of fixator removal. The age at operation ranged from 3–14 years (mean 8). The preoperative ankle varus deformity ranged from 9–29 degrees (mean 19). The differential shortening of the tibia with respect to fibula was on average 1.2 cms. The mean time in frame was 136 days. After a mean follow-up of 1.7 years results were excellent in all patients with complete correction of deformity and shortening. Mechanincal axis was corrected in all patients. Complications included, 4 superficial pin site infections, 1 lateral peroneal nerve palsy which recovered completely. There were no major nerve or vascular complications. We consider that this approach provides a powerful method of correction for this difficult group of patients.
