Background

Patient reported outcomes/experience measures have been a fundamental part of the NHS since 2009. Osteotomy procedures for hallux valgus produce varied outcomes due to their subjective nature. We used PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to assess what the patient reported outcome/experience measures for scarf+/− akin osteotomy for hallux valgus are at UHSM.

Background

PROMS and PREMS are a fundamental and essential part of the NHS. Chilectomy and fusion procedures for hallux rigidus produce varied outcomes due to their subjective nature. PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to compare what PROMS/PREMS for chilectomy/fusion for hallux rigidus are at UHSM including variance across osteoarthritis grades.

Background

Patient reported outcomes measures are a fundamental part of the NHS. Since 2009, they have been used to measure quality from the patient's perspective. PROMS2.0 is a semi-automated web based system, which allows collection and analysis of outcome data. This study looks at the factors, which can influence PROMS. These include looking at general trends which affect reported outcomes such as surgeon, age and gender. We also look to assess the reasons for non-uptake in the study.

There has been evidence of association between femoral shaft fractures and prolonged bisphosphonate therapy. We present a case series of bisphosphonate-associated fractures and invaluable lessons we have learnt.

Over the last three years at our unit we have collected a case series of eight patients who have had atypical femoral fractures whilst on bisphosphonate therapy. We present illustrative cases, a summary of key findings, and invaluable lessons we have learnt.

There was a long period of prodromal pain for two years before incomplete fractures developed. We speculate this is a warning sign of impending fracture. This may have been prevented with screening. Between incomplete fracture and complete fracture there was a short window of one month. Five patients presented with complete fracture, and three with thigh pain +/- evidence of incomplete fracture. Of the latter group all but one went on to develop complete fractures. The one patient who did not progress died six years after diagnosis. Of those five patients who presented with initial complete fracture, three patients recall thigh pain before fracture on further questioning. Despite being diaphyseal femoral fractures, there is a higher risk of neck of femur fractures in this patient cohort (both patients with initial interlocked nails subsequently developed neck of femur fractures soon after and were revised to cephalomedullary nails). Excluding one death from unrelated cause, only one patient has signs of complete fracture healing. All other patients are still receiving follow-up (mean 490 days). Three patients reported bilateral symptoms (pain). Two had had bilateral symptoms for one year. Both had visible incomplete fractures on further radiographic scrutiny; one underwent prophylactic cephalomedullary nailing, one was managed with active surveillance.

We suggest that improved pain and radiographic changes of cortical healing may be misleading and should not be relied upon. Cephalomedullary nailing is the treatment of choice in these fractures due to higher risk of neck of femur fractures in this cohort. We suggest prompt prophylactic cephalomedullary nailing when radiographic incomplete fractures are identified due to a short window before progression to complete fracture, and the need to consider contralateral prophylactic nailing in patients describing bilateral symptoms. We speculate that thigh pain is a warning sign of impending fracture and fracture-progression can be prevented with appropriate screening.

Background

Patient reported outcome and experience measures have been a fundamental part of the NHS. We used PROMS2.0, a semi-automated web-based system, which allows collection and analysis of outcome data, to assess the patient reported outcome/experience measures for scarf+/− akin osteotomy for hallux valgus.

Osteonecrosis of femoral head is well known and recognised complication in Sickle cell disease patients. Due to the severity of the Osteonecrosis, hip pain is major limiting factor for these patients requiring total hip arthroplasty in relatively young age. We studied and report our results in total hip arthroplasty of sickle cell patients.

We studied 80 patients from our combined Orthopaedic & Haematology Sickle cell clinic. Twenty four patients had painful Osteonecrosis with secondary osteoarthritis of hip and underwent total hip arthroplasty. Three patients had bilateral hip replacements. A total of twenty seven replacements were studied retrospectively. 19 patients had uncemented (Corail/Pinnacle), 5 patients had hybrid(Pinnacle/Exeter) and 3 patients had cemented(Exeter) total hip arthroplasties respectively.

The patients were serially followed up for clinical and radiological assessments for loosening. Oxford hip score (OHS) was used to assess the functional outcome. The average age of the patients at the time of surgery was 38.4 (Range – 20 to 59 years. The average follow up was 5.1 years (Range – 6 months to 10 years). There were 13 female and 11 male patients. The average oxford hip score was 38.07 with 10% infection rate and 11% aseptic loosening.

Arthroplasties carry high risk in patients with sickle cell disease. We report lower rates of infection and loosening rates compared to the earlier studies. Combined Haematological and Orthopaedic team input is optimal during assessment, surgery, peri-operative period and follow up. Our results of total hip replacements in sickle cell disease patients are good.

Optimal surgical management of proximal humeral fractures remains controversial. We report our experience and the study on our surgical technique for proximal humeral fractures and fracture-dislocations using locking plates in conjunction with calcium sulphate augmentation and tuberosity repair using high strength sutures. We used the extended deltoid-splitting approach for fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations.

We retrospectively analysed 22 proximal humeral fractures in 21 patients. 10 were male and 11 female with an average age of 64.6 years (Range 37 to 77). Average follow-up was 24 months. Fractures were classified according to Neer and Hertel systems. Pre-operative radiographs and CT scans in three and four-part fractures were done to assess the displacement and medial calcar length for predicting the humeral head vascularity. According to the Neer classification, there were 5 two-part, 6 three-part, 5 four-part fractures and 6 fracture-dislocations (2 anterior and 4 posterior). Results were assessed clinically with DASH scores, modified Constant & Murley scores and serial post-operative radiographs.

The mean DASH score was 16.18 and modified Constant & Murley score was 64.04 at the last follow-up. 18 out of 22 cases achieved good clinical outcome. All the fractures united with no evidence of infection, failure of fixation, malunion, tuberosity failure, avascular necrosis or adverse reaction to calcium sulphate bone substitute. There was no evidence of axillary nerve injury. The CaSO4 bone substitute was replaced by normal appearing trabecular bone texture at an average of 6 months in all patients.