Introduction

Removal of primary components during revision TKA procedure can damage underlying bone, resulting in defects that may need filled for stability of the revision reconstruction. Special revision components including cones and/or augments are often used to compensate for the missing bones. Little work has been done to characterize metaphyseal geometry in the vicinity of the knee joint, however, in order to motivate proper size and shape of cones and augments. The objective of this study was to use statistical shape modelling to evaluate variation in endosteal anatomy for revision TKA.

Introduction

Ankle fractures are common injuries presenting to trauma departments and ankle open reduction and internal fixation (ORIF) is one of the first procedures targeted in early orthopaedic training. Failure to address the fracture pattern with the appropriate surgical technique and hardware may lead to early failure resulting in revision procedures or premature degenerative change. Patients undergoing revision ORIF are known to be at much greater risk of complications, and many of these secondary procedures may be preventable.

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.

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score. We compared the outcome of surgical management Sanders type-2 and type-3 fractures with conservative treatment at 2 years and then, the medium term (> 5 years) outcomes of type-2 and type-3 surgical groups were assessed. Conservative group was a consecutive series of patients recruited to the study later than surgical groups, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group type-2 and 38 in group type-3 with surgical management, while only 18 in the group with conservative management. The mean age for surgical type-2 = 46.2, type-3= 46.3 and conservative group = 51.7. Mean follow-ups for the groups were type-2=6y, type-3 =5.5y and conservative one =2.34y. Mean two-year scores for the surgical groups were type-2=68.13, type-3=63.78, while conservative one =51.36.

There was a statistically significant differences in their score between type-2 surgical and conservative groups (P=0.0006), and between type-3 surgical and conservative ones (P=0.04), but no significant difference between type-2 and type-3 surgical groups.

At medium-term follow-up, the scores for type-2 and type-3 surgical groups were 77.06 and 63.66 respectively, with significant increase in type-2 while type-3 remains similar comparing to two-year scores. There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, surgical type-2 group of patients showed some improvement, while type-3 stayed the same.

In this series, contrary to published articles, there was a better outcome at two years with surgical treatment than conservative treatment.

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score.

We compared the outcome of surgical management Sanders type 2 (Group A) and type 3 (group B) fractures with conservative treatment (group C) at 2 years and assessed the medium term outcomes of groups A and B. Group C were a consecutive series of patients recruited to the study later than A and B, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group A, 38 in group B, and 18 in group C. Mean follow-ups for the groups were A=6y, B=5.5y and C=2.34y. Mean two-year scores for the groups were A=68.13, B=63.78, and C=51.36, with statistically significant differences between groups A and C (P=0.0006), and between groups B and C (P=0.04), but no significant difference between groups A and B.

At medium-term follow-up (> 5 years), the scores for group A and B were 77.06 and 63.66 respectively.

There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, group A showed some improvement and group B stayed the same.

In this series, there was a better outcome at two years with surgical treatment than conservative treatment.

Purpose: To evaluate the objective outcomes in patients who had undergone hardware removal after ORIF of calcaneus fractures.

Materials and Methods: Between 1994 and 2002, 31 cases of hardware removal was performed in 30 patients (25 male, 5 female) with an average age at operation of 47 years (31 to 65 years) were reviewed. Patients’ demographic details were recorded including smoking habit. Fracture patterns were graded according to the Sanders’ classification with preoperative CT scans. The clinical result was assessed using Bristol hind foot scoring system. Serial radiographs assessments were also recorded.

Results: Average follow-up was 4.5 years. Average delay from time of injury to surgery was 12.4 days (range 5 to 24 days). 7 (23%)fractures were Sanders’ type 2A, 8 (26%)fractures were type 2B, 6 (19%)fractures were type 2C, 2 (6%) fractures were type 3AB and 8 (26%) fractures were type 3AC. Average time from surgery to hardware removal was 27 months (range 11 to 45 months). There were 16 smokers and 14 non-smokers. There were 5 deep infections and 3 superficial wound infections after ORIF of calcaneus fractures. 84% of the patients shown objective improvement following hardware removal at the latest follow-up. 2 patients had unsuccessful hardware removal due to dense scarring. No wound infections were recorded. Smoking habit had no significant bearing on the objective outcome improvement following hardware removal (p= 0.891), time from surgery to hardware removal (p=0.53) and wound morbidity (p= 0.4882). Objective improvement showed a statistically significant improvement in the Sanders’ type 2 compared with Sanders’ type 3 (p=0.015).

Conclusion: Removal of hardware is justified in symptomatic patients following ORIF calcaneus fractures. It results in an improved objective outcome and has a low complication rate. Hardware removal may be considered in cases of Sanders’ type 2 calcaneus fractures which are refractory to improvement.

Introduction: Stainsby’s procedure for correction of severe claw toe deformity is a relatively new procedure in foot and ankle surgery. The purpose of this study is to evaluate our early experience in a single institution.

Method: Between 1998 and 2002 we reviewed retrospectively 17 patients who had severe claw toe deformity who had undergone Stainsby’s procedure. All patients had lesser toe involvement. The records and radiographs were reviewed and the subjective assessment by telephone interview.

Results: Eleven females and six males were included. There were 21 feet and 42 toes with four bilateral feet involvement. Mean age of 56.7 years (range 40–78) and median follow-up was 28 months (range 8–48). Ten feet in nine patients undergone single lesser toe correction and 11 feet in eight patients undergone multiple toe correction were reviewed. Five patients (29.4%) with six feet suffered rheumatoid arthritis (RA); four patients (23.5%) with six feet suffered cavus deformity and the remaining eight patients (47.1%) with nine feet had isolated toe pathology. All patients were presented with shoe wear problem with 16 (94.1%) patients had pain related to callosities. Sixteen (94.1%) patients were satisfied with the results; two patients had persistent metatarsalgia. Forty (95.2%) toes had good alignment and two (4.8%) toes had recurrent asymptomatic clawing. Fifteen (88.2%) patients had unlimited daily activities. Eleven (64.7%) patients are able to have normal foot wear, four (23.5%) require insole support and two (11.8%) required soft padding only. Complications included sensory alteration in two patients who had multiple lesser toe correction and seven patients had superficial wound infection. There was no statistical difference in results related to number of toes operated on and association with RA.

Conclusion: Stainsby’s procedure remains a versatile surgical technique when dealing with severe claw toe deformity. It gives very good correction with high patients’ satisfaction rate and a low complication rate. We recommend this surgical technique, as one of the armamentarium foot and ankle surgeons should acquire.

Aims: Minimal invasive surgery is now possible for hip replacement. We present our system (called the SE Hip SystemTM). It is a universal system and is here used with the LINKTM C.F.P stem and T.O.P cup.

Methods: We have used this system on forty patients. It involves five steps. One (incision) – a single 5cm. postero-lateral incision; two (neck cut) – application of a cutting block to the femoral neck and removal of the head; three (broaching the femur) – preparation of the femur; four (reaming the acetabulum) – ream using the modified reamers and precisely place the cup with the lollipop device; five- place the stem and soft tissue balance with the spacers. The hip is then reduced and the wound closed.

Results: The average pre-operative Harris hip score was 28.64; the average post-operative score was 82.65. Complications included one transient sciatic nerve palsy. Average blood loss was 250 mls, the average time in hospital was 3 days and the average number of physiotherapy sessions required was 4.

Conclusions: Minimal invasive hip surgery is now possible. There is a markedly reduced cone of dissection. Navigation systems and intra-operative imaging are not required. This technique should minimize maltracking (and wear) and shorten the recovery period allowing the possibility of day or outpatient hip surgery.

Introduction

Mallet toe is a flexion deformity of the distal interphalangeal joint of the lesser toe. It causes pain and callosity in the toe tip and the dorsum of the distal interphalangeal joint. Campbell refers to the “terminal Syme’s amputation” for this condition but the results of this have not previously been reported.

Material and Methods

This is a retrospective review of 35 toes in 22 patients that underwent distal phalangectomy. Sixteen patients were aged over 70. Patients were interviewed by an independent observer regarding the pain relief, cosmetic acceptability and satisfaction with the procedure and were examined for callosity, stump tenderness, sensitivity and neuroma.

Results

All patients were satisfied including pain relief and cosmetic acceptability at an average follow up of 4.6 years. One patient had mild wound infection. One patient had asymptomatic nail growth. No stump tenderness, sensitivity or neuroma was noted.

Discussion and Conclusion

Coughlin reported a satisfaction rate of 89% and 86% following successful fusion and excision arthroplasty respectively. In this series all patients were satisfied. We feel that distal phalangectomy is an option in a selected group of elderly patients where pain relief and functional outcome is the priority.