Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following acute dislocation of the patella. This study looked at the radiological and functional outcomes of fixation of osteochondral fractures Twenty-nine patients (18 male, 11 female) sustained osteochondral fractures of the knee following patellar dislocation. All patients had detailed radiographic imaging and MRI scan of the knee preoperatively. An arthroscopic assessment was done, followed by fixation using bio-absorbable pins or headless screws either arthroscopically or mini-open arthrotomy. VMO plication or MPFL repair were done if necessary. MRI scan was done at follow-up to assess for healing of the fixed fragment prior to patient discharge.Abstract
Introduction
Methods
Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications.Abstract
Background
Methods
Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation. Eighty-seven patients with knee dislocation were treated at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 4 weeks was preferred unless the patient was too unstable (Injury severity score>16). The collaterals were repaired and augmented using a variety of autografts, allografts or synthetic grafts. PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score.Abstract
Introduction
Methods
Fracture dislocation of the knee involves disruption of two or more knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee(IKDC) score and Knee Injury & Osteoarthritis Outcome Score(KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements & complications.Abstract
Background
Methods
Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. Treatment needs to be customised to the patient taking into consideration injury to the knee; associated neurovascular and systemic injuries. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation.Abstract
Background
Objective
The distal radius is the most frequently fractured bone in the forearm with an annual fracture incidence in the UK of about 9–37 in 10,000. Restoration of normal anatomy is an important factor that dictates the final functional outcome. A number of operative options are available, including Kirschner wiring, bridging or non-bridging external fixation and open reduction and internal fixation by means of dorsal, radial or volar plates. We designed this study to analyse the clinical and radiological outcome of distal radial fracture fixation using volar plating. Thirty-seven patients with distal radius fractures undergoing open reduction and internal fixation using volar plates were included. Tilt of the fractured distal radial fragment was recorded from the initial radiograph and classification of fractures was done using the Orthopaedic Trauma Association system. The QuickDASH questionnaire was used for evaluation of symptomatic and functional outcome six months to one year after surgery. The radiological outcome was assessed using measurements of radial inclination, ulnar variance and volar tilt. Of the thirty-seven patients, 13 were male and 24 were female. The mean age was 55.6 years (range 18–87 years). According to the AO classification, there were 8 cases each of C2 and C3 fractures, 6 cases of C1 fractures and 3 cases each of class A2, A3, B1 and B3 fractures. There were 2 patients with class B2 fracture.Introduction
Materials/Methods
Hip fractures accounts to about 86000 cases per annum in UK. AP and Lateral radiographs form an essential investigation in planning the management of these fractures. Recently it has been suggested that lateral view doesn't provide any additional information in majority of the cases. We looked retrospectively at 25 consecutive radiographs with intracapsular and extracapsular fracture neck of femur each presenting to our department between May 2010 and January 2011. These radiographs were put on the CD in 2 folders as AP and Lateral. It was reviewed by 2 Observers who suggested their preferred treatment. The results were compared for the intra observer agreement to assess the necessity of the lateral view of the radiographs. We also compared the treatment options with the gold standard and looked at the interobserver agreement. Of the 50 set of radiographs that were reviewed, Observer 1 had disagreed with himself on one occasion (98%agreement) compared to the Observer 2 who had two disagreements (96% agreement). When analyzing the intracapsular fractures, we found 100% agreement of OBSERVER 1 with himself when proposing treatment on AP and Lateral View. Whereas, OBSERVER 2 had only one disagreement. It gave us a Free marginal kappa value of more than 0.70 indicating excellent agreement. One difference doesn't have any statistical significance. In the extracapsular fractures, Kappa values ranged from 0.413 to 0.88. OBSERVER 1 did change his opinion after reviewing the lateral view but generally had good outcome (K=0.88). Whereas, the opinion of OBSERVER 2 was unaffected by the Lateral view. The X-ray diagnoses by OBSERVER 1 and OBSERVER 2 had only moderate agreement (K=0.52 (AP) and 0.57 (Lat). Comparing the observer opinion to the gold standard (operation performed) showed moderate agreement both on AP and Lateral view (OBSERVER 1 AP and Lat both K=0.64, OBSERVER 2 AP and Lat both K=0.41). The Lateral view failed to change the opinion of the observers (K > 0.7) but there was moderate to excellent agreement between the observers and observer vs operation (The Gold Standard) with kappa value of more than 0.52. We feel that the Lateral view doesn't make any difference in most of the cases as shown by a good intra-observer agreement. However, we cannot completely rule out their importance and they should be performed in occult fractures, pathological fractures, fractures extending into the shaft, young patients, and on the request of physician.
Nonunions pose complications in fracture management that can be treated using electrical stimulation (ES). Bone marrow mesenchymal stem cells (BMMSCs) are essential in fracture healing, although the effects of different clinical ES waveforms available in clinical practice on BMMSCs cellular activities is unknown. We compared Direct Current (DC), Capacitive Coupling (CC), Pulsed Electromagnetic wave (PEMF) and Degenerate Wave (DW) by stimulating human-BMMSCs for 5 days for 3 hours a day. Cytotoxicity, cell proliferation, cell-kinetics and cell apoptosis were evaluated after ES. Migration and invasion were assessed using fluorescence microscopy and affected gene and protein expression were quantified.Introduction
Materials and Methods
Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery. Fifty consecutive patients who underwent first metatarsal corrective osteotomy from January 2009 to July 2010 were reviewed. The operation type, foot side operated, postoperative complications and other conditions affecting driving were recorded from charts and operation notes. A telephonic survey was then conducted and information was recorded in a predesigned questionnaire. The questions included driving advice given by the medical staff, time interval to begin driving postoperatively, and how long the patient took to gain full confidence at driving. It was also noted whether patients required changing the type of car from manual to automatic.INTRODUCTION
METHODS
We reported the first single surgeon series comparing outcome of microscopic and open primary single level unilateral lumbar decompression or discectomy. We aimed to determine any difference in outcomes between the two techniques. Forty-six decompressions were performed with use of an operating microscope (microscopic), and forty without (open) at two different hospitals. All procedures were performed by the senior author. Information was obtained by analysis of the patients' notes. The average age of the patients in both groups was comparable. Operating time was shorter in the microscopic group (68min, range 30-130) compared to the open group (83 mins, range 30-180). Dural tear rate was 4.3% with use of a microscope (0% symptomatic dural tear rate) and 7.5% without (2.5% symptomatic dural tear rate). Nerve damage incidence was 0% with use of a microscope and 5% (two patients) without. One of these was a neurapraxia and the patient made a full recovery. Wound infection rates, diagnosed on grounds of clinical suspicion, were 4.3% and 2.5% for microscopic and open respectively. There were no incidences of deep infection or post-operative discitis. Average inpatient stay was under 48 hours in both groups. Using the modified Macnab criteria, results using the microscope were 0% poor, 14% fair, 32% good, and 55% excellent. The results for the open group were 0% poor, 10% fair, 37% good and 53% excellent. Average follow-up was six months (1-19) for the microscope group, and seven months (2-16) for the open group. We conclude that primary single level unilateral lumbar decompressive surgery, performed without the use of a microscope, has a higher dural tear rate than the same surgery performed with the benefit of an operating microscope. Surgical time and incidence of nerve damage are also reduced by use of the microscope.
The aim of this study was to review the different surgical modalities for ingrown toenails in the paediatric age group in a hospital setting.
All procedures were carried out under general anaesthetic. The treatment methods practised were:
Nail avulsion with or without nail matrix ablation using phenol. Wedge excision of the nail with or without nail matrix ablation using phenol or thermal ablation.
We also applied the same Fischer’s exact test for rate of infection in all the groups.
During the stage of inflammation, conservative measures in the past have been noted to be successful. In a hospital setting, most patients present in the second stage (infection). Nail avulsion is still commonly practised as a first line treatment. It provides good symptomatic relief in this stage but has been reported to have high rates of recurrence. We noted similar results (recurrence rate: 55%) in our study. Then patients present in the next stage with symptoms of chronic ingrowths i.e. previous infection and presence granulation tissue in the nail fold. The aim of treatment here is to remove the ingrown area along with the nail fold. Wedge excision with or without removal of nail matrix is a commonly performed procedure. There are various methods for removing the nail matrix namely surgical matrixectomy, chemical matrixectomy using phenol or sodium hydroxides, diathermic/electric cauterisation, laser. There are reports that show low recurrence rates with use of phenol. In this study we found recurrence and infection to be high when phenol was used as the ablative agent. We achieved cure rate of 97% when using wedge excision alone and 70% when phenol was used for nail matrix ablation.
In 15 consecutive patients with slipped capital femoral epiphysis we recorded height, weight and skeletal maturity. Sexual maturity was assessed clinically and biochemically, and Harris's hypothesis that there is an increased ratio of serum growth hormone to oestrogen was tested in comparison with 15 age and sex matched controls. We found no difference in skeletal or sexual maturity between the groups, or any overt endocrine abnormality in the patients. However almost half the patients with slipped epiphysis were over the 90th weight percentile, suggesting that mechanical factors such as obesity are more important aetiologically than endocrine abnormalities.
