Introduction. The various problems that are managed with circular external fixation (e.g. deformity, complex fractures) also typically require serial plain x-ray imaging. One of the challenges here is that the relatively radio-opaque components of the circular external fixator (e.g. the rings) can obscure the view of the area of interest (e.g. osteotomy site, fracture site). In this presentation we describe how the geometry of the x-ray beam affects the produced image and how we can use knowledge of this to our advantage. Whilst this can be applied to any long bone, we have focused on the tibia, given that it's the most common long bone that is treated by circular external fixation. Materials & Methods. In the first part of the presentation we describe the known attributes (geometry) of the x-ray beam and postulate what effect it would have when we x-ray a long bone that is surrounded by a circular external fixator. In the second part we demonstrate this in practice using a tibia and a 3 ring circular external fixator. Differing x-ray beam orientations are used to demonstrate both how the geometry of the beam affects the produced image and how we can use this to our advantage to better visualise part of the bone. Results. The practical part of the study confirmed the theoretical part. Conclusions. Knowledge of the beam geometry can be used to minimise the obscuring nature of the circular fixator. This technique is simple and can be easily taught to the radiographer. It is a useful adjunct for the limb reconstruction surgeon

Aims. Patients undergoing limb reconstruction surgery often face a challenging and lengthy process to complete their treatment journey. The majority of existing outcome measures do not adequately capture the patient-reported outcomes relevant to this patient group in a single measure. Following a previous systematic review, the Stanmore Limb Reconstruction Score (SLRS) was designed with the intent to address this need for an effective instrument to measure patient-reported outcomes in limb reconstruction patients. We aim to assess the face validity of this score in a pilot study. Methods. The SLRS was designed following structured interviews with several groups including patients who have undergone limb reconstruction surgery, limb reconstruction surgeons, specialist nurses, and physiotherapists. This has subsequently undergone further adjustment for language and clarity. The score was then trialled on ten patients who had undergone limb reconstruction surgery, with subsequent structured questioning to understand the perceived suitability of the score. Results. Ten patients completed the score and the subsequent structured interview. Considering the tool as a whole, 100% of respondents felt the score to be comprehensible, relevant, and comprehensive regarding the areas that were important to a patient undergoing limb reconstruction surgery. For individual questions, on a five-point Likert scale, importance/relevance was reported as a mean of 4.78 (4.3 to 5.0), with ability to understand rated as 4.92 (4.7 to 5.0) suggesting high levels of relevance and comprehension. Flesch-Kincaid reading grade level was calculated as 5.2 (10 to 11 years old). Conclusion. The current SLRS has been shown to have acceptable scores from a patient sample regarding relevance, comprehensibility, and comprehensiveness. This suggests face validity, however further testing required and is ongoing in a larger cohort of patients to determine the reliability, responsiveness, precision, and criterion validity of the score in this patient group. Cite this article: Bone Jt Open 2021;2(9):705–709

Introduction. Patients undergoing limb reconstruction surgery often face a challenging and often lengthy process to complete their treatment journey. The majority of existing outcome measures do not adequately capture the patient reported outcomes relevant to this patient group in a single measure. Following a previous systematic review, the Stanmore Limb Reconstruction Score (SLRS) was designed with the intent to address this need for an effective instrument to measure patient reported outcomes in limb reconstruction patients. Materials and Methods. The SLRS was designed following the use of structured interviews with a group of patients who have undergone limb reconstruction surgery, limb reconstruction surgeons, specialist nurses and physiotherapists. This has undergone further adjustment for language and clarity. The score was then trialled on 10 patients who have been through the process of limb reconstruction surgery, with subsequent structured questioning to understand the perceived suitability. Results. Ten patients have completed the score and the subsequent structured interview. All patients found the score acceptable to complete in the time while waiting in clinic. Considering the tool as a whole, 100% of respondents felt the score to be comprehensible, relevant and comprehensive regarding the areas that were important to a patient undergoing limb reconstruction surgery. For individual questions, on a 5 point Likert scale, importance/relevance was reported as a mean of 4.78 (4.3–5), with ability to understand rated as 4.92 (4.7–5) suggesting high levels of relevance and comprehension. Flesh-Kincaid reading grade level was calculated as 5.2 (10–11 years old). Conclusions. The current Stanmore limb reconstruction score has been shown to have acceptable scores from a patient sample regarding relevance, comprehensibility and comprehensiveness. This demonstrates face validity, however further testing required and is ongoing in a larger cohort of patients to determine the reliability, responsiveness, precision and criterion validity of the score in this patient group

To review indications and outcomes of all Ilizarov arm fixators applied by the two limb reconstruction surgeons. All patients treated with an upper limb Ilizarov frame were identified. Casenotes were reviewed. Demographic data, indications and duration of frames collected. Forty-seven patients had application of an arm frame. Average age 43 (17–81). Tertiary referrals in 72%. Previous surgery in 79%. Mechanism of injury included: 37% RTA, 40% simple falls. Reasons for frame usually multifactorial. Half of fixators applied acutely (< 6 weeks), 17 for non-unions. Two patients had neurological complications from frame surgery. One radial palsy possibly from humeral plate removal. One median palsy due to pressure from wire. Average frame time was 152 days (34–343). Over 80% achieved expected outcome -obtaining good function or fracture union. One patient had an above elbow amputation for persistent infection. Fourteen needed further frame surgery including 5 for frame removal, 3 adjustments and 2 corticotomies for lengthening. Most frames removed in clinic. The Ilizarov technique appears well tolerated and successful despite often infected or deformed tissues. Indications and intended function of arm frames very varied. This technique allows stabilisation (with/without bone loss), treatment of non-unions and lengthening/ bone transport. The Ilizarov technique is valuable for limb salvage/ reconstruction

Background: The Ilizarov Method is well established for lower limb trauma and reconstruction. However, although the same principles apply, its use in the upper limb is less well described. Aims of Study: To review indications and outcomes of all Ilizarov arm fixators applied by the two limb reconstruction surgeons in our unit. Methods and Results: All patients treated using an upper limb Ilizarov frame were identified and reviewed. Demographic data, indications and durations of frames collected. Fifty-one cases identified. Average age 43 (17–81). Tertiary referrals in 63%. Previous surgery in 78%. Mechanism of injury included: 37% RTA, 40% simple falls. Reasons for frame usually multifactorial including 22 for non-unions. 43% of fixators applied acutely (< 6 weeks). Average frame time was 152 days (34–343). Over 80% achieved expected outcome –obtaining good function or fracture union. 14 needed further frame surgery including 5 for frame removal, 3 adjustments and 2 corticotomies. Most frames removed in clinic. Complications: 30% superficial pin site infection. No deep wire infections. 1 wrist malunion requiring delayed correction. 2 patients had neurological complications from frame surgery. One radial palsy possibly from humeral plate removal. One median palsy due to pressure from wire. One patient had an above-elbow amputation for persistent infection. Conclusions: The Ilizarov technique appears well tolerated and successful despite often infected or deformed tissues. Indication and intended purpose of arm frames very varied. This technique allows stabilization (with/without bone loss), treatment of non-unions and lengthening/bone transport. The Ilizarov Method is valuable for limb salvage/reconstruction

One of the most challenging cases encountered by orthopaedic surgeons is chronic osteomyelitis. The mainstays of successful treatment include: radical debridement, stabilisation of the bone if necessary; control of infection and finally skin cover or closure. Negative pressure dressings have been used for over 10 years in the treatment of acute and chronic wounds with recognised benefits. Topical negative pressure wound therapy with instillation of solution in the local area (VAC Instill Therapy System®) is a new device available in the armamentarium of a limb reconstruction surgeon. This device automatically delivers instillation fluid into the infected wound, where this fluid is held for a while before application of topical negative pressure. This cycle helps remove infectious material leading to clean closed moist environment for better wound healing. Senior authors (MGD and SLR) have used this VAC Instill therapy in 10 cases of chronic osteomyelitis from April 2007 to November 2008. All patients have been included in this study. All patients had (thorough) bony and soft tissue debridement followed by application of VAC Instill therapy with local delivery of antibiotics. All patients were male with mean age of 39 years (range 20–56 years). There were eight cases of tibial osteomyelitis, one distal radial and one calcaneal osteomyelitis. Most had mixed growth, with Staphylococcus being most common infecting organism. Average duration for VAC Instill therapy was 32 days (range 20–71 days). Average hospital stay was 33 days (range 15–85 days) and average time to wound closure was 39 days (range 19–90). There were two failures of treatment one later had Lautenbach procedure and other had below knee amputation. We conclude that VAC Instill therapy is very successful in the management of chronic osteomyelitis. These are the only early results available in the literature. Further studies are needed to back these findings