Ankle fractures represent approximately 10% of the fracture workload and are projected to increase due to ageing population. We present our 5 years outcome review post-surgical management of ankle fractures in a large UK Trauma unit. A total of 111 consecutive patients treated for an unstable ankle fracture were entered into a database and prospectively followed up. Baseline patient characteristics, complications, further intervention including additional surgery, functional status were recorded during five-year follow-up. Pre-injury and post-fixation functional outcome measures at 2-years were assessed using Olerud-Molander Ankle Scores (OMAS) and Lower Extremity Functional Scales (LEFS). A p value < 0.05 was considered significant.Introduction
Methods
First Metatarsophalangeal joint fusion has been successfully used to treat Hallux rigidus. We have attempted to evaluate commonly used methods of fixation and joint preparation. To the best of our knowledge, this is the single largest comparative study on first MTPJ fusion. We aimed to evaluate the radiological union and revision rates. We included 409 consecutive MTPJ fusions performed in 385 patients. We collected demographic, comorbidities and complication data. We evaluated the radiographs for the status of the union. Logistic regression was used to calculate the Odds ratio (OR) of non-union for the collected variables. Our union rate was 91.4% (34/409). 29.4% of our non-unions were symptomatic (10/34). Hallux valgus showed a statistically significant relation to non-union (Odds ratio 9.33, p-value 0.017). Other potential contributing factors like sex (OR1.9, p-value 0.44), diabetes (OR 0, p-value 0.99), steroid use (OR 2.07, p-value 0.44), inflammatory arthritis (OR 0, p-value 0.99) and smoking (OR 2.69, p-value 0.34) did not attain statistical significance. Further, the methods of fixation like solid screws (OR 0, p-value 0.99), plate (OR 3.6, p-value 0.187) or cannulated screws (OR 0.09, p-value 0.06) showed no correlation with non-union. We compared two techniques of joint preparation and found no significant difference in union rates (Chi-Square 1.0426, p-value 0.30). Our crude cost comparison showed the average saving to the trust per year could be 33,442.50£ by choosing screws over plate. Only Hallux Valgus had a statistically significant relation to non-union. Solid screw could be economically the most viable option and a valid alternative.
Computer-assisted minimally invasive total knee arthroplasty (CAMI-TKA) has gained increasing interest from orthopaedic surgeons due to its advantages in improving accuracy of component placement combined with benefits in postoperative recovery due to a smaller incision. However, long-term clinical and radiographic outcomes are lacking. The purpose of the present study is to compare the long-term radiographic features and functional outcomes between patients who underwent CAMI-TKA and those who underwent conventional TKA. One hundred and eight patients who were randomized to undergo CAMI-TKA or conventional TKA during 2004 and 2005 were contacted by phone for a prospective follow-up review. Patients who have passed away or declined to participate in the study were excluded. Patients were asked to return to the hospital for clinical and functional assessments, long-leg and knee roentgenograms. Baseline characteristics were compared to account for potential confounders and multivariate statistical analysis applied to account for any differences in baseline characteristics.Objective
Methods
Patient-specific instrumentation (PSI) is a novel technique in total knee arthroplasty (TKA) which potentially permits more accurate alignment of the components; however, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results of various PSI systems. A 24-month follow-up study was carried out to compare perioperative clinical outcomes, radiological limb alignment and component positioning, as well as functional outcomes following TKA between PSI and conventional instrumentation (CI). During September 2011 and August 2012, 90 consecutive patients were scheduled to undergo unilateral TKA with either PSI or CI. TruMatch® Personalised Solutions was used in this study, and a senior surgeon performed all operations. Patients were clinically assessed before, 6-month and 24-month after surgery.Objective
Methods
Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead to reduced range of motion, patellofemoral maltracking and suboptimal outcomes. The purpose of this study was to analyse the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA). A prospective study was conducted for 168 patients (168 knees) who underwent CAS TKA by two surgeons at a single institution with an average follow-up of two years. The final change in joint line was calculated from the verified tibial resection, distal and posterior femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Postoperative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at six months, one year and two years post-TKA. The final range of motion and the mechanical alignment were documented. There was significant linear correlation between joint line changes and Oxford scores (p = 0.05) and Function scores (p = 0.05) at six months and Oxford scores alone at two years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients have better outcomes in terms of Oxford scores (mean 20 vs 27, p = 0.0003), Function scores (mean 69 vs 59, p = 0.03), SF-1 (mean 63 vs 50, p = 0.03), SF-2 (mean 66 vs 43, p = 0.05), SF-5 (mean 75 vs 63, p = 0.04), SF-6 (mean 84 vs 59, p = 0.003), SF-7 (mean 96 vs 83, p = 0.02), SF-8 (mean 84 vs 73, p = 0.006) and total SF-36 scores (mean 603 vs 487, P = 0.003), at six months, and Oxford scores (mean 18 vs 23, p = 0.0007) at two years. In this study, CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥ 4 mm are associated with poorer clinical outcome scores.
