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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 26 - 26
1 Jan 2014
Logan J Jowett B Lasrado I Hodkinson S Cannon L
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Introduction:

The National institute of Health and Clinical Excellence (NICE) guidelines for thromboprophylaxis following lower limb surgery and plastercast immobilisation recommend pharmacological prophylaxis be considered until the cast is removed. These guidelines have been extrapolated from data for hip and knee arthroplasty, and trauma studies. Recent studies have questioned the validity of these guidelines. At Portsmouth, low molecular weight heparin (LMWH) is prescribed for 14 days following surgery in high risk patients. The protocol predates the most recent NICE guidance. We set out to investigate whether this was a safe method of thromboprophylaxis following elective hindfoot surgery.

Methods:

A retrospective audit of all patients undergoing hindfoot surgery between 01/01/10 and 31/12/12 was performed. All patients were immobilised in a POP backslab and prescribed 14 days of LMWH. All patients were reviewed at 2 weeks and converted to a full cast or boot. Immobilisation was continued for between 6 and 12 weeks. A list of all patients who had undergone investigation for deep vein thrombosis at Queen Alexandra hospital from 01/01/10 to 28/03/13 was obtained from the VTE investigation department. The two lists were cross referenced to identify any DVTs occurring following hindfoot surgery and plastercast immobilisation.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_26 | Pages 24 - 24
1 Jun 2013
Matthews E Aiyenuro O Hodkinson S Lasrado I Cannon L Jowett A
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Hallux valgus is a common condition often leading to significant symptoms. However, its correction has recently been suggested, to be a procedure of limited clinical value. Scarf osteotomy is one of the most commonly performed operations for hallux valgus correction. Although technically demanding, it is powerful in its capacity to correct the hallux valgus deformity and sufficiently robust with internal fixation to allow early weight bearing.

We prospectively collected data for consecutive scarf osteotomies between 2008 and 2011. Preoperative and 6 week postoperative assessment was made using radiographic measurements HVA (hallux-valgus angle) and IMA (inter metatarsal angle). We evaluated 130 scarf osteotomies. The mean HVA improved from 29.5 pre-operatively to 12.6 post correction. The mean IMA improved from 12.4 pre-operatively to 8.1 post correction. The AOFAS hallux scores improved from an average of 55 pre op to 79 post operation.

The results suggest that hallux valgus correction does have clinical value and that scarf osteotomy is a reproducible procedure, with a generally good to excellent results in the short term.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 19 - 19
1 May 2013
Griffiths JT Lewis C Cannon L Lasrado I Hodkinson S Hand C
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The purpose of this study was to quantify the effect of BMP 7 and recombinant Human (rh) BMP 2 at stimulating bone formation and bone union in trauma and elective orthopaedic surgery.

Methods

We retrospectively reviewed the use of BMP 7 and rhBMP 2 at the Queen Alexandra Hospital between 2005 and 2012. The minimum follow up was three months. Inclusion criteria consisted of all patients who had failed to achieve previous surgical bone union and then received either BMP 7 or rhBMP 2 in an attempt to achieve bone union (as part of revision surgery). Patients who have not completed a minimum of three months follow up were excluded. Bone union was defined clinically and radiographically.

Results

17 patients were included (9 elective and 8 trauma patients). 9 patients received BMP2 (8 trauma and 1 elective) and 8 received rhBMP 2 (all elective). The average number of attempted fusions with autogenous bone graft prior to the use of BMP agent in the trauma and elective group was 2 and 3 respectively. The overall union rate following the use of BMP was 94.1%. 1 patient from the BMP 7 group (trauma patient) failed to unite. The union rate with BMP 7 and rhBMP 2 was 88.9% and 100% respectively. Following the use of BMP the average time to union was 117 days (BMP 7 124 days and rhBMP 2 112 days).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_3 | Pages 19 - 19
1 Jan 2013
Moras P Long J Jowett A Hodkinson S Lasrado I Hand C
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Purpose of the study

We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hindfoot problems the Portsmouth experience with the Ilizarov ring fixator.

Methods and results

We report on 10 patients who underwent ankle and hindfoot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR). All patients had undergone multiple previous surgeries which had failed. There were 7 males and 3 females in this group. Average age of the patients was 60 (47 years–77 years) Mean follow up was 32 months (6–56 months) BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening.

Patients were assessed clinically, radiologically and using functional outcome scores EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hindfoot nail. All patients were satisfied with their overall improvement in pain and function.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXII | Pages 26 - 26
1 Jul 2012
Ramakrishna S Moras P Jowett A Hodkinson S Lasrado I Hand C
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We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hind-foot problems - the Portsmouth experience with the Ilizarov ring fixator.

11 patients underwent ankle and hind-foot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR).

All patients had undergone multiple previous surgeries, which had failed. There were 8 males and 3 females in this group. Average age of the patients was 58 (43 years – 77 years) Mean follow up was 36 months (7 – 60 months). Mean frame time was 24 weeks (15 – 36 weeks). BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores - EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hind-foot nail. All patients were satisfied with their overall improvement in pain and function.

We conclude that this is an effective salvage technique for complex ankle and hind-foot problems in patients with impaired healing potential, insufficient bone stock and progressive deformity.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 122 - 123
1 May 2011
Grice J Briant-evans T Dala-ali B Haleem S Hodkinson S Jowett A
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Introduction: Ankle diastasis injury occurs in up to 20% of ankle fractures. Various techniques have been used to treat syndesmosis injuries, but controversy remains and outcome is variable. In light of some recent cases of substandard syndesmosis fixations requiring revision, an audit of our results was undertaken.

Method: Study type: Retrospective audit of radiographs and patient records

Data collection: patients were selected using an orthopaedic database search for operations coded as distal tib/fib ORIF or ankle ORIF.

Study period: 12 months, July 2008 to July 2009 (currently data has been analyzed on the first 6 months only, the remaining 6 months will follow)

Audit questions to be answered: How is ankle diastasis injury being managed? Are we reducing syndesmosis correctly? Should there be a revision to local policy?

Audit standard: Syndesmoses should be adequately reduced and fixation techniques employed should be in accordance with recommendations in standard Orthopaedic reference texts (Rockwood & Green, AO fixation manual 3)

Results: 76 ankle ORIFs in July to December 2008 inclusive. Out of these, 16 had diastasis fixation (21%). 2 of the patients had a syndesmosis width over 6 mm indicating an inadequate reduction of the syndesmosis 1. Both of these required revision surgery. In total 70% of the post operative x-rays showed inadequate syndesmosis fixation or reduction.

Discussion: The single most predictive indicator of a favourable function is accurate reduction of the syndesmosis 2. Substandard fixations are associated with poor long term outcomes. This raises the potential for litigation and the requirement for education and policy change. We have produced policy guidelines for theatre and circulated the information to all surgeons. A further audit will be carried out to assess the effectiveness of this in 6 months time. (The data will be available from this re-audit for presentation at the conference.)


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 127 - 127
1 Feb 2003
Kane T Edwards S Hodkinson S
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Background

Studies have investigated driver reaction time (DRT) following hip replacement, knee replacement and arthroscopy. This study tests the null hypothesis that there is no difference in DRT between patients after right ankle fracture and healthy controls.

Methods

Patients with right ankle fractures were recruited and DRT was measured using a simulator (time taken to achieve a brake pressure of 100 Newtons after a visual stimulus).

Inclusion criteria: drivers aged 17–70 years with right ankle fractures. Patients were tested when first out of plaster (T0), two, four and six weeks subsequently. DRT was compared to controls matched for age, sex and driving experience (paired T test). The percentage reaching a “safe” DRT (0.7 seconds) was determined.

Results

There were 25 patients: 18 conservatively and seven operatively treated fractures. The age range of patients was 19 to 69yrs (mean 41.4yrs), and of controls: 19 to 68yrs (mean 41.8yrs). Conservative group DRT was significantly slower than controls at T0 (p< 0.001) but not thereafter. Operative group DRT was significantly slower than controls at T0 (p< 0.003) and two weeks (p< 0.005) but not thereafter

Conclusion

Following right ankle fracture and removal of cast, DRT is initially prolonged. This study suggests a return to normality within two weeks after conservatively treated fractures and four weeks after operatively treated fractures.