Advertisement for orthosearch.org.uk
Results 1 - 4 of 4
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_18 | Pages 3 - 3
1 Dec 2018
Sharma S Sharma P
Full Access

The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was developed in 2004 to risk-stratify patients with soft tissue infections using common blood tests when the clinical picture is equivocal. A score ≥ 6 conferred a positive predictive value (PPV) of 92% and negative predictive value of 96% for necrotising fasciitis.

We retrospectively calculated LRINEC scores for Orthopaedic patients admitted to ITU in our hospital with limb soft-tissue infection and confirmed Group-A Streptococcus or Staphylococcus in fluid, blood, tissue or swab culture between 2010–2017 (n=10). Mean age = 57.4 and 60% were female. Half of all patients died during admission. Mean LRINEC score of all patients was 5.3±3.1 (median = 6). Mean score in deceased patients was 4.8±2.8 (scores: 0,5,6,6,7; median = 6); in discharged patients mean = 5.8±3.7 (scores: 0,5,7,7,10; median = 7). 6 patients had a score ≥6, making our PPV 60%. 4 patients had necrotising fasciitis confirmed on histology (LRINEC scores = 0,5,7,10).

Our PPV of 60% is less than the figure obtained in the original paper. 2 patients with a LRINEC score <6 died during admission, including a patient with a score of 0. Furthermore, a patient with necrotising fasciitis confirmed on histology also had a LRINEC score of 0. We conclude that LRINEC scores should not delay surgery when clinical suspicion is high, and should be used as an adjunct to clinical decision-making, rather than a replacement, as patients with low LRINEC scores can also have confirmed necrotising fasciitis and poor outcomes.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 328 - 328
1 Mar 2004
Singh S Bombireddy R Sharma P Deo H El-Kadafi M Rowntree M
Full Access

Aim: To assess long-term outcome of Silastic Joint Replacement of the þrst metatarsophalangeal joint. Methods: 32 patients (42 feet) with double stem silicone implant arthroplasty of the 1st MTPJ were reviewed at average 8 years (range 4 Ð 19 years). Surgery was for Hallux rigidus in 25 cases and for Hallux valgus with degenerative osteoarthritis in 17 cases. Patients with Rheumatoid arthritis were excluded. Mean patient age was 64 years. Results: 28 of the 32 patients were very satisþed with the procedure. No patients were dissatisþed. Pain relief was subjectively excellent or good in 28 patients. Three of the four patients with fair or poor relief of pain had surgery for Hallux Valgus with degenerative osteoarthritis. Radiographs showed sclerosis around all prostheses with cysts with bony erosions in 17 cases. 12 had clinical features of silicone synovitis in the early postoperative period but this was not present at þnal review despite radiological þndings of new bone formation (57%) and localised osteolysis (40%). Two patients had transfer metatarsalgia with a stress fracture. No patients required revision surgery. Conclusion: Our long-term study shows patients to have very good subjective and objective results despite poor radiological results. There is a role for double stemmed silicone implant arthroplasty in low demand patients.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 155 - 155
1 Feb 2003
Pettit P Sharma P Sinha J Gibb P Thomas E
Full Access

We present the long-term results of a single institute’s experience of the Mann 3 in 1 procedure. This prospective study initially selected 36 feet (25 patients) with severe hallux valgus, classified by a HV angle < 40° or IM angle> 15°, for the Mann 3 in 1 procedure. Preoperative and postoperative standing radiographs were taken to calculate the correction of the deformity, and a postoperative subjective questionnaire was completed which was based on the assessment criteria suggested by the American Orthopaedic Foot and Ankle Society in 1984. The initial follow-up was completed at up to one year.

The original cohort of patients was contacted again at 10 years (range 9–11 years) to repeat the same questionnaire and radiographs. In total 19 patients (27 feet) were contactable with an average age of 51 years (range 34–74). The questionnaire revealed one patient unable to perform the same occupation and three patients unable to perform the same activities due to ongoig problems with the operated feet. Thirteen patients had to wear modified footwear but only 2 required specially made shoes. Sixteen of the nineteen (84%) were pleased or satisfied with pain relief and appearance following the procedure, with 14 stating that they would undergo the procedure again given the same circumstance and 5 patients that would not. The complications included 8 patients requiring screw removal, 2 patients with metatarsalgia, one patient undergoing multiple further corrective procedures and one requiring a second ray amputation for osteomyelitis.

Sixteen patients (23 feet) were available for repeat radiographic assessment. This revealed that there had been some recurrence of the deformity with the initial correction of the HV angle being a mean of 40° (range 36–51°) to 15° (9–23°) at up to one year and 23° (0–52°) at ten years. Similarly with the mean IM angle initially corrected from 18° (15–25°) to 8.5°(6–12°), being 14° (7–20°) at ten years.

In conclusion, despite some recurrence of the deformity on x-ray the subjective satisfaction with this procedure is good. Care should be taken in patient selection but the Mann 3 in 1 appears to be a good procedure for the correction of severe Hallux Valgus.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 128 - 128
1 Feb 2003
Sharma P Singh S Rao S
Full Access

Tibialis posterior tendon (TPT) dysfunction is a disorder of unknown aetiology. Trauma, inflammatory processes, anatomical abnormalities and iatrogenic factors have all been implicated as causative mechanisms. The condition presents with pain and swelling around the medial malleolus. The pain is characteristically worse on exercise and relieved by elevation. The disorder has been classified by Johnson and Strom (1989); stage I is characterized by pain around the medial malleolus and mild weakness of single heel raising. Without treatment the condition may progress to a fixed valgus deformity along with pes planus.

Aim

To assess the outcome of surgical decompression of stage I TPT dysfunction.

Method

Ten cases were identified, operated on by a single surgeon over a three-year period. The patients were assessed in a dedicated clinic by administration of a questionnaire and by clinical examination.

Results

Nine patients with an average age of 30 years (13–51) agreed to participate in the study. Six of the nine patients recalled a sporting injury to the ankle prior to onset of symptoms. Eight of these of patients underwent a course of physiotherapy prior to surgery. After decompression all patients reported reduction of pain as measured using a visual analogue scale, with five patients reporting complete resolution of pain. Patients experienced relief of pain on average four weeks (1.5–6) after surgery. All patients were able to return to work and normal leisure activities after appropriate rehabilitation.

Conclusions

Decompression of the tibialis posterior tendon in stage I dysfunction leads to pain relief and enables an early return to normal activities. Therefore surgical decompression of the tibialis posterior tendon may be considered in cases of stage I dysfunction which are refractory to conservative measures, particularly in young and active patients.