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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 135 - 135
1 May 2012
A. R A. J A. W
Full Access

Background

Ankle fractures represent an increasing workload, particularly in the elderly female population. The posterior tibial tendon is exposed to injury during displaced medial malleolar fractures. Posterior tibial tendon dysfunction delays rehabilitation and results in significant morbidity and is most prevalent in women over 40.

Objective

To ascertain whether posterior tibial tendon should be routinely explored in displaced medial malleolar fractures and consequently should post-operative rehabilitation of ankle fractures be modified. Intra-operative assessment of the tendon may help with this diagnosis and consequently alter post-operative rehabilitation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 136 - 136
1 May 2012
D. W A. J M. R C. R J. I
Full Access

Background

Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in-hospital mortality, in-hospital post-operative complications, length of stay and non-routine discharges.

Aim

The purpose of this study was to retrospectively compare the complications associated with operatively treated ankle fractures in a group of patients with uncomplicated diabetes versus a group of patients with complicated diabetes. Complicated diabetes was defined as diabetes associated with end organ damage such as peripheral neuropathy, nephropathy and/or PAD. Uncomplicated diabetes was defined as diabetes without any of these associated conditions. Our hypothesis was that patients with uncomplicated diabetes would experience fewer complications than those patients with complicated diabetes.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 10 | Pages 1308 - 1313
1 Oct 2011
Hart AJ Sabah SA Bandi AS Maggiore P Tarassoli P Sampson B A. Skinner J

Blood metal ions have been widely used to investigate metal-on-metal hip replacements, but their ability to discriminate between well-functioning and failed hips is not known. The Medicines and Healthcare products Regulatory Agency (MHRA) has suggested a cut-off level of 7 parts per billion (ppb).

We performed a pair-matched, case-control study to investigate the sensitivity and specificity of blood metal ion levels for diagnosing failure in 176 patients with a unilateral metal-on-metal hip replacement. We recruited 88 cases with a pre-revision, unexplained failed hip and an equal number of matching controls with a well-functioning hip. We investigated the 7 ppb cut-off level for the maximum of cobalt or chromium and determined optimal mathematical cut-off levels from receiver-operating characteristic curves.

The 7 ppb cut-off level for the maximum of cobalt or chromium had a specificity of 89% and sensitivity 52% for detecting a pre-operative unexplained failed metal on metal hip replacement. The optimal cut-off level for the maximum of cobalt or chromium was 4.97 ppb and had sensitivity 63% and specificity 86%.

Blood metal ions had good discriminant ability to separate failed from well-functioning hip replacements. The MHRA cut-off level of 7 ppb provides a specific test but has poor sensitivity.