Aims

There has been an evolution recently in the management of unstable fractures of the ankle with a trend towards direct fixation of a posterior malleolar fragment. Within these fractures, Haraguchi type 2 fractures extend medially and often cannot be fixed using a standard posterolateral approach. Our aim was to describe the posteromedial approach to address these fractures and to assess its efficacy and safety.

Introduction

Active patients may benefit from surgical repair of the achilles tendon with the aim of preserving functional length and optimising push-off power. A mini-open device assisted technique has the potential to reduce wound complications, but risks nerve injury. We present the largest published series of midsubstance achilles tendon repairs using the Achillon® device.

Introduction

Fixation of posterior malleolar fragments associated with ankle fractures aims to stabilise the syndesmosis and prevent posterior subluxation. Haraguchi described 3 types of posterior malleolar fractures, with type 2 being a medial extension injury, these fractures often involve medial and posterior fragments. We describe the techniques and outcomes for a double window posteromedial approach allowing optimal reduction and stabilisation.

Introduction

Bone tumours of the foot are rare, representing 3–6% of all bone tumours. Of these 15–25% are thought to be malignant. Obtaining clear surgical margins remains an important factor in improving outcome from tumours. However, the anatomical complexity of the foot can lead to an inadequate resection, particularly if the operating surgeon is attempting to preserve function. The aim of this paper is to identify the clinical course of patients suffering from malignant bone tumours of the foot.

Purpose

To establish the early outcome, satisfaction and complications of sinus tarsi implants in the management of symptomatic flexible flatfeet for a paediatric population

Introduction

We present a single surgeon series of 20 modified Dunn osteotomies without surgical dislocation of the femoral head for slipped upper femoral epiphysis (SUFE).

Introduction: The senior author undertakes single stage revision hip arthroplasty for cases with no preoperative evidence of infection based on history and examination, ESR and CRP results and negative results from selective aspirations. Despite this a large proportion of intra-operative samples are positive for infection. The purpose of our study is to look at the results of intra-operative histology and microbiology samples in these cases and to assess the subsequent incidence of infection.

Methods: Retrospective case study comprising of 230 single stage revision total hip arthroplasties carried out by a single surgeon over 5 year period (2003–2008). Intra-operatively tissue samples were taken from multiple sites and sent for both histology and microbiology. Microbiology results were reported at 24hrs, 48hrs, 7 days and 21 days and correlated with histology reports.

Results: From a total number of 230 patients, we had 98 left and 132 right hip revision arthroplasties. There were 95 men and 135 women with a mean age of 73 years (range 40–93). Intra-operative microbiology was negative in 108 patients (46.95%), of which 3 patients’ histology samples were consistent with infection. Of the 122 microbiology positive patients (53.04%), there were 8 histology samples consistent with infection. The most frequent growths were of Coagulase negative Staphylococcus (64 cases) and Propionibacterium (18 cases). 3 cases subsequently developed deep infection.

Discussion: This study highlights a significant discrepancy between intra-operative microbiology and intra-operative histology results. There is also a very high discrepancy between pre-operative assessment and intra-operative microbiological findings although the majority of cases subsequently did not show any clinical evidence of infection.

Introduction: The Corail stem is a well proven femoral implant used for the past 22 years. It is the most common uncemented femoral stem used for total hip replacements in the UK. The stem was modified in 2004 with an increased neck taper to allow for an increased range of bearings and modular heads. This study reviews a series of primary total hip replacements using this recently modified Corail stem to assess if this implant is still performing to acceptable standards.

Method: A prospective patient database collated by 2 arthroplasty surgeons recorded data at the time of operation and subsequent follow up. All intra-operative and post-operative complications were recorded. Pre and postoperative oxford hip scores were analysed.

Results: 751 cases were reviewed. The average age was 63 with females accounting for 69%. The pinnacle cup was used in 83% of cases, with a polyethylene bearing in 48%. Survival of the stem at 3 years was 99.9% (1 periprosthetic fracture following a fall), the cup 99.6%, with overall survival of 99.5%. The most common intra operative complication was calcar fracture occurring in 0.9%. Dislocation occurred in 0.5%, subsidence in 0.3%, deep infection in 0.1% and leg length discrepancy requiring shoe raise in 0.1%. Average 3 year oxford hip score was 12.

Discussion: 3 year survival of both the femoral stem and the total hip replacement are above the quoted rates in the National Joint Registry’s 4th annual report for corail and uncemented stems (98.8% and 98.1% respectively), and also exceeds that of cemented stems (99.1%). The same report quotes similar rates of calcar fractures (0.8%), although we recorded no other perioperative complications. We conclude the new generation of Corail stem has excellent 3 year performance.