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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 66 - 66
1 Aug 2012
Singhal R Shakeel M Dheerendra S Ralte P Morapudi S Waseem M
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Background

Volar locking plates have revolutionised the treatment for distal radius fractures. The DVR (Depuy) plate was one of the earliest locking plates which were used and they provided fixed angle fixation. Recently, newer volar locking plates, such as the Aptus (Medartis), have been introduced to the market that allow the placement of independent distal subchondral variable-angle locking screws to better achieve targeted fracture fixation. The aim of our study was to compare the outcomes of DVR and Aptus volar locking plates in the treatment of distal radial fractures.

Methods

Details of patients who had undergone open reduction and internal fixation of distal radii from October 2007 to September 2010 were retrieved from theatre records. 60 patients who had undergone stabilisation of distal radius fractures with either DVR (n=30) or Aptus (n=30) plate were included in the study.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 17 - 17
1 Aug 2012
Dheerendra S Khan W Smitham P Goddard N
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Background & Objectives

Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The aim of this study is to demonstrate that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance.

Methods

Patients with clinical and electrophysiological signs of idiopathic carpal tunnel syndrome meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 17 - 17
1 May 2012
Khan W Dheerendra S Johnson D Andrew J Hardingham T
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INTRODUCTION

Bone marrow derived mesenchymal stem cells are a potential source of cells for the repair of articular cartilage defects. Hypoxia has been shown to improve chondrogenesis in adult stem cells. In this study we characterised bone marrow derived stem cells and investigated the effects of hypoxia on gene expression changes and chondrogenesis.

MATERIALS AND METHODS

Adherent colony forming cells were isolated and cultured from the stromal component of bone marrow. The cells at passage 2 were characterised for stem cell surface epitopes, and then cultured as cell aggregates in chondrogenic medium under normoxic (20% oxygen) or hypoxic (5% oxygen) conditions for 14 days. Gene expression analysis, glycosoaminoglycan and DNA assays, and immunohistochemical staining were determined to assess chondrogenesis.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 68 - 68
1 May 2012
Khan W Dheerendra S Johnson D Andrew J Hardingham T
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Introduction

Mesenchymal stem cells are a potential source of cells for the repair of articular cartilage defects. We have previously demonstrated that the infrapatellar synovial fat pad is a rich source of mesenchymal stem cells and these cells are able to undergo chondrogenic differentiation. Although synovial fat pad derived mesenchymal stem cells may represent a heterogenous population, clonal populations derived from the synovial fat pad have not previously been studied.

Materials and Methods

Mesenchymal stem cells were isolated from the infrapatellar synovial fat pad of a patient undergoing total knee arthroplasty and expanded in culture. Six clonal populations were also isolated before initial plating using limiting dilution and expanded. The cells from the mixed parent population and the derived clonal populations were characterised for stem cell surface epitopes, and then cultured as cell aggregates in chondrogenic medium for 14 days. Gene expression analyses; glycosoaminoglycan and DNA assays; and immunohistochemical staining were determined to assess chondrogenic responses.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 81 - 81
1 Mar 2012
Khan W Dheerendra S Johnson D Andrew J Hardingham T
Full Access

INTRODUCTION

Bone marrow derived mesenchymal stem cells are a potential source of cells for the repair of articular cartilage defects. Hypoxia has been shown to improve chondrogenesis in adult stem cells. In this study we characterised bone marrow derived stem cells and investigated the effects of hypoxia on gene expression changes and chondrogenesis.

MATERIALS AND METHODS

Adherent colony forming cells were isolated and cultured from the stromal component of bone marrow. The cells at passage 2 were characterised for stem cell surface epitopes, and then cultured as cell aggregates in chondrogenic medium under normoxic (20% oxygen) or hypoxic (5% oxygen) conditions for 14 days. Gene expression analysis, glycosoaminoglycan and DNA assays, and immunohistochemical staining were determined to assess chondrogenesis.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 82 - 82
1 Mar 2012
Khan W Dheerendra S Johnson D Andrew J Hardingham T
Full Access

Introduction

Mesenchymal stem cells are a potential source of cells for the repair of articular cartilage defects. We have previously demonstrated that the infrapatellar synovial fat pad is a rich source of mesenchymal stem cells and these cells are able to undergo chondrogenic differentiation. Although synovial fat pad derived mesenchymal stem cells may represent a heterogenous population, clonal populations derived from the synovial fat pad have not previously been studied.

Materials and Methods

Mesenchymal stem cells were isolated from the infrapatellar synovial fat pad of a patient undergoing total knee arthroplasty and expanded in culture. Six clonal populations were also isolated before initial plating using limiting dilution and expanded. The cells from the mixed parent population and the derived clonal populations were characterised for stem cell surface epitopes, and then cultured as cell aggregates in chondrogenic medium for 14 days. Gene expression analyses; glycosoaminoglycan and DNA assays; and immunohistochemical staining were determined to assess chondrogenic responses.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 478 - 478
1 Nov 2011
Butler M Dheerendra S Goddard N Goldberg A Sharp R Ward N Cooke P
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Introduction: Severe haemophilia affects 1 in 10,000 men. The ankle along with the hip and knee are commonly affected. Ankle fusion is the preferred surgery for end stage arthritis in the younger patient although debate exists as to the preferred technique. We conducted a retrospective review of the arthroscopic ankle fusions on haemophiliacs from Oxford and compared data with that of a specialist unit in London using an open technique.

Materials and Methods: We reviewed 22 ankles (22 patients) from Oxford and 10 ankles (8 patients) from London. 90% had Type A haemophilia with similar regular monthly Factor VIII usage: 17941 U/month (Oxford) compared with 17992 (London). 73% of patients in the Oxford Group and 100% of the London group had Hepatitis C and/or HIV.

Results: Union was achieved in all patients. The mean time to union in the open group was 9.1 weeks (Mode- 8 weeks, Range 7–14) compared to 12.2 weeks (Mode- 12 weeks, Range 8–24) in the arthroscopic group. Screw removal was required in 4 patients (3 arthroscopic v’s 1 open). 1 patient in the arthroscopic group suffered a pseudoaneurysm of the dorsalis pedis artery. The arthroscopic group spent less time in hospital- 5.7 days compared to 9.5. Factor VIII usage was less in the arthroscopic group- 32,882 Units compared to 40013.

Discussion: Patients of this nature should be managed in centres used to dealing with their complex needs. Arthroscopic ankle fusion in haemophiliacs is safe for these patients. Although arthroscopic fusion may take slightly longer to unite, there are benefits in terms of reduced patient stay and factor VIII requirement and therefore costs.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 2 | Pages 274 - 276
1 Feb 2011
Chan JHH Ballal MS Dheerendra S Sanchez-Ballester J Pydisetty RV

Injury to the sciatic nerve following closed manipulation of a dislocated total hip replacement is rare. We present such a case in an elderly patient with partial recovery following exploration and release of the nerve.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 563 - 563
1 Oct 2010
Francis R Dheerendra S Natali C Sivaraman A
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Introduction: Schober’s test, along with the modified version have long been used to assess lumbar flexion. The modified Schobers test, as described by McRae et al, is now the more commonly used. Both these tests rely on the assumption that movement of skin over the lumbar spine represents the degree of lumbar spine flexion. To our knowledge neither of these tests have been validated. Our aim is to validate the modified Schobers test as a method for measuring lumbar flexion.

Materials and Methods: Our inclusion criteria were:

normal subjects with no known structural abnormalities in spine or pelvis.

no previous spine operations.

Subjects with acute back pain and those who could not tolerate range of motion measurements were excluded.

Accurate measurement of lumbar spine flexion is possible using a machine made by a Finnish company called Data Based Care (DBC). The machines accurately measure ranges of spine movement by isolating the movement being measured and immobilising any other muscle groups which may interfere with the movement being measured.

We measured lumbar spine flexion as described by Mc Rae et al ie. The modified Schobers test and isolated lumbar spine flexion using the DBC machine.

Two researchers were involved in measuring subjects. One set the subject on the DBC machine and took the measurement, whilst the other assessed when the pelvis began to tilt. Thus only isolated forward lumbar flexion was measured. DBC measurements were carried out in a standardised way. The results were then tabulated and correlated.

Results: Our study included 100 people of whom 54 were male and 46 female. Average age was 38. The median measurements for modified schober’s test and DBC were 5 and 44 cm respectively. The measurements of both modified schober’s test and actual lumbar flexion using DBC were correlated with spearman’s rank correlation test showed no correlation.

Conclusion: Our results show no correlation at all between the actual range of lumbar flexion and the modified Schobers test. We state that this test is invalid and its place in clinical practice unjustified.