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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_10 | Pages 47 - 47
1 Jun 2023
Wilson G Prior C
Full Access

Introduction

The purpose of this study was to analyse the efficacy and complications associated with the use of Calcium Sulphate synthetic bone graft in a paediatric population. There are no published articles on the use in children.

Materials & Methods

A retrospective review was undertaken of the notes, microbiology, and X-Rays of 17 cases (in 15 patients) of calcium sulphate use in paediatric patients. As well as patient demographic data, data collected included indication, use of additional agents (antibiotics), return to theatre, and wound complications. Major complications were also assessed for.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_14 | Pages 2 - 2
1 Aug 2017
Prior C Walton R
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Triplane fractures of the adolescent ankle commonly require operative management. A number of classification systems exist showing a variety of fracture patterns, making fixation planning complex. Our institute has previously presented a classification system that simplifies the fracture pattern. Our aim was to find a fixation method that could be used in all cases.

We devised a universal screw trajectory for the epiphyseal fracture based on a partially threaded screw placed medial-to-lateral at 20 degrees to the inter-malleolar axis of the ankle. We retrospectively reviewed the axial CT images of 59 consecutive operatively managed triplane fractures from a single institute to simulate the placement of the screw.

In all 59 subjects, the simulated universal screw placement was in a satisfactory position to adequately, and safely, reduce the fracture. Two cases were classified as ‘Tillaux variants’, which are classically managed with a lateral-to-medial screw, but they were deemed to be potentially suitable for the universal screw, indeed in one case the treating surgeon used a medial-to-lateral screw and had a successful outcome.

Our classification system demonstrates a reproducible fracture line that is amenable to a universal screw fixation method in the world's largest published triplane series. It offers a low-tech solution to a difficult problem. This could simplify the preoperative plan and obviate the need for a CT scan, which is relevant to departments treating populations without access to such resources.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 15 - 15
1 Nov 2014
Prior C Wellar D Widnall J Wood E
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Introduction:

Fibular malreduction is a common and important cause of pain after surgical fixation following a syndesmosis injury, but it is unclear which components of malreduction correspond to clinical outcome. Plain radiographs have been shown to be unreliable at measuring malreduction when compared to CT scans. A number of published methods for measuring fibular position rely on finding the axis of the fibula. Elgafy demonstrated that fibular morphology varies greatly, and some studies have demonstrated difficulty finding the fibular axis.

Methods:

We developed a new method of measuring the distal fibular position on CT images. We used CT studies in 16 normal subjects. Two assessors independently measured the ankle syndesmosis using the Davidovitch method, and our new protocol for fibular AP position, diastasis and fibular length.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_27 | Pages 7 - 7
1 Jul 2013
Prior C Robb J
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Patients who have an injured limb treated in a cast may need to travel on an aircraft. The Civil Aviation Authority (CAA) have issued guidelines to help clinicians and airline companies decide if patients are safe to travel on an aircraft, or if they need to have the cast altered. Patients may seek advice from the airline companies without consulting their clinicians.

This study looked at the published advice on the websites of commercial airline companies, and requested written guidelines from those with whom no published advice was available. Out of the top 16 companies flying in and out of the UK, only six followed the CAA advice, seven did not have a clear policy, and some offered advice that could be worrying to some clinicians.

This study shows that there is little evidence available to help airline companies and clinicians decide if it is un-safe to allow people to fly with a cast. The advice from airlines is conflicting and confusing for patients, therefore a more consistent approach may be needed to allow safe air travel, to avoid inappropriate alterations of casts and to avoid unnecessary visits to the fracture clinic.