Purpose

To compare the post-operative morbidity, of a novel vertical approach, with that of the standard transverse one, for procurement of Autologous bone graft from the iliac crest, for the purpose of cervical spine fusions.

A prospective study on the management of 23 patients with complex high energy tibial fractures was carried out to assess the outcome following the use of different external fixators. They were all followed up clinically and radio logically till fracture union.

The average age 42 years (range 13–77 years) 17 male & 6 females. Fourteen were closed and 9 open. Eight were falls from height, 9 RTAs, one crush injury and one assault. All of the open fractures were grade 3. Six patients had proximal tibial fractures (one Schatzker Type-II, one Type-IV, two Type-V and two Type-VI) They united at an average of 20 weeks (range 10–40 weeks). Seven were Shaft fractures average duration to union 30 weeks (range 8–104 weeks), and eight were Pilon fractures (Two Ruedi & Allgower Type-II & Six Type-III) they united at an average duration of 13 weeks (range 7–20 weeks)

All patients achieved clinical and radiological union at a mean duration of 22 weeks. Sheffield Ring fixator [SRF] was used primarily in 11 patients, none failed. Two had initial monolateral fixators which were converted to SRF. Two were managed with Illizarov frames and three with hybrid fixators. Seven patients had an initial monolateral fixator, two failed and were converted to a Sheffield fixator, 2 planned conversion to an intramedullary nail, one developed a delayed union and was converted to a Sheffield fixator, only two continued till union. Nine patients developed pin tract infection needing Antibiotics, three of them developed Osteomyelitis, Four had failure of fixation needing a second operation.

Two developed malunion, one managed with total knee replacement, another required Ankle fusion. The average SF 12 score for the Sheffield group PCS was 52.1 and MCS of 51.7. For the Monolateral fixator group PCS was 47.2 and MCS of 48.1. For the Hybrid fixator group PCS of 34.7 and MCS of 42.7 and for the Ilizarov group PCS was 39.85 and MCS was 55.05.

In this cohort of complicated High energy Tibial fractures, those managed with Circular Frames especially SCF augmented with interfragmantary screws proved to be most successful with a very lower failure rate and better patient satisfaction.

Aim: Analyse the impact of definitive corrective surgery on the course of chronic non-healing diabetic foot ulcers.

Method: The specialist diabetic foot clinic at the Kings College Hospital had six thousand attendees in the period Sept 2007 to Sept 2008. We retrospectively reviewed a group of patients with Neuropathic chronic non-healing diabetic foot ulcers who were referred for surgical correction. They underwent a minimum of twelve months of conservative treatment including pressure-relieving methods such as total contact casts. They were all classified as B3 according to the Texas diabetic wound classification at the time of referral; infection was controlled with antibiotics before correction. Seven ulcers were located over the forefoot, and six over the hind foot. Thirteen patients had definitive corrective surgery. Five using Taylor spatial frames and eight had corrective osteotomies and fusions. The period of ulcer prior to surgery together with the time to healing of the ulcer postoperatively was calculated in each case.

Results: There were ten Males and three Females, with a mean age of 57.4 years ranging from 37 to 75 years. The Mean period of ulceration prior to surgical intervention was 4.2 years. Nine ulcers healed in a mean duration of three months with a maximum of six months. One ulcer is improving and three have failed to heal so far.

Conclusion: Definitive corrective surgery on chronic non-healing diabetic foot ulcers is an important tool to reduce the healing time.

The 2007 National Institute for health and Clinical Excellence (NICE) thromboprophylaxis guidelines concerning hip arthroplasty remain contentious. A survey among British Hip Society members was performed to investigate the impact of these guidelines. Information on thromboprophylactic measures before and after guideline publication was gathered in the three categories of Total Hip Replacement (THR), hip fracture and high-risk patients as defined by NICE. The response rate was 185/250 (74%). All responders used thromboprophylaxis, but only 44%, 22% and 7% indicated they were currently acting in accordance with guidance for THR, high risk and hip fracture groups respectively. 19%, 14% and 14% had changed their practice since publication of the guidance in THR, high risk and hip fracture groups respectively. The effects of the NICE guidance in influencing the responders’ thromboprophylactic protocols have been very limited. These results do not appear to endorse the authority of NICE in decisions made in this area.

Background: The over the top technique was first described in 1974. The Mark II ACL reconstruction was a development on the ABC and the Mark I procedure and was introduced into clinical practice in March 1998. The soffix used is a polyester hamstring graft support device with three button holes at each end. Clinical observation showed progressive slackening of some initially successful reconstructions. Retightening restored stability. We studied the medium and long-term outcome of the procedure and tested the effects of preconditioning on its biomechanical properties.

Patients and methods: 90 patients underwent a prospective medium and long-term follow-up (3–5 years) in a dedicated research clinic. Standardised scores Lysholm, Tegner, and IKDC. were used. Biomechanical tests were performed in vitro using double equine extensor tendon-soffix model constructs. 18 experiments with an MTS Hydraulic testing machine, were carried out, preconditioning with 300, 400 and 500N. Constructs were then cyclically loaded 3000 times at 1 Hz and finally tested to failure.

Results Clinical follow-up showed good overall results. The mean Tegner score increased from 2.5 pre-operatively to 4.5. The majority had a Lysholm score of > 90(72%). The majority had an IKDC of B (75%). 10% had a side to side difference > 6mm. The mean stretch of 14mm after 3000 cycles was reduced to 4.2 mm by preconditioning with 500N. This had no adverse effect on the ultimate tensile strength.

Conclusion: The medium and long-term results of the MarK II ACL reconstruction are encouraging. Preconditioning the soffix tendon construct reduces the creep with no adverse effect on the ultimate tensile strength. A pre-conditioning device has been made to replicate this in theatre.

Introduction and aim: In order to harness existing surgical skill and expertise of the operator trained in conventional total hip arthroplasty (THA) it would be advantageous to adopt a mini-incision surgery (MIS) THA technique that is similar. It would also make economic sense for MIS THA to be performed using existing conventional instrumentation available in every elective orthopaedic unit. The aim of this retrospective comparative study was to verify safety, efficacy and durability of this MIS THA technique via a modified anterolateral approach developed in our hospital by the senior author. This technique utilises standard instrumentation and does not require the use of an image intensifier.

Materials and Methods: The implants used in the study were the SL-Plus (Plus Endoprothetik AG, CH-Rotkreuz) and the EPF cup (Plus Endoprothetik AG, CH-Rotkreuz). We report on our experience of a consecutive series of 111 patients operated for osteoarthritis of the hip joint.

Results: Fifty-nine patients (53.2%) were implanted using MIS technique; the remainder (52 cases, 46.8%) were operated using conventional THA via traditional anterolateral approach. In patients undergoing MIS technique a skin incision averaging 8 cm (range 7.5 to 9 cm) was made over the greater trochanter with two thirds lying superior to its tip. The surgical procedure lasted forty minutes on average, and no excessive retraction was needed. The small incision can be extended with ease if access proves difficult, but this proved unnecessary in any of our cases.

The mean follow-up for the MIS THA group was 22.9 months compared to 33.1 months for the conventional THA group. All our MIS patients had less postoperative blood loss, needed less post operative painkillers, and mobilised earlier. There was however no significant difference in the duration of postoperative hospital stay between the two patient groups. We have had no incidence of dislocation and continue to use this technique during routine THA.

Discussion and conclusion: A review of the MIS THA literature is provided to compare this technique with those described by other authors. The authors believe this to be a safe, cost effective alternative to MIS THA techniques that require special instrumentation and the use of the image intensifier.