We present our experience of lower limb reconstruction for patients with obvious defects in the tibia, by bone transport using a stacked Taylor Spatial Frame. A retrospective review of 40 patients treated between 2003 and 2009. There were 19 cases of infected non union, 9 cases of acute bone loss following fracture, 6 cases of chronic osteomyelitis, 4 cases of aseptic non union, 1 case of neurofibromatosis and 1 case of a loose and infected total ankle replacement.Introduction
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We present our experience of lower limb reconstruction for patients with obvious defects in the tibia, by bone transport using a stacked Taylor Spatial Frame. A retrospective review of 40 patients treated between 2003 and 2009. There were 19 cases of infected non union, 9 cases of acute bone loss following fracture, 6 cases of chronic osteomyelitis, 4 cases of aseptic non union, 1 case of neurofibromatosis and 1 case of a loose and infected total ankle replacement. Twenty-eight out of the 40 patients reviewed have completed their treatment. Of these 28 patients, bony union was achieved in 23 patients, of whom 22 were assessed at discharge to have regained good to excellent limb function, a functional assessment was not available for review in the remaining patient. In 5 patients, docking site union failed, 3 of whom then underwent below knee amputation. Two patients required treatment with an intramedullary nail following frame treatment to achieve consolidated union of the docking site. Anatomic sagittal and coronal alignment was achieved in 19 out of 23 patients. The mean bone regenerate was 53.3 mm (range: 15-180mm), with a mean healing index of 9.2 days/mm (range: 4.4-25 days/mm) The majority of patients experienced at least one complication, these included pin site and soft tissue infections, refracture, nerve palsy and joint stiffness. Surgical stimulation of the docking site was required in 12 of the 28 patients to promote union. The use of a stacked Taylor Spatial Frame system is effective for restoring bone length and limb function in patients with bone loss following complex trauma and orthopaedic cases. The computer assisted nature of the spatial frame allows for predictable bone regenerate, minimal residual deformity and accurate bone docking
Children with diplegic cerebral palsy develop progressive musculoskeletal deformities with deterioration in their gait. Multilevel surgery is a well-established treatment modality involving a combination of soft tissue lengthening and correction of bony deformities. At Bristol Royal Children's Hospital we have identified a cohort of 45 children with diplegic cerebral palsy who have undergone multilevel surgery. Video gait analysis had been performed pre-operatively and three years post-operatively. We utilised the Edinburgh Visual Gait Score (EVGS)[1], a validated system that allows direct comparison with gait videos taken during different periods of the patient's treatment. Seventeen measurements are taken per limb at each stage. The patients were also categorised according to the Functional Walking Score (FWS) [2] that assesses their level of independence. Post-operative results demonstrate a significant improvement in gait score on both the EVGS and FWS. Patients whose gait was more severely affected prior to surgery had the greatest improvement in mobility and functional scores. Patients consistently had significant improvements in hip and knee extension in stance phase, with more modest improvement in knee flexion in swing with persistent co-contraction. Both initial contact and heel lift were consistently abnormal pre-operatively, but few patients achieved a heel strike and normal heel lift post-operatively. We are proceeding with a long-term follow-up of this cohort of patients at 15 years following surgery. The combination of using detailed video gait analysis with functional assessment is a valuable tool in retrospective assessment of patients' outcome following surgery. It gives a quantitative evaluation of progression over time as well as allowing comparison with a cohort of patients to estimate the future level of functional independence.
High molecular weight hyaluronan (HA) is widely used in the treatment of osteoarthritis (OA) and rheumatoid arthritis (RA) by intra-articular injection. However, comparative studies of HA actions on catalytically activated cartilages in different pathologic conditions have rarely been investigated. Fibronectin fragments increased in OA and RA joints are known to cause cartilage damage through their catabolic activities. This study aimed to compare the inhibitory effects of HA on nitric oxide (NO) production by COOH-terminal heparin-binding fibronectin fragment (HBFN-f) between normal and diseased cartilages. Articular cartilage explants from normal, OA, or RA joints or isolated chondrocytes in monolayer were incubated with HBFN-f in the presence or absence of HA. Secreted NO levels in conditioned media were determined. Induction of inducible nitric oxide synthase (iNOS) and activation of nuclear factor-?B (NF-?B) were assessed with immunoblotting. Cultures were pre-treated with the specific inhibitor to evaluate the role of NF-?B in HBFN-f action. Immunofluorescence histochemistry was performed using fluoresceinated anti-CD44 antibody.Objective
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