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The Bone & Joint Journal
Vol. 102-B, Issue 11 | Pages 1542 - 1548
2 Nov 2020
Stirling PHC Oliver WM Ling Tan H Brown IDM Oliver CW McQueen MM Molyneux SG Duckworth AD

Aims

The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius.

Methods

We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_5 | Pages 63 - 63
1 Mar 2017
Oh K Tan H
Full Access

Cervical total disc replacement has been in practice for years now as a viable alternative to cervical fusion in suitable cases, aspiring to preserve spinal motion and prevent adjacent segment disease. Reports are rife that neck pain emerges as an annoying feature in the early postoperative period. The facet joint appears to be the most likely source of pain.

50 patients were prospectively followed up through 5 years after having received disc replacement surgery, indicated for symptomatic soft disc herniation of the cervical spine presenting with radiculopathy.

• All were skeletally mature and aged between 22 to 50.• All had failed a minimum of 6 months conservative therapy.• Up to 2 disc levels were addressed. C3 till C7 levels
• Single surgeon (first author)• NDI > 30% (15/50)• Deteriorating radicular neurology

We excluded those with degenerative trophic changes of the cervical spine, focal instability, trauma, osteoporosis, previous cervical spine surgery, previous infection, ossifying axial skeletal disease and inflammatory spondyloarthritides. The device used was an unconstrained implant with stabilizing teeth. Over the 5 years, we studied their postoperative comfort level via the Neck Disability Index (NDI) and Visual Analogue Score (VAS). Pre-operative and post-operative analysis of the sagittal axis and of involved facet joints were done.

22 patients suffered postoperative neck pain as reflected by the NDI and VAS scores. Of these, 10 reported of neck pain even 24 months after surgery. However, none were neurologically worse and all patients returned to their pre-morbid functions and were relieved of pain by 28 months. All 22 patients reported of rapid dissolution of neckache after peri-facetal injections of steroids were done under image guidance.

We draw attention to the facet joint as the pain generator, triggered by inappropriate implant height, eccentric stresses via hybrid constructs, eccentric loading due to unconstrained devices and unaddressed Luschka joint degeneration. Such factors require careful selection of patients for surgery, necessitate proper pre-operative templating and call for appropriate technical solutions during surgery.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 134 - 134
1 Jul 2014
Cai Y Li J Tan H Thian E Fuh JH Tay B Wang W
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Summary Statement

A three dimensional meniscal scaffold with controlled fibre diameter and orientation was fabricated by an improved E-Jetting system that mimic the internal structure of natural meniscus. In vitro cellular tests proved its feasibility in meniscal tissue engineering applications.

Introduction

Current surgical and repair methods for complex meniscal injuries still do not often give satisfactory long-term results. Thus, scaffold-based grafts are the subject of much research interest. However, one major hurdle is that current techniques are unable to replicate the precise 3D microstructure of meniscus, nor the variations in the fibrillar structure and tissue content from layer to layer. In this work, an improved electrohydrodynamic jet printing system (E-Jetting system) was developed to fabricate biomimetic meniscal scaffold for tissue regeneration.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_16 | Pages 22 - 22
1 Apr 2013
Tan H Cuthbert RJ Jones E Churchman S McGonagle D Giannoudis PV
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We hypothesise that the Masquelet induced membrane used for the reconstruction of large bone defects were likely to involve mesenchymal stem cells (MSCs), given the excellent resultant skeletal repair. This study represents the first characterisation in humans of the induced membrane formed as a result of the Masquelet technique.

Methods

Induced membranes and matching periosteum were harvested from 7 patients. Cytokines (BMP2, VEGF, SDF1) and cell lineage markers (CD31, CD271, CD146) were studied by immunohistochemisty. Flow cytometry was used to measure the cellularity and cellular composition. MSCs were enumerated using a colony forming unit fibroblast assay. In expanded cultures, a 96-gene array card was used to assess their transcriptional profile. Alkaline phophatase, alizarin red and calcium assays were employed to measure their in vitro osteogenic potential

Results

Membrane was more cellular(p=0.028), had more MSC phenotype(p=0.043) compared to matched periosteum. The molecular profiles were similar, except for 2-fold abundance of SDF-1 in membrane (p=0.043)compared to periosteum. Membrane and periosteum had a similar proportion of endothelial cells and CFU-F colonies; expanded MSCs from both sources were highly osteogenic.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 172 - 172
1 Jan 2013
Tan H Jones E Henshaw K McGonagle D Giannoudis P
Full Access

Objective

The aim of this study was to investigate PDGF release in the peripheral circulation following trauma and to correlate it with the numbers of MSCs in iliac crest bone marrow (BM) aspirate.

Methods

Trauma patients with lower extremity fractures (n=18, age 21–64 years) were recruited prospectively. Peripheral blood was obtained on admission, and at 1, 3, 5 and 7 days following admission. The serum was collected and PDGF was measured using ELISA. Iliac crest (BM) aspirate (20ml) was obtained on days 0–9 following admission. MSCs were enumerated using standard colony-forming unit fibroblasts (CFU-F) assay.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 155 - 155
1 Sep 2012
Obakponovwe O Mouzopoulos G Tan H Giannoudis P
Full Access

Purpose

In children presenting with irritable hip symptoms we wished to determine the incidence of hip septic arthritis, pathogen characteristics and the functional outcome.

Methods

Between May 2007 and January 2010, children presenting to our institution with irritable hip symptoms were eligible to participate. Exclusion criteria were history of trauma to the hip, systemic inflammatory diseases. Data collected included; demographics, clinical symptoms, temperature, haematological profile, ultrasound and culture reports, microorganism isolated and outcome. The minimum follow up was 6 months (6–24).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVI | Pages 8 - 8
1 Aug 2012
Tan H Jones E Kozera L Henshaw K McGonagle D Giannoudis P
Full Access

Background and objectives

Fracture healing represents a physiological process regulated by a variety of signalling molecules, growth factors and osteogenic progenitor cells. Bone healing following trauma is associated with increased serum concentrations of several pro-inflammatory and angiogenic growth factors1. Platelet-derived growth factor (PDGF) has been shown to stimulate mesenchymal stem cell (MSC) proliferation in vitro. However, the in vivo relationship between the levels of PDGF and the numbers of MSCs in humans has not yet been explored. The aim of this study was to investigate PDGF release in the peripheral circulation following trauma and to correlate it with the numbers of MSCs in iliac crest bone marrow (BM) aspirate and in peripheral blood.

Methods

Trauma patients with lower extremity fractures (n=12, age 18-63 years) were recruited prospectively. Peripheral blood was obtained on admission, and at 1, 3, 5 and 7 days following admission. The serum was collected and PDGF was measured using the enzyme-linked immuno-sorbent assay (ELISA) technique. Iliac crest (BM) aspirate (20ml) and peripheral blood (PB) (20ml) was obtained on days 0-9 following admission. MSCs were enumerated using standard colony-forming unit fibroblasts (CFU-F) assay.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 122 - 122
1 May 2011
Tan H Kanakaris N Harris N Giannoudis P
Full Access

Introduction: Locking plate technology for fixation of periarticular fractures has been adopted widely since its development. Distal tibial/pilon fractures represent one of the major indications of this method of fixation. The recent development of polyaxial locking systems has offered more versatility to the surgeon.

Patients and Methods: In this cohort prospective study we present our early experience of a new polyaxial locked plating system in the treatment of complex ankle and distal tibial fractures (anatomic locked plating systems– ALPS, DePuy). Demographic, mechanism of injury, AO-OTA classification, surgical procedure, postoperative course, complications, rehabilitation scheme, clinical and radiological healing as well as functional outcome (SF-36, Olerud & Molander Ankle Score, AOFAS Ankle-Hindfoot Scale, VAS pain score) were all recorded over a minimum follow-up period of 9 months.

Results: Between July 2008 and July 2009, there were 21 patients with complex ankle and distal tibial fractures who were treated with this method of fixation. There were 16 males and 5 females. The mean age was 42.9 years (16–90). All female patients were over 60 years. The majority of these injuries were related to falls or RTAs (11 and 8 cases respectively). The mean time from injury to operation was 5 days (range 1 to 14 days), and in the majority of these cases a temporary bridging external fixator was applied (in 17/21 cases). All injuries were closed fractures. There were 11 patients with 43-A, 5 with 43-B, 5 with 43-C. Fractures were treated with a choice of medial ALPS tibial plate (12 patients), anterolateral ALPS tibial plate (9 patients). There were 8 associated distal fibular fractures, which were also fixed with a plate. The mean length of stay was 8 days (range 4 to 27 days). One patient had to be converted to a circular external fixator due to local deep sepsis, while two other patients had local wound healing problems managed without implant removal. The overall healing rate was over 95%, with one case of non-union at 9 months. Fifteen of them have returned to their work, while the recorded functional scores at the last follow-up visit were good in the majority.

Conclusions: The overall clinical and functional outcome of this cohort of patients over the short-term follow-up was recorded to be comparable to existing similar case series of open reduction internal fixation of pilon fractures. The surgical advantages of the new system lie in its versatility, and short learning curve.