Functional outcome following an ankle or subtalar arthrodesis in adults.

Arthrodesis surgery aims to give pain relief by abolishing the movement of the joint concerned. Few studies describe the outcome as appreciated by the patient. This was the major concern of the authors, when they set up this retrospective study about the outcome after ankle fusion or subtalar fusion.

Implementing National Institute of Clinical Excellence guidelines for venous thromboembolism prophylaxis.

Introduction: Venous thromboembolism (VTE) is a serious complication after lower limb injury and surgery. Pursuing prophylactic policies, particularly chemical prophylaxis, has been a debatable issue. In April 2007, the National Institute of Clinical Excellence recommended using chemical and/or mechanical prophylaxis for patients undergoing joint arthroplasty and other orthopedic operations.

The outcome after using two different approaches for excision of Morton's neuroma.

Background: The choice for the surgical approach of interdigital neuroma in the foot is controversial. Plantar approach can leave a painful scar on weight bearing area; hence, some prefer dorsal approach. The aim of the current study was to measure the outcome of interdigital (Morton's) neurectomy performed by a single surgeon using dorsal and plantar approaches.

The value of an admissions proforma for elderly patients with trauma.

The authors worked in a busy regional fracture unit, where it was noted that important data was being omitted from the medical notes. In an attempt to improve on this, an admission proforma was formulated. This was designed to be easily and quickly completed.

Non-operative treatment of elderly patients with femoral neck fracture.

Surgery is the routine management for elderly individuals with femoral neck fracture, in order to reduce the morbidity and the mortality and to relieve pain. Sixteen elderly patients with displaced femoral neck fractures who were unfit for surgeries were treated conservatively. The mortality in this group was not higher than reported following surgical management.

Is a femoral component applicator useful in total knee replacement?

The benefit of using an applicator to insert the femoral component during total knee arthroplasty in preventing flexion of the femoral component in the sagittal angle was evaluated in a prospective, consecutive, single-surgeon series. In group I (60 knee replacements) the applicator was used. In group II (64 knees) the femoral component was implanted without an applicator.

The effect of two different types of cement restrictors on the femoral cement mantle.

Cement restriction and pressurisation are helpful technical points in achieving a good cement mantle in cemented hip replacement. In this prospective study, we compared 39 cases where a Hardinge polyethylene restrictor was used and 33 cases where a bone block restrictor was used during Charnley hip replacement. The preoperative radiographs were templated, calibrated holders for the cement restrictors were used intraoperatively, keeping the distal cement height within 2-3 cm from the tip of the femoral prosthesis.

A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model.

Background: Arthrodesis of the great toe metatarsophalangeal joint for osteoarthritis usually involves internal fixation. Ideally, the fixation method should be reproducible, leading to a high rate of fusion and minimal complications.

Methods: This biomechanical study compares circumferential wire and screw fixation methods of arthrodesis.

The value of nerve root infiltration for leg pain when used with a nerve stimulator.

Randomized comparative study of the efficacy of nerve root infiltration (NRI) guided by neurostimulator to find the value of nerve stimulators in nerve root infiltration was undertaken. The response to nerve root infiltration using local anaesthetics and steroid is unpredictable, partly because the exact nerve root giving rise to pain may not be truly infiltrated. The nerve stimulator is advocated to identify the nerve root of concern prior to infiltration.

Correlation between pre-injury mobility and ASA score with the mortality following femoral neck fracture in elderly.

A poor pre-injury mobility and high American Society of Anaesthiologist (ASA) grading is thought to be associated with a poor survival following surgical treatment of femoral neck fracture in the elderly. Hence there are concerns among orthopaedic surgeons about surgical treatment in this group of patients. In this retrospective study, the pre-injury mobility and ASA scores of 401 patients with fractured neck of femur treated by surgery was assessed in relation to mortality following surgery within the first 30 days of injury.

The role of postoperative blood recovery for patients with femoral neck fracture.

Postoperative blood recovery in eighty elderly patients (11 male, 69 female) treated for femoral neck fracture was prospectively studied. Twenty-eight patients underwent hemiarthroplasty for intracapusular fracture and 52 underwent Dynamic Hip Screw fixation for extracapsular femoral neck fracture. The mean blood drainage in the postoperative period and the mean drop in haemoglobin level was higher in the DHS group as compared to the hemiarthroplasty group.

A subjective outcome analysis of tendo-Achilles rupture.

This clinical outcomes study examined factors affecting patient satisfaction after treatment of Achilles tendon rupture. There were 35 patients; 14 treated nonsurgically and 21 treated by open surgical repair. A retrospective chart review was performed to determine the mechanism and type of injury, the time to treatment, any comorbidities, and the length of follow-up.

Bilateral congenital coracoclavicular joint. Case report and review of the literature.

The diagnosis of coracoclavicular articulation was made in an elderly woman, who complained of bilateral anterior shoulder pain with impingement. This congenital pseudo-articulation is rarely symptomatic and is usually an incidental radiological finding. Surgical excision of the prominent bony projection, arising from the inferior surface of the clavicle at the level of the coracoid process, relieved the impingement and gave satisfactory pain relief.

Intra-articular bupivacaine hip injection in differentiation of coxarthrosis from referred thigh pain: a 10 year study.

The authors conducted a retrospective study to validate the specificity of intra-articular injection of local anaesthetic to identify the source of pain in patients with coxarthrosis but ill-defined clinical and radiological features. Forty-seven patients received intra-articular injection of the hip joint as a diagnostic procedure. Twenty-four patients showed a positive response with relief of pain.

Recurrent ankle sprains secondary to nonunion of a lateral malleolus fracture.

A case of an adult man with symptoms of chronic recurrent ankle sprains secondary to nonunion of a fracture of the tip of the lateral malleolus is presented. The nonunion was debrided, bone grafted, and internally fixed by using the tension band wire technique. The fracture healed and the patient experienced no further episodes of ankle sprain.

Study of twenty-seven paediatric patients with open tibial fracture: the role of definitive skeletal stabilisation.

Background: The aim of this retrospective study was to review our practice of the management of open tibial fractures in children.

Methods: Twenty-seven children aged 3-15 years (mean 9.5) with open fractures of the tibia were treated with early aggressive wound debridement and lavage.