Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator.

Introduction: Miserable malalignment syndrome is a complex torsional lower limb deformity with limited consensus on surgical treatment. We present the outcome of de-rotation of the tibia alone using an external fixator.

Methods: Fifteen patients (22 segments) were operated on between 2012 and 2020; 13 presented with anterior knee pain, and two presented with out-toeing.

An Update on the Intramedullary Implant in Limb Lengthening: A Quinquennial Review Part 2: Extending Surgical Indications and Further Innovation.

The use of the intramedullary lengthening nail has gained in popularity over the last decade. The reduction in complications associated with the use of external fixators and excellent patient outcomes has resulted in the largest change in management of limb length discrepancy since the concept of distraction osteogenesis was accepted by the Western world in the 1980s. Success following "simple" limb lengthening has led to surgeons extending the indications for the lengthening nail, including different bone segments, lengthening associated with potential joint instability and lengthening combined with acute deformity correction.

An update on the intramedullary implant in limb lengthening: A quinquennial review Part 1: The further influence of the intramedullary nail in limb lengthening.

The goal of limb lengthening is to restore length to bone, safely stretch soft tissues and improve quality of life with minimal complications. Traditionally this was achieved with the use of external fixators, associated with complications related to pin site tethering and infections, joint stiffness and regenerate deformity and fracture following frame removal. The duration of treatment also impacts on patient mental health and well-being.

Analysis of retrieved STRYDE nails.

Aims: The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices.

Methods: We collected ten nails removed from six patients, together with patient clinical data and plain radiograph imaging. We performed macro- and microscopic analysis of all surfaces and graded the presence of corrosion using validated semiquantitative scoring methods.

Early results from a single centre's experience with the STRYDE nail : a cause for concern?

Aims: The STRYDE nail is an evolution of the PRECICE Intramedullary Limb Lengthening System, with unique features regarding its composition. It is designed for load bearing throughout treatment in order to improve patient experience and outcomes and allow for simultaneous bilateral lower limb lengthening. The literature published to date is limited regarding outcomes and potential problems.

Regenerate Deformity with the Precice Tibial Nail.

Unlabelled: Limb lengthening by distraction osteogenesis is an accepted orthopaedic surgical technique. The Precice intramedullary lengthening system is the most recent innovation in limb lengthening. Early results have been favourable in femoral lengthening but there is little reported on the outcome in tibial lengthening.

Femoral lengthening using the Precice intramedullary limb-lengthening system: outcome comparison following antegrade and retrograde nails.

Aims: The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients.

Patients And Methods: A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients.

External fixation for the correction of adult post-traumatic deformities.

Malalignment of the lower limb is a significant factor in the progression of arthritis of the knee and ankle, and correction of deformity can slow the progress and reduce symptoms. It is less clear that malalignment can cause arthritis de novo, but in post traumatic deformity it has been shown that a fracture of the tibia can increase the risk of pain and stiffness of the knee and ankle irrespective of deformity. The management of deformity of the lower limb by external fixation requires a careful systematic method of deformity analysis combining clinical and radiographic assessment is essential to avoid the pitfalls of overlooking potential soft tissue problems, and hidden secondary deformities.

The role of external fixation in paediatric limb lengthening and deformity correction.

Limb deformity and shortening remains a common presenting complaint in paediatric orthopaedics. The ability to restore length, alignment with consistent bone formation allows standardised treatment in these difficult conditions. The use of an external fixator produces a stable construct which allows manipulation of the bone segments, with a controlled rate and rhythm.

A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation.

Introduction: Clinical studies in orthopedics are using patient-reported outcome measures (PROMs) increasingly. PROMs are often being designed for a specific disease or an area of the body with the aim of being patient centered. As yet, none exists specifically for treatment with circular ring external fixation devices.

A retrieval analysis of the Precice intramedullary limb lengthening system.

Objectives: The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors.

The role of the intramedullary implant in limb lengthening.

Limb lengthening is now an accepted practice in orthopaedic surgery. The principles of distraction osteogenesis have become well established with the use of external fixators, utilizing both monolateral and ring fixators. Corticotomy technique, frame stability, lengthening rate and rhythm all contribute to the formation of bone regenerate and tissues.

Recurrent multifocal diabetic myonecrosis: a cause of severe extremity pain in a diabetic patient.

We detail the unusual occurrence of successive episodes of diabetic myonecrosis in both lower and upper limbs in a young woman with diabetic end organ dysfunction. We highlight the importance of recognising this as a differential diagnosis for acute limb pain in diabetic patients and advocate conservative measures for successful treatment and return to function.

"No one has ever asked for it back!" A survey assessing the fate of reusable external fixation equipment in mortuaries.

Technicians from one hundred and eighteen Human Tissue Authority (HTA) approved mortuaries licensed to perform post-mortems in England completed a telephone interview. All were questioned on whether they had contact with reusable external fixators, who was responsible for the removal, the number removed annually, and the destination of the fixator post-removal. Opinion was sought on how the return of the equipment could be better facilitated.

Reducing missing fracture clinic radiographs by entrusting them to patients.

Background: Missing radiographs in fracture clinics may compromise fracture management and lead to inappropriate use of clerical resources.

Methods: We prospectively compared the number of missing radiographs in two hospitals over a period of two months. In hospital A the radiographs were retained and in hospital B they were entrusted to the patients.

Hydroxyapatite coating of an acetabular prosthesis. Effect on stability.

We report the radiological and clinical outcome of a press-fit (SLF) acetabular component at two to three years in two groups of patients having primary total hip replacement. In 69 the implant was coated with hydroxyapatite (HA) and in 40 it was uncoated. The stability of the cup was assessed by measurement of proximal migration and change in the angle of inclination.

Is stem length important in uncemented endoprostheses?

In an uncemented total hip replacement where the femoral stem is thinner than the medullary canal it may be hypothesized that the distal portion of the stem has no mechanical function. In this study an uncemented total hip replacement has been modelled mathematically using finite element analysis and mechanical tests of a similar system have been carried out loading implants in cadaveric proximal femora. Two implants have been tested mechanically; one with a full length stem and the second with the stem shortened, but three implants have been modelled with an additional intermediate length stem analysed.