End-capping of amputation stumps with a local antibiotic containing hydroxyapatite bio-composite - A report of 13 cases with chronic lower limb osteomyelitis.

We present our novel technique of end capping of amputation stumps with absorbable antibiotic containing hydroxyapatite bone cement as a marrow plug controlling bleeding and achieving high local concentration of antibiotics in cases complicated by chronic osteomyelitis.Our case series consisted of 13 patients who underwent lower limb amputations for chronic medullary osteomyelitis.Of 13 patients 12 had below knee and 1 had above knee amputation.

Manipulation under anaesthesia and steroid injection for pain and stiffness after surgery to the first metatarsophalangeal joint.

Aim: To determine the effectiveness of manipulation under anaesthesia and local steroid injection to treat stiffness of the first metatarsophalangeal joint following surgery for hallux rigidus or hallux valgus.

Methods: Patients were identified who had undergone surgery for hallux rigidus or hallux valgus and subsequently were treated with manipulation and steroid injection for stiffness of their joint. Patient records were reviewed to determine the range of movement of the joint pre-operatively, immediately following the procedure and at subsequent follow up.

Compression stockings in the management of fractures of the ankle: a randomised controlled trial.

In this randomised controlled trial, we evaluated the role of elastic compression using ankle injury stockings (AIS) in the management of fractures of the ankle. A total of 90 patients with a mean age of 47 years (16 to 79) were treated within 72 hours of presentation with a fracture of the ankle, 31 of whom were treated operatively and 59 conservatively, were randomised to be treated either with compression by AIS plus an Aircast boot or Tubigrip plus an Aircast boot. Male to female ratio was 36:54.

Surgical tip: Titanium foam blocks can simplify fusion of failed total ankle replacements.

Ankle arthrodesis following failed ankle replacements is a technically challenging task because of the large defect left behind after the prosthesis is removed. The usual practice is to use bulk grafts which are either autografts or allografts to fill the defect. We report our experience with the use of a titanium foam block specifically designed for fusion of failed ankle replacements.

Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature.

The differential diagnosis of ankle pain is extensive. Pathology may be classified as intra- or extra-articular. Additionally, ankle pain may be traumatic or non-traumatic.

Elastic stockings or Tubigrip for ankle sprain: a randomised clinical trial.

Background: Ankle sprains are common and generally believed to be benign and self-limiting. However, a significant proportion of patients with ankle sprains have persistent symptoms for months or even years.

Aims: The study aimed to evaluate whether elastic stockings improve recovery following ankle sprain.

The factors associated with prolonged inpatient stay after surgical fixation of acute ankle fractures.

In order to identify specific factors associated with prolonged inpatient stay following surgical correction of acute ankle fracture, we conducted a retrospective cohort study of patients who underwent acute ankle fracture repair, comparing length of hospital stay to the reason for delay of surgery (logistical versus clinical), type of fracture, and age. Our findings showed that delay in surgical repair beyond 24 hours following presentation to the emergency department was associated with a statistically significant overall longer length of stay, in comparison to patients who underwent surgery within the first 24 hours (P = .022).

Functional management of Achilles tendon rupture: A viable option for non-operative management.

Background: Functional management of the ruptured Achilles tendon can be effective using orthoses like the removable walker boot (Foam Walker Boot, Air Cast UK Limited, Lincolnshire, United Kingdom). We conducted this study to look at the outcome of our protocol using this orthosis.

Materials And Methods: We retrospectively reviewed 107 non-operatively managed Achilles tendon ruptures over the last 5 years.

Persistent diastasis in a Maisonneuve fracture--interposition of a tibial osteochondral fragment: a case report.

We report a case of failed reduction of the distal tibiofibular syndesmosis following a Maisonneuve fracture due to interposition of an osteochondral fragment in the syndesmosis from the tibial plafond. The displaced fragment was not initially appreciated. It is suggested that surgeons consider this as a possible cause of an incompletely reduced diastasis after deltoid ligament interposition has been excluded.

Irreducible dorsal radiocarpal fracture dislocation with dissociation of the distal radioulnar joint: a case report.

We report a case of dorsal radiocarpal fracture dislocation with dissociation of the distal radioulnar joint. Closed reduction was unsuccessful due to interposition of the osteochondral fragments and open reduction and fixation was carried out with a satisfactory end result. The advantages of volar approach and use of external fixator in the management of this injury are discussed.

Painless limp as a presentation of pelvic eosinophilic granuloma in a child.

Painless limp in children continues to pose a diagnostic challenge. In the majority of the cases transient synovitis of the hip is the cause. However, bone tumours should be considered as a possibility and specifically looked for when a child continues to have ongoing symptoms.

Serology of abnormal fracture healing: the role of PIIINP, PICP, and BsALP.

Objective: To determine whether poorly healing tibial shaft fractures exhibit a serological response of bone-specific alkaline phosphatase (BsALP), collagen I carboxy-terminal propeptide (PICP), collagen III amino-terminal propeptide (PIIINP), and collagen I carboxy-terminal telopeptide (ICTP) different from that of normally healing fractures.

Design: Prospective.

Participants: Twenty consecutive patients with isolated tibial shaft fractures with or without fracture of the fibula.

Fibrous contracture of the elbow following cannulation of the antecubital fossa vein.

A case of flexion contracture of the elbow resulting from thrombophlebitis is described. Thrombophlebitis is a recognised complication following cannulation of the antecubital fossa vein. In severe cases a tender fibrous band is palpable.

Serology of collagen types I and III in normal healing of tibial shaft fractures.

Objectives: To establish that serological indicators of synthesis of collagens I and III in humans with normally healing tibial shaft fractures will display a temporal pattern consistent with the sequence of expression of these collagens observed histologically in animal models of fracture healing.

Design: Prospective.

Setting: Four district general hospitals in the United Kingdom supported by an academic unit.

Widening of the mediastinum following a sternal fracture.

Sternal fractures, once thought of as uncommon, occur with increasing frequency, parallelling the incidence of motor vehicle accidents. A fractured sternum can produce a widening of the mediastinum even in the absence of an aortic injury. The Advanced Trauma Life Support course teaches that a widening of the mediastinum after blunt chest injury is an indication for aortography.

Traumatic radial head dislocation in children--a missed injury.

The purpose of this article is to remind accident and emergency doctors of an easily missed injury-isolated traumatic radial head dislocation in children. We present two such cases. This is a very uncommon injury and the diagnosis was overlooked in both cases.

The Ilizarov method in nonunion, malunion and infection of fractures.

We have reviewed a series of 56 consecutive patients treated by the Ilizarov circular fixator for various combinations of nonunion, malunion and infection of fractures. We used segmental excision, distraction osteogenesis and gradual correction of the deformity as appropriate. Treatment was effective in eliminating 40 out of 46 nonunions and all 22 infections.

Acrylic bone-cement. Influence of mixer design and unmixed powder.

The effects of hand mixing with two different mechanical mixing systems (fixed versus rotating central axis) on unmixed powder content, macroporosity, density, and bending strength of acrylic bone-cement are compared. The effects of voids and unmixed powder on cement bending strength are also evaluated. In acrylic cement, both unmixed powder monomer and voids 1 mm and larger can be easily visualized and analyzed on radiographs of 3-mm-thick samples.

Serum osteocalcin, total and bone-specific alkaline phosphatase following isolated tibial shaft fracture.

We report the changes in osteocalcin concentrations and in total and bone specific alkaline phosphatase activity occurring in the twenty week period following tibial shaft fracture in 20 subjects. Bone formation during the healing process is reflected by progressive increases in the concentration of osteocalcin and bone specific alkaline phosphatase after week 5 and the latter correlated with the height and weight of the subject. In the early post injury period, total alkaline phosphatase activity increased whereas that of the bone isoenzyme initially fell, starting to rise again during the second week.

Endothelial stimulating angiogenic factor in early fracture healing.

The early vascular response is essential for the normal progress of fracture healing and fracture site blood flow has been shown to reach a peak in the first two weeks after injury. Angiogenesis is an important step in this response as new vessel formation is necessary to vascularize the fracture haematoma and the fracture gap. Changes in serum levels of a low molecular weight endothelial stimulating angiogenic factor (ESAF) have been previously reported in a group of four patients with tibial fractures.

Transfusion needs in hip and knee arthroplasty.

A 12 months retrospective study of cross-match and transfusion practice in hip and knee arthroplasty in a general orthopaedic unit was carried out aiming to assess the transfusion needs for these procedures prior to enrolling future patients in a pre-donation program for autologous transfusion. The study revealed acceptable transfusion practice in the unit. For both procedures, over 75% of all transfusions were carried out in the peri-operative period.

A new osteotome for performing chevron trochanteric osteotomy.

We report on the use of a new modified osteotome for performing chevron trochanteric osteotomy during hip arthroplasty. It is easy to use and the apex of the chevron is directed distally, thus producing a large segment of osteotomized trochanter, while avoiding the problems of fragmentation and splintering. At the end of the procedure, the trochanter is easily seated back within its concave bed, automatically achieving anatomical reduction and allowing easier fixation using the cruciate wiring technique.

The huckstep nail. Stable fixation of mechanically deficient femoral bone.

A Huckstep intramedullary nail was used to treat 23 fractures in which the femur was mechanically deficient due to pathologic fracture, nonunion, or complex fracture in osteoporotic bone. All nailings were performed by open surgery, and in some cases this was augmented by corticocancellous bone grafting. The Huckstep nail allows the use of multiple cross screws at 15-mm intervals, providing immediate and adequate stability with successful early postoperative weightbearing.