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1.
Foot Ankle Spec ; 11(4): 378-381, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29577747

ABSTRACT

Fractures of the lateral process of the talus are uncommon, but often overlooked. They can result in significant functional deficit with residual nonunion and arthritis if not recognized and treated appropriately. We describe 2 cases of such injuries, one with acute recognition and management, and one with delayed diagnosis and nonunion. In both cases, pain from the fracture was accompanied by symptoms of instability requiring simultaneous lateral ligament reconstruction along with fracture fixation. Evaluation of patients with lateral process fractures should include assessment of the lateral ligaments; ankle instability may need to be surgically addressed along with intervention for fracture fixation. LEVELS OF EVIDENCE: Level IV: Case report.


Subject(s)
Ankle Injuries/surgery , Fracture Fixation, Internal/methods , Joint Instability/surgery , Range of Motion, Articular/physiology , Talus/injuries , Tomography, X-Ray Computed/methods , Adult , Ankle Injuries/diagnostic imaging , Emergency Service, Hospital , Fracture Healing/physiology , Humans , Injury Severity Score , Joint Instability/diagnostic imaging , Male , Pain Measurement , Risk Assessment , Talus/diagnostic imaging
2.
Foot (Edinb) ; 34: 58-62, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29306736

ABSTRACT

BACKGROUND: Traditionally severe hallux rigidus is treated with arthrodesis. Recently arthroplasty has been used in order to retain motion at the metatarsophalangeal joint. AIM: To assess the early to mid-term functional and radiological outcomes in patients undergoing first metatarsophalangeal arthroplasty using the Rotoglide implant. MATERIALS AND METHODS: A prospective review was undertaken to assess functional and radiological outcomes of all patients undergoing an un-cemented three-component first metatarsophalangeal arthroplasty for hallux rigidus. Thirty four implants were performed in 28 patients over a 2-year period. Mean age was 60.5 years (range 45-77 years). Mean follow-up was 27.7 months (range 7-44 months). RESULTS: Mean AOFAS score improved from 41.2 pre-operatively to 89.1 at final follow-up (47.9; 95% CI=43.6-54.3; p<0.0001). The mean metatarsophalangeal (MTP) range of motion improved from 29.5° pre-operatively to 68.2° post-operatively (38.7; 95% CI=35.1-42.2; p<0.0001). The mean AOFAS pain scores improved from 8.8 preoperatively to 35.0 postoperatively (26.2; 95% CI=22.4-29.9; p<0.0001). Three patients required revision surgery. No radiological complications were observed in any other patients. CONCLUSIONS: This un-cemented prosthesis provides pain relief, while maintaining range of motion of the joint. The authors have observed clinically and statistically significant improvement in functional outcomes, with a low early complication rate and high patient satisfaction levels.


Subject(s)
Arthroplasty, Replacement/methods , Hallux Rigidus/surgery , Joint Prosthesis , Prosthesis Design , Range of Motion, Articular/physiology , Aged , Ambulatory Surgical Procedures/methods , Cohort Studies , Female , Follow-Up Studies , Hallux Rigidus/diagnostic imaging , Humans , Male , Middle Aged , Prospective Studies , Prosthesis Failure , Radiography/methods , Reoperation , Risk Assessment , Treatment Outcome , United Kingdom
3.
Foot (Edinb) ; 25(4): 232-4, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26553388

ABSTRACT

BACKGROUND: Morton's neuroma is a common cause of inter-metatarsal foot pain. Surgical excision is generally indicated when non-operative measures have been unsuccessful; various surgical techniques have been described in the literature for excision, with no consensus on the overall ideal surgical approach. AIM: To assess patient outcomes and complications following plantar surgical approach to neurectomy in a consecutive series of patients. METHOD: An analysis of consecutive patients undergoing excision of Morton's neuroma using a plantar approach by a single surgeon over a 12 month period. Pre- and post-operative AOFAS and VAS scores were completed during outpatient visits. RESULTS: 20 patients were included in the study, with pre-operative confirmation of a soft tissue mass on ultrasound scan. All patients demonstrated improvement in their post-operative functional scores; 2 patients (10%) did not have full resolution of their symptoms post-operatively. Mean AOFAS scores improved from 39 to 80 post-operatively and VAS from 40 to 92. No patients had wound complications or scar pain. CONCLUSION: Neurectomy performed via a plantar approach provides good exposure, adequate soft tissue healing, with rapid resolution of pain and return to normal activities post-operatively.


Subject(s)
Foot Diseases/surgery , Metatarsalgia/surgery , Neuroma/surgery , Orthopedic Procedures/methods , Female , Follow-Up Studies , Foot Diseases/complications , Foot Diseases/diagnosis , Humans , Male , Metatarsalgia/diagnosis , Metatarsalgia/etiology , Middle Aged , Neuroma/complications , Neuroma/diagnosis , Pain Measurement , Prospective Studies , Retrospective Studies , Time Factors , Treatment Outcome
4.
Int J Spine Surg ; 9: 47, 2015.
Article in English | MEDLINE | ID: mdl-26512341

ABSTRACT

Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised. Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature. Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality. Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities. We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery.

5.
Ortop Traumatol Rehabil ; 17(2): 121-6, 2015.
Article in English | MEDLINE | ID: mdl-26248756

ABSTRACT

BACKGROUND: Reported outcomes of shoulder hemiarthroplasty for proximal humeral fractures have been poor due to tuberosity non-union or rotator cuff disruption. Newer designs provide features to allow secure tuberosity apposition and stabilisation. To evaluate the outcomes of a shoulder hemiarthroplasty system with "tuberosity friendly" features in the treatment of multi-fragmentary proximal humeral fractures. MATERIAL AND METHODS: An analysis of 12 patients undergoing Exactech Equinoxe hemiarthroplasty for proximal humeral fractures over a two year period. Radiological and clinical outcomes were assessed. RESULTS: Twelve patients, aged 55 to 84, were examined. Median follow up was 20 months (range 7 to 31). Although tuberosity reduction remained and the tuberosities united radiologically in all cases, 5 patients went on to develop superior migration of the humeral head. The median Oxford shoulder score was 25.7 out of 48 (range 11 to 43). CONCLUSIONS: 1. A trauma hemiarthroplasty system combined with good surgical technique can ensure tuberosity fixation and subsequent union. 2. Superior migration of the prosthesis can still occur due to rotator cuff disruption. 3. The use of reverse shoulder arthroplasty may be more appropriate in elderly patients with multi-fragmentary proximal humeral fractures.


Subject(s)
Hemiarthroplasty/instrumentation , Joint Prosthesis , Prosthesis Design , Range of Motion, Articular/physiology , Shoulder Fractures/surgery , Shoulder Joint/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged
6.
Ortop Traumatol Rehabil ; 17(6): 637-40, 2015.
Article in English | MEDLINE | ID: mdl-27053396

ABSTRACT

Superior migration and malunion of a fractured greater tuberosity can lead to mechanical subacromial impingement with resultant ongoing pain and limitation of abduction. We describe such a case successfully treated with arthroscopic excision of the protruding portion of the greater tuberosity, with marked improvement in pain and range of movement. The greater tuberosity was exposed by elevating the supraspinatus tendon, which was reattached at the end of the procedure. This case, along with outcomes of similar techniques previously reported in literature suggest that arthroscopic excision of a superiorly malunited greater tuberosity is associated with good symptomatic outcome and preservation of rotator cuff function.


Subject(s)
Arthroscopy/methods , Fractures, Malunited/diagnosis , Fractures, Malunited/surgery , Rotator Cuff/diagnostic imaging , Rotator Cuff/surgery , Shoulder Fractures/diagnosis , Shoulder Fractures/surgery , Adult , Female , Humans , Male , Range of Motion, Articular , Recovery of Function
7.
BMJ Case Rep ; 20142014 Oct 15.
Article in English | MEDLINE | ID: mdl-25320263

ABSTRACT

We report the case of a 33-year-old man who presented several times to healthcare professionals over a 6-week period with a painful swollen right knee. He had a history of chronic osteomyelitis of the left femur and had recently stopped taking suppressive antibiotics. A joint aspirate did not demonstrate any organisms. On subsequent review by the orthopaedic team MRI was performed which revealed an isolated area of osteomyelitis and an abscess in his right patella. He underwent arthrotomy, debridement and irrigation of the joint alongside antibiotic treatment. We highlight this case, as isolated osteomyelitis of the patella is a rare condition, especially in adults. In addition, the presenting features of osteomyelitis of the patella are varied and joint fluid aspirates often do not reveal an organism. This case therefore aims to raise an awareness of this condition and thereby ensure a high index of suspicion when symptoms or signs are present and inform clinicians of the investigative steps in order to avoid a delay in diagnosis as seen in this case.


Subject(s)
Osteomyelitis/diagnosis , Patella , Abscess/diagnosis , Abscess/drug therapy , Abscess/surgery , Adult , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Debridement , Humans , Male , Osteomyelitis/drug therapy , Osteomyelitis/surgery , Therapeutic Irrigation
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