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1.
Foot Ankle Surg ; 21(2): 103-7, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25937409

ABSTRACT

BACKGROUND: The purpose of this study was to investigate the influence of joint configuration and preparation on first metatarsophalangeal (MTPJ) union rates. METHODS: We performed a retrospective analysis of first MTPJ arthrodeses undertaken in our institution. Clinical notes, radiographs and postal questionnaires were used to determine outcome. RESULTS: Two hundred first MTPJ arthrodeses (172 patients) were included in the analysis (34 male: 138 female; mean age 62 yr). The overall union rate was 93.5%. Union was achieved in 109/118 MTPJs (92.4%) prepared in the flat-on-flat configuration and in 78/82 (95%) prepared in the ball-and-socket configuration (p=0.438). Higher union rates favoured low-velocity joint preparation [using rongeur only 21/21 (100%), rongeur and burr 26/27 (96.3%) and conical reamer 31/34 (91.2%)] but this did not reach statistical significance (p=0.317). There was a 95% satisfaction rate with surgery but male patients were less satisfied (p=0.031). CONCLUSION: Union rates were not influenced by joint configuration or preparation techniques.


Subject(s)
Arthritis/surgery , Arthrodesis/methods , Hallux Rigidus/surgery , Hallux Valgus/surgery , Aged , Female , Hallux/surgery , Humans , Male , Metatarsophalangeal Joint/surgery , Middle Aged , Retrospective Studies
2.
Foot Ankle Surg ; 20(2): 130-4, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24796833

ABSTRACT

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare benign neoplastic disease of the synovium of joints and tendon sheaths, which may be locally aggressive. It can be broadly classified into localised disease or more diffuse forms, with the latter more prone to recurrence after surgical excision. We describe our experience in the management of foot and ankle PVNS, focusing on the diffuse type. METHODS: Patients with PVNS were identified from a histology database from 2000 to 2010 at the University Hospitals of Leicester. The primary aim was to determine oncological outcomes and evaluate clinical outcomes with the Toronto Extremity Salvage Score (TESS) and the American Academy of Foot and Ankle Surgeons (AOFAS) scores. RESULTS: 30 patients, 16 males and 14 females with a mean age of 37±15 years, who underwent surgery, were identified. There were 22 nodular PVNS and 8 diffuse PVNS. The diffuse PVNS was more likely to be in the hindfoot (75%, 6/8), of which 50% (3/6) had osteoarthritis at presentation. The localised PVNS was mostly located in the forefoot (91%, 20/22). None of the localised PVNS had a recurrence. The surgical recurrence rate in this series was similar to the pooled recurrence rate from the literature [12.5% (1/8) compared to 12.2% (6/49)]. The mean TESS and AOFAS scores were 86 and 78, respectively. CONCLUSIONS: Diffuse PVNS is more likely to occur in the hindfoot and nodular PVNS is more common in the forefoot. Aggressive synovectomy alone is an effective treatment for diffuse PVNS, with good oncological and clinical outcomes.


Subject(s)
Ankle Joint/surgery , Foot Joints/surgery , Osteoarthritis/complications , Synovitis, Pigmented Villonodular/surgery , Adult , Ankle Joint/pathology , Databases, Factual , Female , Foot Joints/pathology , Humans , Male , Middle Aged , Synovitis, Pigmented Villonodular/complications , Treatment Outcome , Young Adult
3.
Bone Joint J ; 96-B(5): 636-40, 2014 May.
Article in English | MEDLINE | ID: mdl-24788498

ABSTRACT

Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case-control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann-Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection. A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores.


Subject(s)
Ankle Injuries/surgery , Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Surgical Wound Infection/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Ankle Injuries/rehabilitation , Ankle Joint/physiopathology , Case-Control Studies , Diabetes Complications , Female , Fracture Fixation, Internal/rehabilitation , Fractures, Bone/rehabilitation , Humans , Male , Middle Aged , Nursing Homes , Recovery of Function , Residence Characteristics , Risk Factors , Surgical Wound Infection/rehabilitation , Trauma Centers , Treatment Outcome , Young Adult
4.
J Bone Joint Surg Br ; 91(2): 225-8, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19190058

ABSTRACT

We examined the incidence of infection with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the Leicester Royal Infirmary Trauma Unit between January 2004 and June 2006. The influence of MRSA status at the time of their admission was examined, together with age, gender and diagnosis, using multi-variant analysis. Of 2473 patients, 79 (3.2%) were MRSA carriers at the time of admission and 2394 (96.8%) were MRSA-negative. Those carrying MRSA at the time of admission were more likely to develop surgical site infection with MRSA (7 of 79 patients, 8.8%) than non-MRSA carriers (54 of 2394 patients, 2.2%, p < 0.001). Further analysis showed that hip fracture and increasing age were also risk factors with a linear increase in relative risk of 1.8% per year. MRSA carriage at admission, age and the pathology are all associated with an increased rate of developing MRSA wound infection. Identification of such risk factors at admission helps to target health-care resources, such the use of glycopeptide antibiotics at induction and the 'building-in' of increased vigilance for wound infection pre-operatively.


Subject(s)
Cross Infection/microbiology , Fractures, Bone/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Surgical Wound Infection/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Carrier State/epidemiology , Carrier State/microbiology , Cross Infection/epidemiology , Cross Infection/mortality , England/epidemiology , Female , Fractures, Bone/mortality , Humans , Incidence , Male , Middle Aged , Risk Factors , Staphylococcal Infections/epidemiology , Staphylococcal Infections/mortality , Surgical Wound Infection/epidemiology , Surgical Wound Infection/mortality , Trauma Centers , Young Adult
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