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. All wounds healed uneventfully without any surgical site infection. There were no stump hematomas/seromas or instances of recurrent stump osteomyelitis or need for revision surgery.

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. Manchester-Oxford foot questionnaires (MOXFQ) were sent to patients to evaluate symptoms post-operatively. RESULTS: In total 35 patients were analysed, which included a total of 38 foot operations. Twenty seven had prior surgery for hallux rigidus and 11 for hallux valgus correction. The total range of movement of the joint improved following manipulation by an overall mean of 44.7° (p<0.0001). At subsequent follow up, the total range of movement of the joint was still improved by 22.2° (p<0.0001) overall. The mean post-operative MOXFQ score was 24.8 but no correlation was found between MOXFQ scores and range of movement. CONCLUSIONS: Manipulation under anaesthesia and local steroid injection is an effective way of treating stiffness following first ray surgery. Treatment results in an improved range of movement of the joint and patients report good function post-operatively.

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. This particular method was chosen to avoid the technical difficulties and morbidities associated with the use of bulk autografts and allografts. We describe the surgical technique and early results in the first two cases performed in our unit. The satisfactory clinical and radiologic results in the two cases demonstrate the ability of the titanium foam block to simplify an otherwise complex procedure without compromising the outcome.

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. METHODOLOGY: All patients within 72 h of ankle sprain were identified in Accident & Emergency or the Fracture Clinic. Consenting patients, stratified for sex, were randomised to either: (i) Tubigrip or (ii) class II below knee elastic stockings (ESs, Medi UK Ltd.) which were fitted immediately and worn until the patient was pain-free and fully mobile. The deep veins of the injured legs were imaged by duplex Doppler for deep vein thrombosis (DVT) at 4 weeks. Outcome was compared using the American Orthopaedic Foot and Ankle Score (AOFAS) and SF12v2 for quality of life. RESULTS: In the 36 randomised patients, the mean (95% confidence interval (CI)) circumference of the injured ankle treated by ES was 23.5 (23-24)cm initially and 22 (22-23) and 22 (21-22.5)cm at 4 and 8 weeks (p<0.001) compared with 24 (23-25) cm initially and 24 (23-25) and 24 (23-24.5) cm using Tubigrip (p<0.001). By 8 weeks, the mean AOFAS and SF12v2 scores were significantly improved by ES at 99 (8.1) and 119 (118-121) compared with 88 (11) and 102 (99-107) with Tubigrip (p<0.001). Of the 34 duplex images at 4 weeks, none had a DVT. CONCLUSION: Elastic compression improves 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). Delay due to clinical reasons statistically significantly increased the length of stay (P = .004), whereas those due to purely logistical reasons also prolonged the stay, although this association was not statistically significant in our study (P = .086). We also observed a statistically significant positive correlation between age and length of stay (P

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.