Long term results and patient reported outcome measures following lisfranc injuries treated with memory staple fixation.

INTRODUCTION: Various modalities of fixation have been proposed for Lisfranc injuries. Memory staple fixation offers a simple option for transarticular fixation in suitable fracture configuration with no diaphyseal extension. However there is little evidence available in the literature regarding its efficacy and patient reported outcomes. Aim of the study was to present the long term outcomes of Lisfranc injuries treated with memory staple fixation and patient reported outcomes at average follow-up of four years. METHOD: This was a retrospective analysis of all the patients who underwent fixation for Lisfranc injury using shape memory alloy (Nitinol) staples from December 2010 to October 2018. Patient demography, mechanism of injury, classification of Lisfranc injury, duration of followup, complication, revision surgery, implant removal and patient reported outcomes (AOFAS midfoot score) was noted. RESULTS: 31 patients satisfied the inclusion criteria. Mean age was 50 years and 17 patients were females. 54 % patients reported low to moderate energy trauma which included simple fall from standing height or twisting injury. 28 (90.3 %) had B2 type of fracture pattern. 13 had fixation with staples only, 15 with a staple and home run screw. No patient had primary fusion. One patient had superficial infection treated with antibiotics only. Three patients developed symptomatic arthritis, out of which one proceeded to fusion. Six had implant removal for hardware related symptoms. Average AOFAS midfoot score at average four years follow-up was 77.8 which are satisfactory. CONCLUSION: This paper highlights good outcome following memory staple fixation for Lisfranc injuries. We believe staples are more suited for the dorsal buttressing that is typically required and provide stable, reproducible fixation Our findings also suggest less need for implant removal compared to transarticular screw or plate fixation though larger studies would be required to make definitive conclusions.

Clinical and Patient reported outcomes following open reduction and internal fixation for distal tibial intra-articular fractures.

INTRODUCTION: Intra-articular distal tibial plafond fractures are rare injuries, provide a challenge for the surgeon and can often have poor outcomes. The aim of this paper was to report long term patient reported functional outcomes, health related quality of life (QoL) scores and rates of complications in order to fully counsel the patient on likely outcomes and set realistic post-operative expectations for the patient. METHODS: We conducted a retrospective review of 20 patients with distal tibial intra-articular fractures that presented to our institution between September 2014 and September 2020. All patients underwent open reduction and internal fixation (ORIF). Clinical, radiological and patient reported outcome measures (PROMS), quality of life (QoL) scores and complications were collected. RESULTS: The mean age of the patients at the time of surgery was 50.6 years (24-71). There were 7 males and 13 females. There were 4 open and 16 closed fractures. There were 7 Rüedi and Allgöwer (RA) Type 1, 9 Type 2 and 4 Type 3 fractures. The mean follow-up was 3.8 years [1-7]. The mean OMAS score was 54.3, reaching a peak at 2 years from injury. The mean QoL score (EQ5D5L) was 0.602, representing only 70 % of aged matched, UK population based norms. CONCLUSIONS: Whilst clinical outcomes are comparable with other studies, this report highlights this is a devastating injury, with most people taking 2 years to reach peak recovery. QoL outcome scores only reach 70 % normal and only 35 % of patients return to within 10 % of age matched population based norms.

Clinical outcomes after using patient specific instrumentation: is it worth the effort? A minimum 5-year retrospective review of 298 PSI knees.

INTRODUCTION: Use of patient specific instrumentation (PSI) for performing total knee arthroplasty (TKA) has been shown to improve component positioning but there is dearth of evidence regarding clinical outcomes. The aim of our study was to report patient satisfaction and functional outcome scores of patients who underwent PSI TKAs at minimum 5 year follow up. METHODS: This is a retrospective study of a prospectively collected data of patients who underwent PSI TKAs between January 2012 and October 2015 under a single surgeon. Patient Reported Outcome Measures (PROMs), patient satisfaction questionnaires, surgeon directed 3D planning changes and intra-operative changes were collected and analysed. RESULTS: The cohort included 298 consecutive PSI TKAs performed on 249 patients at a mean age of 71 years (range: 49-93 years). On an average 4 changes were made for each knee during 3D planning compared to preliminary plan. Intra-operative implant size change was required only in 3% (10 knees). The PROM scores were collected at a mean follow-up period of 6.8 years (range: 5.0-8.6 years) for 224 knees. Oxford Knee Score improved from median pre-operative score of 18 (IQR: 13-24) to median post-operative score of 44 (IQR: 40-47) with a median gain of 23 (IQR: 16-30). The median modified Forgotten Joint Score was 87.5 (IQR: 54.4-98.1). For the Beverland questionnaire, 75% (n = 166) reported being "Very Happy" and only 4% (n = 9/222) were 'Never Happy'. CONCLUSION: Excellent patient satisfaction and functional scores at mid-term can be achieve d using PSI technique to perform TKA with careful surgeon directed pre-operative planning.

Long-Term Outcomes of Collagenase Clostridium Histolyticum Injection for Palmar Dupuytren's Deformity Correction.

Introduction The use of collagenase Clostridium histolyticum injection as a minimally invasive procedure for correction of Dupuytren's deformity is well reported in the literature. We report our experience and long-term outcome of this procedure performed in a single secondary care centre. Methods We prospectively evaluated 143 fingers that underwent Dupuytren's deformity correction using CCH injection. Early side effects, degree of correction, recurrence, and patient-reported outcomes were noted. Results Early local complications were resolved in two weeks' duration. No major complications were encountered. More than 80% achieved immediate full correction of deformity and at an average follow-up of five years, 23% of patients had a recurrence. Around 92% were very satisfied with the procedure. Conclusion CCH is a safe and effective minimally invasive method to achieve correction of palmar Dupuytren's deformity and is associated with a high patient satisfaction rate.

Triplane Ankle Fracture with Concomitant Ipsilateral Shaft of Tibia Fracture: Case Report and Review of Literature.

INTRODUCTION: Triplane fracture is a rare adolescent ankle injury. Its association with ipsilateral tibial shaft fracture is very rarely reported in the literature. CASE REPORT: This is a case of a 14-year-old male who sustained a twisting injury to his right leg after a fall from a height. He sustained a minimally displaced spiral fracture of the mid-shaft of his right tibia with a concomitant ipsilateral two part triplane fracture of the ankle. He underwent minimally invasive percutaneous locking plate fixation for tibial fracture and percutaneous screw fixation for an ankle fracture. Both fractures healed uneventfully in 10 weeks with complete functional recovery in 12 weeks. CONCLUSION: The ankle injury, in such cases, can easily be missed in the presence of the more obvious tibial fracture and emergency physicians should also be aware of such injuries. As this injury is peculiar to the adolescent age group, we recommend ankle assessment of all patients with tibial shaft fractures in this age group.

Translunate, Transradial, Transtriquetral, Transtrapezoid Perilunate Dislocation With Multiple Metacarpal Neck Fractures.

We report a rare case of translunate, transradial, transtriquetral, transtrapezoid perilunate dislocation with multiple metacarpal neck fractures in a young adult. The injury was treated with open reduction and internal fixation. Although the injury was severe, the patient had a satisfactory functional result.

Closed vs open nailing for displaced middle third fracture of clavicle. Does it matter?

BACKGROUND: Intramedullary nailing for fractures of middle third clavicle has become increasingly popular. Though open nailing has been widely described, closed nailing finds less mention. OBJECTIVES: In this study we compared closed nailing with open nailing in fractures of middle third of clavicle to assess if the former holds any advantage. MATERIAL AND METHODS: 34 patients with closed nailing were compared to 31 patients with open nailing in terms of operative time, length of incision, pain, time to union and functional outcome. RESULTS: Only operative time and length of incision were significantly more in open group than in closed group. DISCUSSION: We believe that closed reduction can be attempted in all patients undergoing nailing for middle third clavicle fracture but surgeon should have a low threshold to open the fracture if closed reduction fails as functional outcome and time to union remains unaffected.

Bilateral Simultaneous Traumatic Thumb Injuries - Extensor Pollicis Longus Rupture On One Side And Ulnar Collateral Ligament On The Other. Case Report.

INTRODUCTION: Though isolated traumatic extensor pollicislongus rupture and ulnar collateral ligament rupture of the metacarpophalangeal joint of the thumb are well known injuries, it is rare to have simultaneous bilateral thumb injuries from a single traumatic event. In this article, we report simultaneous bilateral traumatic thumb injury with extensor pollicislongus tendon rupture on one side and ulnar collateral ligament tear on the other side. To the best of our knowledge, such injury has never been reported in the English literature. CASE REPORT: A 48-year-old healthy gentleman sustained simultaneous bilateral thumb injuries after a fall from mountain bike which was initially missed in the emergency department. Both injuries were later treated operatively with an excellent outcome at the end of six months. A peculiar mechanism explained simultaneous injury to both the thumbs. CONCLUSION: This unique combination of bilateral simultaneous traumatic thumb injuries is very rare. Further, due to subtle clinical findings and normal radiographs these injuries are more likely to be missed at initial evaluation Emergency physicians should be aware of it as majority of them require operative intervention for satisfactory outcome.

Epidural versus intra-articular infusion analgesia following total knee replacement.

PURPOSE: To compare the efficacy of epidural versus intra-articular infusion analgesia following total knee replacement (TKR). METHODS: 25 men and 50 women aged 55 to 75 (mean, 67) years who underwent primary TKR by a single surgeon were randomised and consented to receive either epidural (n=35) or intra-articular (n=40) infusion analgesia for 48 hours at 5 ml/ hr. All patients also received intravenous aqueous diclofenac 50 mg twice a day. Patients were assessed 6 hourly for visual analogue score (VAS) for pain to determine the analgesic effect. Complications such as paraesthesia in the lower limbs, hypotension, urinary retention, and abdominal distension were recorded, as was the rehabilitation progress with respect to the time to stand, climb stairs, use of commode chair, and discharge. RESULTS: The epidural and intra-articular infusion groups were comparable with respect to age, sex, weight, and operating time, as was the analgesic efficacy within 48 hours of TKR. Patients with epidural infusion analgesia had a higher complication rate in terms of hypotension (51.4% vs. 22.5%, p=0.015) and troublesome paraesthesia in the lower limbs (45.7% vs. 12.5%, p=0.028), and a trend of higher abdominal distension rate (20% vs. 5%, p=0.073). Patients with intra-articular infusion analgesia were able to stand/ walk earlier (2.08 vs. 2.54 days, p<0.001). The 2 groups did not differ significantly in the time needed to climb stairs, use of commode chair, and discharge. CONCLUSION: The efficacy of epidural and intraarticular infusion analgesia was comparable. Intra-articular infusion was associated with fewer complications and earlier rehabilitation.

Simultaneous bilateral total knee replacement: a prospective study of 150 patients.

PURPOSE: To evaluate the safety of simultaneous bilateral total knee replacement (TKR). METHODS: 124 women and 26 men (mean age, 66 years) underwent simultaneous bilateral TKR for tricompartmental osteoarthritis using a posteriorstabilised, high-flexion implant. All patients underwent dobutamine stress echocardiography for detection of any silent cardiac comorbidity by a cardiologist. None had any adverse effect after testing. Five patients had positive outcome and underwent coronary angiography to detect any significant coronary blockage. Functional outcome was evaluated using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Tranexamic acid was given intravenously to reduce peri-operative blood loss. Femoral blocks and patient-controlled analgesia were used to facilitate early recovery. Aggressive physiotherapy was allowed. Patients were followed up at months 3, 6, and 12, and yearly thereafter. RESULTS: At the 2-year follow-up, the mean range of motion improved from 95º to 129º (p=0.032), the mean KSS from 120 to 158 (p<0.001), and the WOMAC from 51 to 88 (p=0.002). One patient developed patellar crepitus at week 6, which resolved with conservative treatment. Another patient developed infection in both knees at month 6. Despite salvage procedures, infection recurred after 3 months and the patient underwent bilateral arthrodesis. No patient developed deep vein thrombosis or pulmonary embolism, myocardial infarction, atrial fibrillation, or other cardiac event. CONCLUSION: Simultaneous bilateral TKR is safe for properly selected patients.

The "Shetty test" in ankle injuries: validation of a novel test to rule out ankle fractures.

Ankle sprains are by far the commonest ankle injuries. The traditional clinical approach, to any ankle injury, is a clinical examination followed by radiological examination. We have developed a simple clinical test to rule out fractures in ankle injuries and thereby eliminating the necessity for radiological examination. Our test is simple, reproducible, economic, time saving and avoids potential radiation exposure risks.

Is immediate postoperative fever related to drop in haemoglobin? A comparative study in simultaneous bilateral total knee arthroplasty patients.

The purpose of the study was to assess whether fever in the immediate postoperative period after total knee arthroplasty was indeed related to the fall in haemoglobin. Only patients undergoing bilateral simultaneous total knee replacement were included in the study since the fall in haemoglobin is expected to be more as compared to unilateral cases. The mean fall in haemoglobin of 25 patients having immediate postoperative fever ('fever group') was compared with 27 patients having no fever ('no-fever group'). Though the mean fall of haemoglobin in 'fever group' was more compared to 'no-fever group', the difference was not statistically significant. Therefore, this study does not support the view that immediate postoperative fever after total knee arthroplasty is related to drop in haemoglobin.

Hip impingement in the Indian population: hip anthropometry measurements in 100 hips.

We studied 100 hip joints in Indian patients to measure femoral head sphericity, head-neck offset and alpha angle. Our study indicates that the mean values of the above measurements are far below the "danger" level for the onset of femoro-acetabular impingement. It remains to be seen whether these findings explain the low incidence of primary hip osteoarthritis in the Indian population.