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.

Preconsultation Questionnaires for Patients Attending Elective Foot and Ankle Clinics: Is This the Way Forward in Outpatient Clinics?

Orthopaedic clinics can often be overbooked' busy and delayed appointments are a common sight in the National Health Service. We recognize this is becoming a growing problem that needs to be addressed; therefore, we have carried out a quality improvement project (QIP) that can save clinicians time. We have developed the "Stockport Foot and Ankle Questionnaire," a novel preconsultation questionnaire to gather information about patient history and symptoms. We found that the average time required for consultation reduced from a mean of 22 minutes, without questionnaires, to a mean of 15 minutes with the questionnaire, effectively saving 7 minutes per consultation. The preconsultation questionnaire in foot and ankle clinics is a novel technique to improve efficiency, productivity, and standardization in outpatient clinics. It is a patient-centered approach that identifies where effective changes can be implemented in how outpatient services are run. We recommend routine use of these questionnaires to save valuable clinician time.Levels of Evidence: Level II.

Flexor Hallucis Longus Tendon Single-Incision Transfer Stabilized With Autologous Bone Fixation.

Flexor hallucis longus transfer is routinely used as a technique to salvage a chronic or neglected Achilles tendon rupture. The single-incision (or short harvest) technique provides adequate graft suitable for fixation with interference screws. We have used a bore corer instead of a drill to establish the tendon tunnel and at the same time use the harvested autograft for interference fit and avoid the use of screws, providing what we consider to be a more biologic form of fixation.

A case report of missed femoral neck stress fracture.

Femoral neck stress fracture (FNSF) is an uncommon but potentially serious orthopaedic problem. This is a case report on missed femoral neck stress fracture in a 62-year-old female who was initially treated as early-onset coxarthrosis. She later presented to us with a displaced intra-capsular neck of left femur fracture and underwent total hip replacement. This case illustrates that causes other than osteoarthritis should be taken into consideration in patients presenting with anterior hip pain where symptoms are disproportionate to clinical and radiological findings. More advanced investigations such as MRI scan or regular follow up with plain radiographs should be performed. A delay in diagnosis can lead to secondary displacement of the femoral neck stress fracture.

Management of type 3 acromioclavicular joint dislocation: comparison of long-term functional results of two operative methods.

Introduction. Treatment of Rockwood Type 3 Acromioclavicular joint dislocation is controversial. We compared the long-term functional outcome of early repair of coracoclavicular ligament and internal fixation (Tension Band Wiring) with delayed reconstruction by modified Weaver-Dunn procedure for Type 3 dislocations. Method. Retrospective analysis of case records and telephone review to assess the long-term functional outcome by patient satisfaction and Oxford shoulder score. Results. We had 18 cases of Type 3 Acromioclavicular dislocations over a period of 10 years. 7 cases had Tension Band Wiring and 11 cases had modified Weaver-Dunn procedure. Early repair group has higher risk (71%) of post operative complications compared to that of the delayed reconstruction group (9%). All 5 patients who developed postoperative complications in the early repair group required a second operation for metal work removal. Long-term functional results of both groups were comparable in terms of Oxford shoulder score and patient satisfaction. Conclusions. We recommend modified Weaver-Dunn procedure for failed conservative management of Grade 3 Acromioclavicular joint dislocation for the following reasons (1). better short-term functional outcome, low risk of complications and hence faster recovery (2). no need for a second surgery.

A biomechanical study on variation of compressive force along the Acutrak 2 screw.

INTRODUCTION: Acutrak 2 screws are commonly used for scaphoid fracture fixation. To our knowledge, the variation in compressive force along the screw has not been investigated before. The objectives of our study were to measure variance in compression along the length of the standard Acutrak 2 screw, to identify the region of the screw which produces the greatest compression and to discuss the clinical relevance of this to the placement of the screw for scaphoid fractures. MATERIALS AND METHODS: A laboratory model was set up to test the compressive force at 2mm intervals along the screw, using solid polyurethane foam (Sawbone) blocks of varying width. The Acutrak 2 screws were introduced in the standard method. Forces were measured using a custom-made load cell washer introduced between the Sawbone blocks and were plotted as a graph along the whole length of the screw. RESULTS: Maximum compression was at the mid-point of the screw. Overall compressive forces were higher in the proximal half of the screw by 19% when compared with the distal half. Minimum compression was seen at 4mm or less from either end of the screw. CONCLUSIONS: There is variation in compression along the length of the standard Acutrak 2 screw and the maximum compression was obtained at the mid-point of the screw. From this study, we would recommend when using an Acutrak 2 screw for internal fixation of scaphoid fractures, to attain maximum compressive force, place the fracture at the mid-point of the Acutrak screw. If this is not possible, then place the fracture towards the proximal half of the screw.

A modified Jones procedure for managing clawing of lesser toes in pes cavus: long-term follow-up in 8 patients.

UNLABELLED: Pes cavus is a complex foot deformity in which surgical correction remains challenging. We treated lesser-toe clawing in 11 feet of 8 patients (5 women, 1 bilateral; 3 men, 2 bilateral) with a modified Jones procedure and assessed long-term functional outcomes. We reviewed case notes and completed the Bristol Foot Score, the modified American Orthopaedic Foot & Ankle Society Midfoot Score, and a patient satisfaction questionnaire by means of telephone interviews. Mean age of the patients at the time of surgery was 30 years (range, 10-58 years). Mean time from surgery to the last clinical follow-up was 7 years (range, 0.5-17 years), and mean time from surgery to the telephone interview was 9 years (range, 1-18 years). At the final clinical review, all 11 feet were improved, although 6 had minor complications. The mean Bristol Foot Score was 27 (range, 16-55), and the mean modified American Orthopaedic Foot & Ankle Society Midfoot Score was 76 (range, 47-90), indicative of excellent results. Half of the patients had mild persistent foot pain, but all were satisfied with the outcome. Based on our experience with this group of patients, the modified Jones procedure yields satisfactory correction of lesser toe clawing in patients with flexible pes cavus. LEVEL OF CLINICAL EVIDENCE: 4.