Publications by authors named "Adnan Faraj"

22 Publications

  • Page 1 of 1

Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design.

Acta Orthop Belg 2021 Mar;87(1):65-71

Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs. A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically. Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class cor- relation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th​ week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6. The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femoral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.
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March 2021

Functional Outcome of Distal Radial Fractures in Patients With a Mean Age of 75 Years at a Mean Follow-Up of 5.4 Years.

Cureus 2020 Dec 7;12(12):e11959. Epub 2020 Dec 7.

Orthopaedics and Trauma, Scarborough Hospital, Scarborough, GBR.

Purpose Distal radial fractures in the elderly are common and present in a wide spectrum of severity. Their management is varied. The aim of this retrospective case review is to evaluate the late functional outcome of surgically treated distal radial fractures in the elderly population. Methods Forty-two patients (36 female and six male) were surgically treated for an unstable distal radial fracture. The mean age of the patients was 75 years. Frykman classification was used to assess the severity of the injury. Surgical options used were reduction and K wires (19 patients) or open reduction and internal fixation (ORIF) using volar distal radial plate fixation (23 patients). At a mean follow-up of 5.4 years, a validated questionnaire (Patient Rated Wrist Evaluation-PRWE) of the functional ability was completed for each patient. Results The outcome in both groups was satisfactory (PRWE 40-50) with no significant statistical difference, however, a better functional outcome (<40 PRWE) was achieved in the K wire group compared to the ORIF group. Factors such as post injury fear from fall, weakness of grip, wrist pain, and other comorbidities altered the predicted functional outcome score. Conclusion In conclusion, surgically treated fractures in the elderly generally lead to good outcomes. However, confounding factors can contribute to unpredictable results despite good surgical reduction and fixation.
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http://dx.doi.org/10.7759/cureus.11959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725202PMC
December 2020

Erratum to: Correlation between pre-injury mobility and ASA score with the mortality following femoral neck fracture in elderly.

Eur J Orthop Surg Traumatol 2017 12;27(8):1163

Departments of Orthopaedic Surgery, Airedale General Hospital, Skipton Rd, Steeton, West Yorkshire, UK.

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http://dx.doi.org/10.1007/s00590-017-2015-8DOI Listing
December 2017

Functional outcome following an ankle or subtalar arthrodesis in adults.

Acta Orthop Belg 2014 Jun;80(2):276-9

Arthrodesis surgery aims to give pain relief by abolishing the movement of the joint concerned. Few studies describe the outcome as appreciated by the patient. This was the major concern of the authors, when they set up this retrospective study about the outcome after ankle fusion or subtalar fusion. Inclusion criteria were: pre-existing idiopathic and posttraumatic osteoarthritis, leading to joint pain unresponsive to conservative treatment, clinically and radiologically fused with an open approach between 2007 and 2011. Exclusion criteria were: preexisting joint infection, diabetes, rheumatoid arthritis, nonunion, age below 18 years, decease, and arthroscopic fusion. Fifteen ankle fusions and 18 subtalar fusions fulfilled the criteria. The mean age of the patients was 77 and 69 years, respectively; the average follow-up period was 3 and 4 years. A telephone questionnaire showed that the average patients' satisfaction was 7.86/10 in the ankle group and 7.94/10 in the subtalar group. All patients driving a car prior to surgery were able to do so afterwards. Forty percent walked unaided and without problems (excellent). Fifty-one percent were able to mobilise, but their walking distance was limited and a stick was required (good or fair). Nine percent were unable to mobilise out of their homes (poor), however it was generalized osteoarthritis which limited their mobility. Forty-five percent were involved in sports including judo, swimming, cycling, jogging, gardening, bowling, golf, and boules.
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June 2014

Implementing National Institute of Clinical Excellence guidelines for venous thromboembolism prophylaxis.

Am J Med Sci 2012 Feb;343(2):131-135

Airedale NHS Foundation Hospital, Steeton, West Yorkshire, England. Electronic address:

Introduction: Venous thromboembolism (VTE) is a serious complication after lower limb injury and surgery. Pursuing prophylactic policies, particularly chemical prophylaxis, has been a debatable issue. In April 2007, the National Institute of Clinical Excellence recommended using chemical and/or mechanical prophylaxis for patients undergoing joint arthroplasty and other orthopedic operations. A list of risk factors predisposing patients to VTE was published. This article discusses the difficulties and methods of implementing the guidelines.

Methods And Material: Patients undergoing lower limb arthroplasty or treatment for femoral neck fractures were included. In total, 9893 patients required prophylactic treatment for VTE.

Results: The maximum readmission rate within 3 months of lower limb arthroplasty with a deep vein thrombosis or pulmonary embolism was reduced from 70% in 2005 to 28% in 2009.

Conclusion: The incidence of VTE was reduced to one fifth of that before implementing the National Institute of Clinical Excellence guidelines. Thus, it has been valuable to implement the guidelines.
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http://dx.doi.org/10.1097/MAJ.0b013e318226664dDOI Listing
February 2012

The outcome after using two different approaches for excision of Morton's neuroma.

Chin Med J (Engl) 2010 Aug;123(16):2195-8

Department of Orthopaedics & Trauma, Airedale General Hospital, Steeton, Keighley, W. Yorkshire, BD20 6TD, UK.

Background: The choice for the surgical approach of interdigital neuroma in the foot is controversial. Plantar approach can leave a painful scar on weight bearing area; hence, some prefer dorsal approach. The aim of the current study was to measure the outcome of interdigital (Morton's) neurectomy performed by a single surgeon using dorsal and plantar approaches.

Methods: A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified thirty-six patients (42 feet) who had been treated operatively for a primary, persistently painful interdigital neuroma. The mean follow-up was 18 months. Pain, weight bearing, wound problems and rehabilitation period were studied.

Results: The duration to full weight bearing, return to work, driving and recreational activities were at least one week shorter in the dorsal group. The overall satisfaction for surgery was rated as excellent or good in 85% of the thirty six patients. Scar problems were more troublesome and common in the plantar group. There was residual numbness noticed in twenty feet, the pattern of numbness was quite variable and it was bothersome in only seven feet. There was one recurrence in the plantar group.

Conclusions: Resection of a symptomatic interdigital neuroma through a dorsal or a plantar approach can result in a good outcome. Dorsal approach, however, is associated with better rehabilitation and less scar problems.
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August 2010

Lessons to be learned from a missed case of Hamate fracture: a case report.

J Orthop Surg Res 2010 Aug 27;5:64. Epub 2010 Aug 27.

Vishal Borse, Room 346, Institute of Medical & Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.

Introduction: We report the case of a missed fracture through the body of the hamate bone, only detected on a later, mistakenly taken 30° oblique x-ray view. This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays.

Case Presentation: A healthy 26-year-old Caucasian male fell whilst jogging, suffering a low velocity injury to his right hand. Initial accident and emergency examination and x-rays failed to demonstrate a fracture. At clinic, anteroposterior and carpal tunnel radiographs showed no fracture, however a mistakenly taken oblique x-ray revealed a displaced hamate body fracture.

Conclusion: The authors believe that where a hamate fracture is suspected, an oblique x-ray view should be considered as part of the initial diagnostic investigations. Furthermore an oblique x-ray view is of particular use when clinical suspicion for hamate fracture remains high in the light of otherwise normal x-rays.
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http://dx.doi.org/10.1186/1749-799X-5-64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936889PMC
August 2010

The value of an admissions proforma for elderly patients with trauma.

Injury 2011 Feb;42(2):171-2

Department of Orthopaedics & Trauma, Airedale General Hospital, Steeton, Keighley, West Yorkshire, BD20 6TD, United Kingdom.

The authors worked in a busy regional fracture unit, where it was noted that important data was being omitted from the medical notes. In an attempt to improve on this, an admission proforma was formulated. This was designed to be easily and quickly completed. Notes were audited on 2 separate weeks, the first before, and the second after introduction of the proforma.The overall results demonstrate statistically significant improvements in documentation with a proforma, and concur with the limited previous literature in this area.
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http://dx.doi.org/10.1016/j.injury.2010.07.241DOI Listing
February 2011

Non-operative treatment of elderly patients with femoral neck fracture.

Authors:
Adnan A Faraj

Acta Orthop Belg 2008 Oct;74(5):627-9

Department of Orthopaedics & Trauma, Airedale General Hospital, Steeton, Keighley, West Yorkshire, United Kingdom BD20 6TD.

Surgery is the routine management for elderly individuals with femoral neck fracture, in order to reduce the morbidity and the mortality and to relieve pain. Sixteen elderly patients with displaced femoral neck fractures who were unfit for surgeries were treated conservatively. The mortality in this group was not higher than reported following surgical management. Close nursing care, physiotherapy and pain management helped in improving the status and function of these patients. When non-operative treatment of femoral neck fracture is deemed necessary in elderly patients, an intensive medical input is necessary to alleviate pain and enable them to return their function near to pre-injury status.
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October 2008

Is a femoral component applicator useful in total knee replacement?

Knee Surg Sports Traumatol Arthrosc 2009 Feb 9;17(2):125-7. Epub 2008 Sep 9.

Department of Orthopaedics and Trauma, Airedale General Hospital, West Yorkshire, UK.

The benefit of using an applicator to insert the femoral component during total knee arthroplasty in preventing flexion of the femoral component in the sagittal angle was evaluated in a prospective, consecutive, single-surgeon series. In group I (60 knee replacements) the applicator was used. In group II (64 knees) the femoral component was implanted without an applicator. In all these cases, the femoral cuts were precisely done using cutting blocks. Postoperative X-rays were studied to evaluate the flexion angle of the femoral component in the sagittal plane. Alpha, beta and peg angles of the two groups were compared. It was found that in the group where the applicator was used, there were a slightly higher proportion of patients with values lying within the mean values (two-tailed P value of 0.0009). Our study statistically confirmed that the use of an applicator during femoral component insertion does significantly decrease the incidence of tilt of the femoral component in the sagittal angle.
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http://dx.doi.org/10.1007/s00167-008-0621-zDOI Listing
February 2009

The effect of two different types of cement restrictors on the femoral cement mantle.

Acta Orthop Belg 2006 Dec;72(6):702-8

Airedale General Hospital, West Yorkshire, United Kingdom.

Cement restriction and pressurisation are helpful technical points in achieving a good cement mantle in cemented hip replacement. In this prospective study, we compared 39 cases where a Hardinge polyethylene restrictor was used and 33 cases where a bone block restrictor was used during Charnley hip replacement. The preoperative radiographs were templated, calibrated holders for the cement restrictors were used intraoperatively, keeping the distal cement height within 2-3 cm from the tip of the femoral prosthesis. Postoperative radiographs were analysed. The Harris Hip scoring system was used for clinical assessment of results. The preoperative target of having a distal cement height of 2-3 cm was achieved in only 60.6% of the bone block group and 30.6% of the Hardinge group. The difference between the two groups is statistically significant (p = 0.001). Distal migration of the restrictors more than 3 cm from the tip of the femoral prosthesis was associated with a non-homogenous cement mantle in zones 3, 4 and 5 without affecting zones 1, 2, 6 and 7. The cement mantle was adequate when the distal cement mantle remained within 2-3 cm of the tip of the femoral prosthesis.
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December 2006

A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model.

Foot Ankle Int 2007 Jan;28(1):89-91

Airedale General Hospital, Department of Orthopaedics, Skipton Road, Keighley, West Yorkshire BD20 6TD, and Medical Engineering Department, Biomechanical Laboratory, University of Bradford, United Kingdom.

Background: Arthrodesis of the great toe metatarsophalangeal joint for osteoarthritis usually involves internal fixation. Ideally, the fixation method should be reproducible, leading to a high rate of fusion and minimal complications.

Methods: This biomechanical study compares circumferential wire and screw fixation methods of arthrodesis.

Results: The two arthrodesis models have remarkably similar limits of elastic and plastic deformation. However, in the screw, failure by permanent deformation occurs at a load six times higher than the wire.

Conclusions: The use of circumferential wire fixation for osteoporotic bones in which screw purchase is poor is reasonable and for quality bone, screw fixation may be preferable.
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http://dx.doi.org/10.3113/FAI.2007.0016DOI Listing
January 2007

The value of nerve root infiltration for leg pain when used with a nerve stimulator.

Eur Spine J 2006 Oct 12;15(10):1495-9. Epub 2006 Jul 12.

The Centre for Spinal Surgery and Research, University Hospital, Nottingham, UK.

Randomized comparative study of the efficacy of nerve root infiltration (NRI) guided by neurostimulator to find the value of nerve stimulators in nerve root infiltration was undertaken. The response to nerve root infiltration using local anaesthetics and steroid is unpredictable, partly because the exact nerve root giving rise to pain may not be truly infiltrated. The nerve stimulator is advocated to identify the nerve root of concern prior to infiltration. The current study assessed the results of NRI with and without the nerve stimulator. Ninety-six patients with leg pain awaiting selective nerve root infiltration using long acting local aesthetic, were prospectively randomized into two groups, in the first one, the nerve root block was carried out without nerve stimulator (n = 39) and in the second group the block was carried out with the guidance of a nerve root stimulator (n = 57). Seventy-seven of the patients who had lateral canal stenosis (a total 81) responded to NRI; within this group nerve stimulator was used for 50 patients. Nerve root infiltration was used to relieve post-discetomy leg pain (ten), post-disc prolapse (four) and in one patient post-nucleotomy leg pain. Overall 89% of the patients were responders of NRI. Responders of around 65% had the NRI performed with the aid of stimulator. The response rate to pain was 96% when NRI was guided by a neurostimulator and 79% when no neurostimulator was used. When responded there was no significant statistical difference using the Oswestry disability score between both groups. After excluding disc bulge in patients who respond partially to NRI, it is worthwhile repeating the injection. There was a significant difference in response rate when NRI was done under guidance of a nerve stimulator, the stimulator is safe to use and increases the specificity of the block.
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http://dx.doi.org/10.1007/s00586-006-0137-5DOI Listing
October 2006

Outcome of quadriceps tendon repair.

Acta Orthop Belg 2006 Apr;72(2):176-8

Airedale General Hospital, Airedale, United Kingdom.

Complete rupture of the quadriceps tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their quadriceps tendon at our institution over a 13-year period, totalling 21 patients. Males were more commonly affected, with a male/female ratio of 4:1. The peak incidence was in the sixth decade of life. Assessment consisted of the completion of a functional knee questionnaire and a clinical examination. Symptomatic outcome following surgical repair was good with a mean symptom score generated of 19.16 out of a maximum of 25 using the Rougraff et al scoring system. Most of the patients returned to their pre-injury level of activity. Five degrees deficit and extension lag was present in three patients; these patients had the quadriceps repaired using transosseous sutures. Patients who had direct repair of the tendon using the Bunnell technique had lower Rougraff scores than the rest.
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April 2006

Correlation between pre-injury mobility and ASA score with the mortality following femoral neck fracture in elderly.

Eur J Orthop Surg Traumatol 2006 06 11;16(2):130-134. Epub 2005 Oct 11.

Departments of Orthopaedic Surgery, Airedale General Hospital, Skipton Rd, Steeton, West Yorkshire, UK.

A poor pre-injury mobility and high American Society of Anaesthiologist (ASA) grading is thought to be associated with a poor survival following surgical treatment of femoral neck fracture in the elderly. Hence there are concerns among orthopaedic surgeons about surgical treatment in this group of patients. In this retrospective study, the pre-injury mobility and ASA scores of 401 patients with fractured neck of femur treated by surgery was assessed in relation to mortality following surgery within the first 30 days of injury. Following surgery, a temporary deterioration in the ASA grading and mobility was noticed. Patients who required intensive medical care following surgery had higher mortality rate. The mortality was 15% among patients with ASA III and 40% among patients with ASA IV. 14% of 65 immobile patients, 18% of those mobile with Zimmer frame passed away after surgery for femoral neck fracture. 6.1% of ASA I scorers died compared with 40% of ASA IV scorers; this difference was statistically significant (χ=13.883, df=1, P<0.001). Significant number of patients with ASA-IV (60%) and immobile patients (88%) survived following surgery for femoral neck fracture. Poor pre-injury mobility and high ASA scoring are associated with higher early mortality following surgery for femoral neck fracture, however, this should not preclude surgery for patients with poor pre-injury ASA grading and mobility sustaining femoral neck fracture, as significant number of our patients survived.
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http://dx.doi.org/10.1007/s00590-005-0026-3DOI Listing
June 2006

The role of postoperative blood recovery for patients with femoral neck fracture.

Acta Orthop Belg 2006 Jan;72(1):11-4

Department of Orthopaedics and Trauma, Airedale General Hospital, West Yorkshire, United Kingdom.

Postoperative blood recovery in eighty elderly patients (11 male, 69 female) treated for femoral neck fracture was prospectively studied. Twenty-eight patients underwent hemiarthroplasty for intracapusular fracture and 52 underwent Dynamic Hip Screw fixation for extracapsular femoral neck fracture. The mean blood drainage in the postoperative period and the mean drop in haemoglobin level was higher in the DHS group as compared to the hemiarthroplasty group. Mean drainage in the first 6 postoperative hours was 150 ml (range: 10-450 ml) in the DHS group, versus 50 ml in the hemiarthroplasty group (range: 10-100 ml). Out of 52 cases of the dynamic hip screw fixation group, only 10 patients received autologous blood transfusion (19%), among which the drains collected more than 150 ml in only 4 (7%). The blood drainage in this group occurred in the first 6 hours only. Supplementary cross matched bank blood was transfused to patients in the DHS group (8%). Among 28 patients in the hemiarthroplasty group, only 6 patients received autologous blood reperfusion (21%), among which the drains collected more than 150 ml in only 4 (14%). Overall, only six patients out of 28 in the hemiarthroplasty and 10 out 52 in the DHS group had enough blood in their drains to warrant re-perfusion. We conclude that the routine use of Bellovac drains after femoral neck fracture surgery is not necessary and is not cost effective.
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January 2006

A subjective outcome analysis of tendo-Achilles rupture.

J Foot Ankle Surg 2005 Jan-Feb;44(1):32-6

Airedale General Hospital, Keighley, West Yorkshire, England.

This clinical outcomes study examined factors affecting patient satisfaction after treatment of Achilles tendon rupture. There were 35 patients; 14 treated nonsurgically and 21 treated by open surgical repair. A retrospective chart review was performed to determine the mechanism and type of injury, the time to treatment, any comorbidities, and the length of follow-up. Patients completed a questionnaire that evaluated their pre- and postinjury activity levels, occupation, and overall satisfaction with their function by using a visual analogue scale. The mean follow-up was 2 years. Seventy percent were very satisfied with the outcome of treatment, with a mean visual analogue score of 8.4 of 10. Age, sex, and occupation did not have any significant influence on the satisfaction level. The dissatisfied group showed a significantly reduced postinjury leisure activity level (P =. 003). A delay in initiation of treatment had a significant negative impact on satisfaction (P = .015). Regression analysis showed that physiotherapy after treatment increased the postinjury activity level and the level of satisfaction (P = .034). There was no significant difference in the overall outcome between the surgical and nonsurgical groups.
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http://dx.doi.org/10.1053/j.jfas.2004.11.008DOI Listing
June 2005

Bilateral congenital coracoclavicular joint. Case report and review of the literature.

Authors:
Adnan A Faraj

Acta Orthop Belg 2003 Dec;69(6):552-4

Airdale General Hospital, Steeton, West Yorkshire, U.K.

The diagnosis of coracoclavicular articulation was made in an elderly woman, who complained of bilateral anterior shoulder pain with impingement. This congenital pseudo-articulation is rarely symptomatic and is usually an incidental radiological finding. Surgical excision of the prominent bony projection, arising from the inferior surface of the clavicle at the level of the coracoid process, relieved the impingement and gave satisfactory pain relief.
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December 2003

Intra-articular bupivacaine hip injection in differentiation of coxarthrosis from referred thigh pain: a 10 year study.

Acta Orthop Belg 2003 Dec;69(6):518-21

General Hospital, Steeton, Keighley BD20 6TD, U.K.

The authors conducted a retrospective study to validate the specificity of intra-articular injection of local anaesthetic to identify the source of pain in patients with coxarthrosis but ill-defined clinical and radiological features. Forty-seven patients received intra-articular injection of the hip joint as a diagnostic procedure. Twenty-four patients showed a positive response with relief of pain. All of them underwent total hip replacement and remained pain free following surgery. In twenty-three patients intra-articular injection did not relieve the pain; three of these underwent successful total hip replacement two years later. Other negative responders were further evaluated and appropriately managed. This study confirms that intra-articular injection of local anaesthetic is a valuable tool in diagnostic dilemma. The calculated sensitivity of 88% and specificity of 100% is similar to other published series.
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December 2003

Recurrent ankle sprains secondary to nonunion of a lateral malleolus fracture.

J Foot Ankle Surg 2003 Jan-Feb;42(1):45-7

Orthopaedic Surgery Department, Airedale General Hospital, Steeton, West Yorkshire, England.

A case of an adult man with symptoms of chronic recurrent ankle sprains secondary to nonunion of a fracture of the tip of the lateral malleolus is presented. The nonunion was debrided, bone grafted, and internally fixed by using the tension band wire technique. The fracture healed and the patient experienced no further episodes of ankle sprain.
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http://dx.doi.org/10.1053/jfas.2003.50004DOI Listing
March 2003

Study of twenty-seven paediatric patients with open tibial fracture: the role of definitive skeletal stabilisation.

Zhonghua Yi Xue Za Zhi (Taipei) 2002 Oct;65(10):453-6

Orthopaedic Department, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK.

Background: The aim of this retrospective study was to review our practice of the management of open tibial fractures in children.

Methods: Twenty-seven children aged 3-15 years (mean 9.5) with open fractures of the tibia were treated with early aggressive wound debridement and lavage. Gustilo grading was used. The wounds were graded as follows: I (13 patients), II (6 patients), IIIa (3 patients), IIIb (5 patients). Open wounds were treated as appropriate, 30% of patients required a plastic surgical procedure.

Results: Five patients were treated by initial external fixation of the tibia; the remainder was treated by cast immobilisation. The mean period for fracture healing was 6 months (1.5-48 months). There were no cases of non-union or deep infection. The incidence of complications where external fixation was applied was significant: one malunion required osteotomy, there were 2 cases of delayed union and four cases of pin track infection. In the group treated in casts, the most significant complication was loss of reduction of the fracture (five cases), requiring conversion to external fixation in 2 and screw and wire fixation in another; the remaining cases of displaced fractures responded to re-manipulation and plaster application.

Conclusions: We conclude from our results hat majority of isolated open tibial fracture in children can be treated by wound debridement and plaster cast immobilisation. There is still a role for the use of external fixation especially where there is a grossly unstable fracture or extensive soft tissue injury requiring a flap procedure.
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October 2002

Soft-tissue injury in total knee arthroplasty.

Authors:
Adnan A Faraj

J Bone Joint Surg Am 2002 Jun;84(6):1084; author reply 1084-5

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http://dx.doi.org/10.2106/00004623-200206000-00037DOI Listing
June 2002