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Surgical management of the diabetic foot:The current evidence

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World Journal of Orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall roberts Gareth Rhys Davies-jones James Brock Vaishnav Satheesh Greg AJ robertson department of trauma and orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom department of trauma and orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens *** review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,*** escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality *** review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse *** addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot *** integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot Osteomyelitis Amputation Diabetic foot attack Conservative surgery

A Simple Classification System for Hip Fractures

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Open Journal of Orthopedics 2014年第5期4卷 137-143页

作者： Kareem Elsorafy Ahmad Machaurab Tamer Kamal Sherief El-Nikety Sunny Deo department of trauma and orthopaedics at the Great Western hospital Swindon UK department of trauma and orthopaedics at the robert jones and agnes hunt orthopaedic hospital Oswestry UK department of trauma and orthopaedics at the Royal National orthopaedics hospital London UK

Background: We have developed a Hip Fracture Classification which stratifies patients into 4 groups upon admission according to fracture complexity. This classification considers patho-anatomic and physiologic parameters and was developed to help identify high-risk patients, with more surgical demands and consequently higher incidence of morbidity. Materials and Methods: Data was gathered prospectively for a cohort of 273 consecutive patients admitted over a 12- month period between 2008 and 2009 and classified according to the Hip Fracture Complexity Classification (C0 - C3). The following outcome measures (mortality and length of hospital stay) were reviewed at thirty days and one year. Result: The overall mortality was 4.4% at 30 days and 20% at 1 year. There were significant differences in 1-year mortality between all stratified groups

关键词： Hip Fracture Mortality Death Classification Stratification

Anthropometric method for estimating component sizes in total hip arthroplasty

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World Journal of Orthopedics 2021年第11期12卷 859-866页

作者： Rajpreet Sahemey Thomas S Moores Hannah Meacher Bishoy Youssef Shehzaad Khan Christopher R Evans department of trauma and orthopaedics University Hospitals Coventry and WarwickshireCoventry CV22DXUnited Kingdom department of trauma and orthopaedics Walsall Manor HospitalWalsall WS29PSUnited Kingdom department of trauma and orthopaedics Royal Stoke University HospitalStoke-on-Trent ST46QGUnited Kingdom department of trauma and orthopaedics Royal National Orthopaedic HospitalStanmore HA74LPUnited Kingdom department of orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

BACKGROUND Preoperative templating is essential in total hip arthroplasty(THA)as it not only helps to facilitate the correct implant type and size but also determines the postoperative *** is also increasingly important from a medicolegal perspective and recommended in the British orthopaedic Association Guide to Good *** templating has become increasingly digitised,there are no simple anthropometric models to predict implant sizes in the absence of digital *** To assess the accuracy of using an easily obtainable measurement(shoe size)to predict component sizes in THA compared with digital *** Digital radiographs from a cohort of 102 patients(40 male,62 female)who had undergone uncemented or hybrid THA at a single centre were retrospectively templated to desired cup and stem sizes using traumaCad■.We compared the templated size to the actual size of the implant and assessed if there was any correlation with the patient’s shoe *** Statistically significant positive correlations were observed between:shoe size and templated cup size(ρ=0.92,P<0.001);shoe size with implanted cup size(ρ=0.71,P<0.001);shoe size and templated stem size(ρ=0.87,P<0.001);and shoe size with implanted stem size(ρ=0.57,P<0.001).Templated and implanted acetabular cup sizes were positively correlated(ρ=0.76,P<0.001)and were exact in 43.1%cases;80.4% of implanted cup sizes were within 1 size(+/-2 mm)of the template and 100% within 2 sizes(+/-4 mm).Positive correlation was also demonstrated between templated and implanted femoral stem sizes(ρ=0.69,P<0.001)and were exact in 52.6% cases;92.6% were within 1 size of the template and 98% within 2 *** This study has shown there to be a significant positive correlation between shoe size and templated *** measurements are easily obtainable and can be used to predict uncemented component sizes in the absence of digital methods.

关键词： Anthropometric Digital templating Hip Preoperative planning Total hip arthroplasty

Clinical outcome of open ankle fractures in patients above 70 years of age

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World Journal of Orthopedics 2023年第7期14卷 554-561页

作者： Wajiha Zahra Mina Seifo Paul Cool David Ford Tosan Okoro department of trauma and Orthopedics Royal Shrewsbury HospitalShrewsbury SY38XQUnited Kingdom department of trauma and Orthopedics Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom department of trauma and Orthopedics Keele UniversityStafford ST55BGUnited Kingdom

BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and ***,data on the clinical outcomes of open ankle fracture management in patients older than 70 is *** To evaluate the clinical outcomes following open ankle fracture management in patients older than *** secondary aim is to look at predictors of poor *** Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were *** patients older than 70 years of age with an open ankle fracture requiring surgical intervention were *** information,the nature,and the number of surgical interventions were ***,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were *** A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle *** patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing *** SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork *** incidence was 5%during the hospital *** patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and di

关键词： Fragility fracture Open fracture Clinical outcome Mortality Infection Survival

Fibula pro-tibia vs standard locking plate fixation in an ankle fracture saw bone model

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World Journal of Orthopedics 2021年第8期12卷 548-554页

作者： Tosan Okoro Kar Hao Teoh Hiro Tanaka department of Arthroplasty Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom department of orthopaedic Surgery Princess Alexandra Hospital NHS TrustHarlow CM201QXUnited Kingdom department of orthopaedics Royal Gwent HospitalNewport NP202UBUnited Kingdom

BACKGROUND Locking plate fixation in osteoporotic ankle fractures may fail due to cut-out or metalwork *** pro-tibia fixation was a technique prior to the advent of locking plates that was used to enhance stability in ankle fractures by achieving tri or tetra-cortical *** locking plates,the strength of this fixation construct can be further *** is lack of evidence currently on the merits of tibiapro-fibula augmented locking plate fixation of unstable ankle *** To assess if there is increased strength to failure,in an ankle fracture saw bone model,with a fibula pro-tibia construct when compared with standard locking plate *** Ten osteoporotic saw bones with simulated supination external rotation injuries were *** saw bones were fixed with standard locking plates whilst the other 5 saw bones were fixed with locking plates in a fibula pro-tibia *** fibula pro-tibia construct involved fixation with 3 consecutive locking screws applied across 3 cortices proximally from the level of the *** fixations were tested in axial external rotation to failure on an electromagnetic test frame(MTS 858 Mini-Bionix test machine,MTS Corp,Eden Praire,MN,United States).Torque at 30 degrees external rotation,failure torque,and external rotation angle at failure were compared between both groups and statistically *** The fibula pro-tibia construct demonstrated a statistically higher torque at 30 degrees external rotation(4.421±0.796 N/m vs 1.451±0.467 N/m;t-test P=0.000),as well as maximum torque at failure(5.079±0.694N/m vs 2.299±0.931 N/m;t-test P=0.001)compared to the standard locking plate *** fibula pro-tibia construct also had a lower external rotation angle at failure(54.7±14.5 vs 67.7±22.9).CONCLUSION The fibula pro-tibia locking plate construct demonstrates biomechanical superiority to standard locking plates in fixation of unstable ankle fractures in this saw bone ***

关键词： Unstable ankle fractures Pro-tibia fixation Improved stability Simulated biomechanical analysis Osteoporotic fractures Ankle injuries

Surgical Management of Fracture Neck of Femur in a Medically Unfit ASA3/4 Patient Selection Using Direct Infiltration Local Anaesthesia

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Open Journal of Orthopedics 2014年第8期4卷 195-199页

作者： Tamer Kamal Sunil Garg Kareem Elsorafy Anca Duca department of trauma Orthopaedics Leicester Royal Infirmary Leicester UK James Paget University hospital NHS Foundation Trust Great Yarmouth UK robert jones and agnes hunt orthopaedic hospital Oswestry UK

Patients who suffer a Fractured Neck of Femur (NOF) have a high mortality and morbidity rate with up to 20% needing long term care post fracture and a further 30% not returning to their pre fracture functioning. Hip fracture accounts for 87% of total fragility fractures. We describe an anaesthetic technique of fixation of fracture of the femoral neck under direct infiltration local anaesthesia;that can be performed on the sick elderly patient. Twenty-eight NOF fractures were included in this series (24 DHS, 4 Hemiarthroplasty);twenty-three procedures were completed (82.14%);no patient required conversion to another form of anaesthesia either general or spinal;five patients required some degree of light sedation due to agitation (17.8%). This method presents itself as an option in managing patient with high comorbidities which can also be implemented in impoverished areas with limited access to operating surgical facilities.

关键词： Fracture Neck of Femur Local Infiltration ASA4

Biomechanical characteristics of bone in streptozotocin-induced diabetic rats:An in-vivo randomized controlled experimental study

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World Journal of Orthopedics 2013年第3期4卷 124-129页

作者： Nektarios Korres Eleftherios Tsiridis George Pavlou Athanasios Mitsoudis Despina N Perrea Aristedes B Zoumbos KAT First department of orthopaedics and trauma 14561 AthensGreece Academic orthopaedics and trauma Unit Division of SurgeryAristotle University Medical School54124 ThessalonikiGreece department of orthopaedics Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY10 7AGUnited Kingdom department of Biomechanics School of Applied Mathematical and Physical SciencesNational Technical University of Athens14561 AthensGreece department of Experimental Surgical Research "N.S.Christeas" Athens University Medical School14561 AthensGreece department of orthopaedics Academic Orthopaedic Department "Attikon" HospitalAthens University Medical School14561 AthensGreece

AIM: To investigate the in vivo effects of type Ⅰdiabetes on the mechanical strength of tibial bone in a rodent ***: The biomechanical effect of diabetes on the structural integrity of the tibia in streptozotocin induced diabetic Wistar rats was analysed. Induction of diabetes was achieved by an intra-peritoneal injection and confirmed by measuring serial blood glucose levels(> 150 mg/d L). After 8 wk the tibiae were harvested and compared to a control group. Biomechanical analysis of harvested tibiae was performed using a threepoint bending technique on a servo hydraulic MTS 858 MiniB ionix frame. Maximum force applied to failure(N), stiffness(N × mm) and energy absorbed(N/mm) were recorded and plotted on load displacement curves. A displacement control loading mode of 1 mm/min was selected to simulate quasi-static loading conditions. Measurements from load-displacement curves were directly compared between ***: Fourteen streptozotocin induced diabetic Wistar rats were compared against nineteen non-diabetic controls. An average increase of 155.2 g in body weight was observed in the control group compared with only 5 g in the diabetic group during the experimental study period. Levels of blood glucose increased to 440.25 mg/d L in the diabetic group compared to 116.62 mg/d L in the control *** biomechanical results demonstrate a highly significant reduction in the maximum load to failure from 69.5 N to 58 N in diabetic group compared to control(P = 0.011). Energy absorption to fracture was reduced from 28.2 N in the control group to 23.5 N in the diabetic group(P = 0.082). No significant differences were observed between the groups for bending ***: Streptozotocin-induced diabetes in rodents reduces the maximum force and energy absorption to failure of bone, suggesting a predisposition for fracture risk.

关键词： Streptozotocin Rodent Bone Biomechanics