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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

Sonoelastography in the musculoskeletal system:Current role and future directions

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World Journal of Radiology 2016年第11期8卷 868-879页

作者： Naomi Winn Radhesh Lalam Victor Cassar-Pullicino Department of Radiology Robert Jones and Agnes Hunt Ortho-paedic Hospital NHS Foundation Trust

Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.

关键词： Ultrasound Elastography Musculoskeletal system

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

Is Chemokine Receptor CCR9 Required for Synovitis in Rheumatoid Arthritis? Deficiency of CCR9 in a Murine Model of Antigen-Induced Arthritis

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Open Journal of Rheumatology and Autoimmune Diseases 2012年第4期2卷 77-84页

作者： Alison Cartwright Sophie King Jim Middleton Oksana Kehoe Faculty of Medicine and Dentistry School of Oral and Dental Sciences University of Bristol Bristol UK Keele University at robert jones and agnes hunt orthopaedic hospital Oswestry UK Keele University at robert jones and agnes hunt orthopaedic hospital Oswestry UK Faculty of Medicine and Dentistry School of Oral and Dental Sciences University of Bristol Bristol UK.

Objectives: Monocytes/macrophages accumulate in the synovial membrane in rheumatoid arthritis and play a key role in disease pathogenesis, contributing to inflammation, cartilage destruction and bone erosion. Identification of molecules involved in monocyte/macrophage recruitment in inflammation is crucial for development of therapeutic interventions. Chemokine receptor CCR9 is up-regulated on these cells in peripheral blood and synovium of rheumatoid patients. This study investigated the course of antigen-induced arthritis in CCR9 deficient C57BL/6 mice in comparison to wild type animals to determine whether CCR9 is critical for disease severity and progression. Methods: Methylated bovine serum albumin was used for induction of uni-lateral arthritis by direct injection into the knee joints of preimmunized animals. Arthritis is confined to the injected joint allowing comparison with the normal opposing joint. Clinical severity of arthritis was assessed by measuring swelling in the arthritic joint in comparison to the normal joint. Histological analysis was performed to assess the extent of leukocyte infiltration and cartilage depletion. Results: Levels of swelling were not significantly different between wild type and CCR9 deficient mice. Similarly there was no significant difference in histological severity of arthritis when comparing CCR9-deficient mice to wild type mice. Conclusions: CCR9 was not required for development of synovial inflammation and cartilage destruction in the anti-gen-induced model of arthritis in C57BL/6 mice in this study. This may reflect a true lack of a pathogenic role of CCR9 on monocyte/macrophage function in vivo or it may reflect differences in the current antigen-induced arthritis model when compared to human RA.

关键词： Chemokine Receptor CCR9 Rheumatoid Arthritis Inflammation Antigen-Induced Arthritis Mouse Mod-el Monocytes/Macrophages

Ankle Fractures: A Literature Review of Current Treatment Methods

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Open Journal of Orthopedics 2014年第11期4卷 292-303页

作者： Rohit Singh Tamer Kamal Nick Roulohamin Gopikanthan Maoharan Bessam Ahmed Peter Theobald robert jones and agnes hunt Oswestry UK orthopaedic Department Cairo University Giza Egypt Cardiff school of Engineering Cardiff University Cardiff UK

Ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the trauma workload. Ankle fractures usually affect young men and older women, however, below the age of 50;ankle fractures are the commonest in men. Two commonly used classification systems for ankle fractures include the danis weber AO classification and the Lauge-Hansen classification. There is biomechanical evidence that posterior non-locking plates are superior in stability than laterally placed plates;however there is little clinical evidence. There are several different methods of ankle fracture fixation, however the goal of treatment remains a stable anatomic reduction of talus in the ankle mortise and correction of the fibula length as a 1 mm lateral shift of the talus in the ankle mortise reduces the contact area by 42%, and displacement (or shortening) of the fibula more than 2 mm will lead to significant increases in joint contact pressures. Further research both biomechanically and clinically needs to be undertaken in order to clarify a preferable choice of fixation.

关键词： Ankle Fracture Review Current Treatment Classification Management

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

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

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 analysis of tension band wiring （TBW） of transverse fractures of patella

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Chinese Journal of Traumatology 2016年第5期19卷 255-258页

作者： Mohammed Ali Jan Kuiper Joby John Trauma and orthopaedics North Cumbria NHS Trust UK The robert jones and agnes hunt orthopaedics hospital Oswestry UK University hospitals of Nottinghamshire UK

Purpose： Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires （K-wires） and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods： We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners, lnterfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results： Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% （p 〈 0.05, Tukey post ]hoc test）. On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed （p = 0.01; Fisher＇s exact test）. Permanent fracture displacement after cyclic loading was ,57% lower with horizontal figure- of-eight constructs （p 〈 0.05; t test）. Conclusion： Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.

关键词： Patella transverse fractures Tension band wiring Biomechanical analysis