35 results found
Hing CB, Tutton E, Smith TO, et al., 2021, Correction to: Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study., Pilot Feasibility Stud, Vol: 7, ISSN: 2055-5784
Hing CB, Tutton E, Smith TO, et al., 2021, Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study., Pilot Feasibility Stud, Vol: 7, ISSN: 2055-5784
BACKGROUND: Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. An adequately powered randomised controlled trial (RCT) to determine optimum treatment is required. STIFF-F aimed to assess the feasibility of a multicentre RCT comparing IMN with CFEF for segmental tibial fracture. METHODS: STIFF-F was a mixed-methods feasibility study comprising a pilot RCT conducted at six UK Major Trauma Centres, qualitative interviews drawing on Phenomenology and an online survey of rehabilitation. The primary outcome was recruitment rate. Patients, 16 years and over, with a segmental tibial fracture (open or closed) deemed suitable for IMN or CFEF were eligible to participate. Randomisation was stratified by site using random permuted blocks of varying sizes. Participant or assessor blinding was not possible. Interviews were undertaken with patients about their experience of injury, treatment, recovery and participation. Staff were interviewed to identify contextual factors affecting trial processes, their experience of recruitment and the treatment pathway. An online survey was developed to understand the rehabilitation context of the treatments. RESULTS: Eleven patients were screened and three recruited to the pilot RCT. Nineteen staff and four patients participated in interviews, and 11 physiotherapists responded to the survey. This study found the following: (i) segmental tibial fractures were rarer than anticipated, (ii) the complexity of the injury, study setup times and surgeon treatment preferences impeded recruitment, (iii) recovery from a segmental tibial fracture is challenging, and rehabil
Tahmassebi R, Bates P, Trompeter A, et al., 2020, Reflections from London's Level-1 Major Trauma Centres during the COVID crisis., Eur J Orthop Surg Traumatol, Vol: 30, Pages: 951-954, ISSN: 1633-8065
Emergence of the Covid-19 pandemic resulted in dramatic changes in global healthcare provision. Resources were redirected across all healthcare sectors to support the treatment of viral pneumonia with resultant effects on other essential services. We describe the impact of this on the provision of major trauma care in a major capital city.
Ardehali B, Geoghegan L, Khajuria A, et al., 2018, Microbiological and functional outcomes after open extremity fractures sustained overseas: The experience of a UK level I trauma centre, JPRAS open, Vol: 15, Pages: 36-45, ISSN: 2352-5878
BackgroundOpen extremity fractures carry a high risk of limb loss and poor functional outcomes. Transfer of extremity trauma patients from developing countries and areas of conflict adds further layers of complexity due to challenges in the delivery of adequate care. The combination of extensive injuries, transfer delays and complex microbiology presents unique challenges.MethodsA retrospective review was conducted to analyse the surgical and microbiological themes of patients with open extremity fractures transferred from overseas to our institution (Imperial College NHS Trust) between January 2011 and January 2016.ResultsTwenty civilian patients with 21 open extremity fractures were referred to our unit from 11 different countries. All patients had poly-microbial wound contamination on initial surveillance cultures. Five patients (25%) underwent amputation depending on the extent of osseous injury; positive surveillance cultures did not preclude limb reconstruction, with seven patients undergoing complex reconstruction and eight undergoing simple reconstruction to achievewound coverage. Hundred percent of patients demonstrated infection-free fracture union on discharge.ConclusionPatients with open extremity fractures transferred from overseas present the unique challenge of poly-microbial infection in addition to extensive traumatic wounds. Favourable outcomes can be achieved despite positive microbiological findings on tissue culture with adequate antimicrobial therapy. The decision to salvage the limb and the complexity of reconstruction used should be based on the chance of achieving meaningful functional recovery, mainly determined by the extent of bony injury. The complexity of reconstruction was based on the predicted long-term functionality of the salvaged limb.
Little Z, Smith TO, McMahon SE, et al., 2017, The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?, Injury, Vol: 48, Pages: 2306-2310
INTRODUCTION: Segmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question. The objective of this study was to determine whether patient and surgeon opinion was permissive for a randomised controlled trial (RCT) comparing intramedullary nailing to the application of a circular external fixator. MATERIALS AND METHODS: A convenience questionnaire survey of attending surgeons was conducted during the United Kingdom's Orthopaedic Trauma Society annual meeting 2017 to determine the treatment modalities used for a segmental tibial fracture (n=63). Patient opinion was obtained from clinical patients who had been treated for a segmental tibial fracture as part of a patient and public involvement focus group with questions covering the domains of surgical preference, treatment expectations, outcome, the consent process and follow-up regime (n=5). RESULTS: Based on the surgeon survey, 39% routinely use circular frame fixation following segmental tibial fracture compared to 61% who use nail fixation. Nail fixation was reported as the treatment of choice for a closed injury in a healthy patient in 81% of surgeons, and by 86% for a patient with a closed fracture who was obese. Twenty-one percent reported that they would use a nail for an open segmental tibia fracture in diabetics who smoked, whilst 57% would opt for a nail for a closed injury with compartment syndrome, and only 27% would use a nail for an open segmental injury in a young fit sports person. The patient and public preference exercise identified that sleep, early functional outcomes and psychosocial measures of outcomes are important. CONCLUSION: We concluded that a RCT comparing definitive fixation with an intramedullary nail and a cir
Wordsworth M, Lawton G, Nathwani D, et al., 2016, Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines, Bone and Joint Journal, Vol: 98B, Pages: 420-424, ISSN: 2049-4394
AimsThe management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.Patients and MethodsData on all patients with an open tibial fracture presenting to a major trauma centre between 2011 and 2012 were collected prospectively. The treatment and outcomes of the 65 Gustilo Anderson Grade III B tibial fractures were compared with historical data from the same unit.ResultsThe volume of cases, the proportion of patients directly admitted and undergoing first debridement in a major trauma centre all increased. The rate of limb salvage was maintained at 94% and a successful limb reconstruction rate of 98.5% was achieved. The rate of deep bone infection improved to 1.6% (one patient) in the follow-up period.ConclusionThe reasons for these improvements are multifactorial, but the major trauma network facilitating early presentation to the major trauma centre, senior orthopaedic and plastic surgical involvement at every stage and proactive microbiological management, may be important factors.Take home message: This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care.
Pearse M, Chan JK, 2015, Lower limb reconstruction, Plastic and Reconstructive Surgery Approaches and Techniques, Publisher: John Wiley & Sons, ISBN: 9781118655429
Jain A, Glass GE, Ahmadi H, et al., 2013, Delayed amputation following trauma increases residual lower limb infection, JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, Vol: 66, Pages: 531-537, ISSN: 1748-6815
Ball C, Pearse M, Kennedy D, et al., 2011, Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy, Annals of the Royal College of Surgeons of England, Vol: 93, Pages: 634-638, ISSN: 1478-7083
INTRODUCTIONCarpal tunnel syndrome is the most common hand disorder. We describe a pathway that includes clinical assessment, neurophysiological testing, surgery and physical therapy all at the same visit.METHODSAll referrals for carpal tunnel syndrome were screened for inclusion in a ‘one-stop’ surgeon-led clinic. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated, all on the same day. Baseline and one-year follow-up data were analysed for 57 patients (62 hands).RESULTSThere was significant improvement in all domains of the Boston Carpal Tunnel and Michigan Hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. The total mean operating time was 12.8 minutes (range: 5–15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1–11 minutes). Using a dual theatre model produced a short mean turnaround time of 14.8 minutes (range: 2–37 minutes). Patient satisfaction as judged using a Picker questionnaire was very high.CONCLUSIONSA highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction.
Shenoy R, Kubicek G, Pearse M, 2011, The taylor spatial frame™ for correction of neglected fracture dislocation of the ankle., J Foot Ankle Surg, Vol: 50, Pages: 736-739
Treatment of neglected fracture dislocations of the ankle poses a surgical challenge. Extensive open reduction can frequently be contraindicated because of local skin conditions and contractures. The Taylor Spatial Frame™ (TSF) has been used to reduce and maintain reduction of complex fractures. Its use in fracture dislocation of the ankle joint has not been described. We describe a case where a TSF was used to reduce and treat a 6-week-old fracture dislocation of the ankle. The TSF is a versatile device, which has a role in the management of both acute and neglected fractures.
Glass GE, Barrett SP, Sanderson F, et al., 2011, The microbiological basis for a revised antibiotic regimen in high-energy tibial fractures: Preventing deep infections by nosocomial organisms, JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, Vol: 64, Pages: 375-380, ISSN: 1748-6815
Nayagam S, Graham K, Pearse M, et al., 2011, Reconstructive Surgery in Limbs The Case for the Orthoplastic Approach, ANNALS OF PLASTIC SURGERY, Vol: 66, Pages: 6-8, ISSN: 0148-7043
Harry LE, Sandison A, Pearse MF, et al., 2009, Comparison of the Vascularity of Fasciocutaneous Tissue and Muscle for Coverage of Open Tibial Fractures, 76th Annual Conference of the American-Society-of-Plastic-Surgeons, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 1211-1219, ISSN: 0032-1052
Harry LE, Sandison A, Pearse MF, et al., 2009, Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures., Plast Reconstr Surg, Vol: 124, Pages: 1211-1219
BACKGROUND: Early coverage with vascularized soft-tissue flaps has dramatically improved the outcome in open tibial fractures. However, the ideal tissue for covering open fractures remains controversial. Several clinical studies suggest that muscle is superior to fasciocutaneous tissue; this is attributed to the presumed higher vascularity of muscle, although experimental evidence is inconclusive. The authors' previously described novel murine fracture model, which allows exclusive comparison of both tissues, demonstrated enhanced healing beneath muscle. The present study was undertaken to compare the vascularity of muscle and fasciocutaneous tissues over the course of fracture healing. METHODS: Two experimental groups comprised mice with tibial fractures in contact with either muscle or fasciocutaneous tissues exclusively. Controls included a nontrauma group and those where soft tissues and periosteum were dissected but the tibia was not fractured. Animals were harvested between 3 and 28 days after fracture (n = 170 in total). The vascular density of the soft tissues was assessed using immunohistochemical techniques. RESULTS: Fasciocutaneous tissue was found to have a higher vascular density compared with muscle in contact with the fracture site at all time points (p < 0.0001, two-way analysis of variance), despite accelerated healing of fractures covered by muscle. CONCLUSIONS: The authors' data show that the more advanced healing of fractures covered by muscle compared with fasciocutaneous tissue is not related to the vascularity of the tissues, as the latter had a higher vascular density at all time points. Therefore, provided that a flap has sufficient vascularity to effectively reconstitute the soft-tissue envelope, other factors may be important in specifically promoting fracture healing.
Glass GE, Pearse M, Nanchahal J, 2009, The ortho-plastic management of Gustilo grade IIIB fractures of the tibia in children: A systematic review of the literature, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 40, Pages: 876-879, ISSN: 0020-1383
Glass GE, Pearse MF, Nanchahal J, 2009, Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm, Summer Meeting of the British-Association-of-Plastic-Reconstructive-and-Aesthetic-Surgeons, Publisher: ELSEVIER SCI LTD, Pages: 571-579, ISSN: 1748-6815
Glass GE, Pearse MF, Nanchahal J, 2009, Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm., J Plast Reconstr Aesthet Surg, Vol: 62, Pages: 571-579
BACKGROUND: Lower limb fractures with vascular injuries are associated with a high rate of secondary amputation. Reducing ischaemic time is vital for limb salvage. However, the optimal sequence of surgical management remains unclear. We aimed to review the literature to establish an evidence-based management algorithm. METHODS: All identifiable English language or translated literature related to the surgical sequence of lower limb fractures with vascular injuries was reviewed. RESULTS: A total of 101 cases described in 10 publications (median age: 31; range: 2.5-76) were suitable for analysis. The mean MESS was 4.2. The limb-salvage rate with an ischaemic time of less than 6h was 87%, falling to 61% when ischaemic time exceeded 6h. A preoperative angiography caused a significant delay. The rate of re-vascularisation within 6h improved from 46% (33 of 71) to 90% (27 of 30) with the use of a shunt (p=0.04), with a mean ischaemic time of 3.8h (+/-1.7h, 1 standard deviation (SD)) versus 7.6h (+/-3.8h, 1SD) in those re-vascularised using grafts (p<0.001). The amputation rate of 27% was reduced to 13% by using shunts. CONCLUSION: Early recognition of vascular injury is vital. Formal angiograms are unnecessary and cause crucial delays. A vascular shunt can significantly reduce ischaemic time, enabling unhurried assessment of the feasibility of limb salvage, debridement of demonstrably non-viable tissue and safe skeletal fixation prior to definitive vascular and soft-tissue repair.
Harry LE, Sandison A, Paleolog EM, et al., 2008, Comparison of the healing of open tibial fractures covered with either muscle or fasciocutaneous tissue in a murine model, JOURNAL OF ORTHOPAEDIC RESEARCH, Vol: 26, Pages: 1238-1244, ISSN: 0736-0266
Calder JD, Hine AL, Pearse MF, et al., 2008, The relationship between osteonecrosis of the proximal femur identified by MRI and lesions proven by histological examination., J Bone Joint Surg Br, Vol: 90, Pages: 154-158
Total hip replacement in patients with advanced osteonecrosis of the femoral head is often complicated by early loosening of the femoral component. Recent evidence has suggested that abnormal bone extending into the proximal femur may be responsible for the early failure of the femoral component. We aimed to identify which patients were at high risk of early failure by evaluating gadolinium-enhanced MR images of histologically-confirmed osteonecrotic lesions beyond the femoral head. Although the MR signal intensity has been shown to correlate well with osteonecrosis in the femoral head, it was found to be relatively insensitive at identifying lesions below the head, with a sensitivity of only 51% and a predictive value of a negative result of only 48%. However, the specificity was 90%, with the predictive value of a positive MRI finding being 86%. Only those patients with osteonecrosis of the femoral head secondary to sickle-cell disease, who are known to be at high risk of early loosening, had changes in the MR signal in the greater trochanter and the femoral shaft. This observation suggests that changes in the MR signal beyond the femoral head may represent osteonecrotic lesions in areas essential for the fixation of the femoral component. Pre-operative identification of such lesions in the neck of the femur may be important when considering hip resurfacing for osteonecrosis of the femoral head, following which early loosening of the femoral component and fracture of the neck are possible complications.
Nematy M, Powell CA, Brynes AE, et al., 2006, Peptide YY (PYY) is increased in elderly patients with femoral neck fractures: A prospective cohort study, JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, Vol: 30, Pages: 530-531, ISSN: 0148-6071
Naique SB, Pearse M, Nanchahal J, 2006, Management of severe open tibial fractures - The need for combined orthopaedic and plastic surgical treatment in specialist centres, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 88B, Pages: 351-357, ISSN: 0301-620X
Ghali S, Harris PA, Khan U, et al., 2005, Leg length preservation with pedicled fillet of foot flaps after traumatic amputations, PLASTIC AND RECONSTRUCTIVE SURGERY, Vol: 115, Pages: 498-505, ISSN: 0032-1052
Calder JDF, Buttery L, Revell PA, et al., 2004, Apoptosis - a significant cause of bone cell death in osteonecrosis of the femoral head, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 86B, Pages: 1209-1213, ISSN: 0301-620X
Nanchahal J, Pearse M, 2003, Management of soft-tissue problems in leg trauma in conjunction with application of the Ilizarov fixator assembly, PLASTIC AND RECONSTRUCTIVE SURGERY, Vol: 111, Pages: 1359-1359, ISSN: 0032-1052
Pearse MF, Harry L, Nanchahal J, 2002, Acute compartment syndrome of the leg., BMJ, Vol: 325, Pages: 557-558
Pearse MF, Harry L, Nanchahal J, 2002, Acute compartment syndrome of the leg - Fasciotomies must be performed early, but good surgical technique is important, BMJ-BRITISH MEDICAL JOURNAL, Vol: 325, Pages: 557-558, ISSN: 1756-1833
George MD, Pearse MF, 2002, Cemented revision total hip arthroplasty with impaction bone grafting in Gaucher's disease., J Arthroplasty, Vol: 17, Pages: 667-669, ISSN: 0883-5403
Total hip arthroplasty in Gaucher's disease has been associated with high rates of loosening after all types of arthroplasty. We present a patient with type 1 Gaucher's disease who underwent revision cemented total hip arthroplasty for aseptic loosening after 12 months of enzyme replacement therapy. Major osteolysis was managed by impaction morcellized bone grafting. An excellent clinical and radiographic result was obtained at 5-year follow-up. Enzyme replacement therapy combined with modern revision techniques may offer improved outcomes for patients with Gaucher's disease.
Pearse MF, Nanchahal J, 2002, External fixation design strategies in the management of severe open tibial fractures, Tech Orthop, Pages: 153-172, ISSN: 0885-9698
Calder JDF, Pearse MF, Revell PA, 2001, The extent of osteocyte death in the proximal femur of patients with osteonecrosis of the femoral head, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 83B, Pages: 419-422, ISSN: 0301-620X
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