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Katie Young, Shaheel Chummun, Thomas Wright, Elizabeth Darley, Thomas W Chapman, Andrew J Porteous, James R D Murray, Umraz Khan
INTRODUCTION: An exposed knee prosthesis is a limb threatening condition. Our unit manages such cases according to a multidisciplinary orthoplastic protocol. Whilst early prosthetic joint infection with dehiscence may be managed by Debridement, Antibiotics and Implant Retention (DAIR) and soft tissue coverage, the majority of these cases are chronic and in our unit are managed by Debridement, Explantation, Antibiotics (spacer and systemic) and Flap (DEAF). PATIENTS AND METHODS: We report our experience of managing 17 of these challenging cases, 16 DEAFs and one DAIR and flap...
August 2016: Knee
R M T Staruch, P C Jackson, J Hodson, G Yim, M A Foster, T Cubison, S L A Jeffery
The care and challenges of injured service have been well documented in the literature from a variety of specialities. The aim of this study was to analyse the surgical timelines of military and civilian traumatic amputees and compare the surgical and resuscitative interventions. A retrospective review of patient notes was undertaken. Military patients were identified from the Joint Theatre Trauma Registry (JTTR) in 2009. Civilian patients were identified using the hospital informatics database. Patient demographics, treatment timelines as well as surgical and critical care interventions were reviewed...
March 2016: Annals of Medicine and Surgery
Roisin T Dolan, Joseph S Butler, James Wilson-MacDonald, Jeremy Reynolds, Lucy Cogswell, Paul Critchley, Henk Giele
BACKGROUND: Tumor-related spinal surgery has been revolutionized by recent advances in spinal stabilization, modern neuroimaging, and perioperative intensive medicine. This study examines clinical outcomes and factors associated with complications following reconstruction of complex oncologic defects of the spine and sacrum, in an attempt to increase preoperative recognition of high-risk patients with diminished wound-healing capacity and to optimize clinical outcomes in this cohort. METHODS: We performed a retrospective analysis of fifty-five consecutive patients who underwent soft-tissue reconstruction with or without osseous stabilization of defects following spinal or sacral tumor resection at a quaternary referral center over a twelve-year period...
January 20, 2016: Journal of Bone and Joint Surgery. American Volume
N K Jayakumar, V Rathnaprabhu, S Ramesh, A Parameswaran
External nasal splinting is performed routinely after nasal bone fracture reductions, osteotomies, and rhinoplasties. Materials commonly used include plaster of Paris (POP), thermoplastic splints, self-adhesive padded aluminium splints, and Orthoplast, among many others. The disadvantages of these materials are described in this paper, and polyvinyl siloxane is recommended as an effective and more readily available alternative material to counter these pitfalls.
January 2016: International Journal of Oral and Maxillofacial Surgery
J A Mathews, J Ward, T W Chapman, U M Khan, M B Kelly
BACKGROUND: Grade III open fractures of the tibia represent a serious injury. It is recognised that combined management of these cases by experienced orthopaedic and plastic surgeons improves outcomes. Previous studies have not considered the timing of definitive soft tissue cover in relation to the definitive orthopaedic management. This paper reviews the outcomes in patients treated in an orthoplastic unit where the emphasis was on undertaking the definitive orthopaedic and plastic surgical procedures in a single stage, following initial debridement and temporary stabilisation as necessary...
November 2015: Injury
R W Trickett, S Rahman, P Page, I Pallister
INTRODUCTION: The standards for the management of open fractures of the lower limb published by the British Association of Plastic, Reconstructive and Aesthetic surgeons (BAPRAS) and British Orthopaedic Association (BOA) were introduced to improve the treatment received by patients after open injury to the lower limb. These Standards were released after BAPRAS/BOA published Guidelines for the management of open tibial fractures. METHODS: We wished to determine the impact of these Standards upon the surgical management of open tibial fractures by comparing patients admitted to an orthoplastic centre in the 45 months concluding December 2009 (the Guidelines era) with those admitted during 2011 (the Standards era)...
September 2015: Annals of the Royal College of Surgeons of England
M A Fernandez, K Wallis, M Venus, J Skillman, J Young, M L Costa
An observational study was conducted of 105 patients presenting with an open fracture of the tibia or ankle to determine the impact of a dedicated orthoplastic operating list on our management of these injuries over the time period January 2012 to July 2014. There were 51 patients before and 54 after the introduction of the orthoplastic list. Significant improvements were noted in our ability to deliver a service in line with national guidelines across all Gustilo-Anderson grades of injury. Among patients with the most severe grades of injury (Gustilo types IIIB and IIIC), there was a trend towards an improved time to first skeletal stabilisation (29...
September 2015: Annals of the Royal College of Surgeons of England
Vassilis Athanassoglou, Anna Wallis, Svetlana Galitzine
Lower limb orthopedic operations are frequently performed under regional anesthesia, which allows avoidance of potential side effects and complications of general anesthesia and sedation. Often though, patients feel anxious about being awake during operations. To decrease intraoperative anxiety, we use multimedia equipment consisting of a tablet device, noise-canceling headphones, and a makeshift frame, where patients can listen to music, watch movies, or occupy themselves in numerous ways. These techniques have been extensively studies in minimally invasive, short, or minor procedures but not in prolonged orthoplastic operations...
November 2015: Journal of Clinical Anesthesia
S Rajasekaran, S R Sabapathy, J Dheenadhayalan, S R Sundararajan, H Venkatramani, A Devendra, P Ramesh, K P Srikanth
INTRODUCTION: Open injuries of the limbs offer challenges in management as there are still many grey zones in decision making regarding salvage, timing and type of reconstruction. As a result, there is still an unacceptable rate of secondary amputations which lead to tremendous waste of resources and psychological devastation of the patient and his family. Gustilo Anderson's classification was a major milestone in grading the severity of injury but however suffers from the disadvantages of imprecise definition, a poor interobserver correlation, inability to address the issue of salvage and inclusion of a wide spectrum of injuries in Type IIIb category...
February 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Piers R J Page, Ryan W Trickett, Shakeel M Rahman, Angharad Walters, Leila M Pinder, Caroline J Brooks, Hayley Hutchings, Ian Pallister
Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere...
July 2015: Injury
Shaheel Chummun, Thomas C Wright, Thomas W L Chapman, Umraz Khan
INTRODUCTION: We reviewed the functional outcome of 68 patients with open ankle fractures managed in an orthoplastic specialist centre. MATERIALS AND METHODS: Patients managed at Frenchay Hospital over a 6 year period were divided into 3 groups: group P were patients initially seen and managed at Frenchay Hospital (an orthoplastic specialist centre), group S were patients stabilised at a different unit and referred for definitive management, while group R were patients managed in a different unit and referred following complications...
2015: Injury
J Yarrow, S Rahman, N Marsden, I Pallister, S Hemington-Gorse
INTRODUCTION: The joint British Association of Plastic, Reconstructive and Aesthetic Surgeons/British Orthopaedic Association standards define best practice management in open diaphyseal fractures of the lower limb. The aim of our study was to review the regional approach and experience in South West England and Wales. A further objective was to evaluate service provision with regard to the standards' key recommendations. METHODS: A prospective audit was undertaken of open diaphyseal fracture patients...
January 2015: Annals of the Royal College of Surgeons of England
Mark E Fleming, Anthony O'Daniel, Husain Bharmal, Ian Valerio
BACKGROUND: A primary goal in traumatic lower extremity amputation management is preservation of limb length. Energy expenditure during ambulation directly correlates with residual limb length, preserved limb segments, and stable joint preservation. An additional factor affecting limb function includes achieving adequate residual limb soft tissue coverage. This report describes techniques for achieving a stable soft tissue envelope to facilitate limb length and joint preservation. METHODS: A series of traumatic amputation cases with inadequate soft tissue coverage are reviewed...
August 2014: Annals of Plastic Surgery
R Betul Iça, Fırat Öztürk, Burhan Ates, Meral Arslan Malkoc, Ünzile Kelestemur
OBJECTIVE: To quantify, with high-pressure liquid chromatography (HPLC), the amount of residual monomer leached from different orthodontic acrylic materials prepared with two different manipulation methods. MATERIALS AND METHODS: Eighty cylindrical specimens (5 × 25 mm) were divided into eight groups (n  =  10). The specimens were prepared with four acrylic materials-Orthocryl Neon Blue (Dentaurum), Orthocryl EQ (Dentaurum), Orthoplast (Vertex), and O-80 (Imicryl)-and with two different manipulation methods: doughing and spray-on...
September 2014: Angle Orthodontist
H-U Steinau, J Hauser, F Farzaliyev, L Podleska
Multimodal treatment of malignant tumors of the musculoskeletal system with R0 in sano resection plays a key role in prevention of local recurrence in soft tissue and bone sarcoma. In cases of unavoidable neuromuscular or osseous defects, current plastic and orthoplastic reconstruction techniques avoid limb amputation in the majority of patients. Clinical long-term results demonstrate that large resection defects do not necessarily result in impaired limb function if multidisciplinary procedures are integrated...
March 2014: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Umraz Khan, Filippo Boriani, Nicola Baldini
No abstract text is available yet for this article.
February 2013: Plastic and Reconstructive Surgery
Shaheel Chummun, Thomas A Wigglesworth, Katie Young, Beth Healey, Thomas C Wright, Thomas W L Chapman, Umraz Khan
BACKGROUND: Consensus on the definition of a Gustilo grade IIIC injury was sought, and the influence of vascular injuries on outcome of severe open tibial fractures was investigated. METHODS: Three thousand three hundred fifty-one plastic and orthopedic surgeons were sent questionnaires to determine their interpretation of Gustilo grade IIIC injuries. Notes of patients with severe open tibial injuries reconstructed at Frenchay orthoplastic center with free tissue transfer between 2006 and 2010 were reviewed...
February 2013: Plastic and Reconstructive Surgery
H Kurt, K-J Erdelt, A Cilingir, E Mumcu, T Sülün, N Tuncer, W Gernet, F Beuer
This study investigates the wear resistance of four different types of occlusal splint materials based on two-body wear simulations under wet and dry conditions. Twenty specimens of each splint material (Dentalon Plus, Orthoplast, Biocryl C, and Eclipse), each with a diameter of 16 mm and a thickness of 3 mm, were tested, half under wet and half under dry conditions. Each wear test was performed using a device called chewing simulator CS-4 (n=10; test load: 50 N; number of cycles: 10000, 20000, and 30000; continuous rinsing with 30°C water for wet conditions); the antagonists were simulated using steel balls...
August 2012: Journal of Oral Rehabilitation
Justin J Park, Kirk A Campbell, John J Mercuri, Nirmal C Tejwani
Management of traumatic soft-tissue injuries remains a challenging and ever evolving field within orthopedic surgery. The basic principle of addressing life before limb in the initial assessment of critically injured patients has not changed. Although arteriography remains the gold standard for vascular injury screening, computed tomography angiography is being used more often to determine limb viability, and its sensitivity and specificity for detecting vascular lesions are reported to be excellent. Thorough debridement and irrigation with early institution of antibiotics are crucial in preventing infection; debridement should be performed urgently once life-threatening conditions have been addressed...
February 2012: American Journal of Orthopedics
R W Trickett, Elizabeth Mudge, Patricia Price, Ian Pallister
AIM: The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach. PATIENTS AND METHODS: Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included...
July 2012: Injury
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