To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Background:The aim of this study was to review the surgical complications and clinical outcomes o... more Background:The aim of this study was to review the surgical complications and clinical outcomes of patients with Pilon fractures treated with Ilizarov frames.Methods:Data collected included surgical complications, grade of initial injury using the Ruedi-Allgower classification and quality of reduction according to the Teeny and Wiss criteria. Outcome scores were collected retrospectively using the Foot and Ankle Disability Index (FADI).Results:A total of 97 consecutive patients were identified. All patients were treated with indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov external fixator. The mean time to union was 6 months. Data was available for 70 patients. 35 patients developed a pin site infection. There were no cases of osteomyelitis. 4 patients developed a DVT and 1 patient a PE, 4 patients required ankle fusions. Quality of reduction according to the criteria of Teeny and Wiss was anatomic in 40 patients, good in 23 patients, f...
The purpose of this study was to review the long term functional results of patients undergoing t... more The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures. Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements. We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of...
Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov ... more Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov frame. 60 degree osteotomy of plastic tibiae were stabilised using four different Ilizarov frame configurations. Models were loaded and shear displacement measured at the fracture site. The optimum frame design was identified and used in clinical practice. The transfracture locked olive wire frame model offered the least displacement in the experimental model This frame model was used in two patients with shear plane non unions and both healed satisfactorily Both displacements had previously failed to unite with standard frame constructs. Transfracture locked olive wire frame design is useful in the treatment of tibial non unions with shear plane.
IntroductionPatient Reported Outcome Measures (PROMs) are used as outcome of many surgical treatm... more IntroductionPatient Reported Outcome Measures (PROMs) are used as outcome of many surgical treatments such as Hip and knee joint replacements, varicose vein and groin hernia surgery. Outcome scores...
We report our experience of a humanitarian mission to treat the earthquake victims of October 200... more We report our experience of a humanitarian mission to treat the earthquake victims of October 2005 in Pakistan. The team with their equipment, in two periods of four and ten days respectively, treated 26 fractures in 25 patients with the Ilizarov frame and principles. There were 21 III B open fractures and three Tscherne III closed fractures. Seventeen fractures were infected with discharging pus and non-viable bone. Injuries were treated aggressively using different Ilizarov techniques of reconstruction surgery. All but two open fractures required a plastic surgical procedure for wound cover. Three months post-operatively eight out of thirteen fractures which had been treated in the first four days of the visit were healed and corticotomy for bone lengthening, performed during the second 10 days period visit. All wounds have remained clean with no evidence of superficial or deep infection. Limb lengthening procedures are planned for the rest of the patients.
Journal of Bone and Joint Surgery-british Volume, 2013
Currently the debate continues in definitive fixation method for complex tibial plateau fractures... more Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation. 124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of...
Purpose Tibia plateau fractures are severe knee injuries which have a great impact on the patient... more Purpose Tibia plateau fractures are severe knee injuries which have a great impact on the patients9 lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had severe tibia plateau fractures which were treated with circular ilizarov frame. Materials & Methods We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI) in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12) data were also collected. Results We have analysed the gait through the GRF of fifteen patients (aged 50.8 ±17.3 years)...
Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthop... more Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthopaedic surgeon confronts nowadays. The incidence of these fractures is increasing as the population continues to age. These patients absorb the majority of the resources in the hospitals, as their healthcare demands are increased. This study included all patients who were admitted to our hospital between January and October 2015 following a neck of femur fracture. A total of 336 patients were included (72.3% female). We gathered demographic and hospitalisation data from patients’ files. Haemoglobin (Hb) levels at admission and transfusion data were also collected. Male patients appeared to have a relatively higher risk of mortality than females (p=0.01). Patients with high ASA grade (IV) had a higher mortality rate (p=0.01). Age, delay of surgery, type of surgery, AMTS and Hb at admission and type of fracture on the other hand did not have a significant impact on mortality (p>0.05). Pa...
In our unit 180 consecutive hip resurfacing procedures have been performed. All patients had a po... more In our unit 180 consecutive hip resurfacing procedures have been performed. All patients had a posterior approach to the hip joint, followed by standard resurfacing using metal-on-metal components. The patients were evaluated radiographically and clinically preoperatively and postoperatively. The mean age of patients was 56 years (range 25-75). There was a statistically significant improvement between the preoperative Harris Hip Score and those at the latest follow-up. There were four fractures of the femoral neck; one was intra-operative and was converted to total joint arthroplasty. Three further fractures occurred: two were revised and one was treated non-operatively. There were no cases of dislocation or deep infection. The short- and medium-term results that have been achieved in this district general hospital are comparable to those that have been achieved in the originator's institution.
Non-unions of the supracondylar area of the humerus are uncommon but they produce profound functi... more Non-unions of the supracondylar area of the humerus are uncommon but they produce profound functional disability. We have successfully treated a series of these non-unions surgically using the Coventry hip screw. This is a large metaphyseal screw which is applied through both humeral condyles and then compressed on to a single 4. 5mm narrow tibial plate applied to the lateral aspect of the humeral shaft. Between 1993 and 2000 we operated on thirteen consecutive patients aged 20 to 81 years (mean age 51 years). All the patients had a severe functional disability. The mean time to surgery was 23 months following their accidents. The average follow up was 16 months (range 8–18 months). All but two of the thirteen patients went on to bony union. The mean time to radiological union was six months (2 to 12 months). The mean arc of flexion doubled to 90 degrees. Until now, the recommended operative technique for stabilisation of non-unions of the distal humerus is identical to that describ...
To support the global restart of elective surgery, data from an international prospective cohort ... more To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
Background:The aim of this study was to review the surgical complications and clinical outcomes o... more Background:The aim of this study was to review the surgical complications and clinical outcomes of patients with Pilon fractures treated with Ilizarov frames.Methods:Data collected included surgical complications, grade of initial injury using the Ruedi-Allgower classification and quality of reduction according to the Teeny and Wiss criteria. Outcome scores were collected retrospectively using the Foot and Ankle Disability Index (FADI).Results:A total of 97 consecutive patients were identified. All patients were treated with indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov external fixator. The mean time to union was 6 months. Data was available for 70 patients. 35 patients developed a pin site infection. There were no cases of osteomyelitis. 4 patients developed a DVT and 1 patient a PE, 4 patients required ankle fusions. Quality of reduction according to the criteria of Teeny and Wiss was anatomic in 40 patients, good in 23 patients, f...
The purpose of this study was to review the long term functional results of patients undergoing t... more The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures. Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements. We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of...
Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov ... more Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov frame. 60 degree osteotomy of plastic tibiae were stabilised using four different Ilizarov frame configurations. Models were loaded and shear displacement measured at the fracture site. The optimum frame design was identified and used in clinical practice. The transfracture locked olive wire frame model offered the least displacement in the experimental model This frame model was used in two patients with shear plane non unions and both healed satisfactorily Both displacements had previously failed to unite with standard frame constructs. Transfracture locked olive wire frame design is useful in the treatment of tibial non unions with shear plane.
IntroductionPatient Reported Outcome Measures (PROMs) are used as outcome of many surgical treatm... more IntroductionPatient Reported Outcome Measures (PROMs) are used as outcome of many surgical treatments such as Hip and knee joint replacements, varicose vein and groin hernia surgery. Outcome scores...
We report our experience of a humanitarian mission to treat the earthquake victims of October 200... more We report our experience of a humanitarian mission to treat the earthquake victims of October 2005 in Pakistan. The team with their equipment, in two periods of four and ten days respectively, treated 26 fractures in 25 patients with the Ilizarov frame and principles. There were 21 III B open fractures and three Tscherne III closed fractures. Seventeen fractures were infected with discharging pus and non-viable bone. Injuries were treated aggressively using different Ilizarov techniques of reconstruction surgery. All but two open fractures required a plastic surgical procedure for wound cover. Three months post-operatively eight out of thirteen fractures which had been treated in the first four days of the visit were healed and corticotomy for bone lengthening, performed during the second 10 days period visit. All wounds have remained clean with no evidence of superficial or deep infection. Limb lengthening procedures are planned for the rest of the patients.
Journal of Bone and Joint Surgery-british Volume, 2013
Currently the debate continues in definitive fixation method for complex tibial plateau fractures... more Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation. 124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of...
Purpose Tibia plateau fractures are severe knee injuries which have a great impact on the patient... more Purpose Tibia plateau fractures are severe knee injuries which have a great impact on the patients9 lives, but in what extend is not clear yet in the literature. The purpose of this study was to investigate the gait alternations after treatment of patients who had severe tibia plateau fractures which were treated with circular ilizarov frame. Materials & Methods We have evaluated the gait pattern of patients who were treated with circular Ilizarov frame after severe tibia plateau fractures (Schatzker IV-VI) in our department. The gait was tested by using a force plate in a walking platform. Ground Reaction Forces (GRF) data were collected during level walking at self-selected speeds. The patients performed two walking tasks for each limb and the collected data were averaged for each limb. Demographic, clinical, radiological and quality of life questionnaire (SF-12) data were also collected. Results We have analysed the gait through the GRF of fifteen patients (aged 50.8 ±17.3 years)...
Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthop... more Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthopaedic surgeon confronts nowadays. The incidence of these fractures is increasing as the population continues to age. These patients absorb the majority of the resources in the hospitals, as their healthcare demands are increased. This study included all patients who were admitted to our hospital between January and October 2015 following a neck of femur fracture. A total of 336 patients were included (72.3% female). We gathered demographic and hospitalisation data from patients’ files. Haemoglobin (Hb) levels at admission and transfusion data were also collected. Male patients appeared to have a relatively higher risk of mortality than females (p=0.01). Patients with high ASA grade (IV) had a higher mortality rate (p=0.01). Age, delay of surgery, type of surgery, AMTS and Hb at admission and type of fracture on the other hand did not have a significant impact on mortality (p>0.05). Pa...
In our unit 180 consecutive hip resurfacing procedures have been performed. All patients had a po... more In our unit 180 consecutive hip resurfacing procedures have been performed. All patients had a posterior approach to the hip joint, followed by standard resurfacing using metal-on-metal components. The patients were evaluated radiographically and clinically preoperatively and postoperatively. The mean age of patients was 56 years (range 25-75). There was a statistically significant improvement between the preoperative Harris Hip Score and those at the latest follow-up. There were four fractures of the femoral neck; one was intra-operative and was converted to total joint arthroplasty. Three further fractures occurred: two were revised and one was treated non-operatively. There were no cases of dislocation or deep infection. The short- and medium-term results that have been achieved in this district general hospital are comparable to those that have been achieved in the originator's institution.
Non-unions of the supracondylar area of the humerus are uncommon but they produce profound functi... more Non-unions of the supracondylar area of the humerus are uncommon but they produce profound functional disability. We have successfully treated a series of these non-unions surgically using the Coventry hip screw. This is a large metaphyseal screw which is applied through both humeral condyles and then compressed on to a single 4. 5mm narrow tibial plate applied to the lateral aspect of the humeral shaft. Between 1993 and 2000 we operated on thirteen consecutive patients aged 20 to 81 years (mean age 51 years). All the patients had a severe functional disability. The mean time to surgery was 23 months following their accidents. The average follow up was 16 months (range 8–18 months). All but two of the thirteen patients went on to bony union. The mean time to radiological union was six months (2 to 12 months). The mean arc of flexion doubled to 90 degrees. Until now, the recommended operative technique for stabilisation of non-unions of the distal humerus is identical to that describ...
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