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Article ; Online: Avoidance of injury to the posterior neurovascular bundle during total ankle arthroplasty - A simple technical tip.

Ramhamadany, Eamonn / Jennison, Toby / Davies, Howard G / Buedts, Kris / Blundell, Chris M

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons

2022 Volume 28, Issue 8, Page(s) 1239–1240

Abstract: Iatrogenic nerve injury to the tibial nerve is a serious but avoidable complication of total ankle replacements and may be under-reported as it may go unrecognised or thought to be due to tarsal tunnel syndrome. The tibial nerve is particularly ... ...

Abstract	Iatrogenic nerve injury to the tibial nerve is a serious but avoidable complication of total ankle replacements and may be under-reported as it may go unrecognised or thought to be due to tarsal tunnel syndrome. The tibial nerve is particularly vulnerable during the saw cuts at the posteromedial corner without appropriate protection. Prior to drilling the tibial and talar pins of the adjustment block for the Infinity ankle replacement we perform a 2 cm incision behind the medial malleolus. The tibialis posterior tendon sheath is identified and incised. A periosteal elevator is used to develop a plane between the back of the tibia and the tibialis posterior tendon and then exchanged for a mini Hohmann retractor protecting the neurovascular bundle. This allows us to drill the pins and saw cuts safely. The Hohmann retractor can be felt at the tip of the saw blade providing reassurance that the blade is not too deep. Our technique has not previously been reported in the literature. It acts as a simple reproducible way of avoiding injury to structures at the back of the ankle joint.
Language	English
Publishing date	2022-04-29
Publishing country	France
Document type	Journal Article
ZDB-ID	1424533-4
ISSN	1460-9584 ; 1268-7731
ISSN (online)	1460-9584
ISSN	1268-7731
DOI	10.1016/j.fas.2022.04.003
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Article ; Online: The treatment of iatrogenic hallux varus.

Davies, Mark B / Blundell, Chris M

Foot and ankle clinics

2014 Volume 19, Issue 2, Page(s) 275–284

Abstract: Though uncommon, iatrogenic hallux varus is most often the result of overresection of the medial eminence, overtranslation of an osteotomy, overrelease of the lateral soft tissues, or overtightening of the medial tissues. It is not always symptomatic, as ...

Abstract	Though uncommon, iatrogenic hallux varus is most often the result of overresection of the medial eminence, overtranslation of an osteotomy, overrelease of the lateral soft tissues, or overtightening of the medial tissues. It is not always symptomatic, as the degree of deformity can be well tolerated. For soft-tissue reconstructions, releases have little role to play unless minor deformity is detected early on and the longevity of tendon transfer and tenodesis remains unknown. For bony reconstruction, arthrodesis is the recommended salvage technique.
MeSH term(s)	Arthrodesis ; Hallux/diagnostic imaging ; Hallux/surgery ; Hallux Varus/classification ; Hallux Varus/diagnostic imaging ; Hallux Varus/surgery ; Hallux Varus/therapy ; Humans ; Iatrogenic Disease ; Metatarsal Bones/diagnostic imaging ; Metatarsal Bones/surgery ; Osteotomy ; Radiography ; Tendon Transfer ; Tenodesis
Language	English
Publishing date	2014-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2051688-5
ISSN	1558-1934 ; 1083-7515
ISSN (online)	1558-1934
ISSN	1083-7515
DOI	10.1016/j.fcl.2014.02.010
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Zs.A 5780: Show issues

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Article ; Online: Reducing knot prominence during 'Achillon' tendoachilles repair: Technique tip.

Barwick, Thomas W / Blundell, Chris M

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons

2013 Volume 19, Issue 1, Page(s) e5–6

MeSH term(s)	Achilles Tendon/injuries ; Achilles Tendon/surgery ; Humans ; Suture Techniques/instrumentation ; Tendon Injuries/surgery ; Wound Healing
Language	English
Publishing date	2013-03
Publishing country	France
Document type	Case Reports ; Journal Article
ZDB-ID	1424533-4
ISSN	1460-9584 ; 1268-7731
ISSN (online)	1460-9584
ISSN	1268-7731
DOI	10.1016/j.fas.2012.11.007
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Article ; Online: Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods.

van den Heuvel, Stein B M / Doorgakant, Ashtin / Birnie, Merel F N / Blundell, Chris M / Schepers, Tim

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons

2021 Volume 27, Issue 3, Page(s) 339–347

Abstract: Background: Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect ... ...

Abstract	Background: Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA. Methods: A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation. Results: We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance. Conclusion: This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA. Level of evidence: Level IIa.
MeSH term(s)	Adolescent ; Adult ; Aged ; Ankle/surgery ; Ankle Joint/surgery ; Arthrodesis/methods ; Bone Plates ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteoarthritis/surgery ; Prospective Studies ; Retrospective Studies ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2021-01-02
Publishing country	France
Document type	Journal Article ; Systematic Review
ZDB-ID	1424533-4
ISSN	1460-9584 ; 1268-7731
ISSN (online)	1460-9584
ISSN	1268-7731
DOI	10.1016/j.fas.2020.12.011
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Article ; Online: The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients: a prospective case-control cohort study.

Ward, Alex E / Tadross, Daniel / Wells, Fiona / Majkowski, Lawrence / Naveed, Umna / Jeyapalan, Rathan / Partridge, David G / Madan, Suvira / Blundell, Chris M

Bone & joint open

2020 Volume 1, Issue 11, Page(s) 669–675

Abstract: Aims: Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum ... ...

Abstract	Aims: Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods: All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results: Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion: This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected.Cite this article:
Language	English
Publishing date	2020-11-02
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.111.BJO-2020-0141.R1
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Article ; Online: Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia.

Haque, Syed / Kakwani, Rajesh / Chadwick, Caroline / Davies, Mark Bowen / Blundell, Chris M

Foot & ankle international

2016 Volume 37, Issue 1, Page(s) 58–63

Abstract: Background: As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient ... ...

Abstract	Background: As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient surgery. There is the assumption that this leads to a quicker recovery time permitting an earlier return to work. As with any new surgical technique, there is an associated learning curve. This study looked into the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) performed at a University Hospital. Methods: Thirty patients underwent minimally invasive surgery for DMMO. There were 13 males and 17 females with an average age of 60 years. More than one metatarsal osteotomy was done in all cases to facilitate the moulding of the metatarsal head to the correct alignment with full weight bearing. The outcome was measured with the Manchester-Oxford Foot Questionnaire (MOXFQ), patient-reported outcome (PRO), and visual analog scale (VAS) pain score. Minimum follow up was 1 year. Results: At the final review, the average MOXFQ score was an excellent 31. Average improvement in VAS score was 3.5, which ranged from 10 to -7. The VAS was affected by 2 patients whose pain worsened after the operation. There were 4 complications, one each of nonunion, malunion, transfer metatarsalgia, and soft tissue ossification. Conclusion: The 3 most common complications of foot and ankle surgery are infection, wound dehiscence, and skin ulcer or blister. Intra-articular metatarsal osteotomies are commonly associated with stiffness due to scarring and consequently hammertoes. By reducing the soft tissue injury in minimally invasive surgery, these risks can be potentially minimized. Minimally invasive DMMO produced good patient satisfaction, functional improvement, and low complication rates in most cases. Level of evidence: Level IV, retrospective case series.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Metatarsal Bones/surgery ; Metatarsalgia/surgery ; Middle Aged ; Minimally Invasive Surgical Procedures ; Osteotomy/methods ; Patient Satisfaction ; Postoperative Complications ; Retrospective Studies ; Visual Analog Scale
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.1177/1071100715598601
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Article: Acute quadriceps tendon rupture: a pragmatic approach to diagnostic imaging.

Perfitt, Joel S / Petrie, Michael J / Blundell, Chris M / Davies, Mark B

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

2013 Volume 24, Issue 7, Page(s) 1237–1241

Abstract: Introduction: Quadriceps tendon ruptures are uncommon injuries, occurring most frequently in males over 40 years and associated with obesity, renal failure and steroids. Literature states that ultrasonography and magnetic resonance imaging have a role ... ...

Abstract	Introduction: Quadriceps tendon ruptures are uncommon injuries, occurring most frequently in males over 40 years and associated with obesity, renal failure and steroids. Literature states that ultrasonography and magnetic resonance imaging have a role in diagnosis. We discuss the contrasting advantages and disadvantages of each imaging modality and establish their diagnostic value. Materials and methods: A closed loop audit cycle was performed over 68 months by reviewing all patients presenting with a suspected acute quadriceps tendon ruptures to a Teaching Hospital. Results: Sixty-six patients were included in the study; 4/47 patients in the initial audit period were inaccurately diagnosed, either clinically or by ultrasonography, leading to surgical exploration identifying an intact quadriceps tendon. This highlighted the need for improved pre-operative diagnosis and a recommendation to increase the use of magnetic resonance imaging. In the second cycle, the use of magnetic resonance imaging increased from 4 to 42% (p = 0.0004) and misdiagnosis fell from 4/47 (9%) to 1/19 (5%). Ultrasonography was shown to be highly sensitive (1.0) but the specificity of this modality was only 0.67 with a positive predictive value of 0.88. Magnetic resonance imaging displayed a sensitivity of 1.0, a specificity of 1.0 and a positive predictive value of 1.0. Conclusion: We propose that all patients who have a suspected quadriceps tendon rupture after clinical examination and radiography should either proceed directly to magnetic resonance imaging or be initially assessed by ultrasound, and in those with positive findings, a supplementary magnetic resonance imaging to eliminate false positive diagnoses.
MeSH term(s)	False Positive Reactions ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Audit ; Middle Aged ; Predictive Value of Tests ; Quadriceps Muscle/injuries ; Retrospective Studies ; Rupture/diagnosis ; Rupture/surgery ; Tendon Injuries/diagnosis ; Tendon Injuries/diagnostic imaging ; Tendon Injuries/surgery ; Ultrasonography ; Unnecessary Procedures
Language	English
Publishing date	2013-08-31
Publishing country	France
Document type	Journal Article
ZDB-ID	1231084-0
ISSN	1432-1068 ; 1633-8065 ; 0948-4817 ; 0940-3264
ISSN (online)	1432-1068
ISSN	1633-8065 ; 0948-4817 ; 0940-3264
DOI	10.1007/s00590-013-1307-x
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Zs.A 3479: Show issues

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Article ; Online: Assessment of a three-grade classification of complications in total ankle replacement.

Gadd, Richard J / Barwick, Thomas W / Paling, Ellen / Davies, Mark B / Blundell, Chris M

Foot & ankle international

2014 Volume 35, Issue 5, Page(s) 434–437

Abstract: Background: Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritis of the ankle. A 3-grade classification of complications to assist in prediction of ... ...

Abstract	Background: Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritis of the ankle. A 3-grade classification of complications to assist in prediction of early implant failure has been proposed. We have compared the experience of a tertiary referral center in the United Kingdom to the proposed system. Methods: A retrospective review of the Sheffield Foot and Ankle Unit TAR database was performed from 1995 to 2010. All complications were recorded and categorized using Glazebrook et al's proposed system of increasing severity. Low-grade complications including postoperative bone fracture, intraoperative bone fracture, and wound healing problems rarely lead to revision. Medium-grade complications, technical error and subsidence, lead to failure <50% of the time. High-grade complications--deep infection, aseptic loosening, and implant failure--lead to revision >50% of the time. In our center, 217 TAR were implanted in 198 patients with a minimum follow-up of 30 months. Results: The complication rate was 23%, with a revision rate of 17%. All complications recorded in our study except intraoperative bone fracture and wound healing had a failure rate of at least 50%. Conclusion: Unfortunately most complications associated with TAR have a significant impact on the life span of a TAR. Glazebrook et al's proposed 3-tier system did not reliably reflect our experience. Hence, we would categorize complications as either high or low risk for early failure of TAR. Level of evidence: Level IV, case series.
MeSH term(s)	Ankle Joint/surgery ; Arthroplasty, Replacement, Ankle/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications/classification ; Prosthesis Failure ; Retrospective Studies ; United Kingdom
Language	English
Publishing date	2014-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.1177/1071100714524549
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Article ; Online: Absence of the flexor digitorum longus tendon: an MRI study.

Magra, Merzesh / Taqvi, Syed / Cooper, Robert / Blundell, Chris M / Davies, Mark B

Clinical anatomy (New York, N.Y.)

2012 Volume 25, Issue 8, Page(s) 1062–1065

Abstract: Flexor digitorum longus (FDL) is the primary flexor of the lateral four toes. It is a reliable source of tendon for transfer surgery. We present a case whereby a patient who required a reconstruction for adult acquired flatfoot deformity using FDL as a ... ...

Abstract	Flexor digitorum longus (FDL) is the primary flexor of the lateral four toes. It is a reliable source of tendon for transfer surgery. We present a case whereby a patient who required a reconstruction for adult acquired flatfoot deformity using FDL as a dynamic structure for transfer was found to have an absent FDL tendon at the time of operation, necessitating the use of flexor hallucis longus (FHL) instead. This unusual finding prompted us to investigate the frequency of absence of the FDL tendon. We reviewed our hospital MRI database of foot and ankle images specifically looking for patients with absence of this tendon. After randomization, 756 images were reviewed independently by two surgeons and a consultant musculoskeletal radiologist. No instances of an absent FDL tendon were identified. In conclusion, the frequency of absence of the FDL tendon is less than 1 in 750. Surgeons who require FDL for tendon transfer surgery need not image the foot preoperatively to anticipate the need for the use of FHL as an alternative.
MeSH term(s)	Female ; Flatfoot/surgery ; Foot/anatomy & histology ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Posterior Tibial Tendon Dysfunction/surgery ; Prevalence ; Retrospective Studies ; Tendon Transfer/methods ; Tendons/abnormalities ; Tendons/anatomy & histology ; Tendons/surgery ; Tibia/anatomy & histology
Language	English
Publishing date	2012-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1025505-9
ISSN	1098-2353 ; 0897-3806
ISSN (online)	1098-2353
ISSN	0897-3806
DOI	10.1002/ca.22044
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Zs.A 2592: Show issues

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Article ; Online: Correlation of Hallux Rigidus Grade With Motion, VAS Pain, Intraoperative Cartilage Loss, and Treatment Success for First MTP Joint Arthrodesis and Synthetic Cartilage Implant.

Baumhauer, Judith F / Singh, Dishan / Glazebrook, Mark / Blundell, Chris M / De Vries, Gwyneth / Le, Ian L D / Nielsen, Dominic / Pedersen, M Elizabeth / Sakellariou, Anthony / Solan, Matthew / Wansbrough, Guy / Younger, Alastair S E / Daniels, Timothy R

Foot & ankle international

2017 Volume 38, Issue 11, Page(s) 1175–1182

Abstract: Background: Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade.: Methods!# ...

Abstract	Background: Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade. Methods: A prospective, randomized study examining outcomes of arthrodesis compared to synthetic cartilage implant was performed. Patients underwent preoperative clinical examination, radiographic assessment, hallux rigidus grade assignment, and intraoperative assessment of cartilage loss. Visual analog scale (VAS) score for pain was obtained preoperatively and at 24 months. Correlation was made between active peak dorsiflexion, VAS pain, cartilage loss, and hallux rigidus grade. Fisher's exact test was used to assess grade impact on clinical success ( P < .05). Results: In 202 patients, 59 (29%), 110 (55%), and 33 (16%) were classified as Coughlin grades 2, 3, and 4, respectively. There was no correlation between grade and active peak dorsiflexion (-0.069, P = .327) or VAS pain (-0.078, P = .271). Rank correlations between grade and cartilage loss were significant, but correlations were small. When stratified by grade, composite success rates between the 2 treatments were nearly identical. Conclusions: Irrespective of the grade, positive outcomes were demonstrated for both fusion and synthetic cartilage implant. Clinical symptoms and signs should be used to guide treatment, rather than a grade consisting of radiographic, symptoms, and range of motion factors. Level of evidence: Level II, randomized clinical trial.
MeSH term(s)	Adult ; Aged ; Arthrodesis/methods ; Cartilage/physiopathology ; Female ; Hallux Rigidus/diagnosis ; Hallux Rigidus/diagnostic imaging ; Hallux Rigidus/surgery ; Humans ; Intraoperative Care/methods ; Male ; Middle Aged ; Physical Examination/methods ; Prospective Studies ; Prostheses and Implants ; Prosthesis Design ; Prosthesis Implantation/methods ; Radiography/methods ; Range of Motion, Articular/physiology ; Risk Assessment ; Severity of Illness Index ; Treatment Outcome ; Visual Analog Scale
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.1177/1071100717735289
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