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Article ; Online: Etiology, Epidemiology, and Outcomes of Managing Charcot Arthropathy.

Hester, Thomas / Kavarthapu, Venu

2022 Volume 27, Issue 3, Page(s) 583–594

Abstract: Surgical intervention for Charcot arthropathy is becoming more common; this is driven by an increased prevalence, better understanding of the cause, identifying patient risk factors that influence outcomes, and how to best optimize these. This article ... ...

Abstract	Surgical intervention for Charcot arthropathy is becoming more common; this is driven by an increased prevalence, better understanding of the cause, identifying patient risk factors that influence outcomes, and how to best optimize these. This article aims to summarize the cause of Charcot, look at the factors that influence the outcomes, and the financial cost of managing what is a very challenging condition.
MeSH term(s)	Arthropathy, Neurogenic/diagnosis ; Arthropathy, Neurogenic/epidemiology ; Arthropathy, Neurogenic/etiology ; Humans
Language	English
Publishing date	2022-08-10
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.2022.03.002
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Article ; Online: Combined Charcot hindfoot and midfoot reconstruction using internal fixation method-surgical technique and single surgeon series.

Kavarthapu, Venu / Guduri, Venugopal / Hester, Thomas

Annals of joint

2023 Volume 8, Page(s) 10

Abstract: Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third ...

Abstract	Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.
Language	English
Publishing date	2023-01-15
Publishing country	China
Document type	Journal Article
ISSN	2415-6809
ISSN (online)	2415-6809
DOI	10.21037/aoj-22-23
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Article: Charcot hindfoot deformity reconstruction using a hindfoot nail- surgical technique.

Kavarthapu, Venu / Hester, Thomas

Journal of clinical orthopaedics and trauma

2021 Volume 16, Page(s) 277–284

Abstract: Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow ...

Abstract	Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow correction of deformity, obtain stability and allow progression to weightbearing in orthotic shoes. We describe our preoperative evaluation, planning and surgical timing. We also hope to share some technical pearls and details on the finer points to achieve a satisfactory correction and reduce the learning curve.
Language	English
Publishing date	2021-02-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2021.02.007
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Article: Peristomal intestinal metaplasia with response to serial electrosurgery.

Poppens, McKayla / Hester, Thomas / Renati, Sruthi / Billi, Allison C / Lowe, Lori / Mervak, Julie E

JAAD case reports

2024 Volume 45, Page(s) 38–40

Language	English
Publishing date	2024-01-13
Publishing country	United States
Document type	Case Reports
ZDB-ID	2834220-3
ISSN	2352-5126
ISSN	2352-5126
DOI	10.1016/j.jdcr.2024.01.002
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Article: Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon.

Alkhalfan, Yousif / Lewis, Thomas Lorchan / Kavarthapu, Venu / Hester, Thomas

Journal of clinical orthopaedics and trauma

2023 Volume 48, Page(s) 102330

Abstract: Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving ... ...

Abstract	Diabetic foot osteomyelitis (DFO) poses a significant challenge in the management of diabetic patients, often leading to severe complications and increased morbidity. Effective management of DFO requires a multidisciplinary approach, involving endocrinologists, infectious disease specialists, vascular surgeons, orthopaedic surgeons, and wound care experts. Early diagnosis is paramount, facilitated by advanced imaging techniques such as magnetic resonance imaging (MRI) and bone scintigraphy. Once diagnosed, the treatment strategy hinges on a combination of medical and surgical interventions. Antibiotic therapy, guided by culture results, plays a central role in managing DFO. Tailored regimens targeting the specific pathogens involved are administered, often for prolonged durations. Surgical intervention becomes necessary when conservative measures fall short. Surgical approaches range from minimally invasive procedures, like percutaneous drainage, to more extensive interventions like debridement and bone resection. Prevention of DFO recurrence is equally vital, emphasising glycemic control, meticulous foot care, patient education, monitoring of at-risk signs, revascularization and early intervention when indicated. The management of diabetic foot osteomyelitis mandates a comprehensive strategy that addresses both the infectious and surgical aspects of the condition. A collaborative, interdisciplinary approach ensures timely diagnosis, tailored treatment, and holistic care. Further research into novel therapeutic modalities and long-term outcomes remains essential in refining the management of this complex and debilitating complication of diabetes.
Language	English
Publishing date	2023-12-31
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2023.102330
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Article: Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature.

Nash, William J / Hester, Thomas / Ha, Joon

Journal of clinical orthopaedics and trauma

2021 Volume 17, Page(s) 44–53

Abstract: Background: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options.: Methods: Following the methodology of the ... ...

Abstract	Background: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. Methods: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. Results: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or "complicated" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to non-diabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. Conclusion: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of 'ORIF plus' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.
Language	English
Publishing date	2021-02-03
Publishing country	India
Document type	Journal Article
ZDB-ID	2596956-0
ISSN	2213-3445 ; 0976-5662
ISSN (online)	2213-3445
ISSN	0976-5662
DOI	10.1016/j.jcot.2021.01.016
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Article: Visualising the Future of Orthopaedic Surgery: A Novel Application of Wireless Smart Glasses to Visualise Intraoperative Imaging.

Park, Se Ri / Park, Jae Yong / Ghani, Rafia / Ha, Joon / Hester, Thomas

Cureus

2022 Volume 14, Issue 2, Page(s) e22004

Abstract: Smart glasses can provide a heads-up display of advanced imaging intraoperatively. In recent years, growing attention has been drawn to the use of smart glasses as an assistive technology to improve both efficiency and ergonomics in a surgical setting. ... ...

Abstract	Smart glasses can provide a heads-up display of advanced imaging intraoperatively. In recent years, growing attention has been drawn to the use of smart glasses as an assistive technology to improve both efficiency and ergonomics in a surgical setting. Previous studies have reported improved surgical accuracy, efficiency, and ergonomics with its usage, but its effectiveness as a form of intraoperative heads-up display remains elusive in the context of orthopaedics. This study provides a novel account of a wireless set-up of the Moverio BT-35E Smart Glasses (Suwa, Japan: Epson Inc.), incorporated in a complex orthopaedic procedure. Hind-foot nailing was performed on a patient with a complex open ankle fracture and multiple co-morbidities. Smart glasses were worn by the primary surgeon throughout the procedure to provide heads-up visualisation of the intraoperative fluoroscopy. In our surgical case, the surgeon experienced improved ergonomics and reduced disruption to focus with the use of smart glasses. The wireless set-up provided excellent signal transmission throughout the duration of the procedure. The wireless set-up of smart glasses is a potential solution for common occupational risks imposed on orthopaedic surgeons. Smart glasses minimise musculoskeletal strain from switching of vision from monitor to patient, whilst the wireless set-up allows for efficient use of space in an operating theatre and may potentially limit radiation exposure. Lastly, ergonomic benefits may increase the efficiency of movement for the surgeon, decreasing operative duration, and in turn minimising the risk of surgical complications for patients.
Language	English
Publishing date	2022-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.22004
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Article ; Online: Predictors of metalwork failure and nonunion after hindfoot Charcot reconstruction.

Najefi, Ali-Asgar / Zaidi, Razi / Chan, Oliver / Hester, Thomas / Kavarthapu, Venu

The bone & joint journal

2022 Volume 104-B, Issue 6, Page(s) 703–708

Abstract: Aims: Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot ...

Abstract	Aims: Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions. Methods: We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded. Results: There were 70 patients with mean follow-up of 54 months (SD 26). Overall, 51 patients (72%) and 52 patients (74%) were fully weightbearing at one year postoperatively and at final follow-up, respectively. The overall hindfoot union rate was 83% (58/70 patients). Age, BMI, glycated haemoglobin, and prior revascularization did not affect union. The ratio of nail diameter and isthmus was greater in the united compared to the nonunited group (0.90 (SD 0.06) and 0.86 (SD 0.09), respectively; p = 0.034). In those with a supplementary hindfoot compression screw, there was a 95% union rate (19/20 patients), compared to 78% in those without screws (39/50 patients; p = 0.038). All patients with a miss-a-nail hindfoot compression screw went on to union. Hindfoot metalwork failure was seen in 13 patients (19%). An intact medial malleolus was found more frequently in those with intact metalwork ((77% (44/57 patients) vs 54% (7/13 patients); p = 0.022) and in those with union ((76% (44/58 patients) vs 50% (6/12 patients); p = 0.018). Broken metalwork occurred more frequently in patients with nonunions (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001) and midfoot deformity recurrence (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001). Conclusion: Rates of hindfoot union and intact metalwork were noted in over 80% of patients. Union after hindfoot reconstruction occurs more frequently with an isthmic fit of the intramedullary nail and supplementary hindfoot screws. An intact medial malleolus is protective against nonunion and hindfoot metalwork failure. Cite this article:
MeSH term(s)	Ankle Joint/surgery ; Arthrodesis ; Bone Screws ; Foot/surgery ; Humans ; Retrospective Studies
Language	English
Publishing date	2022-05-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.104B6.BJJ-2022-0127
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Zs.A 6989: Show issues

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Article ; Online: Disaster Planning for Animals in Hazardous Agent Containment Units.

Roble, Gordon / Pullium, Jennifer / Hester, Takechia / Harvey, Stephen

ILAR journal

2019 Volume 59, Issue 2, Page(s) 195–202

Abstract: Disaster response planning for laboratory animal facilities is a time- and personnel-intensive undertaking. This article outlines numerous considerations in formulating a plan for disaster response in a high containment animal unit. The planning process ... ...

Abstract	Disaster response planning for laboratory animal facilities is a time- and personnel-intensive undertaking. This article outlines numerous considerations in formulating a plan for disaster response in a high containment animal unit. The planning process is discussed around a set of elements: planning team formation, situational understanding, goal and objective determination, plan development, preparation, and rehearsal or implementation. The importance of an appropriate planning team and personnel development is explored in relationship to exemplary disaster scenarios such as natural disaster and terrorism. Specific risks such as hazardous agent and animal species type serve to delineate goal-setting methods. These goals provide the framework for an institutional disaster plan. The review further uses elements of the planning process to explore the difficulties of euthanasia of animals treated with hazardous agents. Ultimately, the pitfalls of handling media relations following disaster are examined. Proactive measures for preparing to speak to the media and mitigate negative perceptions of research are presented.
MeSH term(s)	Animals ; Animals, Laboratory ; Disaster Planning
Language	English
Publishing date	2019-04-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2192062-X
ISSN	1930-6180 ; 1084-2020
ISSN (online)	1930-6180
ISSN	1084-2020
DOI	10.1093/ilar/ily022
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Article ; Online: Does 3D CT reconstruction help the surgeon to preoperatively assess calcaneal fractures?

Halai, Mansur / Hester, Thomas / Buckley, Richard E

Foot (Edinburgh, Scotland)

2019 Volume 43, Page(s) 101659

Abstract: Background: With the advent of 3D volume rendered CT scans, more information is potentially available to aid the surgeon in complex calcaneal fractures. The primary aim was to determine if there is a difference in inter-observer and intra-observer ... ...

Abstract	Background: With the advent of 3D volume rendered CT scans, more information is potentially available to aid the surgeon in complex calcaneal fractures. The primary aim was to determine if there is a difference in inter-observer and intra-observer reliability of 3D CT reconstructions compared to 2D CTs of calcaneus fractures based on classification, identification of specific fracture characteristics and proposed treatment. It is hypothesized that the correlation will be greater between experienced surgeons and trainees when using 3D CT. As a secondary aim, the authors wished to investigate the surgeons' satisfaction with 3D CT. Patients and methods: There were six raters, split into 2 groups: high and low surgical experience. Both 2D and 3D scans (10 patients) were reviewed by each rater by filling out a validated questionnaire. This sitting was over a period of six months and all scans were sent separately and randomly by our research coordinator. This process was repeated after a four-week break. Results: The overall evaluation and satisfaction of CT scans of calcaneal fractures was improved by the additional use of volume rendered 3D images. Inexperienced surgeons benefited more than experienced surgeons in terms of reliabilities with fracture configuration. 3D CTs were more likely to change the surgeons' operative strategy. The consistency of deciding on the fracture classification and satisfaction was more uniform between all the raters when 3D CT was used. Conclusion: Inter-observer and intra-observer reliability of 3D CT reconstructions compared to 2D CTs of calcaneus fractures was greater based on classification, identification of specific fracture characteristics and proposed treatment. Inexperienced surgeons were more consistent when interpreting the scans using 3D CTs (improved inter-observer reliability) and were always more satisfied using the 3D CTs. As there is no extra cost or radiation exposure, we propose that 3D CTs may be valuable with preoperative teaching and planning.
MeSH term(s)	Calcaneus/injuries ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/surgery ; Humans ; Imaging, Three-Dimensional ; Observer Variation ; Reproducibility of Results ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-12-11
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1070358-5
ISSN	1532-2963 ; 0958-2592
ISSN (online)	1532-2963
ISSN	0958-2592
DOI	10.1016/j.foot.2019.101659
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