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Wrightington Hospital, United Kingdom

Mehta S.S.,Wrightington Hospital | Singh H.P.,Birmingham City Hospital | Pandey R.,University of Leicester
Bone and Joint Journal | Year: 2014

Our aim was to compare the outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. We prospectively compared the outcome in 21 patients with and 21 patients without diabetes, two years post-operatively. The modified Constant score was used as the outcome measure. The mean age of the patients was 54.5 years (48 to 65; male:female ratio: 18:24), the mean pre-operative duration of symptoms was 8.3 months (6 to 13) and the mean pre-operative modified Constant scores were 36.6 (standard deviation (SD) 4.6) and 38.4 (SD 5.7) in the diabetic and non-diabetic groups, respectively. The mean modified Constant scores at six weeks, six months and two years post-operatively in the diabetics were 55. 6 (SD 4.7), 67. 4 (SD 5.6) and 84. 4 (SD 6.8), respectively; and in the nondiabetics 66.8 (SD 4.5), 79.6 (SD 3.8) and 88.6 (SD 4.2), respectively. A total of 15 (71%) of diabetic patients recovered a full range of movement as opposed to 19 (90%) in the nondiabetics. There was significant improvement (p < 0.01) in the modified Constant scores following arthroscopic release for frozen shoulder in both groups. The results in diabetics were significantly worse than those in non-diabetics six months post-operatively (p < 0.01) with a tendency towards persistent limitation of movement two years after operation. These results may be used when counselling diabetic patients for the outcome after arthroscopic treatment of frozen shoulder. © 2014 The British Editorial Society of Bone & Joint Surgery.

Broadbent M.R.,Wrightington Hospital | Will E.,Royal Infirmary | McQueen M.M.,Royal Infirmary
Injury | Year: 2010

Purpose: The aim of this study is to examine the demographic factors, functional outcome and radiological data to predict the outcome of humeral diaphyseal fractures. Methods: We performed a prospective study on a consecutive series of 110 patients of 16 years or over, who had sustained a humeral diaphyseal fracture. There were 42 males and 68 females, with an average age of 59 years (range 16-93 years). A total of 72% sustained low-energy injuries, and 89 patients (81%) were primarily treated non-operatively. Shoulder function was assessed using the Neer's and Constant's scores at 8 weeks, 3 months, 6 months and 1 year after injury. Muscle strength was determined isokinetically using a Biodex System 2 dynamometer. Non-union was defined as a failure to bridge at least three cortices and persistence of tenderness or mobility at the fracture site 16 weeks after fracture. Results: Sixteen patients (17%) had non-union at 16 weeks, while 80 had achieved union and a further 14 were lost to follow-up. After stepwise multiple linear regression was performed to isolate independent factors affecting outcome, only the presence of a proximal diaphyseal fracture was found to predict non-union along with a poor Neer's score at 8 and 12 weeks. Poor Neer's scores could be predicted at 26 weeks by age (P < 0.05), previous stroke (P < 0.001) and non-union (P < 0.001). At 52 weeks both age (P < 0.01) and previous stroke (P < 0.01) were independently predictive of poorer Neer's scores. Malunion of any degree had no detectable effect on function. Conclusions: Our results indicate that non-union of humeral diaphyseal fractures can be predicted in the presence of a proximal third fracture with a Neer's score of less than 45 by 12 weeks after fracture. Early surgery improves early function, but this is not a lasting effect. Poor shoulder function is predicted by increasing age, proximal third fractures and non-union. We recommend that surgery to promote union be considered at 12 weeks after fracture in fit patients with fractures of the proximal third of the humerus, poor Neer's scores and no radiographic progression to union. © 2009 Elsevier Ltd. All rights reserved.

Zou Z.,University of Manchester | Chavez-Arreola A.,University of Manchester | Mandal P.,University of Manchester | Board T.N.,Wrightington Hospital | Alonso-Rasgado T.,University of Manchester
Journal of Orthopaedic Research | Year: 2013

Periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in developmental dysplasia of the hip (DDH). It changes the position of the acetabulum to increase femoral head coverage and distribute the contact pressure over the cartilage surface. The success of PAO depends significantly on the surgeon's experience. Using computed tomography data from patients with DDH, we developed a 3D finite element (FE) model to investigate the optimal position of the acetabulum following PAO. A virtual PAO was performed with the acetabulum rotated in increments from the original center edge (CE) angle. Contact area, contact pressure, and Von Mises stress in the femoral and pelvic cartilage were analyzed. Five dysplastic hips from four patients were modeled. Contact area, contact pressure, and Von Mises stress in the cartilage all varied according to the change of CE angle through virtual PAO. An optimal position could be achieved for the acetabulum that maximizes the contact area while minimizing the contact pressure and von Mises stress in the pelvic and femoral cartilage. The optimal position of the acetabulum was patient dependent and did not always correspond to what would be considered a "normal" CE angle. We demonstrated for the first time the interrelation of correction angle, contact area, and contact pressure between the pelvic and femoral cartilage in PAO surgery. Copyright © 2012 Orthopaedic Research Society.

Clement N.D.,Royal Infirmary | Watts A.C.,Wrightington Hospital | Phillips C.,Royal Infirmary | McBirnie J.M.,Royal Infirmary
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015

Purpose To conduct a prospective randomized controlled trial to assess whether arthroscopic bursectomy and debridement of the calcific deposit, with or without subacromial decompression, influences the functional outcome of patients with calcific tendonitis. Methods During a 4-year period, 80 patients were recruited who presented to the study center with refractory calcific tendonitis of the shoulder. Forty patients were randomized to have a subacromial decompression, and 40 were randomized not to have a subacromial decompression in combination with bursectomy and arthroscopic removal of the calcific deposit. All surgery was performed by one surgeon who was blinded to the functional assessment of the patients. Patient demographics, body mass index (BMI), and length of symptoms were recorded at the time of randomization. Patients were asked to complete a pain visual analog score (VAS), short form (SF-12), disability arm shoulder and hand (DASH), and Constant score (CS) preoperatively and at 1 year postoperatively. Results There were 21 male and 59 female patients with a mean age of 49 (range, 32 to 75) years. The mean time of follow-up was 13 (range, 12 to 15) months. There were no significant differences in gender, age, BMI, length of symptoms, or preoperative outcome measures assessed between the groups. Overall, for both groups there was a significant improvement in the pain VAS (P <.001), DASH (P <.001), and CS (P <.001) at 1 year compared with preoperative scores. There were no significant differences demonstrated between the groups for improvement in the pain VAS (P =.57), DASH (P =.93), SF-12 physical component score (P =.58), or CS (P =.27) at 1 year. Conclusions This study has demonstrated that the short-term functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression. Level of Evidence Level I therapeutic study, randomized controlled trial. © 2015 Arthroscopy Association of North America.

Manning C.J.,Stepping Hill Hospital | Delaney R.,Wrightington Hospital | Hayton M.J.,Wrightington Hospital
Journal of Hand Surgery: European Volume | Year: 2014

In clinical trials, treating Dupuytren's contracture with collagenase injection involves manipulation the day after injection, without local anaesthesia. We evaluated the efficacy and tolerability of manipulation 2 days after injection with local anaesthesia. Forty-five patients received 50 injections into cords contracting metacarpophalangeal and proximal interphalangeal joints; follow-up visits were at 3 and 14 weeks. For the metacarpophalangeal joints there were >90% reduction in contracture at both visits. The proximal interphalangeal joints that improved spontaneously after metacarpophalangeal injection or received direct injections showed 51-55% reduction in contracture. Changes in scores on the Patient Evaluation Measure suggest that patients perceived improvements in their hand function was good and they were satisfied with the procedure. Collagenase and local anaesthesia injections were well tolerated; adverse events were localized to the injection site and were mild and transient in nature. These findings provide another viable option for practising surgeons and may help with the logistics of patient care. © The Author(s) 2013.

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