Nick Harris

Ankle Stabilization with Hamstring Autograft: A New Technique Using Interference Screws

Many techniques have been advocated for the late surgical reconstruction of the lateral ankle ligament complex, including the use of hamstring tendon autografts. A new technique is described which attempts to restore anatomically the anterior talofibular ligament using hamstring autograft. The distal end of the graft is secured in a blind-ended tunnel in the talus without the need for transosseous tensioning. This is achieved with the use of the Bio-Tenodesis Screw System.

Fibula lengthening osteotomy to correct valgus mal-alignment following total ankle arthroplasty

Total Ankle Arthroplasty (TAA) is increasing in popularity following the development of the, next generation of implants and improved surgical technique giving better long-term results. Significant mal-alignment of the ankle pre-operatively has always provided a challenge to the surgeon, to regain anatomical alignment to reduce subsequent wear. We present a series of two cases of TAA, who developed post-operative valgus deformity requiring salvage procedure in the form of a fibula, lengthening osteotomy.

Flexor Digitorum Longus Transfer Using an Interference Screw for Stage 2 Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction generally is classified into three stages as proposed by Johnson and Strom.1 Stage 2 is dysfunction of the tendon without fixed deformity and represents the best possibility of obtaining good function of the foot after a flexor digitorum longus (FDL) transfer. Transfer of the FDL restores adduction to the transverse tarsal joint and inversion to the subtalar joint and opposes the peroneus brevis, which may protect the spring ligament complex from further deterioration.2 Bioabsorbable interference screws (Arthrex Biotenodesis Screw System, Sheffield, England) (Figure 1)

Periprosthetic Fracture After Total Ankle Replacement: Surgical Technique

Level of Evidence: V, Expert Opinion

Joint Orthopaedic and Rheumatology Clinics: Evidence to Support the Guidelines

Joint Orthopaedic and Rheumatology Clinics: Evidence to Support the Guidelines Heidi J. Siddle* Bsc (Hons), MSc, Michael R. Backhouse BSc (Hons), PGCert, Ray Monkhouse MB ChB, FRCS (Tr. & Orth), FRCS (Ed), Nick J. Harris FRCS (Tr. & Orth) & Philip S. Helliwell MA, FRCP, PhD Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK Foot Health Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK

Interference screw fixation of flexor hallucis longus tendon transfer to calcaneus

We present a case of achilles tendon re-rupture and its subsequent management with a flexor hallucis longus tendon transfer. We describe a technique of fixation of the tendon transfer using an interference screw. We believe this technique offers advantage over others in that it is simple, assists accurate tensioning of the graft, provides a very secure fixation and allows early mobilization.

Is there a role for total ankle replacement in polio patients?: A case report and review of the literature.

Although poliomyelitis is almost eradicated, as orthopaedic surgeons we occasionally encounter residual deformities in patients who suffered the disease in the past. An equino-varus deformity of the foot is the commonest deformity seen. In this report we present a 53 years old lady who had poliomyelitis as a child and presented with a painful, degenerate ankle and 12 degrees of varus deformity. CT confirmed advanced degenerative changes. The management options included realignment and fusion, supramalleolar ostoetomy or total ankle replacement. In view of the satisfactory active range of motion and advanced OA confirmed by CT scan we considered the option of total ankle replacement. To our knowledge this has never been reported before. At two and half years follow up the patient showed satisfactory functional results (AOFAS score 88/100) and high satisfaction. Plain radiographs revealed a well aligned joint with no evidence of loosening or osteolysis.

An audit of a combined rheumatology and orthopaedic foot and ankle surgery clinic

Failure of conservative care is often followed by orthopaedic intervention with foot surgery accounting for 1/3 of lower limb surgery in Rheumatoid Arthritis (RA). National guidelines encourage combined rheumatology & orthopaedic care.

Total Ankle Arthroplasty

Total ankle arthroplasty is indicated for painful arthritis of the ankle most commonly posttraumatic, primary, or rheumatoid. Other causes include psoriatic arthritis of the ankle, hemophilic arthropathy, and hemochromatosis.

Technique Tip: The Use of a Modified Interrupted Vertical Mattress Suture after Bunion Surgery

Skin closure after bunion surgery can be difficult. The principle reason for this is the excess skin over the medial border of the foot postoperatively. In general terms, the aims of any skin closure technique are to provide approximation of the wound edges with some degree of eversion and provide cutaneous hemostasis while avoiding excess tension on the skin.1,2,3 The vertical and the horizontal mattress sutures are commonly used for skin closure in orthopaedic surgery. When used to close wounds after bunion surgery, the approximation and eversion of the wound edges that is achieved by the vertical mattress suture may be localized to the close vicinity of each stitch. There may still be puckering of the skin and gaping of the edges in the areas between each two consecutive stitches (Figure 1). The use of horizontal sutures in a similar situation can prevent intersuture skin gaping but may not achieve a skin eversion as effectively as that provided by the vertical suture and may even cause some degree of inversion of the skin edges (Figure 2). On the other hand, the use of a modified interrupted vertical mattress suture after bunion surgery helps obtain a satisfactory approximation and eversion of skin edges without the undesired effect of skin puckering (Figure 3). It prevents inter-suture gaping while reducing the incidence of skin edge inversion associated with the horizontal mattress suture. We have performed this suturing technique to close all operative wounds after foot and ankle surgery, mainly using