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Ribbans WJ, Chaudhry MS, Goudriaan B. Hand trauma in English domestic professional county cricket. S Afr J Sports Med 2021; 33:v33i1a10689. [PMID: 36816893 PMCID: PMC9924506 DOI: 10.17159/2078-516x/2021/v33i1a10689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Hand trauma is a frequent and disabling injury in cricket. However, there is limited published data on its impact on the sport at the elite level. Objectives This study investigated the incidence and mechanism of hand injuries in professional cricket over a decade and the impact of these injuries upon player availability. Methods A retrospective hand injury review at Northampton County Cricket Club (NCCC) over 10 years (2009-2018) was performed. All hand injuries had been contemporaneously documented. They were analysed for cause of injury, treatment, and time away from competitive play. Results There were 45 hand injuries in total. Eleven percent needed surgical intervention. These hand injuries required a total recovery time of 1561 days, and in-season 1416 days were lost from competitive play. The injuries requiring surgery were unavailable for 229 total days during the season. A player had an annual 18% risk of sustaining a hand injury requiring time away from the sport and resulting in a 4% reduction in playing resources during a season. Conclusion Hand injuries have major implications for player selection during the cricket season and place a potential burden upon the entire squad and the team's success.
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Affiliation(s)
- WJ Ribbans
- Northamptonshire County Cricket Club, Northampton, England,The University of Northampton, Northampton, England,The County Clinic, 57 Billing Road, Northampton, England NN1 5DB
| | - MS Chaudhry
- Northamptonshire County Cricket Club, Northampton, England
| | - B Goudriaan
- Northamptonshire County Cricket Club, Northampton, England
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Abstract
The first case of bilateral distal tibiofibular joint fusions for osteochondromas is reported with excellent long-term outcomes.
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Affiliation(s)
- W J Ribbans
- The University of Northampton, Northampton NN2 7AL, UK
| | - J Chadwick
- Northampton General Hospital, Northampton NN1 5BD, UK
| | - R Natarajan
- Northampton General Hospital, Northampton NN1 5BD, UK
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Heffernan SM, Stebbings GK, Kilduff LP, Erskine RM, Day SH, Morse CI, McPhee JS, Cook CJ, Vance B, Ribbans WJ, Raleigh SM, Roberts C, Bennett MA, Wang G, Collins M, Pitsiladis YP, Williams AG. Fat mass and obesity associated (FTO) gene influences skeletal muscle phenotypes in non-resistance trained males and elite rugby playing position. BMC Genet 2017; 18:4. [PMID: 28103813 PMCID: PMC5248469 DOI: 10.1186/s12863-017-0470-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/10/2017] [Indexed: 11/25/2022] Open
Abstract
Background FTO gene variants have been associated with obesity phenotypes in sedentary and obese populations, but rarely with skeletal muscle and elite athlete phenotypes. Methods In 1089 participants, comprising 530 elite rugby athletes and 559 non-athletes, DNA was collected and genotyped for the FTO rs9939609 variant using real-time PCR. In a subgroup of non-resistance trained individuals (NT; n = 120), we also assessed structural and functional skeletal muscle phenotypes using dual energy x-ray absorptiometry, ultrasound and isokinetic dynamometry. In a subgroup of rugby athletes (n = 77), we assessed muscle power during a countermovement jump. Results In NT, TT genotype and T allele carriers had greater total body (4.8% and 4.1%) and total appendicular lean mass (LM; 3.0% and 2.1%) compared to AA genotype, with greater arm LM (0.8%) in T allele carriers and leg LM (2.1%) for TT, compared to AA genotype. Furthermore, the T allele was more common (94%) in selected elite rugby union athletes (back three and centre players) who are most reliant on LM rather than total body mass for success, compared to other rugby athletes (82%; P = 0.01, OR = 3.34) and controls (84%; P = 0.03, OR = 2.88). Accordingly, these athletes had greater peak power relative to body mass than other rugby athletes (14%; P = 2 x 10-6). Conclusion Collectively, these results suggest that the T allele is associated with increased LM and elite athletic success. This has implications for athletic populations, as well as conditions characterised by low LM such as sarcopenia and cachexia.
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Affiliation(s)
- S M Heffernan
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, UK.
| | - G K Stebbings
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, UK
| | - L P Kilduff
- A-STEM, College of Engineering, Swansea University, Swansea, UK
| | - R M Erskine
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - S H Day
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, UK
| | - C I Morse
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, UK
| | - J S McPhee
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - C J Cook
- A-STEM, College of Engineering, Swansea University, Swansea, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - B Vance
- Institute of Cardiovascular & Medical Sciences University of Glasgow, Glasgow, UK
| | - W J Ribbans
- Centre for Physical Activity and Chronic Disease, Institute of Health and Wellbeing, University of Northampton, Northampton, UK
| | - S M Raleigh
- Centre for Physical Activity and Chronic Disease, Institute of Health and Wellbeing, University of Northampton, Northampton, UK
| | - C Roberts
- Medical and Scientific Department, South African Rugby Union, Cape Town, South Africa.,Discipline of Sports Science, Faculty of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - M A Bennett
- A-STEM, College of Engineering, Swansea University, Swansea, UK
| | - G Wang
- FIMS Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Brighton, UK
| | - M Collins
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town (UCT), Cape Town, South Africa
| | - Y P Pitsiladis
- FIMS Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Brighton, UK
| | - A G Williams
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe Green Road, Crewe, CW1 5DU, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
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Heffernan SM, Kilduff LP, Erskine RM, Day SH, McPhee JS, McMahon GE, Stebbings GK, Neale JPH, Lockey SJ, Ribbans WJ, Cook CJ, Vance B, Raleigh SM, Roberts C, Bennett MA, Wang G, Collins M, Pitsiladis YP, Williams AG. Association of ACTN3 R577X but not ACE I/D gene variants with elite rugby union player status and playing position. Physiol Genomics 2016; 48:196-201. [PMID: 26757799 PMCID: PMC4929273 DOI: 10.1152/physiolgenomics.00107.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/07/2016] [Indexed: 12/30/2022] Open
Abstract
We aimed to quantify the ACE I/D and ACTN3 R577X (rs1815739) genetic variants in elite rugby athletes (rugby union and league) and compare genotype frequencies to controls and between playing positions. The rugby athlete cohort consisted of 507 Caucasian men, including 431 rugby union athletes that for some analyses were divided into backs and forwards and into specific positional groups: front five, back row, half backs, centers, and back three. Controls were 710 Caucasian men and women. Real-time PCR of genomic DNA was used to determine genotypes using TaqMan probes and groups were compared using χ2 and odds ratio (OR) statistics. Correction of P values for multiple comparisons was according to Benjamini-Hochberg. There was no difference in ACE I/D genotype between groups. ACTN3 XX genotype tended to be underrepresented in rugby union backs (15.7%) compared with forwards (24.8%, P = 0.06). Interestingly, the 69 back three players (wings and full backs) in rugby union included only six XX genotype individuals (8.7%), with the R allele more common in the back three (68.8%) than controls (58.0%; χ2 = 6.672, P = 0.04; OR = 1.60) and forwards (47.5%; χ2 = 11.768, P = 0.01; OR = 2.00). Association of ACTN3 R577X with playing position in elite rugby union athletes suggests inherited fatigue resistance is more prevalent in forwards, while inherited sprint ability is more prevalent in backs, especially wings and full backs. These results also demonstrate the advantage of focusing genetic studies on a large cohort within a single sport, especially when intrasport positional differences exist, instead of combining several sports with varied demands and athlete characteristics.
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Affiliation(s)
- S M Heffernan
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom;
| | - L P Kilduff
- A-STEM, College of Engineering, Swansea University, Swansea, United Kingdom
| | - R M Erskine
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Institute of Sport, Exercise and Health, University College London, London, United Kingdom
| | - S H Day
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom
| | - J S McPhee
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - G E McMahon
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom; Northern Ireland Sports Institute, Newtownabbey, Belfast, United Kingdom
| | - G K Stebbings
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom
| | - J P H Neale
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom
| | - S J Lockey
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom
| | - W J Ribbans
- Division of Sport, Exercise and Life Science, University of Northampton, Northampton, United Kingdom
| | - C J Cook
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, United Kingdom
| | - B Vance
- Institute of Cardiovascular & Medical Sciences University of Glasgow, Glasgow, United Kingdom
| | - S M Raleigh
- Division of Sport, Exercise and Life Science, University of Northampton, Northampton, United Kingdom
| | - C Roberts
- Medical and Scientific Department, South African Rugby Union, Cape Town, South Africa; Discipline of Sports Science, Faculty of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - M A Bennett
- A-STEM, College of Engineering, Swansea University, Swansea, United Kingdom
| | - G Wang
- Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Brighton, United Kingdom; and
| | - M Collins
- MRC/UCT Research Unit for Exercise Science and Sports Medicine, University of Cape Town (UCT), Cape Town, South Africa
| | - Y P Pitsiladis
- Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Brighton, United Kingdom; and
| | - A G Williams
- MMU Sports Genomics Laboratory, Manchester Metropolitan University, Crewe, United Kingdom; Institute of Sport, Exercise and Health, University College London, London, United Kingdom
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Hammond LE, Lilley JM, Pope GD, Ribbans WJ. The impact of playing in matches while injured on injury surveillance findings in professional football. Scand J Med Sci Sports 2013; 24:e195-200. [DOI: 10.1111/sms.12134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 12/01/2022]
Affiliation(s)
- L. E. Hammond
- Division of Physiotherapy; University of Nottingham; Nottingham UK
- Division of Sports Therapy; University of Bedfordshire; Luton UK
| | - J. M. Lilley
- Division of Rehabilitation and Ageing; University of Nottingham; Nottingham UK
| | - G. D. Pope
- Division of Physiotherapy; University of Nottingham; Nottingham UK
| | - W. J. Ribbans
- School of Health; University of Northampton; Northampton UK
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Abstract
The incidence of acute and chronic conditions of the tendo Achillis appear to be increasing. Causation is multifactorial but the role of inherited genetic elements and the influence of environmental factors altering gene expression are increasingly being recognised. Certain individuals' tendons carry specific variations of genetic sequence that may make them more susceptible to injury. Alterations in the structure or relative amounts of the components of tendon and fine control of activity within the extracellular matrix affect the response of the tendon to loading with failure in certain cases. This review summarises present knowledge of the influence of genetic patterns on the pathology of the tendo Achillis, with a focus on the possible biological mechanisms by which genetic factors are involved in the aetiology of tendon pathology. Finally, we assess potential future developments with both the opportunities and risks that they may carry.
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Affiliation(s)
- W J Ribbans
- University of Northampton, School of Health, Boughton Green Road, Northampton, UK.
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Carmont MR, Stroud R, Bjorndalen H, Crowther J, Ribbans WJ, Griffin D. The safety profile of a retrospective Accessory Postero-Lateral hind foot portal: the risk of sural nerve damage during visualisation of the Achilles tendon insertion. Foot Ankle Surg 2012; 18:128-31. [PMID: 22444001 DOI: 10.1016/j.fas.2011.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/27/2011] [Accepted: 05/20/2011] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The Accessory Postero-Lateral (AccPL) portal has recently been described to improve the visualisation for the endoscopic debridement of Haglund's tubercle. The safety of using this portal has been considered previously for posterior ankle arthroscopy. We performed a study to determine the proximity of the AccPL portal to the sural nerve. METHODS We compared the distances between AccPL and PL portals to the sural nerve in 17 cadaveric specimens. RESULTS The AccPL portal was significantly closer (mean 12.0mm, range 6-19 mm, SD=3.64) to the sural nerve than the PL portal (mean 14.1mm, range 11-18 mm, SD=2.34) (t(16)=-2.34, p=0.03). In two cases the sural nerve was in contact with the clip but on close inspection, the nerve had not been damaged in any of the specimens. CONCLUSIONS We conclude that the AccPL portal is a safe method to allow visualisation during endoscopic debridement of the Achilles tendon insertion. We also recommend that the portal is used for visualisation rather than instrumentation.
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Affiliation(s)
- M R Carmont
- The Department of Orthopaedic Surgery, the Princess Royal Hospital, Telford, Shropshire, United Kingdom.
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8
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El Khoury L, Posthumus M, Collins M, Ribbans WJ, Handley CJ, Cook J, Raleigh SM. The ADAMTS2 and ADAMTS14 genes and risk of achilles tendon pathology. Br J Sports Med 2011. [DOI: 10.1136/bjsports-2011-090606.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Posthumus M, Collins M, van der Merwe L, O'Cuinneagain D, van der Merwe W, Ribbans WJ, Schwellnus MP, Raleigh SM. Matrix metalloproteinase genes on chromosome 11q22 and the risk of anterior cruciate ligament (ACL) rupture. Scand J Med Sci Sports 2011; 22:523-33. [DOI: 10.1111/j.1600-0838.2010.01270.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Posthumus M, Collins M, Cook J, Handley CJ, Ribbans WJ, Smith RKW, Schwellnus MP, Raleigh SM. Components of the transforming growth factor- family and the pathogenesis of human Achilles tendon pathology--a genetic association study. Rheumatology (Oxford) 2010; 49:2090-7. [DOI: 10.1093/rheumatology/keq072] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Beeson P, Phillips C, Corr S, Ribbans WJ. Hallux rigidus: a cross-sectional study to evaluate clinical parameters. Foot (Edinb) 2009; 19:80-92. [PMID: 20307455 DOI: 10.1016/j.foot.2008.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/02/2008] [Accepted: 12/04/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment. METHOD A cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18-70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions. RESULTS Seventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14-68 years) years and median HR duration 6 years (1-33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found (r=0.84, p=0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI degrees ) was greater than normal (< or =10 degrees ). A correlation between HAI and reduced 1st MTPJ ROM was found (r=0.92, p=0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found (r=.78, p=.05). A positive relationship was found between 2nd toe length and 1st MTPJ pain (p=0.001<0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found (r=0.78, p=0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion (p<0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings. CONCLUSIONS HR was associated with female gender, bilateral involvement, older age groups, increased HAI degrees, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.
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Affiliation(s)
- P Beeson
- Division of Podiatry, School of Health, The University of Northampton, Park Campus, Boughton Green Road, Northampton, United Kingdom.
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12
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Beeson P, Phillips C, Corr S, Ribbans WJ. Cross-sectional study to evaluate radiological parameters in hallux rigidus. Foot (Edinb) 2009; 19:7-21. [PMID: 20307444 DOI: 10.1016/j.foot.2008.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 07/03/2008] [Accepted: 07/17/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux rigidus (HR) is a common condition with X-rays used to evaluate its pathology, grade joint changes and to inform treatment. METHOD A cross-sectional study was undertaken to evaluate radiological foot parameters in HR. In 110 subjects (180 feet) aged 18-70 years (mean 52 years) standard weight-bearing X-rays were examined using dorsal plantar and lateral views. RESULTS Seventy (64%) subjects had bilateral HR and 73 (66%) were female. The mean onset of HR (denoted by first metatarsophalangeal (MTP) joint restriction/pain) was 44 (14-68 years) years and median HR duration was 6 years (1-33 years). Flat or chevron-shaped metatarsal heads presented in 131 (73%) feet and a history of first MTP joint trauma in 22% (74% of whom had unilateral HR). In 74% of feet hallux abductus interphalangeus angle (HAI degrees) was greater than normal (< or =10 degrees). Correlations between first MTP joint narrowing and sclerosis (r=0.76, p=0.01) and increased HAI degrees and first MTP joint narrowing (r=0.34, p=0.01) was found. The mean hallux equinus angle of 11 degrees was outside the normal range (16-18 degrees). Abnormal sesamoid morphology presented in 117 (65%) feet (30% irregular or hypertrophic). Proximal sesamoid displacement was greater than that seen in non-HR. Metatarsus primus elevatus was within normal range (< or =8 mm) in 160 (89%) feet. The first metatarsal was longer than the second metatarsal in 66 (37%) feet although the first metatarsal was longer than the third metatarsal in 131 (73%) feet and may be responsible for altered forefoot function in HR. CONCLUSIONS HR was associated with female gender, bilateral involvement, older age groups, flat or chevron-shaped metatarsal head, longer proximal phalanx, increased HAI degrees and a first metatarsal longer than the third metatarsal. For radiological parameters to be considered valid for inclusion in a classification of HR their content validity needs to be established by formal research.
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Affiliation(s)
- P Beeson
- Division of Podiatry, School of Health, The University of Northampton, Park Campus, Boughton Green Road, Northampton NN2 7AL, UK.
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Hammond LE, Lilley J, Ribbans WJ. Coding sports injury surveillance data: has version 10 of the Orchard Sports Injury Classification System improved the classification of sports medicine diagnoses? Br J Sports Med 2008; 43:498-502. [PMID: 19050000 DOI: 10.1136/bjsm.2008.051979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare versions 8 and 10 of the Orchard Sports Injury Classification System (OSICS) to determine whether the revised version of OSICS has improved its use in a sports medicine setting, and to assess the inter-rater reliability of OSICS-10. METHODS Injury surveillance data, gathered over a 2 year period in professional football, cricket and rugby union to produce 335 diagnoses, were coded with both OSICS-8 and OSICS-10. Code-diagnosis agreement was assessed for OSICS-8 in terms of whether a diagnosis was codeable or noncodeable, and for OSICS-10 by evaluating the highest available OSICS-10 tier of coding. Eight clinicians coded a list of 20 diagnoses, comprising a range of pathologies to all gross anatomical regions, which were compared to assess inter-rater reliability. RESULTS All diagnoses could be assigned an appropriate code with OSICS-10, compared with 87% of diagnoses that could be assigned an OSICS-8 code. Contusions comprised almost half of OSICS-8 noncodeable diagnoses. OSICS-10 tier 2 codes accounted for 20% of diagnoses coded with the updated system. Of these 20%, almost half contained a more detailed diagnosis that did not have an available OSICS-10 tier 3 or 4 code. Inter-rater reliability increased with decreasing diagnostic detail, with an overall level shown to be moderate (k = 0.56). CONCLUSIONS OSICS-10 is a more encompassing system than OSICS-8 to use in classifying sports medicine diagnoses, and has a moderate level of inter-rater reliability. Further minor revision may be required to address lack of detail in some strain, effusion and contusion codes.
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Affiliation(s)
- L E Hammond
- University of Nottingham, Division of Rehabilitation and Ageing, B Floor, The Medical School, Queens Medical Centre, Nottingham, NG7 2UH.
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14
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Raleigh SM, van der Merwe L, Ribbans WJ, Smith RKW, Schwellnus MP, Collins M. Variants within the MMP3 gene are associated with Achilles tendinopathy: possible interaction with the COL5A1 gene. Br J Sports Med 2008; 43:514-20. [DOI: 10.1136/bjsm.2008.053892] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Isaac A, Gwilym SE, Reilly IN, Kilmartin TE, Ribbans WJ. Interprofessional relationships between orthopaedic and podiatric surgeons in the UK. Ann R Coll Surg Engl 2008; 90:663-70. [PMID: 18796189 DOI: 10.1308/003588408x318183] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present.
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Affiliation(s)
- A Isaac
- Department of Orthopaedic Surgery, Northampton General Hospital, Northampton, UK
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16
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Gwilym SE, Aslam N, Ribbans WJ, Holloway V. The impact of implementing the Ottawa ankle rules on ankle radiography requests in A&E. Int J Clin Pract 2003; 57:625-7. [PMID: 14529066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
This audit was set up to quantify the effect of implementing the Ottawa ankle rules in a district general hospital that relies on both medical and nursing radiography requests. Data were collected prospectively on 207 patients who presented with an acute ankle injury between August 2001 and February 2002. The department's activity was recorded before and after a period of teaching on the Ottawa ankle rules. Before teaching, 71% of patients with an acute ankle injury were sent for radiography; teaching reduced this figure to 56% (p < 0.05). Auditing the activity of our department enabled us to observe a significant decrease in the number of patients sent for ankle radiography following acute ankle injury. This correlates well with research in other settings. The difficulties of rationalising radiology investigations are discussed.
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Affiliation(s)
- S E Gwilym
- Department of Accident & Emergency, Northampton General Hospital, Northampton, UK
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17
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Ribbans WJ. Orthopaedic care in haemophilia. Hosp Med 2003; 64:68-9. [PMID: 12619331 DOI: 10.12968/hosp.2003.64.2.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Haemophilia, affecting 1 in 10 000 males, is the most common congenital coagulation disorder affecting about 6000 patients in the UK. Although most patients inherit the disorder as an X-linked inheritance, one third arise as spontaneous mutations.
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Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, York J. Infected joint replacements in HIV-positive patients with haemophilia. ACTA ACUST UNITED AC 2001. [DOI: 10.1302/0301-620x.83b7.0831050] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
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Affiliation(s)
- J. L. Hicks
- Nuffield Orthopaedic Centre NHS Trust, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - W. J. Ribbans
- Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, UK
| | - B. Buzzard
- Newcastle Haemophilia Comprehensive Care Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - S. S. Kelley
- University of North Carolina, Department of Orthopaedic Surgery, 242 Burnett-Womack, CB 7055, Chapel Hill, North Carolina 27599, USA
| | - L. Toft
- Watkins Medical Centre, 225 Wickham Terrace, Brisbane 4000, Australia
| | - G. Torri
- Institute of Clinical Orthopaedics, 1 Via Bignami, Milan 20126, Italy
| | - J. D. Wiedel
- University of Colorado Health Sciences Centre, Department of Orthopaedics, 4701 East Ninth Avenue, E203, Denver, Colorado 80262, USA
| | - J. York
- Department of Rheumatology, Rachel Forster Hospital, PO Box 1127, Strawberry Hills, Sydney, New South Wales 2012, Australia
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Hicks JL, Ribbans WJ, Buzzard B, Kelley SS, Toft L, Torri G, Wiedel JD, York J. Infected joint replacements in HIV-positive patients with haemophilia. J Bone Joint Surg Br 2001; 83:1050-4. [PMID: 11603522 DOI: 10.1302/0301-620x.83b7.11242] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.
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Affiliation(s)
- J L Hicks
- Northampton General Hospital NHS Trust, Cliftonville, England
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Abstract
Fifty patients undergoing foot or ankle surgery were randomized into two groups for the purposes of toe preparation. Twenty-four patients underwent a standard preparation which included placing antiseptic between the toes while 26 were additionally cleaned by sliding a gauze swab soaked in topical antiseptic back and forth several times. Povidone iodine followed by chlorhexidine in alcohol was used in both groups. All toes were covered by a sterile glove during surgery unless the toes themselves were to be operated upon. Bacteria were cultured from the toe clefts in 4% of all patients immediately following preoperative disinfection. Significantly fewer patients whose toes had been additionally scrubbed (group 1) showed bacterial recolonization at the end of surgery compared with those undergoing a standard prep (group 2) (7.7% vs 20.8%). We conclude that additional scrubbing of toe clefts prior to surgery reduces the incidence of recolonization of bacteria during the surgical procedure.
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Abstract
Traumatic dislocation of the hip represents a major injury that is associated with significant morbidity. In particular, the risk of osteonecrosis of the femoral head is greatly affected by the time it takes to reduce the hip. Therefore, thorough understanding of the clinical and radiologic features is essential if this injury is to be recognized and treated promptly. Most patients present in severe distress after a high-energy injury such as a motor vehicle accident. Associated injuries, particularly of the knee, are common and the leg usually is held in a specific posture characteristic of the direction of dislocation. Plain anteroposterior radiographs of the pelvis will clearly show the dislocation in most patients but lateral views or a computed tomography scan may be required to confirm the diagnosis and to show the direction if the signs are subtle. Associated acetabular wall fractures and femoral head fractures also may be identified by computed tomography scans. After reduction, plain radiographs alone are not adequate to assess reduction; computed tomography is more sensitive in detecting osteochondral fragments and may reliably detect residual subluxation of 2 mm in any part of the joint. Magnetic resonance imaging is useful in detecting changes of osteonecrosis but rarely is indicated in the early treatment of this condition.
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Affiliation(s)
- R A Brooks
- Department of Orthopaedics, Northampton General Hospital, UK
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Abstract
Equinus deformity has been a significant problem in haemophilia. It causes difficulties in walking and secondary problems in adjacent joints. There are a number of potential causes in haemophilia. A careful history, examination, and plain radiographs will determine the aetiology, which frequently is multifactorial. Hopefully, prophylactic factor replacement will reduce the incidence of such problems in the future. Prompt 'on demand' therapy will reduce the complications of articular and soft-tissue bleeds. Physiotherapy, splints, and orthotics will usually allow a full recovery of function and comfort. Rarely, surgical intervention is required to correct articular and/or musculo-tendinous problems. The choice of surgery depends upon the cause(s) of the deformity and should only be undertaken in experienced haemophilia units following careful counselling of the patient regarding the aims and nature of the operation and the patient's involvement in an effective rehabilitation programme.
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Ribbans WJ, Giangrande P, Beeton K. Conservative treatment of hemarthrosis for prevention of hemophilic synovitis. Clin Orthop Relat Res 1997:12-8. [PMID: 9345199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Acute hemarthroses are probably the most frequent type of bleeding in the patient with hemophilia. Delayed and/or inadequate treatment can trigger a series of pathologic changes within the joint leading to a painful and disabling arthropathy. Despite the advent of prophylactic treatment with factor concentrates, the majority of patients in the world have no access to even on demand factor replacement. Care for all patients involves a team approach led by the hematologist but including input from orthopaedic surgeons and physiotherapists. Optimal treatment involves a combination of factor replacement, rest, ice, and supervised rehabilitation. In certain cases, joint aspiration may be considered. In developing countries, where factor concentrates are in short supply, such bleeding episodes usually are treated by physical means alone or with the addition of cryoprecipitate or fresh frozen plasma. After successful resolution of such episodes by whatever means, the events leading to the bleeding episode and its subsequent management should be considered within the setting of the treating unit. Such debriefings should aim to provide counsel regarding any appropriate lifestyle modifications and, where necessary, treatment should be arranged to minimize the risk of additional episodes.
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Affiliation(s)
- W J Ribbans
- Department of Orthopaedics, Northampton General Hospital, United Kingdom
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Phillips AM, Sabin CA, Ribbans WJ, Lee CA. Orthopaedic surgery in hemophilic patients with human immunodeficiency virus. Clin Orthop Relat Res 1997:81-7. [PMID: 9345211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients registered at the author's hemophilia center between 1982 and 1994 were studied to establish whether major orthopaedic surgical procedures accelerate the fall of CD4 lymphocyte counts of patients with hemophilia who are infected with the human immunodeficiency virus, and whether patients who had surgery had different rates of development of acquired immune deficiency syndrome or death when compared with patients who did not have surgery. The patients were divided into four groups: Group 1, 22 patients who were human immunodeficiency virus positive undergoing orthopaedic surgery; Group 2, 89 patients who were human immunodeficiency virus positive not undergoing orthopaedic surgery; Group 3, 18 patients who were human immunodeficiency virus negative undergoing orthopaedic surgery; and Group 4, 135 patients who were human immunodeficiency virus negative not undergoing orthopaedic surgery. There was no significant difference between the rates of decline of CD4 lymphocyte counts for patients who were human immunodeficiency virus positive who underwent surgery when compared with human immunodeficiency virus positive patients who did not undergo surgery, nor was there any significant difference between the two human immunodeficiency virus negative groups. There were no significant differences in the rate of development of acquired immune deficiency syndrome or mortality rates between patients who had surgery and those who did not.
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Affiliation(s)
- A M Phillips
- Royal Free Hospital, Northampton, United Kingdom
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Seuser A, Wallny T, Klein H, Ribbans WJ, Schumpe G, Brackmann HH. Gait analysis of the hemophilic ankle with silicone heel cushion. Clin Orthop Relat Res 1997:74-80. [PMID: 9345210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Shock absorption becomes very important in damaged joints with destroyed cartilage and progressive muscular imbalance as occurs in hemarthropathy. The effects of silicone heel cushioning on the ankle motion of hemophilic patients in different stages of hemarthropathy of the ankle joints was measured using an ultrasound motion analysis system. It is concluded that silicone heel cushioning has no influence on ankles in the late stage of hemarthropathy. Silicone heel cushioning will lead to uncontrolled changes of the ankle joint in the early hemarthropathic ankle, involving the tibiotalar and the subtalar joints. The angular velocity of the ankle is increased producing higher acceleration at the ankle joint. The higher angle acceleration is related to higher joint loading uncontrolled by the muscles. The resulting uncoordinated motion can cause ligamentous overloading, strains, and a higher probability of joint bleeding. Therefore, silicone heel cushioning or other shock absorbing devices that return the energy immediately to the foot are not useful for prevention and treatment of chronic hemophilic synovitis and may cause additional deterioration of the joint.
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Affiliation(s)
- A Seuser
- Kaiser-Karl-Klinik, Bonn, Germany
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Ribbans WJ. Confusion over pressure sore risk assessment scale. Prof Nurse 1997; 12:673. [PMID: 9248445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Phillips AM, Birch NC, Ribbans WJ. Protective gloves for use in high-risk patients: how much do they affect the dexterity of the surgeon? Ann R Coll Surg Engl 1997; 79:124-7. [PMID: 9135240 PMCID: PMC2502805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Twenty-five orthopaedic surgeons underwent eight motor and sensory tests while using four different glove combinations and without gloves. As well as single and double latex, surgeons wore a simple Kevlar glove with latex inside and outside and then wore a Kevlar and Medak glove with latex inside and outside, as recommended by the manufacturers. The effect of learning with each sequence was neutralised by randomising the glove order. The time taken to complete each test was recorded and, where appropriate, error rates were noted. Simple sensory tests took progressively longer to perform so that using the thickest glove combination led to the completion times being doubled. Error rates increased significantly. Tests of stereognosis also took longer and use of the thickest glove combination caused these tests to take three times as long on average. Error rates again increased significantly. However, prolongation of motor tasks was less marked. We conclude that, armed with this quantitative analysis of sensitivity and dexterity impairment, surgeons can judge the relative difficulties that may be incurred as a result of wearing the gloves against the benefits that they offer in protection.
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Abstract
Ankle arthropathy remains a frequent source of disability in the hemophilic patient. Bleeding into the ankle most commonly commences in the second decade, and, once established as a target joint, progressive damage leads to significant pain, stiffness, and deformity affecting general mobility and leisure and occupational pursuits. Review of cohorts of hemophilic patients at the Royal Free Hospital has monitored this deterioration and there is no evidence that, despite improvements in medical treatment, the pattern of insidious decline in hindfoot function has changed during the past 4 decades. Based on these observations, a combined clinical and radiologic scoring system has been developed, incorporating ankle specific features, such as talar tilt, tibial osteophytes, and talar dome flattening, which give a better correlation than traditional systems with objective measures, such as treadmill walking. There is no substitution for prophylactic treatment in arresting ankle function decline, and surgical interventions are rare. However, the types of potential procedures are numerous and choices must be made according to the degree of disability and state of overall damage to the joint and adjacent soft tissues.
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Affiliation(s)
- W J Ribbans
- Haemophilia Unit, Royal Free Hospital, Hampstead, London, England
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Abstract
We have reviewed 4521 patient-years and analysed 185,066 seizures to calculate the incidence of five common fractures in an epileptic population. Only 25.0 per cent of these fractures were known to have occurred during a seizure. When age and sex matched against a 'normal population', there was an increased incidence of femoral neck fractures (5.2 x), inter-trochanteric fractures (9.9 x), ankle fractures (9.9 x) and proximal humerus fractures (4.2 x). Surprisingly, there was no increased incidence of wrist fractures. Overall, there was a 4.3 x increased risk for all fractures and 3.2 x increased risk of fractures not related to fits. There was no evidence for the first fracture occurring at a younger age in this population. The possible causes of this greatly increased risk are discussed.
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Affiliation(s)
- K B Desai
- Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
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Ribbans WJ. Third Musculoskeletal Congress of the World Federation of Hemophilia, Herzilya, Israel, 17?20 June 1995: a review of the scientific programme. Haemophilia 1996; 2:54-5. [DOI: 10.1111/j.1365-2516.1996.tb00012.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We have treated five patients with an infected non-union of the tibia by a modification of the Papineau technique, consisting of a wound microenvironment chamber and bone stabilization with a circular frame. In all cases bone union and elimination of infection was achieved.
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Affiliation(s)
- M Saleh
- Limb Reconstruction Service, Northern General Hospital Trust, Sheffield, UK
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Abstract
Since factor replacement concentrates became widely available in the 1970s, total prosthetic replacement of joints in haemophilic patients has become increasingly common, with success particularly in the knee and hip. However, there has been no published series of elbow or shoulder replacements large enough to draw conclusions about the advisability of these procedures in this group of patients. We report a case of prosthetic replacement of the shoulder in a 58-year-old man with haemophilia B, and replacement of the elbow joint of the same limb 21 months later. The results are initially very encouraging, with no pain in either joint since the early post-operative period. There have been no bleeds into either joint since surgery. Ranges of movement are satisfactory. Follow-up is now 37 months for the shoulder and 16 months for the elbow.
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Affiliation(s)
- A M Phillips
- Royal Free Hospital Orthopaedic Department, London
| | - W J Ribbans
- Royal Free Hospital Orthopaedic Department, London
| | - N J Goddard
- Royal Free Hospital Orthopaedic Department, London
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Charnley GJ, Ridge J, Ribbans WJ. Traumatic medial displacement of Rotalok uncemented acetabular component. A case report. J Arthroplasty 1994; 9:221-3. [PMID: 8014654 DOI: 10.1016/0883-5403(94)90072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The failure of uncemented acetabular components has been described in association with component wear, disassembly, and proximal migration. The authors report a case of medial displacement following minor trauma some 18 months after surgery. The component involved differs in design from both press-fit, porous-coated or screw-in, fully threaded acetabular cups. The authors suggest that additional screws should be inserted to enhance long-term stability.
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Affiliation(s)
- G J Charnley
- Orthopaedic Surgery Unit, Royal Free Hospital, London, United Kingdom
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Birch NC, Ribbans WJ, Goldman E, Lee CA. Knee replacement in haemophilia. J Bone Joint Surg Br 1994; 76:165-6. [PMID: 8300672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Saleh M, Ribbans WJ, Meffert RH. Bundle nailing in nonunion of the distal radius: case report. HANDCHIR MIKROCHIR P 1992; 24:273-5. [PMID: 1427469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A previously unreported technique for dealing with severe distal radial nonunion in the presence of marked osteoporosis and deformity in a 65-year-old female is presented. The technique involves temporary ankylosis of the wrist with bundle nails connecting the second and third metacarpal with the distal and proximal fragment of the radius, dorsal to the carpal bones and joints. Union was achieved radiographically after nine months. When the bundle nails were removed, there was some recovery of wrist movement and useful function.
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Affiliation(s)
- M Saleh
- University Department of Orthopaedics, Northern General Hospital Sheffield, England
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Abstract
A series of 100 consecutive patients with unstable intertrochanteric fractures were treated by compression hip screw fixation; 55 patients had an anatomical reduction (Group 1) and 45 patients a Sarmiento osteotomy and valgus reduction (Group 2). Group 1 spent an average of 10 days less in hospital than Group 2 (21 days compared with 31 days) (P less than 0.02). They also had a greater chance of returning to their pre-injury accommodation and of achieving their pre-injury walking capability. Radiological failure of fracture fixation, with varus angulation of the femoral head by cutting out of the screw, was seen seven times in Group 1 but only once in Group 2. Anatomical reduction provides better clinical results than valgus osteotomy in the patient with an unstable intertrochanteric fracture stabilized by a compression hip screw. The capacity for failure of fracture fixation is greater, however, in the former. Valgus osteotomy provides a simple means of securing a stable reduction of the fracture which cannot be satisfactorily reduced by closed means.
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Abstract
Computerised arthrotomography was performed on 33 patients four to six weeks after acute primary anterior dislocation of the shoulder. Seventeen patients were under, and 16 over 50 years of age. Damage to the anterior glenoidal labrum was seen in all the younger patients and in 75% of the older ones. A large redundant capsular pouch, seen in the older patients, was present in 35% of the younger ones, and a posterior humeral head defect was seen in 82% of the younger patients and only 50% of the older. Associated fractures were more common in the older patients, and a tear of the rotator cuff was demonstrated in 63% of the older patients and in none of the younger ones.
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Affiliation(s)
- W J Ribbans
- Northwick Park Hospital and Clinical Research Centre, Harrow
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Ribbans WJ. Bilateral anterior dislocation of the shoulder following a grand-mal convulsion. Br J Clin Pract 1989; 43:181-2. [PMID: 2511914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bilateral dislocation of the shoulders is an uncommon event. The majority are posterior and occur during a seizure, electrical shock or electroconvulsive therapy, and in patients with neuromuscular disorders and psychiatric disturbances. The literature contains only eight cases of traumatic bilateral anterior dislocations. This report describes only the second case sustained during a grand-mal convulsion.
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Ribbans WJ, Angus PD. Simultaneous bilateral rupture of the quadriceps tendon. Br J Clin Pract 1989; 43:122-5. [PMID: 2692688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The simultaneous, complete rupture of both quadriceps tendons is a rare event. Only 30 previous cases have been reported and the majority have had well-documented predisposing factors, such as chronic renal failure, gout, hyperparathyroidism, diabetes and obesity. We report a case which presented without any predisposing cause, and review the literature to date.
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Abstract
Two unusual cases of Kienböck's disease are reported. The first is of a young woman whose presenting feature was spontaneous rupture of the flexor pollicis longus tendon. This is the first reported case in which such a rupture was the presenting feature of the condition. The second is of a 71-year-old woman with scleroderma and Raynaud's disease who did not develop her Kienböck's disease until late in life. The literature contains no older patient with this condition and a likely association is made between the avascular necrosis and the vasculitis associated with this connective tissue disorder.
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Ribbans WJ. Kienböck’s Disease: Two Unusual Cases. Journal of Hand Surgery 1988; 13:463-5. [PMID: 3249152 DOI: 10.1016/0266-7681_88_90181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two unusual cases of Kienböck’s disease are reported. The first is of a young woman whose presenting feature was spontaneous rupture of the flexor pollicis longus tendon. This is the first reported case in which such a rupture was the presenting feature of the condition. The second of a 71-year-old woman with scleroderma and Raynaud’s disease who did not develop Kienböck’s disease until late in life. The literature contains no older patient with this condition and a likely association is made between the avascular necrosis and the vasculitis associated wit this connective tissue disorder.
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Allum RL, Ribbans WJ. Day case arthroscopy and arthroscopic surgery of the knee. Ann R Coll Surg Engl 1987; 69:225-6. [PMID: 3674684 PMCID: PMC2498588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A Day Case Unit was opened at Wexham Park Hospital in October 1985 and this paper describes the first year's experience in arthroscopy and arthroscopic surgery. Ninety nine knees in 96 patients were examined. The predominant diagnoses were lesions of the medial meniscus (33%), ruptures of the anterior cruciate ligament (30%) and lesions of the lateral meniscus (20%). Fourteen knees (14%) were normal. There was one postoperative infection, 3 patients had troublesome effusions and one patient developed a synovial fistula. Two patients required overnight admission. The waiting list was reduced from 14.7 weeks to 3.0 weeks. The advantages and limitations of this technique is discussed.
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Affiliation(s)
- R L Allum
- Wexham Park Hospital, Slough, Berkshire
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43
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Abstract
A patient with chronic pancreatitis presented with a series of massive upper gastrointestinal haemorrhages due to bleeding into the pancreatic duct. This report emphasizes the value of intensive investigation before surgery, since it may be impossible to identify the site of bleeding at laparotomy.
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44
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Abstract
A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids is presented. Subsequent necrosis of the underlying tissues produced a rectal perforation and retroperitoneal abscess, which necessitated emergency laparotomy and defunctioning colostomy. Healing of the perforation allowed later closure of the stoma. A brief review of the known complications of this technique has been made. It would appear that necrosis and perforation with abscess formation can be added to this list.
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