We investigated the effects of ingesting a leucine-enriched essential amino acid (EAA) gel alone or combined with resistance exercise (RE) versus RE alone (control) on plasma aminoacidemia and intramyocellular anabolic signaling in healthy younger (28 ± 4 years) and older (71 ± 3 years) adults. Blood samples were obtained throughout the three trials, while muscle biopsies were collected in the postabsorptive state and 2 h following RE, following the consumption of two 50 mL EAA gels (40% leucine, 15 g total EAA), and following RE with EAA (combination (COM)). Protein content and the phosphorylation status of key anabolic signaling proteins were determined via immunoblotting. Irrespective of age, during EAA and COM peak leucinemia (younger: 454 ± 32 µM and 537 ± 111 µM; older: 417 ± 99 µM and 553 ± 136 µM) occurred ~60–120 min post-ingestion (younger: 66 ± 6 min and 120 ± 60 min; older: 90 ± 13 min and 78 ± 12 min). In the pooled sample, the area under the curve for plasma leucine and the sum of branched-chain amino acids was significantly greater in EAA and COM compared with RE. For intramyocellular signaling, significant main effects were found for condition (mTOR (Ser2481), rpS6 (Ser235/236)) and age (S6K1 (Thr421/Ser424), 4E-BP1 (Thr37/46)) in age group analyses. The phosphorylation of rpS6 was of similar magnitude (~8-fold) in pooled and age group data 2 h following COM. Our findings suggest that a gel-based, leucine-enriched EAA supplement is associated with aminoacidemia and a muscle anabolic signaling response, thus representing an effective means of stimulating muscle protein anabolism in younger and older adults following EAA and COM.

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.

There are many conditions ranging from the benign to the malignant, which can present with enlargement of one or more digits. An understanding of the differential diagnosis is important such that the potentially serious aetiologies are not missed and patients can therefore be treated appropriately. We present two patients, a male and a female aged 58 and 49 respectively, who presented to orthopaedic surgeons with gross enlargement of the toes. There were significant delays to presentation in both cases. Histological and microbiological analysis revealed that chronic, untreated infection was the most likely cause in both cases. Both patients were successfully treated by amputation of the offending digits. Congenital, infective, inflammatory and neoplastic conditions may all cause enlargement of a digit. The cause should be thoroughly sought prior to deciding upon management. Amputation can be successful, enables definitive tissue diagnosis and allows quick return to normal activities. The correct level must be identified pre-operatively.

Revision of a failed total ankle replacement is a surgical challenge due to paucity of the revision ankle implants. We report early results of two cases in which Scandinavian Total Ankle Replacements (STAR) were revised to hybrid AES (Ankle Evolution System)–STAR replacements for aseptic loosening of the tibial components. We are not aware of any similar case report in the literature reporting hybrid total ankle replacements.

Non-anatomic stabilisation of an unstable ankle using Peroneous brevis graft has been well reported. We describe the use of an interference screw to fix the Peroneous brevis graft to the fibula. The use of a bioabsorbable interference screw enhances stability and allows tensioning of the graft.

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)

Fractures of the foot and ankle are common in all age groups. Soft tissue swelling, diabetes mellitus and peripheral vascular disease should be considered when forming the management plan. Open fractures should be treated urgently. Temporary external fixation may be required to stabilize the fracture before definitive fixation and subsequent soft tissue cover. Foot elevation is essential because compartment syndrome of the foot occurs after major fractures or crush injuries. Mild forms of compartment syndrome are easily missed and result in clawing of the toes so, as part of the routine examination, the foot pulses and peripheral nerves must be assessed and documented.

We present a new technique for reconstruction of the superior peroneal retinaculum in chronic dislocation of the peroneal tendons. This uses an autologous hamstring graft and an interference screw providing a low profile, secure fixation in the os calcis. This aims to restore normal anatomy without significant donor site morbidity.

The aim of this study was to identify the number of accidents and types of injury related to the Supertram system in Sheffield. Data was collected prospectively over an 18 month period, commencing in April 1994, on all patients attending the Accident and Emergency department at the Royal Hallamshire Hospital whose injuries were related to the tram system. Ninety patients were included in the study, 54 males and 36 females with a median age of 39 years (range 16-82), representing approximately 0.13% of the patients attending the department during the study period. Forty one patients were cyclists, twenty three pedestrians, twelve were motorists or motorcyclists and fourteen sustained injuries due to ongoing construction work. Thirty one patients sustained fractures, most commonly involving the upper limb/shoulder girdle (63%), with cyclists suffering 83% of these serious upper limb injuries. Following assessment 38 patients were discharged, 29 patients were referred to fracture clinic, 12 were sent for physiotherapy and 11 admitted to hospital. Eight patients required a total of 13 operations during the study period. We have demonstrated a significant number of injuries in this study related to the tram system in Sheffield. Cyclists appear to be the group at highest risk, followed by pedestrians and motor vehicle users.

We describe the case of a young male with plantar lateral foot pain secondary to degenerative change between the os perineum and its articular facet with the cuboid. He was otherwise fit and well. There was a tender lump proximal to the 5th metatarsal, X-ray examination revealed an os perineum, and a bone scan showed increased uptake over the os perineum–cuboid articulation. As conservative measures showed no benefit, elective excision of the os perineum was performed, subsequent to which the patient made a good recovery with significant pain relief at six-month follow-up.

The purpose of this study was to relate changes in bone mineral density post-operatively around a cemented femoral prosthesis with changes in bone turnover. This might allow appropriate timing of antiresorptive therapies in the prevention of aseptic loosening. We recruited ten patients and evaluated both bone turnover, by measurement of urinary N-telopeptide of collagen type I, bone specific alkaline phosphatase and osteocalcin, and bone mineral density following total hip arthroplasty. Bone formation markers decreased significantly postoperatively (p<0.001). Bone resorption markers increased postoperatively and were maximal at 6 weeks (p<0.05). There was a 5–15% decrease in bone mineral density at the proximal femur by 6 months (p<0.01). The changes in bone mineral density confirm the pattern of reduced stress in the proximal femur. The early decrease in bone formation markers was unexpected and could relate to enoxaparin therapy. The optimal time to administer antiresorptive therapy might be 6–12 weeks post-operatively.

Complete anterior tibial tendon transfer for the treatment of the recurrent clubfoot was first described by Garceau.1 Split anterior tibial tendon transfer has been described in the treatment of the spastic equinovarus foot deformity in both the adult and child.2–4 To our knowledge, split tibialis anterior tendon transfer has not been reported before as an isolated treatment of the recurrent idiopathic clubfoot. A split tendon transfer is thought to have a lower risk of over-correction, although this has never been proven in comparative studies. We report our results using a split tendon transfer for the treatment of the recurrent clubfoot. We assess outcome clinically, pedobarographically and ultimately whether the patient required further surgery.

Distal femoral periprosthetic fractures associated with total knee replacement occur more commonly in patients with osteopenia and rheumatoid arthritis. This compromises the results of either conservative treatment or internal fixation. We describe a technique in which the distal femur together with the femoral component are removed and replaced with a custom made endoprosthesis which articulates with the tibial component which remains in situ. The surgery is quick and simple with good short term results.

The Journal of Bone and Joint Surgery. British volumeVol. 81-B, No. 6 CorrespondenceFree AccessScrew versus suture fixation of Mitchell’s osteotomyA. A. FARAJA. A. FARAJSearch for more papers by this authorPublished Online:21 Feb 2018https://doi.org/10.1302/0301-620X.81B6.0811084aAboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByClinical Tip: Transosseous Capsular Stabilization of Modified Mitchell Osteotomy4 December 2016 | Foot & Ankle International, Vol. 26, No. 8 Vol. 81-B, No. 6 Metrics Downloaded 22 times History Published online 21 February 2018 Published in print 1 November 1999 InformationCopyright © 1999, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Four patients with mucolipidosis type III, three of them brothers, were seen initially in the first two decades of life. Their main symptoms were carpal tunnel syndrome, trigger fingers and generalized joint stiffness. Radiographs showed spinal deformities and hip dysplasia, but these were not causing pain. Carpal tunnel syndrome was treated surgically but joint stiffness and hip and knee contractures were managed by physiotherapy. Up to the age of 24 none of these patients has had pelvic osteotomy for hip dysplasia; this operation, not yet reported in mucolipidosis type III, may eventually be necessary.