Total wrist arthroplasty with the Freedom® prosthesis: a short-term follow-up.

We retrospectively reviewed our series of primary total wrist arthroplasty with the Freedom® prosthesis. The primary outcome measure was revision, and secondary measures included radiographic loosening, pain, complications, movement range, grip strength and patient-reported measures. We reviewed 12 implants in 11 patients (mean age 59 years, range 45-80) with a mean radiological and clinical follow-up of 2.7 and 3 years, respectively. One radial component failed to integrate and was revised at Day 84. Four carpal components demonstrated areas of lucency. There was a statistically significant reduction in pain, and total flexion-extension increased. Despite high patient satisfaction on a ten-point visual analogue scale score (mean 8.7 out of 10), the mean patient-rated wrist evaluation, Quick Disabilities of the Arm, Shoulder and Hand and Patient Evaluation Measure scores were 52, 55 and 53, respectively. The Freedom® implant reduced pain and preserved wrist movement in our patients; however, annual surveillance is recommended due to the high incidence of early carpal component lucency.Level of evidence: IV.

Elective Ambulatory Unit: Experience of Local Anesthetic Only Surgery During the Pandemic.

BACKGROUND: The second COVID-19 wave severely limited access to elective surgery. METHODS: Between December 2020 and May 2021, 530 patients underwent a procedure in the elective ambulatory unit (EAU), a walk-in and walk-out model of surgery, and we used a prepandemic cohort of day-case patients for comparison. RESULTS: We have had no confirmed cases of COVID-19 transmission on-site. The infection rate for EAU and day-case units for carpal tunnel decompression was 1.36% and 2%, respectively, and this difference was not significant, P = .696. Patient satisfaction was excellent at 9.8 of 10. The waiting time from primary care referral to carpal tunnel decompression was cut from 36 weeks to 12 weeks during the study period. Significant benefit in efficiency and cost saving was also found. CONCLUSION: Elective ambulatory unit provides a template to perform high-volume low-complexity hand and wrist surgery in a safe, efficient, and cost-effective manner.

Long-term outcomes of the Universal 2 total wrist replacement: revision and loosening at 10 years and beyond.

The aim of this study was to ascertain the long-term revision rates of the Universal 2 wrist prosthesis in a previously published cohort of patients with rheumatoid arthritis. The time to, and reasons for revision were determined. Radiographs were analysed to determine whether loosening had occurred in the long-term according to the Wrightington zonal classification of loosening. Seventy-eight wrists from the original cohort of 85 wrists could be identified for analysis. The longest follow-up was 16 years and 29 wrists had follow-up beyond 10 years. Seventeen wrists had been revised or were on the waiting list for revision, an overall revision rate of 22%. The 10-year survivorship was 78%. Long-term revision was commonly for periprosthetic loosening with pain and component subsidence. In those with more than 10-year follow-up, significant lucency was seen in 16 carpal components and 15 radial components. Explant analysis showed significant polyethylene wear and we postulate this is the principal reason for component loosening.Level of evidence: IV.

Arthroplasty in thumb trapeziometacarpal (CMC joint) osteoarthritis: An alternative to excision arthroplasty.

Trapeziectomy for base of thumb arthritis is well established, but base of thumb arthroplasty offers potential advantages. The review covers the development of arthroplasty for the thumb from interposition arthroplasty to total joint replacement. It discusses contemporary prosthesis designs and results, including trapezial component geometry, bearing surfaces, and dual mobility.

Pyrocarbon Lunate Replacements Perform Well at Two Years: A Retrospective Case Series and Technique from Two UK Tertiary Centres.

Background: We report medium-term results in our case series of patients with Kienböck disease receiving a pyrocarbon lunate replacement (Integra, Smith and Nephew, Watford, UK). Methods: Patients with Kienböck receiving a pyrocarbon lunate between September 2012 and November 2020, with stage 3b and above were included. Patients were staged preoperatively with radiographs and MRIs. Pre- and postoperative visual analogue scores and movement were documented. Postoperative radiographs were obtained at 6 weeks, 6 months and 1 year. Results: Seven patients were identified, all female, with a median age of 28.0 years. All but one had 3b disease and the median follow-up was 2 years (range 13-112 months). A mean 9/10 preoperative VAS score improved to 1/10 by 3 months postoperatively (p < 0.001, paired t-test). No major complications were seen, and implants were stable radiologically. Conclusions: A semi-constrained pyrocarbon lunate can provide good results for patients with advanced Kienböck's disease, offering an alternative to proximal row carpectomy salvage surgery. Level of Evidence: Level IV (Therapeutic).

MatOrtho Proximal Interphalangeal Joint Arthroplasty via Lateral Approach: Minimum 2-Year Follow-Up.

Background: The MatOrtho implant is a cementless, mobile-bearing surface arthroplasty with a cobalt-chromium metal-on polyethylene articulation designed to treat osteoarthritis of the PIP joint. Early results for the prosthesis inserted through a dorsal approach have demonstrated good pain relief but no significant improvement in range of motion. In an attempt to improve the range of motion the senior author has changed his surgical practice to inserting the MatOrtho implant via a lateral approach. The purpose of this study is to assess the outcome of this change of surgical technique. Methods: Consecutive patients with osteoarthritis who underwent PIPJ replacement surgery via the lateral approach at a single institution, with a minimum follow-up period of 2 years were identified. A visual analogue score was used to assess pain. Grip strength, range of motion and functional outcomes scores were collected. Results: A total of 46 PIP joint arthroplasties were performed in 29 patients. Ten patients were lost to follow-up resulting in 33 PIP joint arthroplasties reviewed in 19 patients. Six implants failed. The mean follow-up time at the final follow-up for the remaining 25 prosthesis was 34.2 months (range 24-52). Range of motion improved from a mean of 37.2 preoperatively to a mean of 57.9 postoperatively. This was statistically significant (p = 0.0007). There was also a significant improvement in pain and functional outcome scores but not for grip strength. Conclusions: The MatOrtho PIPJ replacement delivers significant improvements in pain relief and functional outcome scores, as well as increased range of motion when the surgical procedure is performed through a lateral approach. There are, however, limitations to the use of this implant. Currently we do not consider this implant when there is instability or deformity of the PIP joint preoperatively.

Bare bones: Fundamentals of diagnostic wrist arthroscopy.

Diagnostic wrist arthroscopy is an essential component of the modern orthopaedic wrist surgeon's skill set. Fundamental elements of diagnostic wrist arthroscopy include pre-operative planning and consent, operative set up, surface anatomy, a systematic approach and applied clinical anatomy, and closure. These fundamentals are described, including options and preferences for implementation. A sound understanding of these elements is key to lay the foundations for successful clinical procedures.

COVID-19 consent and return to elective orthopaedic surgery: allowing a true patient choice?

AIMS: The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality. METHODS: All orthopaedic trauma cases at the Wrightington Wigan and Leigh NHS Foundation Trust from 'lockdown' (23 March 2020) to date (15 June 2020) were collated and split into three groups. Adult ambulatory trauma surgeries (upper limb trauma, ankle fracture, tibial plateau fracture) and regional-specific referrals (periprosthetic hip fracture) were performed at a stand-alone elective site that accepted COVID-19-negative patients. Neck of femur fractures (NOFF) and all remaining non-NOFF (paediatric trauma, long bone injury) surgeries were performed at an acute site hospital (mixed green/blue site). Patients were swabbed for COVID-19 before surgery on both sites. Age, sex, nature of surgery, American Society of Anaesthesiologists (ASA) grade, associated comorbidity, length of stay, development of post-surgical COVID-19 infection, and post-surgical COVID-19-related deaths were collected. RESULTS: At the elective site, 225 patients underwent orthopaedic trauma surgery; two became COVID-19-positive (0.9%) in the immediate perioperative period, neither of which was fatal. At the acute site, 93 patients underwent non-NOFF trauma surgery, of whom six became COVID-19-positive (6.5%) and three died. A further 84 patients underwent NOFF surgery, seven becoming COVID-19 positive (8.3%) and five died. CONCLUSION: At the elective site, the rate of COVID-19 infection following orthopaedic trauma surgery was low, at 0.9%. At the acute mixed site (typical district general hospital), for non-NOFF surgery there was a 6.5% incidence of post-surgical COVID-19 infection (seven-fold higher risk) with 50% COVID-19 mortality; for NOFF surgery, there was an 8.3% incidence of post-surgical COVID-19 infection, with 71% COVID-19 mortality. This is likely to have significance when planning a resumption of elective orthopaedic surgery and for consent to the patient.Cite this article: Bone Joint Open 2020;1-9:556-561.

Which Headless Compression Screw Produces the Highest Interfragmentary Compression Force in Scaphoid Fracture?

BACKGROUND: Interfragmentary compression at the fracture site facilitates healing. Headless compression screws used to treat scaphoid fractures can be grouped as shank screws, conical tapered screws and double component screws. There has been no meta-analysis of biomechanical studies to compare interfragmentary compression produced by the above screws. METHODS: A computerised search of Pubmed, Embase and OVID database was undertaken to identify the studies. We estimated the weighted mean difference of interfragmentary compression (in Newton) with 95% confidence intervals. Random effects model was selected for meta-analysis. RESULTS: The pooled estimate of nine studies demonstrated that conical tapered screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 19.96, 95% CI 11.2-28.8, p < 0.0001, I 2 = 99%). The pooled estimate of four studies demonstrated that dual component screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 16.93, 95% CI 12.3-21.6, p < 0.0001, I 2 = 97.7%). The pooled estimate of four studies showed that there was no significant difference in the interfragmentary compression force generated by either conical tapered screw or dual component screw (WMD 3.93, 95% CI - 8.3 to 16.2, p = 0.53, I 2 = 99.7%). There was evidence of minimal publication bias. CONCLUSION: Conical tapered screws and dual component screws produced statistically significant higher interfragmentary compression force at the scaphoid fracture site compared to shank screws. There was no difference in the compression force generated by either conical tapered screw or dual component screw.

Performance evaluation of surgical techniques for treatment of scapholunate instability in a type II wrist.

We investigated the performance of three tenodesis techniques, modified Brunelli, Corella, and scapholunate axis (SLAM) methods in repairing scapholunate interosseous ligament (SLIL) disruption for a type II wrist using finite element-based virtual surgery and compared the results with those of a previous investigation for a type I wrist. In addition, a comparison of the carpal mechanics of type I and type II wrists was undertaken in order to elucidate the difference between the two types. For the type II wrist, following simulated SLIL disruption, the Corella reconstruction technique provided a superior outcome, restoring dorsal gap, volar gap, and SL angle to within 3.5%, 7.1%, and 8.4%, respectively, of the intact wrist. Moreover, application of the ligament reconstruction techniques did not significantly alter the motion pattern of the type II and type I wrists. For the type I wrist, SLIL disruption resulted in no contact between scaphoid-lunate cartilage articulation, whereas for the type II wrist, some contact was maintained. We conclude that the Corella ligamentous reconstruction technique is best able to restore SL gap, angle, and stability following SL ligament injury for both type II and type I wrists and is able to do so without altering wrist kinematics. Our findings also support the view that type I wrists exhibit row behaviour and type II wrists column behaviour. In addition, our analysis suggests that the extra articulation between the lunate and hamate in a type II wrist may help improve stability following SL ligament injury.

Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation.

Chronic scapholunate ligament (SL) injuries are difficult to treat and can lead to wrist dysfunction. Whilst several tendon reconstruction techniques have been employed in the management of SL instability, SL gap reappearance after surgery has been reported. Using a finite element model and cadaveric study data, we investigated the performance of the Corella, scapholunate axis (SLAM) and modified Brunelli tenodesis (MBT) techniques. Scapholunate dorsal and volar gap and angle were obtained following virtual surgery undertaken using each of the three reconstruction methods with the wrist positioned in flexion, extension, ulnar deviation and radial deviation, in addition to the ulnar-deviated clenched fist and neutral positions. From the study, it was found that, following simulated scapholunate interosseous ligament rupture, the Corella technique was better able to restore the SL gap and angle close to the intact ligament for all wrist positions investigated, followed by SLAM and MBT. The results suggest that for the tendon reconstruction techniques, the use of multiple junction points between scaphoid and lunate may be of benefit. Graphical abstract The use of multiple junction points between scaphoid and lunate may be of benefit for tendon reconstruction techniques.

Early results of Latitude primary total elbow replacement with a minimum follow-up of 2 years.

BACKGROUND: The aim of this study was to present outcomes of primary Latitude total elbow replacement (TER) with a minimum follow-up of 2 years. METHODS: A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital. RESULTS: The mean age of the patients was 62 years (33-85 years). Five primary TERs (4 patients) were lost to follow-up. The primary diagnosis was rheumatoid arthritis in 49, osteoarthritis in 8, and trauma in 6 elbows. The mean flexion-extension arc was 75° preoperatively and 97° postoperatively. Mean postoperative Elbex pain score was 19/100, and function score was 37/100. Mean postoperative scores were 42/100 for the Quick Disabilities of the Arm, Shoulder, and Hand and 38/50 for the elbow-specific American Shoulder and Elbow Surgeons assessment. Four patients died of unrelated causes, and 8 of 63 underwent further surgical intervention, including explantation and conversion from unlinked to linked implant. On radiographic review of 41 surviving TERs, aseptic radiologic loosening was observed of the humeral component in 4 elbows and of the ulnar component in 9. Seven elbows had no radial component, and of the remaining 34 elbows, 16 (47%) had signs of loosening of the radial implant. Complications included 1 heterotopic ossification, 1 olecranon fracture, and 3 further procedures for ulnar nerve entrapment. CONCLUSION: The results indicate that the early outcome of Latitude TER is comparable to that of other prostheses. There is concern about early radiologic loosening of the radial component.

Analysis of tenodesis techniques for treatment of scapholunate instability using the finite element method.

Chronic scapholunate ligament (SL) injury is a common disorder affecting the wrist. Despite advances in surgical techniques used to treat this injury, SL gap re-emergence may occur postoperatively. This paper presents an investigation into the performance of the Corella, schapolunate axis (SLAM), and modified Brunelli tenodesis (MBT) surgical reconstruction techniques used to treat scapholunate instability. Finite element (FE) models were used to undertake virtual surgery, and the resulting scapholunate (SL) gap and angle obtained using the 3 techniques were compared. The Corella technique was found to achieve the SL gap and angle closest to the intact (ligament) wrist, restoring SL gap and angle to within 5.6% and 0.6%, respectively. The MBT method resulted in an SL gap least close to the intact. The results of our study indicate that the contribution of volar scapholunate interosseous ligament to scapholunate stability could be important.

Evaluating the Surface Topography of Pyrolytic Carbon Finger Prostheses through Measurement of Various Roughness Parameters.

The articulating surfaces of four different sizes of unused pyrolytic carbon proximal interphalangeal prostheses (PIP) were evaluated though measuring several topographical parameters using a white light interferometer: average roughness (Sa); root mean-square roughness (Sq); skewness (Ssk); and kurtosis (Sku). The radii of the articulating surfaces were measured using a coordinate measuring machine, and were found to be: 2.5, 3.3, 4.2 and 4.7 mm for proximal, and 4.0, 5.1, 5.6 and 6.3 mm for medial components. ANOVA was used to assess the relationship between the component radii and each roughness parameter. Sa, Sq and Ssk correlated negatively with radius (p = 0.001, 0.001, 0.023), whilst Sku correlated positively with radius (p = 0.03). Ergo, the surfaces with the largest radii possessed the better topographical characteristics: low roughness, negative skewness, high kurtosis. Conversely, the surfaces with the smallest radii had poorer topographical characteristics.

Pyrocarbon Proximal Interphalangeal Joint Arthroplasty: Minimum Five-Year Follow-Up.

PURPOSE: To report the outcomes, complications, and survivorship of pyrocarbon proximal interphalangeal joint arthroplasty at a minimum of 5-year follow-up. METHODS: A review of 97 implants in 72 consecutive patients from our joint arthroplasty database was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure; Quick Disabilities of the Arm, Shoulder, and Hand score; and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. RESULTS: Diagnosis was osteoarthritis in 60 joints, rheumatoid arthritis in 12 joints, psoriatic arthritis in 11 joints, and trauma in 14 joints. The average follow-up was 118 months (range, 60-164 months). The mean arc of motion was 35° (range, 0° to 90°). There was no difference in grip strength between operated and nonoperated side. Of the 97 implants, 36 required additional surgery, of which 14 were revised and 22 required reconstruction around a retained implant. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 33 (range, 10-69) and 35 (range, 0-93), respectively. Mean visual analog scores for pain, satisfaction, and appearance were 2 (range, 0-8), 7 (0-10), and 8 (0-10), respectively. All implants had a lucent line with nearly all classified as either Herren grade 2 or 3. Progressive loosening was seen in 48% of implants. Implant survival as assessed by Kaplan-Meier was 85% at both 5 and 10 years. CONCLUSIONS: Good pain relief and maintenance of preoperative arc of motion was achieved with no major deterioration over time. Most implant revisions were performed within 24 months of the index procedure. Currently progressive loosening was not translated into revision surgery. Implant revision rate was higher than with other prostheses. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Pyrocarbon Metacarpophalangeal Joint Arthroplasty in Noninflammatory Arthritis: Minimum 5-Year Follow-Up.

PURPOSE: To report the outcomes, complications, and survivorship of pyrocarbon metacarpophalangeal joint arthroplasty in noninflammatory arthropathy at a minimum 5-year follow-up. METHODS: A retrospective review of 51 implants in 36 patients was undertaken. Patient demographics, complications, further surgery, and implant revision were recorded. Objective outcome was assessed by grip strength, range of motion, and radiological assessment of alignment, loosening, and subsidence. Subjective outcome was assessed by Patient Evaluation Measure, Quick Disabilities of the Arm, Shoulder and Hand score, and visual analog scores (0, best; 10, worst) for appearance, satisfaction, and pain. RESULTS: There were 35 index and 16 middle fingers. The average follow-up was 103 months (range, 60-172 months). The mean arc of motion was 54° (range, 20° to 80°). There was no difference in grip strength between operated and nonsurgical side. Six implants were revised, and 3 of these required additional surgery. The average Patient Evaluation Measure and Quick Disabilities of the Arm, Shoulder and Hand scores were 27 (range, 10-54) and 29 (range, 0-57), respectively. Mean visual analog scores for pain, satisfaction, and appearance were all 1 with the respective ranges being 0-7, 0-4, and 0-6. Most implants were Herren grade 1 lucency with the remaining 5 proximal and 12 distal implants being grade 2. Mean subsidence in the proximal component was 2 mm (range, 0-4 mm) and 1 mm (range, 0-3 mm) in the distal component. The degree of loosening or subsidence did not correlate with outcome. Implant survival as assessed by Kaplan-Meier was 88% at 10 years. CONCLUSIONS: Good pain relief, a functional range of motion, and high satisfaction were seen in the majority of patients. All implant revisions were performed within 18 months of the index procedure. This may represent technical issues rather than problems with the implant.

In vitro wear testing of the PyroCarbon proximal interphalangeal joint replacement: Five million cycles of flexion and extension.

Clinical results of the PyroCarbon proximal interphalangeal joint replacement are inconsistent with various complications reported. To address this, in vitro testing was conducted using finger joint simulators. Two PyroCarbon proximal interphalangeal prostheses were tested in a lubricant of dilute bovine serum to 5 × 10(6) cycles of flexion-extension (90°-30°) with dynamic forces of 10 N applied. At intervals of 3000 cycles testing ceased and a static load of 100 N was applied to simulate gripping. In addition, two 'control' prostheses were immersed alongside the test prostheses to account for lubricant absorption. Wear and roughness averages (Ra) were measured every 1 × 10(6) cycles. Minimal wear for all of the components was measured with a negligible increase in Ra for most of the components. One condyle of one component increased in Ra over the 5 × 10(6) cycles with a value above the recommended 50 nm. Unidirectional marks were visible on the condyle from micrographs, consistent with an abrasive wear mode.

The long-term outcome of four-corner fusion.

Introduction Four-corner arthrodesis with excision of the scaphoid is an accepted salvage procedure for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) and has been performed in our unit for over 20 years. We have undertaken a retrospective review of 116 of these procedures performed in 110 patients between 1992 and 2009. Fifty-eight patients attended for a clinical evaluation, and 29 responded by postal questionnaire. Methods The surgical technique undertaken was standard. That is, through a dorsal approach the scaphoid and tip of the radial styloid were excised. The capitate, lunate, triquetrum, and hamate articular surfaces were then prepared down to bleeding bone. Bone grafts from the scaphoid and radial styloid were then inserted and fixation undertaken. For the latter, various methods were used, including Kirschner (K-)wires, staples, bone screws, but predominantly the Spider plate (Integra Life Sciences, USA). Thereafter the wrist was immobilized for a minimum period of 2 weeks prior to rehabilitation. Results Follow-up was done at a mean of 9 years and 4 months (range 3-19 years). All patients reported a significant improvement in pain relief and ∼50% of flexion extension, although only 40% of radioulnar deviation. Grip strength was again ∼50% of the contralateral side. Most patients reported a significant improvement in function with 87% returning to work. In addition, radiologic evaluation identified 28 patients (31%) who demonstrated ongoing signs of nonunion, particularly around the triquetrum. Fourteen of these (15%) underwent a further procedure, generally with success. Finally, none of the patients demonstrated any arthritic changes in the lunate fossa on follow-up X-ray, and all secondary procedures were undertaken within 2 years of the primary. Discussion This research has demonstrated that four-corner fusion fixed with a circular plate can result in a satisfactory outcome with a reduction in pain, a functional range of motion, and a satisfactory functional outcome. The bulk of the complications appear to occur in the first 2 years after surgery. Thereafter, analysis shows long-term satisfaction with little deterioration. Nonunion, particularly around the triquetrum, continues to be a problem, but it may be that this bone should be excised along with the scaphoid, resulting in a three-part fusion only. Alternatively, a simple capitolunate fusion may be satisfactory.

Intermediate outcomes of ulnar head arthroplasty.

PURPOSE: To determine the survivorship and clinical outcomes of ulnar head arthroplasty. METHODS: The study design included a review of medical records and clinical assessment of all patients who had an ulnar head arthroplasty more than 2 years previously. Survivorship of 79 implants in 74 patients was determined. Forty-seven of these patients participated in a clinical review using the Patient Examination Measure, Patient-Related Wrist Examination, Wrightington Wrist Score, and EQ5D to measure outcomes. Analysis of outcomes was performed for diagnostic subgroups (inflammatory arthritis, posttraumatic, osteoarthritis/impingement, and other), primary versus revision surgery, and whether the procedure was performed for ulnar stump instability (related to either a previous Darrach or Sauvé-Kapandji procedure). RESULTS: The 5- and 15-year survival of the implants was 90% for both, with mean follow-up of 7 ± 4 years. Mean age at surgery was 50 ± 13 years (range, 24-76). Mean range of motion was within the functional range and grip strength was 67% that of the contralateral side. Patient satisfaction was generally high, but outcomes scores indicated substantial residual disability. Overall scores were 41 for the Patient Examination Measure, 52 for the Patient-Related Wrist Examination, and 70 for the WWS. Patients in the "other" category had the worst scores for all measures. Patients with prior wrist surgery had poorer outcomes than those for whom the arthroplasty was a primary procedure. Patients with posttraumatic diagnoses had worse EQ5D scores and were less likely to recommend the procedure to others. CONCLUSIONS: Ulnar head arthroplasty had good long-term survival and acceptable patient satisfaction. Substantial disability remained in all groups, with the posttraumatic, "other", and revision groups faring worse. Patients should be counseled about the expected outcomes of this specialized procedure as they pertain to the patient's specific situation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Necrotising fasciitis: a series of seven cases.

Necrotising fasciitis of the extremities is a rapidly progressive, potentially life threatening soft tissue infection. Early diagnosis, aggressive surgical and critical care management is vital in preventing mortality. This series reports the clinical presentation, behaviour of inflammatory markers, histological, microbiological and radiological findings in seven cases, which presented to our orthopaedic unit over the last one year. Seven patients (4 male and 3 female) were included. Usual presentation was spreading erythema and pain. Duration of symptoms varied from 3 to 14 days. All except one case affected the lower limbs. The average Laboratory risk indicator for necrotising fasciitis (LRINEC) score on the day of presentation was 5. Imaging demonstrated subcutaneous oedema, fluid and air pockets in muscular planes. Group A beta haemolytic Streptococcus was the most common organism isolated from culture. Treatment modalities included antibiotics, immunoglobulins and surgical debridement. Four of the patients showed full remission. However, three (one with pre-existing carcinoma) of them succumbed to the condition.