First published in The Open Orthopaedics Journal, 2014, 8,
(Suppl 1: M5) 162-167)
HEFT Orthopaedic Directorate 
Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?
A novel technique for extraction of a fractured femoral stem in revision hip arthroplasty.
Management of Leg Length Inequality and Foot Drop Following Staged Reconstruction of Pelvic Discontinuity, with Massive Femoral and Acetabular Bone Loss
Four-Year Results Following Composite Bone Grafting (CBG) Technique for Primary Total Hip Replacements (THR) with Patient Outcome Scores.
I have developed a new technique for Acetabular Impaction Grafting and have an excellent outcome with supportive data collected over 15 years.
The potential for research from this data is extensive.
I would benefit from some support from the Trust in terms of rationalising my workload and allocation of Junior Grades to assist with the continued research and writing papers based on the work.
I have shown examples of recent publications and presentations below.
I have numerous ideas for new papers and currently have several papers in the pipeline.
Femoral Stem in Revision Hip Arthroplasty has been proposed for E-POSTER presentation at the XXVI SlCOT Triennial World Congress combined with the 48th SHOT Annual Meeting, to be held In Rio de Janeiro, Brazil, from 19 to 22 November 2014. Trevor Lawrence FRCS (Orth) Research
1. Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?
Lesley McKee (1), Mazin S. Ibrahim* (1), Trevor Lawrence (1), Ioannis P. Pengas2 and Wasim S. Khan (2).
(1) Trauma and Orthopaedic Department. Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital. Bordesley Green East, Birmingham, B9 5SS. UK
(2) University College London Institute of Orthopaedics and Musculoskeletal Sciences. Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
Abstract: Traumatic knee dislocation is a serious and potentially limb threatening injury that can be easily missed if meticulous history and examination have not been employed. Neurovascular injuries are common in this condition, and due diligence should be given to their thorough evaluation at the time of secondary survey so as to avoid complications such as ischaemia, compartment syndrome and eventual amputation. There is growing evidence in the literature that morbid obesity is associated with low energy knee dislocation, therefore this should be considered when assessing this cohort of patients presenting with an acute knee injury. Early operative intervention especially with multi ligaments involvement is the preferable strategy id the management of this acute injury. Controversy exists whether to reconstruct or repair damaged structures, and whether to adopt a one-stage or two-stage reconstruction of the cruciate ligaments. Early rehabilitation is important and essential to achieve satisfactory outcomes. This article is an evidence-based overview of this rare but devastating injury.
Keywords: Knee dislocation, knee injuries, knee joint, ligaments, nerve injury, vascular system injuries.
INTRODUCTION
Traumatic knee dislocation (KD) is a serious and potentially limb threatening injury, albeit a relatively rare condition, the incidence has been reported as approximately 0.02-0.2% of orthopaedic injuries [I-3J. There is some variance on the definition of knee dislocation, though it can be generally considered to include disruption of at least 2 out of 6 of the major ligamentous and cartilaginous structures, with or without instability. These injuries have historically beet ) attributed to high-velocity impacts (HVKD ) however, more recently they are being noted in low-velocity incidents (LVKD ), particularly involving morbidly obese people. There is an associated high risk of neurovascular damage particularly to the popliteal artery and the common peroneal nerve, where they are tethered by the popliteal fossa boundaries and fibular head respectively, reported to be between 20 -40% and as high as 64% for popliteal artery damage in some studies [4, 5J.
Knee dislocations (KD) often reduce spontaneously out with the emergency department, potentially leading to a high rate of delayed presentation or missed diagnosis (6, 7]. With regard to the latter, spontaneously reduced dislocations often have normal radiographs and minimal clinical signs: the physician must be vigilant and have a high index of suspicion to avoid missing the diagnosis and its potentially devastating complications. Complications of missed KD can include vascular compromise, ischaemic limb, permanent nerve damage, popliteal vessel thrombosis, acute compartment syndrome requiring decompression fasciotomies and even amputation (1, 5, 6, 8].
EPIDEMIOLOGY
The true rate of knee dislocations is not known due to the number of spontaneous dislocations [8]. Knee dislocations arc traditionally divided epidemiologically into those caused by high-velocity trauma such as an R.TA or low-velocity trauma such as those sustained in sporting injuries. KD tends to occur in younger patients and occurs in a male to female ratio of 4: 1 [8], More recently there has been literature reporting the rise of knee dislocations in the morbidly obese [9 -13]. Georgiadis et al. reported an increase in low-velocity knee dislocations in the morbidly obese from 17% between 1995-2000 to 53% in 2007- 2012 (J I]. The same study also found that obese patients with low energy knee dislocations were more likely to have neurovascular injuries requiring surgical intervention than patients with higher energy traumatic dislocations. However, traditionally, low-velocity knee dislocations have lower rates of neurovascular injury [12].
CLASSIFICATIONS
Conventionally, the dislocated knee is categorised radiographically m a positional fashion by the displacement of the tibia relative to the femur. This system was originally developed by Kennedy in 1963 [2]. It classifies dislocations into 5 types: Anterior, posterior, medial, lateral or rotatory. Rotatory subtypes are divided into anterolateral, anteromedial, posterolateral and posteromedial types. Of these, posterolateral disruptions are the most difficult to reduce [6].
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* Address correspondence to this author al the Trauma and Orthopaedic Department, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley (Green East. Birmingham, 09 5SS. UK; Tel: 07902017594; E-mail: dibrm80@yahoo.com
1874-5250,-14
2014 Bentham Open
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2. A Novel Technique for Extraction of a Fractured Femoral Stem in Revision Hip Arthroplasty
Mas L McKee, BSc, MBChB, MRCS
Specialist Registrar, Trauma and Orthopaedic surgery. Heart of England NHS Trust
Work: via switch 0121 424 2000
moNte: 07782514182
On Tub, 20 May 2014 11:4138+0100 (BST)
"SICOT CONGRESS* <congress@sicot.org> wrote:
Dear Mr Gurdip CHAHALL,
We are pleased to inform you that your abstract , number 37587, entitled : A Novel Technique for Extraction of a Fractured Femoral Stem in Revision Hip Arthroplasty . has been proposed for E-POSTER presentation at the XXVI SlCOT Triennial World Congress combined with the 48th SHOT Annual Meeting, to be held In Rio de Janeiro, Brazil, from 19 to 22 November 2014.
The e-posters will be available during the entire Congress via computers in the e-poster area at the SulAm8eacute;rica Convention Centre Only those authors who have received a confirmation of their registration and payment from the SICOT Congress Secretariat by 19 June 2014 will receive a link to upload their e-posler file(s). The links will be sent later on Io all registered authors presenting e-posters.
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Slide 4: Results
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IMPORTANT NOTE: The presenting author of an accepted abstract must register and pay the congress registration fee by 19 June 2014 to be included in the Final Programme. The Congress Secretariat will not check if co-authors have registered Abstract submitters can change the presenting author of an abstract through the abstract submission system until 19 June 2014, by clicking on the link in the confirmation email received after submitting the abstract. Please ensure that the family name, given name, institute, and address of the presenting author have been inserted in the system.
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3. Management of Leg Length Inequality and Foot Drop Following Staged Reconstruction of Pelvic Discontinuity, with Massive Femoral and Acetabular Bone Loss
Heart of England
L McKee. G. Chahal, J. McArthur. T. Lawrence
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4. Four-Year Results Following Composite Bone Grafting (CBG) Technique for Primary Total Hip Replacements (THR) with Patient Outcome Scores.
Dear Mr Sheethai prasad PATANGE SLIBBA RAO,
We are pleased to inform you that your abstract, number 37696, entitled: Four-Year results following composite bone grafting ( CBG) technique for primary total hip replacements (THR) with patient outcome scores: prospective single centre study ., has been proposed for ORAL presentation at the XXVISCOT Triennial World Congress combined with the 46th SBOT Annual Meeting, to be held In Rio de Janeiro, Brazil, from 19 to 22 November 2014.
The allocated presentation time is sot minutes, plus an extra two minutes lor discussion. The scientific programme is subject to change and the final date, time, and session will only be announced after 19 June 2014. Please check the SICOT website for updates.
IMPORTANT NOTE: The presenting author of an accepted abstract must register and pay the congress registration fee by 19 June 2014 to be included in the Final Programme. The Congress Secretariat will not check HI co-authors have registered. Abstract submitters can change the presenting author of an abstract through the abstract submission system until 19 June 2014 by clicking on the link in the confirmation email received after submitting the abstract.
Please ensure that the family name, given name, Institute, and address of the presenting author have been inserted in the system. Registration can be done on the SICOT website: http://www.sicot.org/?id_page=802. Presenting authors are kindly requested to Insert their abstract number) on the registration form and to check that their FAMILY name and GIVEN names) have been inserted In the corresponding field and spelt in the same way as on the abstract submission form. For example, if 'Smith’ has been Inserted as the Family Name on the abstract submission form, please ensure that ’Smith* has also been Inserted as the Family Name on the congress registration form.
Become a SICOT member and save money on your congress registration tee. Special preferential membership dues are available tor new members residing In the APOA (Asia Pacific Orthopaedic Association) and SLAOT (Latin American Society of
Orthopaedics and Traumatology) member country, our Friendship Societies They will also benefit from the reduced registration fee for SICOT members. Visit the SICOT website, http://www.sicot.org/?id_page=17, to find out how you can join SCOT.
If you have any questions, please do not hesitate to contact us at congress@sicot.org.
We look forward to seeing you in Rio de Janeiro.
Yours sincerely,
José Sergio Franco
Congress President
Keith DK Luk
SICOT President Elect
Chairman of the Congress Scientific Advisory Committee
This text has been extracted from a printed copy. Whilst every effort has been taken to accurately OCR the original paper, please see attached pdf of the original document for further reference.
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