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Audit / Research

Scarf

Mountain

Scarf osteotomy for hallux valgus 2010

April 2008-Mar 2010
Total patients identified = 64 All treated by Mr Sturdee at Calderdale Royal Hospital
83 scarfs in 64 patients ( 19 bilateral)
Total patients contactable = 42
53 scarfs in 42 patients (11 bilateral)
Age range 17 – 89years ( mean age = 52 )
F: M = 54:10 = 5.4 : 1
Number of Akin + Scarf = 30 (36%)

Over 83% patients are satisfied with surgery at CRH in this single surgeon series
Only 2 patients were unsatisfied(4.7%)

88 % would recommend this procedure to a friend or undergo it again

Summary
Over 95% were either very satisfied, satisfied or neutral
Scarf procedure is successful , safe and reproducible correction of Hallux Valgus
83% of CRH / HRI patients satisfied with this surgery in this single surgeon series
It can take 9-12 months for patients to fully recover from forefoot surgery, particularly swelling

1st MTP fusion

Mountain

1st MTP fusion for hallux rigidus 2012
• 51 procedures in 45 pts all surgery performed by Mr Sturdee or under direct supervision
• Avr age – 63 yrs 13 males:32 females
• 3 non-unions requiring revision
• Non-union / revision rate – 5.9%
• 3 Superficial infections resolved with oral antibiotics
• Non union rate within that of international literature

Tarsal Tunnel

Mountain

Tarsal Tunnel Syndrome audit 2013

34 ankles in 30 patients under care of Mr Sturdee, Mr Shenolikar and Mr Wells
14 Female : 16 Male
18 Left : 15 Right

Surgery April 2008 to April 2012
Follow up of 12-60 months (mean 36)
Duration of symptoms (34 ankles)

18 with symptoms for >12 month duration
Remaining 16 cases average symptom duration of 4.6 months

Tinel’s sign + ve 18 pts, – ve / not documented 15
100 % cases had pre-operative NCS

94% positive suggestive Tarsal tunnel syndrome
53% positive EMG study

Operative findings – 33 op notes
7 cases tight flexor retinaculum
2 cases engorged veins in tarsal tunnel
1 ganglion within tarsal tunnel
1 subtalar OA with osteophytes
1 nerve entrapment in scar of prev ankle athrodesis
1 incidental Mortons neuroma on MRI
excised at time of tar Clinic letter reported outcomes

24 cases good outcome 79%
3 cases slight improvement
7 cases no improvement in symptoms 21%

Summary
All patients underwent pre-op NCS as per recommendation in literature

Results of surgical treatment at HRI/CRH comparable with that reported in the literature (79% good outcome) unnel surgery

Mortons

Mountain

Audit of Mortons Neuroma 2014

40 cases of Morton’s Neuroma diagnosed on presentation in 38 patients all treated by Mr Sturdee at Calderdale Royal Hospital.
Mean age on presentation – 47.11 years. Age range on presentation – 17-72 years
Gender ratio female:male – 4:1
11 cases reported resolution with use of an insole alone (27.5%).
A further 5 cases settled following subsequent steroid injection (12.5%).
22 cases underwent surgical excision (55%).
Of the 22 cases treated surgically;
1 case reported persistent symptoms post-op.
Summary
Conservative measures have a clear role with 40% of cases achieving resolution with these measures alone.
Surgical management has a high success rate, with only 1 case from 22 (4.55%) reporting persistence of symptoms on follow-up.

Research Publications

Mr Sturdee has been involved in many aspects of research over the last twenty years. A full list of publications are listed below.

Spire Elland Hospital and Mr Sturdee are a recognised centre for the ASSERT study (Assessment of Effectiveness of ESWT for Soft Tissue Injuries). All patients will be invited to be part of the ASSERT study which is looking at the results of shockwave treatment in multiple centres. ASSERT is an online database which monitors the effectiveness of ESWT in a systematic and consistent way. The study was launched in March 2011 by Professor Nicola Maffulli.

In 2014 the preliminary results of ASSERT 1 were published and found improvement in patients receiving ESWT for calcific tendinopathy of the shoulder; tennis elbow; trochanteric bursitis; patellar tendinopathy; Achilles tendinopathy; plantar fasciitis. However, significant differences were identified for patients receiving ESWT for: tennis elbow, Achilles tendinopathy and plantar fasciitis in both the short term and long term follow-up.

From June 2014 ASSERT 2 superseded ASSERT and Mr Sturdee has started to recruit patients into ASSERT 2.
The ASSERT studies involve information about the severity of the condition being collated and function and pain scores will be performed up to three months by the treating clinician. After this time ASSERT researchers will contact patients by email or telephone to get long term results.

Peer Reviewed Publications

1, Sturdee SW, Seronegative Polyarthritis: Side-effect of an Orthopaedic Metal Implant? British Journal Of Rheumatology 1998;37:699-700.

2, Sturdee SW, Bainton R, Barnham M, Intravascular Infection with Lactobacillus paracasei. Journal of Infection 1998;37:184-186.

3, Sturdee SW, Bollen SR, Jennings AG, Revision ankle reconstruction using autologous semitendinosus tendon, a new technique. The Foot 2001;11:66-67.

4, Sturdee SW, Oxborrow NJ, Templeton PA, Internal fixation of a patellar fracture using an absorbable suture. The Journal of Orthopaedic Trauma 2002;16(4): 272-273.

5, Sturdee SW, Timothy J, Tyagi A, Total extrusion of a cranial peritoneal shunt per rectum: Case report. Journal of Clinical Neuroscience 2002;9(2):p 199-200.

6, Sturdee SW, Oxborrow NJ, Templeton PA, Internal fixation of a patellar fracture using an absorbable suture. (Letter) The Journal of Orthopaedic Trauma 2002; 16(7): 529.

7, Sturdee SW, Beard DJ. A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. (Letter) Journal of Bone Joint Surgery (Br) 2004; 86-B(3): 464-465.

8, Sturdee SW, Giannoudis PV, C-Reactive protein in patients who had operative fracture treatment. (Letter) Clinical Orthopaedics 2004;419:318.

9, Sturdee SW, Bollen SR, Intra-articular calcification in primary hyperparathyroidism. The Knee 2004;11(4): 323-325.

10, Gholve PA, Kosygan P, Sturdee SW, Faraj AA, Multidisciplinary integrated care pathway for fracture neck of femur. A prospective trial with improved outcome. Injury 2005;36(1):93-98.

11, Sturdee SW, Beard DJ, Nandhara G, Sonanis SV. Decreasing the blood transfusion rate in elective hip replacement surgery using an autologous drainage system. Annals Royal College of Surgeons of England 2007;89:136-139.

12, Sturdee SW, Templeton PA, Cullen E. Femoral fractures in children, is early interventional treatment beneficial? Injury 2007:38(8):937-944.

13, Hennessy MS, Molloy AP, Sturdee SW. Non-insertional Achilles tendinopathy. Foot and Ankle Clinics 2007;12:617-641.

14, Harris NJ, Brooke BT, Sturdee S. A wear debris cyst following S.T.A.R total ankle replacement – Surgical management. Foot and Ankle Surgery 2009;15(1):43-45.

15, Rambani R, Elnaggar M, Sturdee S. Syndactly with hallux valgus: A case report. Foot and Ankle International 2011;32(6):641-643.

16, Hassanein M, Taylor D, Sturdee S. Unusual operative treatment and outcome of femoral shaft fracture in a non-ambulatory cerebral palsy patient. Ortopedia Traumatologia Rehabilitacja 2013;6(6) Vol 15:649-651.

Abstract Publications

1, Campbell D, Muthusamy K, Sturdee S, Finlayson D, Stone M. The posterior lip augmentation device for recurrent dislocation. Journal of Bone Joint Surgery (Br) 2001;83-B:Supp IV p395.

2, Sturdee SW, Templeton PA, Oxborrow NJ. Study of femoral diaphyseal fractures in the paediatric population. Journal of Bone Joint Surgery(Br) 2002;84-B:Supp II p169.

3, Sturdee SW, Templeton PA, Oxborrow NJ. Study of femoral diaphyseal fractures in the paediatric population. Injury 2002;33:Issue 10 p847 – 883.

4, Sturdee SW, Dahabreh Z, Templeton PA, Cullen E. Early active treatment of femoral shaft fractures in children. – A proposed protocol. Journal of Bone Joint Surgery(Br) 2006;88-B:Supp I p120.

5, Tomlinson JE, Hannon E, Sturdee SW, London NJ. Bilateral simultaneous two surgeon knee replacement – Efficient, safe and educational. Journal of Bone Joint Surgery(Br) 2008;90-B:Supp III p584

6, Campbell D, Dearing J, Finlayson D, Datir S, Sturdee S, Stone M. The posterior lip augmentation device – Two centre study outcomes at a minimum of five years follow up. Journal of Bone Joint Surgery(Br) 2008;90-B:Supp III p534

7, Sturdee SW, Harris NJ, Farndon M. A prospective clinical and radiological review of 137 AES total ankle replacements over a 4 year period in a single centre. Journal of Bone Joint Surgery(Br) 2008;90-B:Supp III p495

8, Sidhom S, Al-Lami M, Sturdee S, Anderson A, Muthukumar N, Hughes V, Bennett C, London N. Reduced length of stay with mini-incision knee arthroplasty – A prospective randomised controlled trial. Journal of Bone Joint Surgery(Br) 2010;92-B:Supp II p328

9, Sturdee S, Duffy D, Dimitriou R, Giannoudis P, Templeton P. Accelerated rehabilitation of children with lower limb fractures and acquired brain injury (ABI). Journal of Bone Joint Surgery(Br) 2012;94-B:Supp XXXVII p55

Non – Reviewed Publications

1, Sturdee SW, Malawi, The warm heart of Africa: Medicine Matters, (Leeds Medical School Journal) Summer 1996. Issue 5 (A report of my medical student elective at Mulanje mission hospital, Mulanje, Malawi, Africa.)

2, Sturdee SW, Hackney RG, Guidelines for the assessment of acute compartment syndrome. For The Leeds Teaching Hospitals NHS Trust, February 2001. Guidelines for the wards issued across the trust.

3, Sturdee SW, SpR Training is rigorous. : Hospital Doctor (Letter) 9th June 2005. Page 19

4, Sturdee SW, FRCS (Tr & Orth) Exam : BOTA Yearbook 2006 – 2007. Pages 44 – 45.

5, Sturdee SW, EFORT Spring Travelling Fellowship 2006 : British Orthopaedic News (BON). Autumn 2006;34: 35-36.