Browsing by Person "Uddin, Akram"

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Early Weight-bearing Following Modified Lapidus Arthrodesis: A Retrospective Review of 104 Cases & Postoperative Protocol
(Elsevier, 2025-09-27) Uddin, Akram; Bramall, John W.; Leong, Keng; Klos, Kajetan; Roth, Edgar; Santos, Derek
Background Lapidus arthrodesis is indicated for the treatment of first ray dysfunction or hypermobility, hallux valgus (HV) and functional hallux limitus (FHL). Postoperative weightbearing protocols vary amongst surgeons. Purpose To report radiographic osseous healing and patient-reported outcome measures (PROMS) following a single early weightbearing protocol. Study Design Retrospective review of 104 adults (≥18 years) (104 feet) who underwent open modified Lapidus arthrodesis (without bone graft) by single compression screw and medial locking plate by two surgeons at one centre (between January 2019 to May 2023). Methods Pre- and postoperative radiographs and electronic records were reviewed for evidence of osseous healing and return to full weightbearing. Secondary measures included deformity reduction and PROMS. Results At 6-weeks follow-up 98 patients (94%) were confirmed of osseous healing and returned to full weightbearing. Six patients (6%) had delayed osseous healing at 6-weeks but showed signs of osseous healing by 3-months follow-up. Postoperative HV and intermetatarsal angle (IMA) showed significant reduction (mean difference: -12 (SD=8) and -5 (SD=4) degrees respectively; p<0.001 for both). Ten patients (10%) had postoperative complications: hardware irritation 5 (5%), sesamoiditis 2 (2%), hypertrophic scar 2 (2%) and joint stiffness 1 (1%). Eight patients (8%) required further surgery (5 required fixation removal due to hardware irritation. Three underwent either; 1st MTPJ open-mobilization, excision of scar or distal metatarsal osteotomy with tibial sesamoid planning). Manchester-Oxford Foot Questionnaire (MOXFQ) showed significant improvement across all domains (mean difference (SD): -51 (SD=22); walking/standing -49 (SD=24); pain -52 (SD=22); and social interaction -51 (SD=28); (p<0.001 for all) with clinically significant effect size (Cohen’s d: 2.37; 2.01; 2.37; and 1.84 respectively). Patient satisfaction questionnaire (PSQ-10) score was high mean of 91 (SD=8). 5 patients (5%) were lost by 6-months follow-up. Conclusion Early weightbearing achieved consistent osseous healing and high PROMS. Larger controlled studies are required to validate these results. Level of evidence Retrospective study. Level III.
The effectiveness of systemic antibiotics for osteomyelitis of the foot in adults with diabetes mellitus: A systematic review protocol
(BMC, 2022-06-17) Uddin, Akram; Russell, David; Game, Fran; Santos, Derek; Siddle, Heidi J.
Background: Osteomyelitis of the foot is a major complication of diabetes that can be limb and life threatening. Systemic antibiotic pharmacotherapy is often used frst line to eradicate infection and allow restoration of devitalised bone. The aim is to conduct a systematic review of the efectiveness of systemic antibiotics on osteomyelitis of the foot in adults with diabetes mellitus. Methods: A systematic review of all interventional studies treating osteomyelitis with systemic antibiotics in participants with diabetes mellitus and an ulcer of the foot below the malleoli will be conducted. Studies not available in English and in people below the age of 18 will be excluded. Study selection will follow the Patient Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P guidelines). The quality of the studies will be assessed using the Cochrane risk-of-bias tool (RoB 2) for all randomised controlled trials and the Newcastle–Ottawa Scale (NOS) will be used for non-randomised controlled trials. Electronic databases will be searched with no timeline restrictions. Data Extraction: All identifed references will be imported to the Rayyan Application. Studies for eligibility will be screened by two reviewers. One reviewer will perform the data extraction and quality appraisal will be conducted by two authors. If sufcient data is available, the quality will be analysed and a meta-analysis will be performed. Data synthesis will be conducted, and meta-analysis undertaken using RevMan 5.4.1 Meta-analysis software. Non-parametric data may be compared between selective intervention and outcomes. Discussion: The results of this systematic review will identify the efectiveness of systemic antibiotic therapy on osteomyelitis of the foot in people with diabetes based on the set outcome measure criteria. The fndings will establish if there are existing consistent standards or variation in practice when treating diabetic foot osteomyelitis (DFO). The study may establish if guidelines are required to standardise practice when treating DFO with systemic antibiotic therapy. This systematic review protocol will synthesise the existing evidence on the efectiveness of systemic antibiotic therapy for treating DFO. Trial registration: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42021245424.
Phalangeal autologous bone graft for flail digit subluxation: A case report
(SAGE, 2022-06-13) Uddin, Akram; Bramall, John; Santos, Derek
A 70-year-old patient was referred for a surgical opinion with a flail digit. Flail digit occurs as a result of over resection to the head of the proximal phalanx beyond the surgical neck and proximally into the shaft. The patient was complaining of a symptomatic right fourth digit (pain 7/10 on a Visual Analogue Scale) that had previously undergone two failed hammer toe surgeries resulting in symptomatic plantar hyperkeratosis with no history of ulceration or infection. The patient was surgically managed with autologous bone graft harvested from an adjacent digit biphalangic phalanx. Six months postoperative, the patient presented asymptomatic. Anatomical alignment, digital stabilisation and function were achieved. Full autologous graft consolidation was confirmed radiographically. Favourable patient-reported outcomes using the Manchester–Oxford Foot Questionnaire showed improvement in all domains. Currently, there is no published case study or description utilising our surgical technique to treat flail digit deformity.
Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review
(MDPI, 2024-05-24) Uddin, Akram; Russell, David A; Game, Fran; Santos, Derek; Siddle, Heidi J
Background: Diabetic foot osteomyelitis (DFO) is a major complication and can lead to significant morbidity and mortality. Systemic antibiotic therapy is often initiated first line to achieve quiescence of infection. To perform a multi-centre case review of systemic antibiotic intervention to treat adults with DFO in England and Wales and compare with national guidelines ‘Diabetic foot problems: prevention and management’. Methods: Eight centres from England and Wales retrospectively collated data from a minimum of five adults (aged ≥ 18 years) from electronic case records. All patients were treated with systemic antibiotics following a new diagnosis of DFO (1 June 2021–31 December 2021). Results: 40 patients (35 males and 5 females) were included; the mean age was 62.3 years (standard deviation (SD) 13.0). Patients commenced systemic oral 14 (35%) or intravenous 26 (65%) antibiotic therapy following a new diagnosis of DFO. Twenty-seven (67.5%) patients were medically or surgically managed in the 12-week period with clinical quiescence of infection. Twenty-one patients (52.5%) had no recurrence of DFO infection within 12 weeks; seventeen (42.5%) of these patients had clinical quiescence of infection with systemic antibiotics alone without surgical intervention and nine (22.5%) of these cases had no recurrence of DFO. There were no cases of major amputation or death. All centres showed significant in-centre variability in systemic antibiotic management; variability was reported in the clinical and quantity indicators specifically to antibiotic selection, single versus dual therapy, mode of delivery and duration of treatment. Conclusions: This case review identifies there is existing variation when treating adults with systemic antibiotics for DFO. Further national guidance is required to standardise service delivery and care to improve patient outcomes.