Nima Heidari

Orthopaedic Specialists

Background Anatomical reduction of unstable Lisfranc injuries is crucial. Evidence as to the best methods of surgical stabilization remains sparse, with small patient numbers a particular issue. Dorsal bridge plating offers rigid stability and joint preservation. The primary aim of this study was to assess the medium-term functional outcomes for pa...

Objective To identify key variables predictive of patient responses to microfragmented adipose tissue (MFAT) treatment in knee osteoarthritis (KOA) and evaluate its potential to delay or mitigate the need for total knee replacement (TKR). Methods We utilised a dataset comprising 329 patients treated with MFAT for KOA, incorporating variables such a...

Background Quantum computing and quantum machine learning (QML) are promising experimental technologies that can improve precision medicine applications by reducing the computational complexity of algorithms driven by big, unstructured, real-world data. The clinical problem of knee osteoarthritis is that, although some novel therapies are safe and...

Fracture Related Infection (FRI) represents one of the biggest challenges for Trauma and Or-thopaedic surgery. A better understanding of the microbiological profile should assist with decision-making and optimising outcomes. Our primary aim was to report on the microbiological profile of FRI cases treated over a six-year period at one of Europe's b...

Background: Talus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. Methods: We retr...

Introduction Pin site infection is a commonly encountered complication. There is no universally accepted definition or classification system which impairs data interpretation and the development of evidence-based practice. The aim of this systematic review is to investigate the existing classification systems and the quality of reporting pin site i...

Purpose Fracture-related infections (FRI) following intramedullary nailing for tibial shaft fractures remain challenging to treat with associated high patient morbidity and health care costs. Recently, antibiotic-coated nails have been introduced as a strategy to reduce implant related infection rates in high-risk patients. We present the largest s...

Objectives: To assess medium-term functional outcomes and the complication profile for unstable Lisfranc injuries treated with Dorsal Bridge Plate (DBP) fixation when implants are not routinely removed. Design: Large single-center retrospective case series. Setting: Level-1 Trauma Center, London, United Kingdom. Patients: Consecutive cases o...

Introduction: Circular frame fixation remains a key tool in the armamentarium of the limb reconstruction surgeon. One of the key drawbacks is the onset of pin-site infection (PSI). As a result of limited evidence and consensus of PSI prevention, a wide variation in practice remains. Aim: The principal aim of this review is to synthesise primary...

Introduction Malunited comminuted calcaneal fractures result in poor function due subtalar joint arthritis and altered biomechanics. We aimed to assess whether percutaneous subtalar joint screws after fracture reduction provide good outcomes for these difficult injuries. Methods We retrospectively analysed 15 comminuted calcaneal fractures (in 14...

Monomeric C-reactive protein (mCRP), once thought to be a figment of the imagination and whose biological activity was ascribed to its sodium azide preservative, has now pronounced itself as a critical molecule playing a direct role in mediating many of the acute and chronic aberrant pathological responses to inflammation. In this focused mini revi...

Hip osteoarthritis (OA) is a major contributor to reduced quality of life and concomitant disability associated with lost working life months. Intra-articular injection of various biological materials has shown promise in alleviating symptoms and potentially slowing down the degenerative process. Here, we compared the effects of treatment of a coho...

Category Midfoot/Forefoot; Trauma Introduction/Purpose Lisfranc injuries represent a significant disruption to the complex articulations of the midfoot. Many of these injuries are unstable with displacement and articular incongruity. This necessitates surgical intervention with the primary goals of anatomic reduction and midfoot stability. Evidenc...

Category Ankle; Hindfoot; Trauma Introduction/Purpose Open talar dislocations with complete or partial extrusion of the talus are rare, high energy injuries associated with major complications including infection, avascular necrosis and post-traumatic arthritis. These are debilitating injuries with significant long-term effects including avascular...

Category Midfoot/Forefoot; Trauma Introduction/Purpose Overwhelming demand for trauma services with increasing emergency department (ED) attendances, has increased pressure on fracture clinics in many units, with this demand exceeding capacity. Virtual fracture clinics (VFCs) have been shown to be safe and cost-effective in many specialties. Optim...

Category Ankle; Trauma Introduction/Purpose Ongoing controversy exists over the indications and benefits of posterior malleolar fixation in ankle fractures. These injuries require careful evaluation of the bony and ligamentous structures with theoretical benefits of posterior malleolar fixation now widely accepted as restoration of articular congr...

Purpose The optimal means of local antibiotic delivery for fracture related infection is unknown. Until now, intramedullary application of calcium sulphate based local antibiotics has been challenging. We report on the use of a newly available mode of preparation and delivery: the Stimulan Bullet Mat and Introducer (Biocomposites Ltd, Staffordshire...

Background Quantum computing (QC) and quantum machine learning (QML) are promising experimental technologies which can improve precision medicine applications by reducing the computational complexity of algorithms driven by big, unstructured, real-world data. The clinical problem of knee osteoarthritis is that, although some novel therapies are saf...

Rotational deformities following intramedullary (IM) nailing of tibia has a reported incidence of as high as 20%. Common techniques to measure deformities following IM nailing of tibia are either based on clinical assessment, plain X-rays or Computed Tomography (CT) comparing the treated leg with the uninjured contralateral side. All these techniqu...

Introduction Osteoarthritis is a leading cause of global disability and is set to worsen with the concurrent rise in rates of obesity and an ageing population [1]. Current clinical solutions are sub-optimal with regards to their invasiveness and outcomes. Orthopaedic biologics is an emerging field that offers alternative and parallel treatment opti...

Background The effect of demineralized bone matrix (DBM), bone marrow–derived mesenchymal stromal cells (BMSCs), and platelet-rich plasma (PRP) on bone tunnel healing in anterior cruciate ligament reconstruction (ACLR) has not been comparatively assessed. Hypothesis These orthobiologics would reduce tunnel widening, and the effects on tunnel diame...

Fracture-related infection (FRI) is one of the most challenging complications following operative management of fractures. It can have profound implications for the patient, can be associated with considerable morbidity and often lead to impaired outcomes. There are significant healthcare-related costs. In recent years, there has been significant p...

Subtalar distraction bone block arthrodesis is a useful technique commonly employed in the management of calcaneal and talar fracture malunion. Traditionally it is performed via a posterolateral or extensile lateral approach, however such approaches have been associated with wound complications, particularly secondary to the added stress caused by...

Background: Knee osteoarthritis (KOA) is a significant cause of disability in a globally ageing population. Knee replacement surgery has been shown to improve function and quality of life. Access to this intervention can be limited for a number of reasons including rationing of care, lack of healthcare provision in austere environments, and more r...

Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients' lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the...

This book covers key areas of pharmaceutical research. The contributions by the authors include gestational diabetes mellitus, pregnancy, complications, hyperglycaemia, DFT calculations, Kinetics, acid-catalyzed hydrolysis,LLamotrigene formulations, gangliosides, signal transduction, mast cells, activation, newly formed mediators, newly synthesized...

Adipose tissue and more specifically micro-fragmented adipose tissue (MFAT) obtained from liposuction has recently been shown to possess interesting medicinal properties whereby its application supports pain reduction and may enhance tissue regeneration particularly in osteoarthritis. Here we have characterised samples of MFAT produced using the Li...

Monomeric C-reactive protein (mCRP) is now accepted as having a key role in modulating inflammation and in particular, has been strongly associated with atherosclerotic arterial plaque progression and instability and neuroinflammation after stroke where a build-up of the mCRP protein within the brain parenchyma appears to be connected to vascular d...

Knee osteoarthritis is a major cause of disability worldwide. Newer modalities of treatment with less morbidity, such as intra-articular injection of microfragmented fat (MFAT), are showing promise. We report on our novel observation that women show a greater improvement in pain and function to MFAT than men. Traditionally, women have been underrep...

Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturati...

Aims Ongoing controversy exists over the indications and benefits of posterior malleolar fixation in ankle fractures. The aim of this pragmatic study was to evaluate the outcomes of posterior malleolar fracture fixation in ankle fractures in the setting of a major trauma centre. Our hypothesis is that posterior malleolus fixation leads to improved...

Objectives: The aim of this study is to review the available literature addressing the safety and efficacy of antiseptics in surgical wounds. The different antiseptic solutions, irrigation volumes, time scales and delivery methods have been compared so that evidence-based recommendations on antiseptic use in orthopaedic, foot and ankle surgical pro...

Objectives: The aim of this study is to review the available literature addressing the safety and efficacy of antiseptics in surgical wounds. The different antiseptic solutions, irrigation volumes, time scales and delivery methods have been compared so that evidence-based recommendations on antiseptic use in orthopaedic, foot and ankle surgical pro...

Introduction: Rotational deformities following IM nailing of tibia has a reported incidence of as high as 20%. Common techniques to measure deformities following IM nailing of tibia are either based on clinical assessment, plain X-rays or CT-scan comparing the treated leg with the uninjured contralateral side. All these techniques are based on exam...

Introduction. Microfragmented adipose tissue (MFAT) has been shown to benefit osteoarthritic patients by reducing pain and supporting tissue regeneration through a mesenchymal stem cell (MSC)-related paracrine mechanism. This observational study of 110 knees assessed patient-centered outcomes of pain, functionality, and quality of life, analyzing t...

Background Intraoperative two-dimensional (2D) fluoroscopy is the standard imaging modality available to orthopaedic surgeons worldwide. It is well-accepted, however, multiplanar 3 dimensional (3D) CT scanning is superior to 2D imaging for visualising joint surfaces and is now a fundamental feature of the pre-operative planning of intra-articular f...

Bone transport for large femoral bone defects using a magnetic lengthening nail to pull the transport segment and double plating to allow immediate full weight bearing and knee range of movement.

Background: A variety of techniques for management of segmental femoral bone loss have been described, each with different advantages and challenges during treatment. The development of motorized lengthening nails has provided a potential for all internal bone transport, avoiding some of the difficulties with external fixation in the femur. At pres...

Aim: The aim of this is to allow the use of unsterile kit (clamps and rods) in situations where the demand for external limb fixators exceeds the available sterile equipment. Background: In view of the recent rise in violence and terrorist activity, we have to be prepared for situations causing major incidences. These can place a large strain on...

Recommendation Patients who present with clinical symptoms and signs of periprosthetic ankle infection (pain, erythema, warmth, sinus tract, abscess around the wound) and sinus tracts communicating with the ankle/subtalar joint are likely to have total ankle arthroplasty (TAA) infection. In the absence of a sinus tract, elevated inflammatory marker...

Recommendation Yes. Bone biopsies play both a crucial diagnostic and interventional role in the management of diabetic foot infection. Although bone biopsies are not required in every case of diabetic foot infection, their most important role is in guiding accurate antibiotic treatment, as they provide more accurate microbiological information than...

Recommendation With regard to total ankle arthroplasty (TAA), there is a lack of evidence to recommend for or against the use of betadine solution. Level of Evidence Consensus. Delegate Vote Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Recommendation Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The maj...

Recommendation Differentiation between acute Charcot neuroarthropathy (CN) and acute infection/osteomyelitis is complex and requires multiple (>1) diagnostic criteria. These criteria include an emphasis on the presence of neuropathy, history, and physical examination. The absence of skin wounds and resolution of swelling/erythema with elevation mak...

Background: Flexible idiopathic flatfoot is the most common form of flatfoot. First line treatments are parental reassurance and conservative measures; however, surgical treatment may be needed in some cases. A number of surgical techniques with varying results have been described in the literature. Here, we present our clinical and radiological o...

Aims: The management of a significant bony defect following excision of a diaphyseal atrophic femoral nonunion remains a challenge. We present the outcomes using a combined technique of acute femoral shortening, stabilized with a long retrograde intramedullary nail, accompanied by bifocal osteotomy compression and distraction osteogenesis with a t...

Aims: Computer hexapod assisted orthopaedic surgery (CHAOS), is a method to achieve the intra-operative correction of long bone deformities using a hexapod external fixator before definitive internal fixation with minimally invasive stabilisation techniques. The aims of this study were to determine the reliability of this method in a consecutive c...

Introduction Surgical training is undergoing major changes with significant reductions in time to train and an increasing focus on patient safety. Low fidelity, low-cost laparoscopic simulators have been shown to be an effective training tool and acceptable to trainees however there is no comparable evidence within the orthopaedic context. The Arth...

Introduction: Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal...

We describe the intraoperative use of the Taylor Spatial Frame to correct complex multiplanar deformities of the tibia prior to definitive internal stabilization utilizing minimally invasive techniques.Thirteen consecutive procedures were performed in 12 patients. All deformities of the tibia were assessed with standardized radiographs allowing est...

Fractures of the foot are uncommon in childhood and account for 5–8 % of all fractures and 7 % of all physeal injuries. The forefoot is the most common site of injury comprising two-thirds of the fractures.

Slipped upper femoral epiphysis is a disabling condition with an annual incidence of 2-13 per 100,000. In situ surgical fixation is the preferred initial treatment for both stable and unstable slipped capital femoral epiphysis (SCFE) cases. The main aim is to avoid further slippage and complications such as osteonecrosis and chondrolysis. The choic...

Emergency treatment in the pediatric trauma patient with a pelvic fracture is orientated to the concepts established in adults (59). The main parameters in decision making are the hemodynamic situation and the grade of instability of the pelvis (36). It has to be considered that the child has a longer hemodynamic compensation before a severe shock...

Background: Injections, punctures, and aspirations of the first metatarsophalangeal joint are common interventions. Accurate intra-articular placement of the needle is a prerequisite for the achievement of desirable results and the avoidance of complications. We evaluated the rate of successful intra-articular injections and the influence of the d...

Injury to the acetabular growth plate is rare. Accordingly, data on the incidence in the literature are controverse. Other difficulties include the clear definition of a pediatric acetabular injury. The modified classification according to Salter-Harris described by Bucholz is used in immature patients. The majority of these injuries can be treated...

In paediatric patients with fractures of the distal radius, the consequences of associated ulnar styloid fractures are often underestimated. These may include persisting pain or functional deficits. The aim of the present study was to report the outcome of these fractures using a modified DASH-Score. All children with distal radius fractures treate...

Gene therapy has been used successfully in several areas of medicine as a technique to either alter defective genes or as method to enable delivery of therapeutic proteins. Despite advances in surgical and pharmaceutical interventions for diseases of bone regeneration and healing, results in certain patient groups remain sub-optimal. With this cons...

Operative treatment of displaced and comminuted radial head fractures involves internal fixation with plates and screws in cases where reconstruction is possible and replacement with a radial head prosthesis when comminution renders the radial head unreconstructable. The purposes of this study were to evaluate the morphometry of the radial head usi...

Pediatric pelvic injury is of major significance despite these injuries in children are rare with a suspected yearly rate of 3% of all pelvic injuries. The special pediatric bone anatomy of the pelvis is responsible for different fracture patterns, and overall, a bony or joint injury of the pelvis is an indicator of a severe trauma. The vast majori...

Trauma is the leading cause of death in children. Pelvic ring injuries account for 0.3-4 % of all paediatric injuries. The pattern of fractures differs to that seen in adults as it is more ductile. Pelvic ring injuries tend to be more stable as the relatively thick periosteum restricts bony displacement. Intrapelvic viscera are not well protected a...

Chemical thromboprophylaxis has been shown to reduce the incidence of venous thromboembolism (VTE) for patients with fractures of the hip, but it is not known with certainty whether it use also reduces mortality. Using postal and telephone questionnaires we collected data from English National Health Service (NHS) hospitals about their thromboproph...

Background: Posterolateral tibial plateau shear fractures often require buttress plating, which can be performed through a posterolateral approach. The purpose of this study was to provide accurate data about the inferior limit of dissection. Methods: Forty unpaired cadaver adult lower limbs were used. The anterior tibial artery was identified b...

Purpose: Low anterior external fixators are constructed by placing half pins in the dense bone tunnel of the supra-acetabular region in an anterior to posterior direction. Although the placement of these pins is extra-articular, they may still breach the hip capsule on the anterior inferior iliac spine and thus be intra-capsular. We aim to provide...

The Taylor Spatial Frame (TSF) is a circular external fixator used to treat complex fractures and skeletal deformities [1-3]. The device consists of two rings attached to bone by wires or half pins, connected by universal hinge joints to six independent telescopic struts, creating a hexapod. The output piece is defined as the movable ring which has...