We present a novel approach to the management of patients with longstanding
Introduction: Polymodal anaesthesia has become the core approach for the modern anaesthetist. Femoral, sciatic and obturator nerve blockade, individually or in combination, by means of either single shot or continuous infusion, are often used as adjuncts to general anaesthesia in knee arthroplasty. Methods: We examine the outcome of 2 groups of 100 patients from 2 surgeons and their anaesthetists. All patients received a general anaesthetic. The first group receive a single shot femoral and sciatic nerve block, the second group a standard GA and local infiltration of the surgical field. Post operatively, both groups received identical analgesic regimes and rehabilitation programmes. Results: Length of stay was prolonged in the nerve blockade group, with 21 of the 100 patients still in hospital on day 6 versus 9 patients in the local infiltration group. An initial advantage in flexion and extension in the nerve blockade group was reversed by day 2 and persisted thereafter. Motor dysfunction was seen to be more prevalent and of longer duration in the nerve blockade group. Muscle groups supplied by the sciatic nerve were 4 times more likely to be involved than those supplied by the femoral nerve. Dysaesthesia in the sciatic nerve dermatomes was 5 times more likely within the nerve blockade group, but less likely in the local infiltration group. No significant difference in rates of VTE. Pain control was superior and less analgesia was required in the nerve blockade group. Fewer patients required urethral catheterisation in the local infiltration group. One
The cost effective management of diabetic foot infections is a challenge to the Canadian health system. The objective of this study was to predict preoperatively diabetic foot patients who will fail a transmetatarsal amputation (TMA) and end in a costly and disabling below knee amputation (BKA) and hence perform a primary BKA in select patients. Twenty-one patients failing TMA and revised to BKA within the first year were compared with a matched cohort of twenty-one successful TMA’s. The factors that were selected for comparison were: age at amputation, sex, smoking, type of DM, use of osetoset, presence of charcot fractures, previous contralateral surgery, previous debridement before TMA, debridement after TMA, dialysis, duration of ulcer prior to TMA, hemoglobin level at time of TMA, HbA1C, presence of
Introduction and Aims: The cost-effective management of diabetic foot infections is a challenge to the Canadian health system. The objective of this study was to predict pre-operatively diabetic foot patients who will fail a transmetatarsal amputation (TMA) and end in a costly and disabling below knee amputation (BKA) and hence perform a primary BKA in select patients?. Method: Twenty-one patients failing TMA and revised to BKA within the first year were compared with a matched cohort of 21 successful TMAs. The factors that were selected for comparison were: age at amputation, sex, smoking, type of DM, use of osetoset, presence of charcot fractures, previous contralateral surgery, previous debridement before TMA, debridement after TMA, dialysis, duration of ulcer prior to TMA, hemoglobin level at time of TMA, HbA1C, presence of
Introduction and Aims: The transmetatarsal amputation (TMA) is a limb-saving alternative to below knee amputation (BKA) for diabetic patients with forefoot infections. The purpose of this study was to retrospectively review the outcomes of diabetic patients who received a TMA for a non-healing ulcer of the forefoot with or without insertion of antibiotic beads into the surgical wound. Method: Sixty-five diabetic patients were treated for forefoot ulcers by a single stage TMA and 49 of these patients had insertion of antibiotic pellets into the wound during surgery. A comprehensive chart review was conducted on all patients to gather information on patient age at amputation, sex, smoking, type of diabetes, use of osetoset, time to wound healing, debridement before and after TMA, duration of ulcer prior to TMA, hemoglobin level at time of TMA, HbA1C, presence of
Introduction: Historically, off-loading forefoot neuropathic ulcers with a total contact cast has been an effective treatment method. However, large neuropathic ulcers located on the plantar aspect of the heel or midfoot have been resistant to the off-loading with total contact casting. Therefore, it is not uncommon for these ulcers to persist for several years leading to eventual infection and/or amputation. Objective: To assesses a new and effective off-loading mode of treatment for hindfoot and midfoot ulcers. The device is composed of a fiberglass cast with a metal stirrup and a window around the ulcer. Research, Design and Methods: A retrospective study of 14 diabetic and non-diabetic patients was performed. All had a single chronic planter hindfoot or midfoot neuropathic ulcer that failed to heal via the conventional methods. A fiberglass total contact cast with a metal stirrup was applied. A window was made over the ulcer so as to continue with daily ulcer care. The cast was changed every other week. Results: The average duration of ulcer prior to application of the metal stirrup was 26 ± 13.2 months (range 7 to 52 months). The ulcer completely healed in 12 of the 14 patients (86%) treated. The mean time for healing was 10.8 weeks for the midfoot ulcers and 12.3 weeks for the
