Introduction:

Failure to adequately treat an injury of the syndesmosis leads to poor functional outcomes and posttraumatic arthritis. Many techniques have been proposed to salvage chronic instability. We report on the largest series of chronic syndesmotic injuries to be managed by syndesmotic arthrodesis from Europe to date.

Between October 2006 and September 2007, eight consecutive patients with syndesmotic diastasis of the ankle had Tight Rope suture –endobutton fixation. We present our early results following this fixation. There were 3 males and 5 females with a mean age of 42 years (range 21 – 67). All were followed up for a mean of 7 months. Five patients had right side involvement. Majority were twisting injuries. These patients were compared with a cohort group (10 patients) who had diastasis screw fixation for similar fractures during the same period.

Results: The mean post operative Olerud & Molander ankle subjective score was 86 points. The tourniquet time was significantly less in endobutton group compared to the diastasis screw group(mean of 56 minutes vs. 72 minutes). There was some difference in time to mobilisation between the two groups (mean of 10 days). The endobutton group patients were able to return to work and leisure activities earlier (mean of 4 weeks) compared to the diastasis group. Range of motion was similar in both groups. There were fewer complications in both groups with superficial infection and stiffness being the most common. Both groups were satisfied with the fixation.

Advantages of Tight rope fixation: The tourniquet time was reduced; there was no need for 2nd operation with its attendant risks. Earlier mobilisation was possible leading to early return to work and leisure activities.

We recommend the use of this new suture endobutton fixation for ankle diastasis with promising early functional results. Further prospective studies are needed to evaluate this new type of fixation device.

Background: There is increasing concern regarding radiation exposure to surgeons’ using fluoroscopic guidance during orthopaedic procedures. However, there is currently a paucity of information regarding the level of radiation exposure to the foot and ankle surgeon during fluoroscopically assisted foot and ankle surgery.

Methods: We conducted a 12 month prospective study to measure radiation dose absorbed by the hands of a dedicated right handed foot and ankle surgeon. A thermo-luminescent dosimeter ring (TLD) was worn on little finger of each hand. Measurement of the cumulative radiation dose was recorded on a monthly basis.

Results: A total of 80 foot and ankle cases involving fluoroscopy were performed. The total screening time was 3028seconds (s) (mean screening time 37.4s). Screening time correlated positively with the number of procedures performed (r=0.92, p< 0.001), and with radiation dose in both the left TLD (r=0.85, p=0.0005) and right TLD (r=0.59, p=0.0419). There was no significant difference in radiation dose between either hand (p=0.62). The total radiation dose to the right TLD over the 12 months was 2.4 milli-sieverts.

Conclusion: Radiation dose incurred during orthopaedic foot and ankle procedures is proportional to the screening time. Our results show radiation exposure to be well below the annual dose limit set by the International Commission on Radiological Protection. This work demonstrates a simple and convenient method for evaluating a single surgeon’s radiation exposure.

Background: A subcuticular suture is an ideal closure method of a surgical wound, in patients undergoing foot & ankle surgery, when the aim is healing by primary intention. However, the addition of adhesive strips over the subcuticular suture has become an accepted method of closure despite being based on anecdotal, rather than experimental evidence.

Methods: We performed a prospective study to compare the postoperative wound complications of combination closure (3/0 Monocryl & steri strips) with subcuticular closure alone (3/0 Monocryl). Patients undergoing foot & ankle surgery were allocated to either group on an alternate basis. The wounds of sixty consecutive patients were assessed clinically for wound complications at one-week post op.

Results: Patients who had a combined closure were more likely to develop a wound discharge (23% vs 7%), friable skin (53% vs 3%) and were more likely to have non-opposed wound edges (60% vs 23%). They were also twice as likely to return to clinic for a further wound check (20% vs 10%).

Discussion: Adhesive strips were originally developed as wound dressings and offer no improvement in the tensile strength of the subcuticular closure. Instead their addition exposes the surgical wound to the possibility of epidermal injury from the adhesive in the tape and increases the likelihood of developing wound complications. We recommend meticulous closure of surgical wounds of the foot and ankle with continuous, absorbable, subcuticular suture without adhesive strips, for an optimal outcome.

Arthrodesis of 1st MTP joint is a reliable procedure for hallux rigidus. We have studied the effects of first MTP joint arthrodesis on activities of daily living and leisure activities

Methods: We retrospectively evaluated 103 1st MTP fusion, done by a single orthopaedic surgeon with special interest in foot surgery over seven years period. All patient underwent two cross screw fixation for primary operation. Same operative technique was used in all patients.

We evaluated pre op scoring for pain, walking distance, walking up hill – stairs, foot wear, return to leisure activity and work, chronicity of symptoms, associated symptoms, radiological appearance pre op, post op and at radiological fusion and complication rate.

All patients were followed up.

The patients were contacted with questionnaire to evaluate the function after the fusion.

The patients were asked whether they would participate in the foot pressure study; which was done with the help of podiatrist at same trust.

We have tried to correlate the functional outcome and its relation to foot pressure.

Results: Fusion was achieved in all patients. (three after revision). Pain scores evaluated using the visual analogue scale, indicated effective pain relief. High levels of return to functions were noted. The pressure (under 1st or 2nd Metatarsal heads or laterally) study has revealed a pattern of changes with various symptoms.

Conclusion: Arthrodesis of first MTP joint, using two cross screws, is a successful surgical technique for Hallux rigidus and also allows high level of function in daily activities of living and leisure activities.