The aim is to describe the safety and efficacy of TAL in out-patient clinics when managing diabetic forefoot ulcers. Consecutive patients, who underwent TAL and had minimum 12m follow-up were analysed. Forceful dorsiflexion of ankle was avoided and patients were encouraged to walk in Total contact cast for 6-weeks and further 4-weeks in walking boot. 142 feet in 126 patients underwent this procedure and 86 feet had minimum follow-up of 12m. None had wound related problems. Complete transection of the tendon was noted in 3 patients and one-patient developed callosity under the heel. Ulcers healed in 82 feet (96%) within 10 weeks however in 12 feet (10%), the ulcer recurred or failed to heal. MRI showed plantar flexed metatarsals with joint subluxation. The ulcer in this subgroup healed following proximal dorsal closing wedge osteotomy.Abstract
Patients and Methods
Results
Restoration of mechanical axis is one of the main aims during Total Knee Arthroplasty (TKA) surgery. Treatment of osteoarthritis (OA) of the knee with extra-articular deformity either in femur or in tibia poses a technical challenge in achieving this aim. Insufficient correction of axis is associated with poor clinical outcome of total knee arthroplasty (TKA). Extra-articular deformity can either be addressed with compensatory intra-articular bone resection at the time of TKA or correctional osteotomy prior to or at the time of TKA. We present our experience of treating 7 patients with knee arthritis (9 knees) and significant extra-articular deformity. Two patients had OA knee with severe valgus deformity in tibia from recurrent stress fractures. One was treated with one-stage corrective osteotomy and long stem modular TKA. The other had deformity correction with two level tibial osteotomy with intramedullary nail and modular long stem TKA later. Both required tibial tubercle osteotomy during TKA. Two patients with bilateral OA knees and significant varus deformity had sequential deformity correction with Taylor Spatial Frame (TSF) followed by TKA on one side and a single stage intra-articular correction during TKA on the other. Three patients with knee OA and associated deformity (femoral - two pt., tibia one pt.) had symptom resolution with just correction of malaligment with Taylor Spatial Frame (TSF) and did not require TKA.Introduction
Patients & Methods & Results
A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work following carpal tunnel surgery. Impressions were formed from information given by other health professionals or by friends and relatives who had previously undergone surgery. Some patients declined surgery because of their concerns over this particular issue. We therefore set out to challenge these traditional beliefs. This prompted us to adopt a more aggressive postoperative approach by encouraging immediate and unrestricted hand use following surgery. We found that patients were able to tolerate early activity and were able to return to work sooner than they had expected. For the purposes of this study, our aim was to identify when a return to any form of meaningful employment occurred, such that the individual was earning a salary. Consequently, we did not differentiate between the individual returning to either light or full duties. Subsequently, in a cohort of 494 patients prospectively studied, we have seen 93.1% patients return to work by two weeks and 99.4% by four weeks. This has obvious benefits in terms of reducing loss of income. Individuals undergoing surgery now do not have to be concerned with taking lengthy periods of time off work with the financial implications for them and their families. There are obvious economic implications to our findings. An individual back at work should not be claiming related sickness benefit. The Confederation of British Industry (May 2007) report a cost of £76.70 for each day an employee is off work due to sickness. An individual who is able to return to work even one week earlier than previously would have been expected following carpal tunnel surgery could theoretically produce a saving to the economy of £383. In this series there were 318 (64.4%) patients in employment indicating a potential economic saving of £121,794. Given that nationally there are about 50 000 carpal tunnel procedures carried out each year then the potential savings are significant. There may be a number of reasons for our observations. The absence of a bulky restrictive dressing and sling following surgery clearly allows immediate mobilization to occur. Our service allows the development of a close professional relationship based on trust between the operator and the patient. This ultimately reassures patients who, we believe, feeling more involved in decisions about their post-operative care, are consequently well-motivated and have the confidence to use their hand immediately following surgery. We have seen a low postoperative complication rate in this group of patients, in particular, a low incidence of swelling, stiffness and scar sensitivity. Reasons for these low complication rates are unclear, but we would suggest that early mobilisation protects patients against these particular problems.
The purpose of the study was to evaluate if 2 week Levine score can provide an adequately responsive outcome measure in Carpal Tunnel Decompression by comparing it with 6 month score. The treatment outcome of 300 patients with Carpal Tunnel Decompression was determined by using Levine score at 2 weeks and 6 months after surgery. The mean age of patients was 55 years and 6 months, 71.3% (214) were female with 55.33% (167) operations being performed on right hand. All patients were scored through Levine questionnaire pre operatively and at 2 weeks and 6 months from date of surgery. The correlation between the scores was evaluated. Although statistical significance was found between the pre operative score and the scores at both 2 weeks and 6 months, no statistical difference was found between the scores at 2 weeks and 6 months post surgery. Multiple regression analysis with the 2 week–6 month score difference as the dependable variable shows a predictable outcome at 2 weeks. We conclude that the Levine score at 2 weeks is a reliable, responsive and practical instrument for outcome measure in Carpal Tunnel Surgery. It coincides with suture removal and provides a convenient and predictive assessment of the medium term results in a high percentage of treated patients.
