Venous Thrombo-Embolism is a recognized complication of lower limb immobilization. In the neuropathic patient total contact casting (TCC) is used in the management of acute charcot neuroathropathy and/or to off-load neuropathic ulcers, frequently for long time periods. To our knowledge there is no literature stating the prevalence of VTE in patients undergoing TCC. We perceive that neuropathic patients with active charcot have other risk factors for VTE which would predispose them to this condition and would mandate the use of prophylaxis. We report a retrospective case series assessing the prevalence of VTE in the patients being treated with TCCs. Patients undergoing TCC between 2006 and 2018 were identified using plaster room records. These patients subsequently had clinical letters and radiological reports assessed for details around the TCC episode, past medical history and any VTE events.Background
Methods
Swelling following an ankle fracture is commonly believed to preclude surgical fixation, delaying operative treatment to allow the swelling to subside. This is in an attempt to achieve better soft tissue outcomes. We aim to identify whether pre-operative ankle swelling influences postoperative wound complications following ankle fracture surgery. This is a prospective cohort study of 80 patients presenting to a tertiary referral centre with operatively managed malleolar ankle fractures. Ankle swelling was measured visually and then quantitatively using the validated ‘Figure-of-eight’ technique. Follow-up was standardised at 2, 6, and 12 weeks post-operatively. Wound complications, patient co-morbidities, operative time, surgeon experience, and hospital stay duration were recorded. The complication rate was 8.75% ( Increasing age ( Visual assessment of ankle swelling had a poor to moderate correlation to ‘Figure-of-eight’ ankle swelling measurements Neither ankle swelling nor time to surgery correlates with an increased risk of postoperative wound complication in surgically treated malleolar ankle fractures. Increasing patient age and female gender had a significantly greater probability of wound infection, irrespective of swelling. Visual assessment of ankle swelling is unreliable for quantifying true ankle swelling. Operative intervention at any time after an ankle fracture, irrespective of swelling, is safe and showed no better or worse soft tissue outcomes than those delayed for swelling.
We aim to demonstrate the value of deep tissue biopsies to guide antimicrobial treatment of diabetic ulcers. Some recent studies have advocated the role of superficial swabs to guide antibiotic treatment in comparison to deep tissue biopsies previously perceived as the gold standard of microbiology diagnosis. We performed a retrospective analysis of microbiology culture results of patients with infected diabetic ulcers comparing superficial versus deep biopsy microbiology results. Forty-one diabetic ulcers in 41 patients were included. The mean numbers of isolates from soft tissue and bone biopsies were 2.1 and 1.8 respectively. 39/41 combined soft tissue and bone biopsies were culture positive. The most prevalent organism seen in deep samples was Staphylococcus aureus (14) followed by anaerobes (9), and enterococcus (9). In superficial swab cultures 21 patients (51%) cultured non-specific, mixed skin flora and enteric species. The remaining 20 patients cultured Staphylococcus aureus (11), Streptococcus (6), Pseudomonas (2) and anaerobes (6). Three superficial swabs matched deep tissue biopsy cultures. 16 deep biopsies grew organisms seen none specifically in superficial swab cultures with 22 deep tissue biopsies cultures growing organisms not seen on superficial swab with 8 being anaerobes. We have shown that in 54% of cases, deep tissue cultures isolated organisms that were not grown by superficial swab cultures. We highlight the importance of deep tissue biopsies to guide effective treatment.
Diabetic ulcer superficial swab cultures have a low specificity for guiding antibiotic treatment. Some studies have recently re-assessed and advocated the role of superficial swabs. We have performed an analysis of microbiology results in patients with infected diabetic ulcers to further appraise the need for using deep tissue cultures as a guide for antimicrobial treatment. We reviewed 23 consecutive diabetic patients in 2013. All patients underwent investigation and treatment by the Orthopaedic department for deep, intractable diabetic ulceration. Microbiology culture results from superficial swabs were compared to deep tissue and bone biopsies.Introduction:
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Informed consent is integral to good-practice. It protects the patient and offers proof of discussion and interaction between the surgeon and the patient. We compare efficacy of last clinic consent, specialised consent clinic with or without provision of patient specific literature. Group A patients underwent written consent at their last outpatient clinic and conformation of consent on the morning of surgery. Group B underwent consent in designated pre-admission clinic in the week prior to surgery. Group (C) attended the same preadmission clinic and were provided with a surgeon dictated written explanation of their surgery and particular risks. This included a explanation of the procedure, complications, risks and rewards in layman's terms, aimed at patients with a reading age of 14 years, with advice concerning alternative procedures and the consequences of taking no action. The risks are graded: common, less common and rare. All patients undertook a pre-surgery questionnaire on the morning of surgery by an independent observer prior to any contact with the surgical team. Questions focused on their planed procedure, post-operative instructions and possible complications in order to assess the recall of the consent process. A VAS-scale was added to assess overall satisfaction. Statistical analysis was undertaken by a T-test. In total 162-patients were assessed, the response rate was 68.5% (n=111). In-group A (n=16) 18.8% patients remembered 3 relevant complications, 56.2% recalled their post-operative considerations their overall satisfaction was 4/10. In-group B (n=57) 45.5% remembered three complications, 63.7% recalled their postoperative considerations and had a patient satisfaction of 5/10. In-group C (n=38) 48.3% remembered three complications, and 70.7% recalled postoperative considerations, the overall satisfaction improved to 6/10. We observed that the consent process is improved by the use of routine pre-operative consent clinics; however the addition of patient specific literature is observed to further improve recall and satisfaction.
Literature in respect to the MRI appearances of surgically confirmed spring ligament pathology is sparse. The authors conducted a retrospective review of MRI examinations comprising 13 patients with surgically proven spring ligament abnormality. Records for operations performed for planovalgus foot deformity with operation notes confirming presence of spring ligament abnormality were obtained for patients treated 2010–11. Of 32 procedures 13 patients (3 male, 10 female) mean age 48.5 (range, 21–86 years) underwent preoperative MRI scanning using a standard musculoskeletal protocol on a T1.5 unit. Scans were retrospectively reviewed by one of the senior authors and consultant musculoskeletal radiologist for pathological findings.Introduction
Methods
Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.Background
Methods
Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.Background
Methods
Injuries to the lateral ligamentous complex of the ankle are common. The most commonly injured ligament is the anterior talofibular ligament (ATFL) followed by the calcaneofibular ligament (CFL). The posterior talofibular ligament (PTFL) is less commonly injured. There are few studies reporting the incidence of PTFL injury and less data available which describes the significance of this injury. We aim to establish an incidence of PTFL injury and allude to the possible significance of such an injury. A retrospective review of patient notes and magnetic resonance (MR) scans dating from September 2007 to present day was undertaken. Patients complaining of acute or chronic ankle pain, swelling, and instability were included in the study. Exclusion criteria consisted of patients that had undergone previous surgery to the ankle. Routine MR was performed on all patients with oblique axial, coronal and sagittal views taken. 312 patients were included in the study. The incidence of PTFL injury was 10.9%. The PTFL never ruptured in isolation. In 12.3% of patients the PTFL had ruptured with the ATFL and in 28.6% of patients it had ruptured with the CFL. Osteochondral defects were also present in the majority of patients with PTFL failure (57.1%).Methods
Results