Aim

To assess if immediate post-operative weight bearing has a negative influence on the results of osteotomy plus distal soft tissue repair to correct hallux valgus.

The purpose of our study was to ascertain whether complete debridement and cancellous bone grafting prevents the progression of early (Ficat stages I to III) non-traumatic avascular necrosis of the femoral head.

Between 1995 and 2001 15 patients presented at the Pre-toria Academic Hospital with atraumatic avascular necrosis of the femoral head. The necrosis was staged according to the modified Ficat classification based on radiographs and on MRI and/or a bone scintigram: there were five Ficat stage-I, six stage-IIA, two stage-IIB and two stage-III hips. Postoperatively the diagnosis was confirmed histologically in all cases.

Using the Harris Hip Score (HHS), patients were clinically evaluated preoperatively and at each follow-up examination. The Ficat classification was also determined at each follow-up. A lateral approach with a trap door procedure was followed by debridement of the necrotic area and autogenous bone grafting. The mean follow-up period was 20 months, with the longest follow-up six years. There was no progression of disease in the five patients with Ficat stage-I hips, and there was a mean HHS improvement of 40 points. The six Ficat stage-IIA and two stage-IIB patients also had no progression of disease and exhibited 53 and 78 point respectively HHS improvements. Both Ficat stage-III patients progressed to total hip arthroplasties after a mean of 17 months.

We conclude that debridement and cancellous bone grafting is effective in treating patients with Ficat stage-I to IIB avascular necrosis.

We retrospectively reviewed 100 consecutive cases of foot trauma, sometimes accompanied by other injuries, in people who had instituted legal proceedings to recoup losses after motor vehicle accidents. To keep matters in their correct perspective, it must be noted that claims on a contingency basis were not acceptable at the time of this review.

We excluded from the study patients with only minor foot injuries and significant other injuries. There was significant foot trauma in 14% of the reviewed motor vehicle accident cases, and 75% of patients had significant other injuries. Of patients who had suffered only foot trauma, 32% were male and 68% female. Their mean age was 36 years and the review was conducted a mean of 28 months after injury. Of those who suffered multiple injuries, 65% were male and 35% female. Their mean age was 34 years and the review conducted a mean of 21 months after injury. Combining the effects of patients’ other injuries but reviewing foot injuries separately, we assessed the long-term impact of the injuries as minimal, slight, moderate, severe or very severe. Nearly 50% of the foot injuries had a severe or very severe long-term impact, involving loss of amenities of life and the ability to earn a living. In 44% of the multiple trauma cases, the foot injury alone would cause significant loss of income. In about 30% of these cases the other injuries would have a similarly negative effect. We estimated that 60% of foot injures and 40% of other injuries would later come to need surgical treatment.

When we assessed the quality of care the patients received, we found that 50% of those with only foot injuries and 40% of those with foot and other injuries had not been given optimal treatment for their foot injuries. In 15% of cases the other injuries could have received better treatment.

Our review showed that foot injuries sustained in motor vehicle accidents can have serious long-term effects. However, because they are not life-threatening, at the time of the accident foot injuries receive suboptimal treatment. In multiple trauma patients, foot injuries should not be overlooked. Optimal treatment will improve the final outcome and enjoyment of life of motor vehicle accident victims.