Aims

The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated.

Scarf osteotomy for correction of painful hallux valgus is an effective technique, giving a predictable correction of the deformity. However, some patients remain less than fully satisfied, despite normalisation of the usual radiographic parameters. This study examines whether lateral soft tissue release can cause late splaying of the forefoot.

A series of 32 feet in 29 consecutive patients in a single centre, operated on by a single surgeon, over a 12 month period were studied. After pre-operative weight-bearing x-rays and consenting, a standardised ‘Barouk-technique’ Scarf procedure was undertaken with on-table assessment for lateral soft tissue release and phalangeal varisation. Post-operatively, patients were kept heel weight-bearing without cast for 6 weeks, with use of a fabric splint after removal of bandages at 2 weeks.

HVA and IMA were measured pre-operatively, at 6 weeks, and at 6-12 month follow-up. Distance from the mid-points of the 1st to the 5th metatarsal heads and distance from lateral sesamoid to 2nd metatarsal shaft were also recorded by blinded observers. AOFAS Foot Scores were collected prospectively. Student's t-test for single-tailed paired data was applied and p-values calculated. There were 22 female and 10 male feet; in patients aged 27 to 74 (mean 58).

Average HVA improved from 34° to 17° and was maintained at 16°. IMA improved from 14° to 7°, but then increased significantly to 10°. Overall inter-metatarsal width reduced from 76mm to 65mm but then significantly increased to 71mm. Sesamoid distance was also reduced and later increased, but not significantly. Mean foot scores improved from 52 to 85 at late follow-up. Complication rate was low.

Late widening occurred more in those feet with bigger original HVA, which were likely to have had more extensive soft tissue release (deep inter-metatarsal ligament). We recommend cautious release; and pre-operatively counselling specifically regarding eventual overall foot-width.

Introduction: There are no guidelines for the use of any particular tourniquet in foot surgery. We undertook this prospective randomised study to assess the efficacy of the S-MART ^TM tourniquet in foot surgery as compared to the pneumatic tourniquet. A literature review confirms this is the first randomised controlled study objectively measuring the outcomes of this tourniquet system.

Material and Methods: We included 40 consecutive patients who had foot surgery from May 2006 to August 2006. Informed consent with local medical ethics committee approval was obtained. We excluded patients with history of diabetes mellitus, deep vein thrombosis, fractures, limb circumference more than 40 centimetres and smokers. The ease of application of tourniquet, intraoperative bloodless field and ease of removal was scored on a scale of 1–10. Patients were followed up at 2 weeks.

Results: 20 patients were randomised into group one with pneumatic tourniquet (average age 63.36) and 20 patients in group two with S-MART ^TM tourniquet (average age 61.25). The average tourniquet placement time in-group one was 144.36 seconds as compared to 12 seconds ingroup two. The mean ease of application scores was 4.27 in-group one as compared to 1.46 in-group two. Total tourniquet time was more in-group one. Intraoperative haemostasis was rated higher in-group two.

Discussion: SMART ^TM tourniquet provides a good intraoperative haemostasis and is easy to apply. This tourniquet helps to exsanguinate; this frees up theatre personnel, saves resources and decreases tourniquet time for surgery.

The limitation is it cannot be reinflated and cannot be used in patients with fractures.

Conclusion: S-MART tourniquet is a good for foot surgery, provides a good operative field, is easy to apply and saves precious theatre time and resources.