Vitamin D plays an important role in bone turnover. Deficiency (including borderline deficiency, or insufficiency) has a known association with fractures and has been linked to delayed or nonunion of fractures. We therefore routinely test vitamin D in cases of nonunion. Noting a high rate of vitamin D deficiency in this group, we instituted a policy to routinely screen for and treat vitamin D deficiency in both post-operative and pre-operative patients. We hypothesised that, in the post-operative patients, levels would correlate with rates of union. We sent serum vitamin D levels on consecutive post-operative patients seen in clinics between January and May 2014. They included those with an arthrodesis of the ankle, triple joint or first MTPJ. Union was deemed to have occurred when the patient was comfortable full weight bearing and radiographs showed trabeculae crossing the fusion site. Nonunions were all confirmed with computed tomography.Introduction:
Methods:
Calcaneal osteotomy is an established technique in correcting hind foot deformity. Patients have traditionally received an open osteotomy through Atkins lateral approach. In order to reduce the rate of wound complications associated with the Atkins approach, a minimally invasive surgical (MIS) technique has been adopted since 2011. This uses a low-speed, high-torque burr to perform the same osteotomy under radiographic guidance. The results of the new MIS technique, including post-operative complication rates, are compared to the standard open approach. The safety of the new MIS technique was investigated by conducting a case controlled study on all patients who underwent displacement calcaneal osteotomy at the Nuffield Orthopaedic Centre, Oxford from 2008 to 2014. The primary outcome measure was 30 day post-operative complication rate. Secondary outcome measures included operating time, duration of stay, fusion rates and amount of displacement achieved.Background:
Methods:
Surgeons want to counsel their patients accurately about the risks of rare complications. This is difficult for venous thromboembolism (VTE), as most studies report rates of asymptomatic disease, which may not be clinically relevant. Generic guidelines promote chemoprophylaxis in foot and ankle surgery despite a relative dearth of evidence. We therefore calculated the rate of confirmed, symptomatic deep vein thrombosis and pulmonary embolism, after surgery or trauma to the foot or ankle, in our hospital. In a retrospective cohort design, we scrutinised referrals for venous Doppler ultrasound and computed tomography pulmonary angiography, and found all confirmed deep vein thromboses (DVTs) or pulmonary embolisms (PEs) over an 18 month period from November 2010 to May 2012. These patients were cross-referenced with our orthopaedic database. All adult trauma admissions and fracture clinic attendances were retrieved and divided according to injury. We then identified all adult elective patients using Healthcare Resource Group code data.Introduction:
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Potential benefits include a reduced incidence of wound complications, faster return to employment and normal footwear. There are no studies published regarding the results of minimally invasive dorsal cheilectomy. Thirty eight patients with painful grade I hallux rigidus underwent dorsal cheilectomy between April 2006 and June 2010. Minimally invasive cheilectomy (MIC) was introduced in August 2009. AOFAS scores, satisfaction, return to normal shoes and employment were assessed.Minimally Invasive foot surgery remains controversial
Patients and Methods
Uncontrolled deep sepsis in the diabetic foot often leads to below knee amputation (BKA). However, for deep sepsis in the forefoot, a transmetatarsal amputation can be curative while preserving the native ankle and hindfoot and allowing mobility without a prosthesis. We critically examined the outcome of transmetatarsal amputation in our diabetic patients with forefoot ulceration and proven osteomyelitis. Data were collected prospectively at the multidisciplinary diabetic foot clinic. We recorded demographic details, duration of diabetes, comorbidities, nature of ulceration, radiological findings, Texas wound score and details of surgery. Patients were followed up regularly in the diabetes clinic. Medical records were reviewed and complications recorded.Introduction
Materials and Methods
