Arthordesis of small joints of the foot is a commonly performed procedure in orthopaedics. A variety of fixation devices have been used for this purpose. Nickel-Titanium Memory compression staples for arthrodesis have been used in our institute since June 2003. We report the results of the procedure over a period of 7years involving 252 feet in 232 consecutive patients who underwent arthrodesis or an osteotomy fixation using compression staples. The patients were evaluated to determine the period of immobilization in cast and the time to radiographic joint fusion.

The emphasis of this study was to validate the safety of the implant for fusion of small joints of the foot, as well as to determine whether there is a demonstrable trend in time to fusion and period of immobilization required.

The average time to fusion was 7.2 weeks, the average period of immobilisation was 6.5 weeks. Successful union was achieved in 98% cases. We report the follow up results, finer technical aspects of the procedure and pitfalls to avoid whilst performing the fusions.

Background. A pedobarograph is a device that records pressures exerted by the foot on contact with the ground. Clinically most publications using pedobarography investigated diabetic foot pressures for prevention of ulcers, and assessing gait and sway. Only limited work was done on the effects of foot surgery on foot pressures. Any comparison between papers is hampered by the absence of available defined normal ranges of foot pressures. Aims of Study. The objective of the research project is to describe the foot pressures for 250 volunteers and to identify any trends and relationships of age, sex, body mass index (BMI), shoe & foot size and ethnic origin to foot pressures. The study is to provide a baseline upon which further comparative clinical research can be built. Materials and Methods. a sample size of 250 volunteers was determined after statistical advice. Ethics approval was sought. Recruitment was done after consent from Leicester Royal Infirmary and Leicester University. Volunteers with lower limb injury, diabetes, peripheral vascular disease or spinal cord injuries were excluded. Participants walked barefooted onto a (Takscan) matrix pressure mat. They walked at a speed they considered normal for themselves, as recommended by Taylor et al. We used the two step initiation protocol, invented by Myers-Rice et al to control the stride length, volunteers stood two steps away from the mat and hit the mat in their second step. Five steps per foot were collected for each patient and the average per foot area was calculated. The five steps method provided a coefficient of reliability of 0.94. Each foot was divided into 13 areas using the Tekscan software package. Data analysis was done using SPSS. Study participants’ characteristics (age, sex, foot size, height, weight and BMI) were summarised as a whole and by ethnic group, in tabular and graphical form. Histograms of foot pressure parameters (mean peak pressure at the medial and lateral heel, the mid foot, the head of each metatarsal and at each toe) were generated. The confidence interval was set to 95% and the level of significance to 0.05. Regression analysis testing was carried out to determine any significant relations between the variables. Coefficient of determination was reported for models including age, sex and ethnic origin, with and without adjustment for other body size measures. Results. Study population demographics, as well as BMI, height, weight and the average foot size were described. The average peak foot pressure for each foot area for each ethnic group was described and compared. Regression analysis of the variables has shown statistically significant associations between >70 years age group and low midfoot pressure, high BMI/weight and high midfoot pressure, big foot size and high midfoot pressure. The white western European group had the highest overall foot pressures

Objectives

The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.

Aims

Although infrequent, a fracture of the cuboid can lead to significant disruption of the integrity of the midfoot and its function. The purpose of this study was to classify the pattern of fractures of the cuboid, relate them to the mechanism of injury and suggest methods of managing them.

The incidence of deep-vein thrombosis and the need for thromboprophylaxis following isolated trauma below the knee is uncertain. We have investigated this with a prospective randomised double-blind controlled trial using low molecular weight heparin with saline injection as placebo in patients aged between 18 and 75 years who had sustained an isolated fracture below the knee which required operative fixation. All patients had surgery within 48 hours of injury and were randomised to receive either the placebo or low molecular weight heparin for 14 days, after which they underwent bilateral lower limb venography, interpreted by three independent radiologists. Further follow-up was undertaken at two, six, eight and 12 weeks.

A total of 238 patients fulfilled all the inclusion criteria, with 127 in the low molecular weight heparin group and 111 in the placebo group, all of whom underwent bilateral venography. There was no statistically significant difference in the incidence of deep-vein thrombosis between those patients treated with low molecular weight heparin or the placebo (p = 0.22). The number of deep-vein thromboses in the two groups was 11 (8.7%) and 14 (12.6%), respectively. Age and the type of fracture were significantly associated with the rate of deep-vein thrombosis (p = 0.001 and p = 0.009, respectively) but gender, comorbidities and the body mass index were not.

The overall incidence of deep-vein thrombosis in this series was 11%. There was no clinical or statistical significant reduction in the incidence of deep-vein thrombosis with the use of thromboprophylaxis. However, we accept that owing to a cessation of funding, recruitment to this trial had to be ended prior to establishing the necessary sample size. Our results cannot, therefore, categorically exclude the possibility that low molecular weight heparin treatment could be beneficial. We recommend a further multicentre trial be undertaken to resolve this matter.