Recent advances in minimally invasive surgery and improved post-operative pain management make it possible to perform major foot/ankle operations as day-case. This could have significant impact on length of stay, saving resources and is in keeping with government policy. However, there are theoretical concerns about complications and low patient satisfaction due to pain. The survey was developed following review of the literature and was approved for distribution by the BOFAS (British Orthopaedic Foot & Ankle Society) scientific committee. An online survey (19 questions) was sent to UK foot and ankle surgeons via the BOFAS membership list. Major foot/ ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended pathway.Introduction
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The use of cannulated screws for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 10–20% of fixed intracapsular fractures. The aim of this study was to investigate the rate of AVN with current surgical techniques within our unit. A single centre retrospective review was performed. Operative records between 1st July 2014 and 31st May 2019 were manually searched for patients with an intracapsular neck of femur fracture fixed with cannulated screws, with minimum one year follow up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN and/or non-union. Fracture pattern and displacement, screw configuration and reduction techniques were recorded, with radiographs independently analysed by five orthopaedic surgeons.Abstract
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Diabetes has been associated with greater risk of complications and prolonged postoperative recovery following ankle trauma. Our cohort study seeks to review the operative management and outcomes of ankle fractures in diabetic adults relative to non-diabetic adults. Cases were identified using ICD-10 coding criteria. 572 patients from Jan 2016–2019 presented with ankle fractures; 34 in diabetic patients. Mechanism of injury and stability were determined from the index radiograph using a validated Lauge-Hansen classification algorithm. Admission, primary post-operative and discharge radiographs were reviewed independently by two foot and ankle reconstruction specialists to assess adequacy of fixation method. 32% of diabetic patients were managed non-operatively compared to 29% of the matched non-diabetic cohort. The distribution in Lauge-Hansen fracture pattern was comparable between cohorts. Non-diabetic controls were frequency age-matched 2:1.Abstract
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Knee injuries in cyclists are often thought to result from an imbalance of load during the cycling motion as a consequence of inappropriate bike set-up. Recently, it has been postulated that incorrect foot positioning may be a significant factor in lower limb injury and poor cycling performance. The purpose of this study is to assess the effect of changing the foot position at the shoe-pedal interface on Vastus Medialis (VM) and Vastus Lateralis (VL) activity (mean and mean peak), knee angle and knee displacement. Maximum power tests were completed on a first visit, with data collection on a second visit recorded at 60% of the subjects maximum. Video footage and surface electromyography (SEMG) from VM and VL muscles was obtained. Data was recorded over 10 crank cycles in 3 experimental conditions; neutral, 10 degrees inversion and 10 degrees eversion using Ethylene Vinyl Acetate (EVA) wedges fitted between the cyclists shoe and the shoe cleat. Raw data (mean SEMG, mean peak SEMG) was obtained using Noraxon and SiliconCOACH measured knee angle and knee displacement. Data was analyzed using Friedmans test with appropriate post hoc tests. 12 male subjects (range 26-45, mean 35.9 years) completed the study. Mean and mean peak SEMG data showed no significant differences between the 3 experimental conditions for VM and VL. VM:VL ratios from raw mean SEMG data demonstrated a decrease in synchronicity in inversion and eversion compared to neutral. Pronators demonstrated most synchronicity in inversion and least synchronicity in eversion. There were statistically significant differences in knee angle and knee displacement between neutral, inversion and eversion (p<0.05). Inversion promoted smaller knee valgus angles and greater knee displacement from the bike. Eversion promoted larger knee valgus angles and a smaller displacement from the bike. By altering the foot position to either 10 degrees inversion or 10 degrees eversion, knee angle and knee displacement can be significantly influenced. Clinically, subjects who foot type is classified as pronating may benefit from some degree of forefoot inversion posting. Further research on subjects with knee pain needs to be undertaken.
