Background

In the adolescent population, operative management of hallux-valgus is controversial. Operations may be less successful than in adults and post-operative recurrence is more common before full skeletal maturity. This study assesses the radiographic, functional and qualitative outcomes of surgical Hallux Valgus correction in adolescents.

Introduction

Venous thromboembolism (VTE) is an uncommon complication of foot and ankle surgery but has the potential for significant morbidity and mortality. The incidence, risk factors and prevention of VTE in foot and ankle surgery is not clear.

Background: Postoperative pain following hindfoot surgery can be difficult to control with opioid analgesics. Popliteal nerve blocks have been shown in the literature to be effective in both delaying the onset of postoperative pain and reducing the intensity of the pain, with a variable duration of effect. In 2007 we established a ‘block team’ of anaesthetists available to administer popliteal blocks preoperatively.

Methods: Forty-nine consecutive patients undergoing hindfoot surgery were selected. Data was collected: The proportion of patients having a block; opiate requirement during surgery, in the recovery room and on the ward; pain score; time to mobilize after surgery; and length of stay.

We compared two techniques used for popliteal block and also compared post-operative pain control with and without a popliteal block.

Results: There was a considerable increase in the percentage of patients who had a popliteal block after the block team was established (40% to 91%). Six of 23 (23%) patients needed opiates in the recovery room in the nerve block group; compared to12 of 20 (60%) patients who did not have a block. Comparing the two techniques used for the nerve block, ultrasound guidance reduced postoperative intravenous opiate usage compared to blocks given with the aid of a nerve stimulator (p< 0.05). Fifteen of 16 (94%) patients mobilized on the first post operative day in the ultrasound group compared to 16 of 23 (64%) in the patients who had no block. There were no complications recorded as a result of popliteal nerve blocks.

Conclusions: Establishing a block team has improved the proportion of patients receiving a popliteal block in hindfoot surgery in our hospital. The ultrasound guided technique gives superior results in terms of pain relief and earlier mobilization, when compared blocks administered using a nerve stimulator.

Introduction: Long waiting times for surgery and government targets places added pressure on the administration of surgical units. In an effort to decrease waiting times from initial referral to surgery and to meet new to follow-up patient ratios set by the government, a policy of early discharge from follow-up was introduced for many procedures involving the foot and ankle. This audit assessed whether this policy increased procedure morbidity and patient dissatisfaction.

Methods: A 12-month retrospective audit was performed (October 2005 – September 2006) on the foot and ankle surgery cases performed at the Great Western Hospital, Swindon and Marlborough Trust, UK. Procedure and out-patient appointment data was accessed including new, follow up and ‘SOS’ patient attendances. Appointments were considered SOS if a patient sought consultation with a surgeon following discharge in the post operative setting.

Results: A total of 1128 foot and ankle procedures were performed on 639 patients. Eighty five percent (958) procedures met the early discharge from follow-up criteria. There were 2750 appointments for the respective period. Twelve hundred and seven (44%) were new patient appointments and 1543 (56%) were follow-up appointments. There were 84 SOS attendances related to a surgical episode, comprising 2% of appointments and 6% of procedures. Sixty-seven of the SOS attendances (80%) were related to an early discharge from follow-up procedure. A high proportion of SOS attendances were associated with joint stiffness, digital malposition and dysesthesia relating to Hallux Valgus correction, lesser digit arthrodesis and intermetatarsal neurectomy respectively.

Discussion: In this series, the aforementioned complications are consistent with those reported in the literature and we conclude they were not a consequence of early discharge. Early discharge from follow-up following selected common surgical procedures for the foot and ankle can potentially increase productivity of the out patient department without impact on procedure morbidity and patient satisfaction.

Introduction and Aims: To study the natural history of the bone bruising of the knee and to identify the effect of weight-bearing and associated internal derangement on clinical improvement and radiological progress of the bone bruising of the knee.

Method: Patients with an acute knee injury were prospectively subjected to clinical and MRI examination within 48 hours of injury. Patients with osteoarthritis, bleeding disorder and previous injury or surgery to the injured knee were excluded. Internal derangement of the knee joint was identified. Patients with bone bruising (study group) were randomised into weight-bearing and non weight-bearing groups and followed-up for clinical and MRI examination at six weeks, three months, six months and 12 months. At follow-up, bone bruising on MRI was classified as Progressive, Static, Resolving or Resolved. Patients without bone bruising (control group) were similarly followed up for clinical examination. Lyshom score was used for clinical assessment.

Results: 28 patients were available for the follow-up. Average age was 24. There were eight patients in control group and 10 patients each in weight-bearing and non weight-bearing group. Eleven patients had associated internal derangement of the knee joint.

Clinical improvement was better in the control group compared to the study group. Patients with isolated bone bruising were doing better than those with associated internal derangement.

On radiological examination there was tendency for the bone bruise to progress in the first six weeks but majority started resolving by three months time. All isolated BB were resolved by six months, but there was delayed resolution of BB associated with ID.

Weight-bearing status did not influence clinical or radiological course of bone bruising.

Conclusion: Weight bearing does not alter the course of the bone bruising. Internal derangement associated with bone bruising delayed radiological resolution and clinical improvement of the patient.

Aim To study the natural history of bone bruising of the knee and to identify the effect of weight bearing and associated internal derangement (ID) on clinico-radiololgical progress of bone bruising of the knee.

Method Patients with an acute knee injury were prospectively assessed by clinical and MRI examination within 48 hours of injury. Patients with fracture, osteoarthrosis, bleeding disorder and previous injury or surgery to the injured knee were excluded. Internal derangement (ID) of the knee joint was identified. Patients with bone bruising (study group) were randomised into weight bearing and non weight bearing groups and followed up for clinical and MRI examination at six weeks, three months, six months and twelve months. At follow up, bone bruising on MRI was classified as Progressive, Static, Resolving or Resolved. Patients without bone bruising (control group) were similarly followed up for clinical examination. This is an ongoing study

Results Twenty-eight patients were available for the follow up. There were 8 patients in the control group and 10 patients each in the weight bearing and non-weight bearing group. Eleven patients had associated internal derangement of the knee joint.

Clinical improvement was better in the control group compared to the study group. Patients with isolated bone bruising were doing better than those with associated ID.

Radiololgically there was a tendency for the bone bruise (BB) to progress in the first six weeks but the majority started resolving by three months time. All isolated BB were resolved by six months but there was delayed resolution of BB associated with internal derangement.

Weight bearing status did not influence clinical or radiological course of bone bruising.

Conclusion Weight bearing does not alter the course of the bone bruising. Internal derangement associated with bone bruising delayed radiological resolution and clinical improvement of the patient.