This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64).Aims
Methods
Damage to the dorsomedial branch of the medial
dorsal cutaneous nerve is not uncommon in surgery of the hallux. The
resultant morbidity can be disabling. In the light of the senior
author’s operative observation of a sentinel vein, we undertook
a cadaver study to investigate the anatomical relationships of the
dorsomedial branch of the medial dorsal cutaneous nerve. This established
that in 14 of 16 cadaver great toes exposed via a modified medial
incision, there is an easily identified vein which runs transversely
superficial and proximal to the nerve. In a prospective clinical
study of 171 operations on the great toe using this approach, we
confirmed this anatomical relationship in 142 procedures (83%),
with no complaint of numbness or pain in the scar at follow-up.
We attribute this to careful identification of the ‘sentinel’ vein
and the subjacent sensory nerve, which had been successfully protected
from damage. We recommend this technique when operating on the great
toe.
Procedures performed at the incorrect anatomical site are commonly perceived as being relatively rare. However, they can be a devastating event for patients and doctors. Evidence from the United Kingdom and North America suggests that wrong-site, wrong-procedure and wrong-patient events occur more commonly than we think. Furthermore, their incidence may be increasing as NHS Trusts increase the volume and complexity of procedures undertaken in order to cope with increasing demands on the system. In previous studies from North America orthopaedic surgery has been found to be the worst-offending specialty. In this paper we review the existing literature on wrong-site surgery and analyse data from the National Patient Safety Agency and NHS Litigation Authority on 292 cases of wrong-site surgery in England and Wales. Orthopaedic surgery accounted for 87 (29.8%) of these cases. In the year 2006 to 2007, the rate of wrong-site surgery in England and Wales was highest in orthopaedic surgery, in which the estimated rate was 1:105 712 cases.
