Foot & ankle international
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Ultrasound has been increasingly utilized in procedures involving intra-articular injections. This study's purpose was to compare the accuracy of intra-articular injections of the foot and ankle using palpation versus dynamic ultrasound in a cadaver model. ⋯ Intra-articular injections of the subtalar and ankle joints can be successfully performed utilizing palpation alone. Ultrasound guidance significantly increases injection accuracy into the TMT joints compared to palpation alone and therefore US or Fluoroscopy is performed when injecting these TMT joints. When using selective diagnostic injections into a TMT joint to assess for the symptomatic joint and potential need for arthrodesis, the injected anesthetic may not remain isolated within that joint. These isolated TMT injections should not be done to answer that question without fluoroscopy confirmation with radiopaue dye demonstrating the injected fluid remained within the one joint of interest.
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Combined nerve blocks at the knee can provide safe anesthesia below the knee avoiding the potential complications of general or spinal anesthesia while reducing the need for opioids in the postoperative period. This study presents the outcomes of a large series of patients that underwent foot and ankle surgery receiving a triple nerve block at the knee. ⋯ We found triple nerve block at the knee to be a safe and reliable method of regional anesthesia providing low morbidity, high success rate, long acting analgesia, and fewer complications than general or spinal anesthesia. It is a simple method that can be performed by the orthopaedic surgeon.
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Randomized Controlled Trial
Preoperative footbaths reduce bacterial colonization of the foot.
Previous studies have demonstrated higher infection rates following elective procedures on the foot and ankle compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to ascertain if preoperative chlorhexidine bathing decreased the number of bacteria on the forefoot. ⋯ These data indicate that chlorhexidine provides better reduction in skin flora than placebo. Based of these data, we recommend the use of a chlorhexidine footbath in addition to standard surgical preparatory agent before foot and ankle surgery.