Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons
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Comparative Study
A critical evaluation of venous thromboembolism risk assessment models used in patients with lower limb cast immobilisation.
There is a recognised link between lower limb cast immobilisation and the development of venous thromboembolism (VTE). Our aim was to assess the diagnostic accuracy of risk assessment models (RAMs) applicable to this patient group. This has not been done before. ⋯ Each RAM demonstrated significant limitations. Two displayed very limited clinical utility. Three recommended chemical thromboprophylaxis to all patients because they weighted lower limb immobilisation as an absolute risk factor for the development of VTE. Cast immobilisation should not be considered an absolute risk factor when risk assessing patients who all have casts. Prospective evaluation with a larger patient cohort is required.
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The differences at the attachment site of peroneus brevis (PB) to the fifth metatarsal bone is important in terms of the forces exerted on the bone and hence the mechanism of fractures involving this structure. In this study, we investigated the anatomical properties of PB at the insertion site to the base of fifth metatarsal bone, its possible intertendinous connections with peroneus tertius (PT) and their possible effects on the fracture occurrence at the bony attachment site. ⋯ Knowing the width and insertional types of PB aids in understanding the mechanism of fractures at the site of bony attachment. The existence of slips may help the surgeon in the procedures involving PB or the lateral side of the forefoot.
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Many types of screws, plates, and strut grafts have been utilized for ankle arthrodesis. Biomechanical testing has shown that these constructs can have variable stiffness. More recently, headless compression screws have emerged as an evolving method of achieving compression in various applications but there is limited literature regarding ankle arthrodesis. The aim of this study was to determine the biomechanical stability provided by a second generation fully threaded headless compression screw compared to a standard headed, partially threaded cancellous screw in a cadaveric ankle arthrodesis model. ⋯ There is no demonstrable difference between traditional cannulated partially threaded screws and headless compression screws studied in this model.
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Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported. ⋯ Realignment and fixation with MFB in severe CN result in adequate correction with minimal loss of correction in the observed clinical course. The non-union rate was lower than previously reported. Stable fixation with MFB is a valuable treatment option for CN with minimal loss of correction and high union rates. The use of a minimum of two bolts is recommended to avoid recurrent deformity. Clinical Trials.gov: NCT01770639.
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Lower-limb immobilization has been implicated as an etiologic factor for a venous thromboembolism (VTE). Most of the current literature encourages the use of thromboprophylaxis with injectable low-molecular-weight heparin (LMWH) in trauma patients. Injectable anticoagulants have inherent problems of producing pain and bruising. They are also difficult to administer, leading to low compliance. Oral anticoagulants are therefore gaining popularity for use as thromboprophylactic agents in hip and knee arthroplasty patients. There are not enough studies in the literature, however, to support their use in ambulatory trauma patients whose ankle fractures are being managed nonoperatively on an outpatient basis. ⋯ This study shows that an oral anticoagulant was a safe alternative to injectable LMWH as a thromboprophylactic agent for ambulatory trauma patients requiring temporary lower limb immobilization for non-operative management of an ankle fracture.