Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons
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Ankle fractures requiring operative fixation often swell up after 24h and surgery during this period is not feasible as there are several associated risks including infection and wound breakdown. The affected limb is kept elevated usually in hospital and once the swelling has sufficiently subsided then the operation takes place. We conducted a study looking at the impact of a home therapy ankle pathway on the length of stay and safety of patients with ankle fractures requiring surgical fixation. ⋯ With patients in whom it is indicated, the home therapy ankle pathway has proved to be a safe and resource sparing method of managing ankle fractures prior to surgery.
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Minimally invasive Q3 repair has been proposed for acute Achilles tendon rupture with low rate of complications. However there are still controversies about optimal technique. In this study we aimed to describe Endobutton-assisted modified Bunnell configuration as a new Achilles tendon repair technique and evaluate its biomechanical properties comparing with native tendon and Krackow technique. ⋯ Level II, Biomechanical research study.
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Comparative Study Controlled Clinical Trial
Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture.
Ankle fractures requiring open reduction and internal fixation (ORIF) are common and place considerable burden on inpatient beds. ORIF cannot be performed once the associated swelling is too excessive to permit tension-free wound closure. Where ORIF cannot be performed before the onset of swelling in the first 24-48h, patients typically require up to 7 days of inpatient bed-rest and elevation to reduce swelling to an acceptable level for ORIF. The primary aim of this study was to determine whether delay to ORIF could be reduced with the pre-operative application of an intermittent pneumatic foot pump (IPF). These devices were designed as anti-embolic adjuncts, but have also been shown to be effective in the reduction of swelling. We compared 12 patients managed with an IPF to 12 matched historical controls who were not. No previous studies have addressed this question in unselected patients requiring ankle ORIF. ⋯ We conclude that foot pumps reduce the time to surgery and total hospital stay of patients requiring ankle ORIF, and are cost effective.
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Comparative Study
The effect of the Tscherne injury pattern on the outcome of operatively treated Lisfranc fracture dislocations.
Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury. ⋯ Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations.
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Randomized Controlled Trial
Ankle block in forefoot reconstruction before or after inflation of tourniquet--Does timing matter?
Forefoot surgery causes postoperative pain frequently requiring strong painkillers. Regional blocks are now increasingly used in order to control postoperative pain especially in the first 24h when the pain is at its worst. We conducted a prospective study to see if timing of ankle block i.e. before or after inflation of tourniquet showed any difference in efficacy in postoperative pain control in first 24h. ⋯ A regional anaesthetic ankle block should be routinely used in forefoot surgery to control postoperative pain. The ankle block should be applied after the inflation of tourniquet as this appears to provide better pain control.