Improving the standard of operation notes in orthopaedic and trauma surgery: the value of a proforma.

Comprehensive documentation of surgical procedures is an essential component of good medical practice, but the standard of operation notes in orthopaedic and trauma surgery has been notoriously poor. The value of proformas in the production of high standard operation notes has been demonstrated in various surgical specialities. We have compared the standard of documentation of operation notes before and after the introduction of a proforma and report a significant improvement (P < 0.001) with the proforma. In addition, the results from a neighbouring hospital where a similar proforma was in use show a sustained standard of documentation 5 years after it was first used.

Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study.

We prospectively reviewed 24 patients (35 feet) who had been treated by a Scarf osteotomy and Akin closing-wedge osteotomy for hallux valgus between June 2000 and June 2002. There were three men and 21 women with a mean age of 46 years at the time of surgery. The mean follow-up time was 20 months. Our results showed that 50% of the patients were very satisfied, 42% were satisfied, and 8% were not satisfied. The mean American Orthopaedic Foot and Ankle Society score improved significantly from 52 points pre-operatively to 89 at follow-up (p < 0.001). The intermetatarsal and hallux valgus angles improved from the mean pre-operative values of 15 degrees and 33 degrees to 9 degrees and 14 degrees, respectively. These improvements were significant (p < 0.0001). The change in the distal metatarsal articular angle was not significant (p = 0.18). There was no significant change in the mean pedobarographic measurements of the first and second metatarsals after surgery (p = 0.2). The mean pedobarographic measurements of the first and second metatarsals at more than one year after surgery were within the normal range. Two patients had wound infections which settled after the administration of antibiotics. One patient had an intra-operative fracture of the first metatarsal and one required further surgery to remove a long distal screw which was irritating the medial sesamoids. We conclude that the Scarf osteotomy combined with the Akin closing-wedge osteotomy is safe and effective for the treatment of hallux valgus.

Circumferential periosteal sleeve resection for limb length inequality complicated by growth plate tether.

Correction of limb length inequality can be achieved by stimulation of growth of the short limb. Circumferential periosteal sleeve resection has been reported as a safe and reliable method of stimulating longitudinal bone growth. We report the complication of growth tethers to the distal tibial physes in two patients following circumferential periosteal sleeve resection to the distal femur, tibia and fibula. This was done under direct vision. This complication may have arisen due to damage to the perichondrial ring as a result of raising the periosteum too close to the distal tibial physes. A limited response may be seen in young patients following this procedure as a result of this complication. Circumferential periosteal sleeve resection for limb length inequality is a treatment option that is not without complication.