ABSTRACT
The senior author (N.P.G.) observed that if the foot became dependent in the first 48 hours after foot surgery, the patient had swelling and pain. This effect seemed less after about 48 hours. The authors set out to see if there was a scientific basis for this. Laser Doppler was used to assess blood flow in 14 patients. Flow was recorded in the big toe, at heart level, and on dependency, preoperatively and postoperatively. Postural vasoconstriction was calculated, and time for blood flow to normalize was recorded. Mean postural vasoconstriction preoperatively was 51.31%; postoperative mean at 24 hours was 23.05%, at 48 hours 36.62%, and at 72 hours 44.24%. There was a difference between the preoperative levels and the 24-, 48-, and 72-hour postoperative levels (P < .05). Results showed that it takes longer than 72 hours rather than 48 hours for microcirculation to return to normal. The results emphasized the importance of postoperative foot elevation for at least 48 hours because of this phenomenon.
Subject(s)
Ankle/surgery , Foot/blood supply , Foot/surgery , Adult , Aged , Humans , Laser-Doppler Flowmetry , Microcirculation , Middle AgedABSTRACT
Nineteen patients (27 feet) with symptomatic hallux valgus who underwent modified McBride procedure were studied prospectively. The outcome measures included preoperative and postoperative American Orthopaedic Foot and Ankle Society's Hallux Metatarsophalangeal-Interphalangeal scoring, weight-bearing radiographs, and pedobarography using the EMED-SF*6 System. The average patient age was 49.7 years, and all patients were women. The average follow-up was 7 months. Results showed an average improvement in rating scale score from 53 to 87/100, in the hallux valgus angle from 32 degrees to 15 degrees, and in the first intermetatarsal angle from 15 degrees to 10 degrees. Pedobarographic analysis showed a statistically significant increase in the contact area of the hallux by 17.5% (P<.001), with a reduction of peak pressures of the hallux by 29% from 67.5+/-29.5 N/cm2 to 48+/-34 N/cm2 (P<.001; confidence interval, 9.887, 29.233) and the total foot by 8% from 89+/-26 N/cm2 to 82+/-25 N/cm2 (P<.05; CI, 0.727, 14.900). The overall satisfaction rate was 96%. We conclude that the modified McBride procedure has a role in patients with passively correctable hallux valgus and a supple metatarsocuneiform joint.
Subject(s)
Hallux Valgus/surgery , Orthopedic Procedures/methods , Adult , Aged , Female , Hallux/physiopathology , Hallux/surgery , Hallux Valgus/diagnostic imaging , Hallux Valgus/physiopathology , Humans , Middle Aged , Pressure , Prospective Studies , Radiography , Reproducibility of ResultsABSTRACT
The case, of a patient who is believed to be the longest surviving person with a hip arthroplasty is reported. The patient is still pleased with the function of the Smith-Petersen arthroplasty 46 years following its insertion, and has declined revision to a total hip arthroplasty.
Subject(s)
Hip Prosthesis , Adult , Female , Follow-Up Studies , Humans , Osteoarthritis, Hip/surgery , Time FactorsABSTRACT
A plastazote support is described which has advantages over the conventional roller towel method for elevating the upper limb. The reasons for elevation are briefly discussed.
