The prescription of lidocaine patches in osteoarthritis-a complete audit cycle.

OBJECTIVES: Nationally, 5% of the population have been prescribed topical lidocaine patches (TLPs). These patches cost €77-230 per month. The only licensed indication for TLP is post-herpetic neuralgia (PHN). It has not proven to be effective for any other indication including musculoskeletal and post-surgical pain. It is estimated that only 5-10% of patients on TLP have PHN. The aim of this study was to audit the number of inpatients currently prescribed TLP-appropriately and inappropriately-and to examine the prescribing patterns. METHODS: The acute inpatient population was audited in August 2017 to determine TLP prevalence. Demographics, indication, prescriber grade, and whether TLP was commenced during the current admission were recorded. Education was given surrounding indications and licensed usage of TLP. The acute inpatient population was subsequently re-audited in February 2018. RESULTS: There were 304 patients included in the initial study and 300 in the repeat study. The most common indication was musculoskeletal pain in each study, 75 and 77.78%, respectively. The number of inpatients on TLP fell from 17.1% (n = 52) to 6% (n = 18) after the intervention. The potential savings between the study periods are therefore €31,418-93,840 in total and €23,100-69,000 in musculoskeletal patients. CONCLUSION: A large proportion of inpatients are inappropriately prescribed TLP predominantly for musculoskeletal pain, resulting in substantial avoidable cost to the hospital. Education of prescribers and implementation of policies is required to limit inappropriate prescribing.

Varus hindfoot deformity after talar fracture.

Posttraumatic malalignment after talar neck fractures invariably leads to painful functional impairment. Anatomic reduction and definitive, stable osteosynthesis at the primary surgical intervention is preventative. Secondary anatomic reconstruction with joint preservation should be considered in the absence of arthrosis in the peritalar articulations. Reorientating arthrodeses should be entertained where deformity has resulted in joint incongruity and, ultimately, posttraumatic arthritis. TAA may have a role as a motion-conserving procedure in combination with adjacent subtalar and midtarsal fusions.

Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

Outcome after surgery for Maisonneuve fracture of the fibula.

The aim of this study was to assess outcome in patients treated surgically for Maisonneuve fractures and to highlight factors associated with a suboptimal result. The authors present a review of 14 patients with Maisonneuve fractures. The mean age was 35.5 years. The most common injury mechanism was a twist incurred whilst participating in sport. The goal of treatment was the anatomic restoration of the ankle mortice with accurate renewal of fibular length. All patients had one or two suprasyndesmotic screws inserted percutaneously under fluoroscopic guidance. These were successfully removed under local anaesthesia in 13 cases (93%). Patients were reassessed clinically and evaluated both functionally and radiographically. Average follow-up was 25.3 months. Twelve patients (86%) had a satisfactory result. They returned to previous activity levels and had favourable Global Foot and Ankle (mean: 95.57) and Shoe Comfort (mean: 81.66) Raw Scores. Ankle range of motion and radiographs were normal. Two patients had an unsatisfactory result. Surgical intervention is recommended to maintain reduction of the fibula into the notch on the tibia, as shortening results in mandatory lateral talar displacement, predisposing to painful ankle arthrosis. The severity of the initial injury and co-morbid disease may adversely affect outcome.