Different fixation constructs and the risk of non-union following first metatarsophalangeal joint arthrodesis.

BACKGROUND: The aim of this study was to determine if a single or separate construct with interfragmentary screw was associated with higher rates non-union following first metatarsophalangeal joint (MTPJ) arthrodesis. METHODS: A retrospective analysis of patients undergoing first MTPJ arthrodesis between April 2010 and June 2017 was performed. Patients who received either a single (Stryker Anchorage 1 MTP Cross Plate) or separate (Stryker Anchorage 1 MTP locking plate with one Asnis partially threaded compression screw) construct locking plate and interfragmentary compression screw were reviewed. Descriptive statistics were generated for sample demographics and between-group differences were calculated. Multivariable regressions explored internal fixation type and association with non-union. RESULTS: A total of 280 first MTPJ arthrodesis met the inclusion criteria and were reviewed. The incidence of non-union was 7.9% of procedures (22 joints). Following multivariable binary logistic regression, the single construct locking plate with interfragmentary compression screw was associated with an increased risk of non-union (OR 3.43, 95% CI 1.26-9.33), adjusting for age, gender and comorbidity. CONCLUSIONS: A single construct interfragmentary screw and locking plate (Stryker Anchorage 1 MTP Cross Plate) was associated with an increased incidence of non-union following first MTPJ arthrodesis.

Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high-risk foot coordinator in an acute foundation trust hospital.

BACKGROUND: To enhance the acute management of people with diabetic foot disease requiring admission, an extended scope of practice, podiatric high-risk foot coordinator position, was established at the Great Western Hospital, Swindon in 2010. The focus of this new role was to facilitate more efficient and timely management of people with complex diabetic foot disease. The aim of this project was to investigate the impact of the podiatric high-risk foot coordinator role on length of stay, rate of re-admission and bed cost. METHOD: This study evaluated the difference in length of stay and rate of re-admission between an 11- month pre-pilot period (November 2008 to October 2009) and a 10-month pilot period (August 2010 to June 2011). The estimated difference in bed cost between the pre-pilot and pilot audits was also calculated. Inclusion criteria were restricted to inpatients admitted with a diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause for admission. Eligible records were retrieved using ICD-10 (V9) coding via the hospital clinical audit department for the pre-pilot period and a unique database was used to source records for the pilot phase. RESULTS: Following the introduction of the podiatric high-risk foot coordinator, the average length of stay reduced from 33.7 days to 23.3 days (mean difference 10.4 days, 95% CI 0.0 to 20.8, p = 0.050). There was no statistically significant difference in re-admission rate between the two study periods, 17.2% (95% CI 12.2% to 23.9%) in the pre-pilot phase and 15.4% (95% CI 12.0% to 19.5%) in the pilot phase (p = 0.820). The extrapolated annual cost saving following the implementation of the new coordinator role was calculated to be £234,000 for the 2010/2011 year. CONCLUSIONS: This audit found that the extended scope of practice coordinator role may have a positive impact on reducing length of stay for diabetic foot admissions. This paper advocates the role of a podiatric high-risk foot coordinator utilising an extended scope of practice model, although further research is needed.

Calcanectomy: avoiding major amputation in the presence of calcaneal osteomyelitis-A case series.

BACKGROUND: Calcaneal osteomyelitis is a surgical diagnosis that may be treated by local, resection or major amputation. OBJECTIVE: To determine the effectiveness of calcanectomy for treating calcaneal osteomyelitis. METHOD: We conducted a retrospective review of patients receiving calcanectomy between 1st April 2005 and 1st October 2011 for calcaneal osteomyelitis. We reviewed these cases to determine healing, rate, microbiological analysis, length of stay, limb salvage rate and survival rate. RESULTS: There were 10 patients included in this review. There were 7 with diabetes and 3 without. Mean age of group with diabetes was 64 years, of this group 5/7 healed at a mean of 64 days. Mean length of stay for this group was 49.3 ± 39.4 days. 2 patients required a transtibial amputation. Mean age of group without diabetes was 77 years, healing at a mean of 19 days. Mean length of stay for this group was 14 ± 16.8 days and all survived over 3 years. Microbiological analysis of suspected osteomyelitic bone typically isolated >4 organisms. CONCLUSIONS: Calcanectomy is a useful procedure for limb salvage. It may reduce morbidity rates for people with calcaneal osteomyelitis, those with diabetes can expect prolonged wound healing and longer length of stay.