The effect of smoking on fracture healing and on various orthopaedic procedures.

Ten percent of all fractures lead to problems with healing. Smoking is said to be a cause. There are 13.5 million smokers in the U.K. Healing of tibial fractures, for instance, requires two more months in smokers. Nicotine, carbon monoxide and hydrogen cyanide are most often seen as the offenders, among the 4000 chemicals found in cigarettes. Many studies plead for the negative effect of smoking in general, yet there is uncertainty as to the precise role of nicotine. The authors recommend that patients should attempt smoking cessation therapy before elective orthopaedic treatment.

Joint preserving surgery for rheumatoid forefoot deformities improves pain and corrects deformity at midterm follow-up.

BACKGROUND: Rheumatoid arthritis is a chronic autoimmune disorder that commonly affects the metatarsophalangeal (MTP) joints. Conventional surgical treatment involves joint-sacrificing surgery to relieve pain and correct deformity. OBJECTIVES: We retrospectively reviewed 49 patients with rheumatoid forefoot deformities who underwent 66 joint preserving procedures with Scarf osteotomy of the first metatarsal and Weil's shortening osteotomy of the lesser metatarsals. METHOD: There were 5 males and 44 females with mean age 56.1 years and mean follow-up 51 months. All patients were evaluated clinically and radiologically with hallux valgus angle (HVA) and inter-metatarsal angle (IMA). RESULTS: Mean AOFAS score improved from 39.8 preoperatively to 88.7 at final follow-up. Subjectively patients reported their outcome as excellent in 49 feet (74%), good in 9 feet, fair in 7 feet and poor in 1 foot. Five feet had residual stiffness and 11 residual pain. Mean HVA and IMA decreased from 32° to 14° and from 15° to 11° respectively. CONCLUSION: In intermediate to severe stages of the disease, joint preserving surgery by Scarf osteotomy of the first MTP joint and Weil osteotomy of the lesser metatarsals may be performed as an alternative to joint-sacrificing procedures and should be considered as a complement to the various surgical treatments of the rheumatoid forefoot.

A comparison of post-op haemoglobin levels and allogeneic blood transfusion rates following total knee arthroplasty without drainage or with reinfusion drains.

The effects of re-infusion drains on the rate of allogeneic blood transfusion and post-op haemoglobin levels in Total Knee Arthroplasty were examined. A group of 22 patients undergoing primary Total Knee Arthroplasty using a CBCII Constavac Stryker re-infusion drainage system were compared with a group of 30 patients, matched for age, sex and type of prosthesis but without any drain usage. The re-infusion drain.group had a significantly lower day 1 and day 3 post-operative haemoglobin compared to the non-drainage group. The re-infusion drain group had a higher allogenic transfusion rate compared to the non-drainage group. There were no significant differences between the two groups regarding the rate of wound and transfusion related complications and mean length of post-operative stay. We found that reinfusion drains were ineffective in reducing allogeneic transfusion requirements as compared with non-drainage in total knee arthroplasty.