Bunions: A review of management.

BACKGROUND: Bunions are a common complaint, particularly among older female patients. They are characterised by progressive deformity at the metatarsophalangeal joint, resulting in a painful dorsomedial prominence. This may cause difficulties with shoe wear and contribute to falls in the elderly. OBJECTIVE: The aim of this article is to discuss the aetiology, non-operative and operative management of bunions, as well as indications for referral. DISCUSSION: Initial treatment of symptomatic bunions should be non-operative. Accommodative footwear is important. There is evidence supporting the use of nonsteroidal anti-inflammatory drugs, orthotics, splints/braces and toe spacers. However, these may not provide long-term relief, and referral to an orthopaedic surgeon is recommended if the patient has a painful prominence, has exhausted non-operative treatment and is a suitable operative candidate. Cosmesis alone is not an indication for operative management. Smoking is a relative contraindication to surgery, and cessation is recommended. In paediatric or adolescent patients (juvenile bunion), surgery should be delayed until skeletal maturity.

Can Prophylactic Cables Stop Crack Propagation in Revision Arthroplasty: A Biomechanical Study.

BACKGROUND: Intraoperative femur fractures are a common complication of revision hip arthroplasty. This study examined the use of a prophylactic cable in stopping a crack from propagating beyond the cable. METHODS: Seventy sheep femora were prepared. A 5-mm vertical incision was performed. Using a force-controlled materials testing machine, a Wagner shaft was advanced until a crack occurred. Cracks were visualized with green ink. In the first part, the control group without any cable (n = 10) was compared with polyethylene (n = 15) and single CoCr cable (n = 15) groups. The cables were positioned 15 mm distal to the osteotomy. In the second part, three different CoCr configurations were compared, single-wrapped (n = 15), double-wrapped (n = 125), and two separate cables at 10 and 15 mm distal to the osteotomy (n = 15). RESULTS: The polyethylene cable stopped only 3 of 15 cracks (20%), whereas the CoCr cable stopped 11 of 15 cracks (73%) (P = .009). The force needed to initiate the crack between the different groups was not significant. Twelve (80%) of 15 cracks were stopped at the level of the cable with two separate CoCr cables and 15 (100%) of 15 cracks with a double-wrapped cable (P = .11). CONCLUSION: This study demonstrated that an elastic cable is not suitable for preventive cabling. The force required to form a crack is not improved with the use of a prophylactic cable placed 10-15 mm below the osteotomy. While the results on the different configurations were not conclusive, the double-wrapped cable was able to stop all cracks from progressing distally.

Patient acceptance of long head of biceps brachii tenotomy.

HYPOTHESIS: Long head of biceps brachii tenotomy is well accepted by patients and the procedure has comparable outcomes in younger manually active and older sedentary populations. MATERIALS AND METHODS: A total of 117 individuals at least 12 months after tenotomy of the long head of biceps brachii attended for review. Typical of clinical practice, in only one patient was the tenotomy performed in isolation. Interviews, clinical examination, and strength testing were performed to determine the rates of (1) cosmetic deformity, (2) cramping pain in the biceps muscle, (3) weakness, and (4) patient satisfaction. RESULTS: There was no significant difference between the younger manually active and the older sedentary groups in measures of cramping, weakness, or deformity, and 95% of patients were satisfied or very satisfied with the outcome of their surgery. Three percent of patients were concerned with deformity but none requested correction. Objective testing found no statistical difference in elbow flexion or forearm supination strength between the operated-on and nonoperated-on sides. Nineteen percent of patients reported cramping sensations. DISCUSSION: This study demonstrated similar rates of adverse effects to previous tenotomy studies in cramping sensations, strength deficits, and cosmetic deformity. It demonstrated that results are similar in older sedentary and younger manually active patients and are comparable to the alternative, tenodesis. CONCLUSIONS: Biceps tenotomy is well accepted by most patients with good overall results. Some adverse effects occur but appear to be mild and of little concern to patients. The procedure is tolerated in manually active populations.