RESUMO
BACKGROUND: Dislocated metatarsophalangeal joints from clawed or hammer toes can be a disabling consequence of several conditions. The Cobb-Stainsby forefoot arthroplasty combines partial phalangectomy (Stainsby) with extensor tendon transfer to the metatarsal head (Cobb). We present a retrospective, three surgeon case series of 215 toes in 126 patients. METHODS: Early results and complications were gathered from the medical charts of 126 patients who met the inclusion criteria. Seventy-five patients were contactable by phone with a follow up range of 12-82 months (median follow up 45 months). Primary outcome measures were improvement of pain and function, reduction in plantar callosities and cosmetic improvement of the deformity. RESULTS: Pre-operatively all patients presented with pain and shoe wear problems. Post-operatively seventy-two patients (96%) were satisfied, 72 (96%) reported pain relief, 55 (73%) were happy with toe control, 61 (81%) were pleased with cosmesis and 56 (75%) reported unlimited daily activities. Superficial wound infections were observed in 13 of the 126 patients (10%) and two in 75 patients (2%) developed recurrent clawing. CONCLUSION: Our case series demonstrates improved outcomes over alternatives such as the Weil's osteotomy.
Assuntos
Deformidades Adquiridas do Pé/cirurgia , Síndrome do Dedo do Pé em Martelo/cirurgia , Articulação Metatarsofalângica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia , Feminino , Deformidades Adquiridas do Pé/etiologia , Síndrome do Dedo do Pé em Martelo/etiologia , Humanos , Masculino , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/lesões , Pessoa de Meia-Idade , Estudos Retrospectivos , Transferência Tendinosa , Falanges dos Dedos do Pé/cirurgia , Adulto JovemRESUMO
A protocol was devised to address the issue of unnecessary attendance at fracture clinic by children who have a fracture of the clavicle that is deemed to be uncomplicated. For the purposes of this protocol, the clavicle was divided into three zones. Fractures of the middle clavicle for which displacement was minimal, heal quickly in the majority of cases, without the need for follow up. As a result these children can be discharged provided the parents are adequately advised. This article outlines a study which investigated the effectiveness of the protocol. The study found that implementation of the protocol reduced unnecessary attendance at clinic from 85% (47/55) to 17% (4/23). This resulted in cost savings to the trust and reduced the pressure on staff working in busy fracture clinics.