Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray.

BACKGROUND: It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. METHODS: One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. RESULTS: At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. CONCLUSION: Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. LEVEL OF EVIDENCE: Level II, prospective randomized controlled trial.

Predictors of poor clinical outcome following hip fracture in middle aged-patients.

The aim of this study was to investigate morbidity and mortality following hip fractures in middle aged patients. In addition, we aimed to identify risk factors which could be used to predict postoperative complications. All patients aged 40-55 who sustained a hip fracture in Lothian from 2007 to 2008 were identified from a prospective trauma database. The main outcomes were complications and 5-year mortality. Thirty hip fractures were included in the study. Complications occurred in nine (30%) cases. Deep infection was seen in three cases (10%). Mortality was 20% at 5 years, 26 times higher than for the general population. All surviving patients were contacted for risk factor analysis (24). Low energy fractures, alcohol excess, smoking and history of previous fractures were significantly associated with complications (p<0.05). Complications only occurred amongst low energy fractures. Risk factors were further analysed using the WHO FRAX algorithm. No patient with a FRAX score of less than 10 suffered a complication, whereas 50% of patients who had a FRAX score of more than 10 suffered a complication. The results of our study suggest that low energy hip fractures in middle age are due to underlying morbidity and are associated with a high incidence of postoperative complications and mortality. The FRAX score could be used as a simple method of identifying patients in this age group who are at risk of a poor outcome.