Antibiotic Use and Kirschner Wire Fixation in Forefoot Surgery: A National Survey.

In foot and ankle patients, the use of Kirschner wires is common, and the population in the typical foot and ankle practice has higher rates of comorbidities associated with infection. This study assessed national trends regarding the use of postoperative prophylactic antibiotic therapy in patients undergoing foot and ankle surgery treated with percutaneous Kirschner wires. Attending physicians at foot and ankle fellowships were mailed a questionnaire that included 3 clinical vignettes containing questions on the use of postoperative antibiotics in patients treated with percutaneous Kirschner wires. A total of 112 physicians were identified; 64 physicians (57%) returned the survey. In the first case of a nondiabetic patient, 16 physicians (25%) indicated they would place the patient on postoperative antibiotics for an average of 9.4 days with an average duration of Kirschner wire fixation of 35.1 days. In the second case of a non-neuropathic diabetic patient, 18 surgeons (28%) indicated they would place the patient on postoperative antibiotics for an average of 13.8 days with an average duration of Kirschner wire fixation of 35.4 days. In the third case of a diabetic patient with neuropathy, 19 physicians (32%) indicated they would place the patient on postoperative antibiotics for an average of 14.5 days with an average duration of Kirschner wire fixation of 36.7 days. Few attending physicians at orthopedic foot and ankle fellowships placed their patients treated with percutaneous Kirschner wires on postoperative antibiotic prophylaxis, even in diabetic patients for whom an increased risk of infection has been documented. [Orthopedics. 2017; 40(4):e594-e597.].

Cuban Ocular Toxoplasmosis Epidemiology Study (COTES): incidence and prevalence of ocular toxoplasmosis in Central Cuba.

BACKGROUND: Serological studies indicate that rates of ocular toxoplasmosis (OT) vary geographically, with higher rates in tropical regions. Little is known about population-based rates of active OT. We aimed to describe the epidemiology of OT in Central Cuba. METHODS: This large-population, cross-sectional cohort study used a prospective database at a large regional referral centre in Central Cuba. The patient database was searched for all patients who presented with OT during the 12-month study period from 1 April 2011 to 31 March 2012. Inclusion criteria were the clinical diagnosis of OT, characterised by focal retinochoroidal inflammation and a response to therapy as expected. Gender-stratified and age-stratified study population data from the 2012 Cuban Census were used to calculate incidence rates and prevalence ratios. RESULTS: Among 279 identified patients with OT, 158 presented with active OT. Of these, 122 new-onset and 36 prior-onset cases were confirmed. Based on the total population in the Sancti Spiritus province (466,106 persons), the overall incidence of active OT was 26.2 per 100,000 person-years (95% CI 21.7 to 31.3) with an annual prevalence ratio of 33.9 per 100,000 persons (95% CI 28.8 to 39.6). The incidence of active OT was lowest in the oldest age group and highest in patients aged 25-44 years (4.5 and 42.1 per 100,000 person-years, respectively). CONCLUSIONS: This first report describing population-based rates of OT in the Cuban population highlights the importance of patient age as a likely risk factor for OT. Disease rates were found to be highest in females and young to middle-aged adults.

Bridle procedure combined with a subtalar implant: a case series and review of the literature.

BACKGROUND: The bridle procedure is a tritendon anastomosis between the tibialis posterior, peroneus longus, and tibialis anterior, utilized in the treatment of drop foot. Concerned about the potential for acquired flatfoot deformity following the bridle procedure, the authors hypothesized that placing a sinus tarsi implant would prevent this potential sequela. MATERIALS AND METHODS: Over a 10-year period, 15 patients (16 feet) were treated with a bridle procedure for drop foot, and 9 of these feet also had a subtalar arthroereisis implanted; 8 patients (9 feet) positively responded to requests for long-term follow-up evaluation and returned for subjective evaluation with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Scale and Short Form (SF)-36 forms and objective clinical and radiographic measurements. RESULTS: At an average follow-up of 61 months, the 8 patients (9 feet) who returned for long-term evaluation maintained a plantigrade foot, were able to dorsiflex above neutral both actively and passively, and did not develop a flatfoot deformity at long-term follow-up. There were no significant differences between those who had a sinus tarsi implant (6 feet) and those who did not (3 feet). Although 7 of the 9 feet evaluated in this study wore a brace preoperatively, none continued to use a brace after surgery. The major complaints were occasional pain at the subtalar arthroereisis site and a feeling that the great toe was dragging. CONCLUSION: The bridle procedure provided excellent outcomes in patients with drop foot, with patients achieving long-term success in being free from brace wear. The ability to actively dorsiflex the foot during gait was also restored, reestablishing a normal heel-to-toe gait pattern. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Arthritides of the foot.

Arthritis of the foot can be a difficult problem. It is initially managed with antiinflammatory medications and footwear modifications or bracing. However, a significant percentage of people with arthritis of the foot go on to require surgical intervention, which is most commonly arthrodesis.

Tibiofibular bone-bridging osteoplasty in transtibial amputation: case report and description of technique.

Transtibial amputation osteoplasty procedures were originally designed as a technique for achieving a functional end-bearing limb in the post-World War I era; the Ertl procedure is now often used as a reconstructive procedure for failed primary amputations. Modifications of the original periosteal sleeve-covering technique include the tibiofibular bone-bridging osteoplasty. The theoretical advantages to this procedure are highly debated among trauma surgeons. For the patient with a lower extremity injury that necessitates a transtibial amputation, there are many psychologic and physiologic factors to consider, and a persistently painful residual limb postamputation may be mentally and physically disabling. Although the advantages of these techniques may be unproven, they are fairly simple and add little additional operative time to the primary transtibial amputation. A surgeon who performs transtibial amputations should at least be aware of the osteoplasty techniques and how to perform them. The decision to use these techniques may then be made by the surgeon on a case-by-case basis, given the individual demands of the patient. This article presents a case report and outlines the use of the fibular bone-bridging osteoplasty technique in transtibial amputations.

Wound complications in thyroxine-supplemented patients following foot and ankle surgery.

BACKGROUND: Our hypothesis was that thyroxine supplementation in patients undergoing foot and ankle surgery would be associated with increased postoperative wound complications and wound dehiscence compared to patients without thyroxine supplementation. MATERIALS AND METHODS: A retrospective review of 48 patients supplemented with thyroxine that underwent foot and ankle surgery was conducted and analyzed for wound complications. All patients were non-diabetic. A total of 94 historical controls were used to compare the incidence of wound complications to the thyroxine sample. Patient demographics, medical comorbidities, principal diagnosis and procedure performed were recorded. The presence or absence of wound dehiscence, infection or other wound complications was recorded for all patients based on the followup clinical notes in the electronic record. RESULTS: In the thyroxine group, the most common diagnosis was degenerative arthritis (31%, n=15), which also occurred in 28.7% of control patients (n=27). Wound dehiscence was reported in 36.2% (n=17) of thyroxine-supplemented patients compared to 10.8% of control patients (n=10). After adjusting for age, gender, hypertension diagnosis, and vascular disease diagnosis, the odds for wound dehiscence remained significantly greater for the thyroxine group compared to control patients (adjusted OR=3.7; 95% CI: (1.3, 11.4); p=0.01). CONCLUSION: Overall, our results suggest increased wound dehiscence complications in the postoperative period for thyroxine-supplemented patients compared to control patients. This finding remained even after adjusting for the associated cardiovascular comorbidities seen in thyroxine-supplemented patients.

Unusual orientation of talar osteochondral fragment: a case report.

The identification of the correct orientation of an osteochondral fragment can be challenging. Orthopaedists have been able to take advantage of advanced imaging techniques to provide guidance to the appropriate surgical intervention. Many advancements have been made in imaging modalities specific to articular cartilage [Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5T and 3.0T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol 2005;46(1):67-73 [Erratum in: Acta Radiol 2005;46(April (2)):218]] Furthermore, with the increasing use of bioabsorbable fixation pins, it is imperative that careful attention is paid to the correct orientation of the fragment that is to be fixed. Without awareness of the orientation, it is possible that the 180° displaced fragment could potentially be fixed in this position. At the time of this report, the patient in this case was 6 weeks postoperative and reported 0/10 pain with full painless range of motion without instability. Our goal with this case report is to promote awareness among orthopaedists and radiologists alike regarding the importance of recognizing the orientation of an osteochondral fragment and/or defect of the talus. The patient was informed that data concerning the case would be submitted for publication, and he consented.

Nefropatía incipiente: factores relacionados con la excreción de albúmina urinaria en pacientes diabéticos insulinodependientes / Incipient nephropathy: factor related to urinary albumin excretion in insulin-dependent diabetic patients

Se evaluó la excreción de albúmina urinaria (EAU) a 54 pacientes diabéticos insulino-dependientes, quienes no presentaban proteinuria (>0,5 g/24 horas). La microalbuminuria persistente (nefropatía incipiente) se halló en el 31,5 por ciento de la muestra estudiada. Los pacientes diabéticos (sexo masculino) con nefropatía incipiente presentaron la presión sanguínea (sistólica, media y diastólica) superior significativamente, comparada con la de aquéllos con normoproteinuria. La edad promedio del diagnóstico, los añños de evolución y la presión sistólica, fueron las variables asociadas con la EUA. En el sexo femenino sólo la presión sistólica se relacionó con la EUA. En el análisis de regresión múltiple, la presión sistólica, solamente en el sexo masculino, fué el factor más relevante asociado con la microalbuminuria