A retrospective review of the effect of metatarsus adductus on healing time in the fifth metatarsal jones fracture.

PURPOSE: The fifth metatarsal Jones fracture is a unique injury. Previous studies have identified possible biomechanical risk factors related to this fracture, as well as potential subsequent effects on bone healing complications. The purpose of this retrospective study was to determine the effect of metatarsus adductus (MAA) on bone healing in patients following intramedullary screw fixation of the Jones fracture. METHODS: This study reviewed 14 Jones fractures that underwent intramedullary screw fixation. Serial radiographs taken approximately every two weeks were evaluated to determine bone healing time (BHT). Weight-bearing antero-posterior radiographs were used to determine the MAA using standard osseous landmarks. RESULTS: There was a strong positive correlation between MAA and BHT. Moderate correlations were also found between age and BHT and between age and MAA. A prediction algorithm derived from the regression model shows that 63.2% of the variability in the Jones fracture healing time (BHT) can be predicted by a minimum of 22.7 days increased by an average of 1.23 days for each degree of MAA. CONCLUSION: This study suggests healing time in Jones fractures to be highly related to the MAA following intramedullary screw fixation. The ability to predict osseous union of Jones fracture offers advantages such as patient expectations as well as individualized rehabilitation programs.

Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery.

BACKGROUND: The purpose of this study was to evaluate the efficacy of topically applied vancomycin powder in reducing the rate of surgical site infections (SSIs) in patients with diabetes mellitus (DM) undergoing foot and ankle surgery. METHODS: Eighty-one patients with DM who underwent reconstructive surgery of a foot and/or ankle deformity and/or trauma and who received topically applied vancomycin were matched to 81 patients with DM who did not receive topically applied vancomycin. The mean age was 60.6 years in the vancomycin group and 59.4 years in the control group (P < .05). The 2 groups were similar with regard to gender, body mass index, duration of DM, short-term and longer term glycemic control, and length of surgery. RESULTS: The overall likelihood of SSI was decreased by 73% in patients who received topically applied vancomycin (odds ratio [OR], 0.267; 95% CI, 0.089-0.803; P = .0188). The rate of superficial infection was not significantly different between the 2 groups (OR, 0.400; 95% CI, 0.078-2.062; P = .2734); however, deep infections were 80% less likely in patients who received vancomycin powder (OR, 0.200; 95% CI, 0.044-0.913; P = .0377). CONCLUSION: High-risk diabetic patients undergoing foot and ankle surgery were notably less likely to develop an SSI with the use of topically applied vancomycin powder in the surgical wound, particularly with regard to deep infections. Topically applied vancomycin was associated with a very low rate of complications and was inexpensive ($5 per 1000 mg). Based on this study, foot and ankle surgeons may consider applying 500 to 1000 mg of vancomycin powder prior to skin closure in diabetic patients who are not allergic to vancomycin. LEVEL OF EVIDENCE: Level III, retrospective case control series.

A biomechanical analysis of the effects of low-Dye taping on arch deformation during gait.

BACKGROUND: The low-Dye technique serves to limit hindfoot pronation and medial arch collapse. Few studies exist that investigate the effects on medial arch deformation from a biomechanical perspective. METHODS: Kinematic data was collected using a Motion Analysis System. Foot function of 21 healthy adults was assessed during the stance phase of gait. Subjects were evaluated prior to and immediately following the low-Dye tape application, as well as at 48 h. Foot deformation was assessed during the stance phase of gait using the calcaneus, navicular and 1st metatarsal head markers to calculate the medial longitudinal arch angle (MLA) and the dynamic arch height index (dAHI). Paired t-tests were used to assess low-Dye tape effectiveness. RESULTS: There was a significant 19.3% reduction in MLA immediately after application of the tape. However only 4.01% reduction remained in deformation after 48 h. The MLA deformation findings were consistent with the AHI change, showing a significant change in the arch deformation between Pre and Post0 low-Dye taping. The effects were short-lived. CONCLUSIONS: There are measurable changes to medial arch height and amount of arch height deformation during gait following low-Dye taping. Although changes were present immediately after application, results were diminished 48 h after application.