Winograd Wedge Resection Matrixectomy versus Partial Nail Avulsion with Chemical Cautery: A Tertiary Institution's Clinical Outcomes and Proposed Triaging Protocol.

BACKGROUND: Onychocryptosis, or ingrown toenail, is a common condition affecting patients of varying age groups, although usually, younger patients are affected. METHODS: We compared two techniques used in our institution: Winograd wedge resection with matrixectomy (WG-M) versus partial nail avulsion with phenolization of the nail matrix (PNA-P). RESULTS: Primary outcomes of interest were presence of nail regrowth and patient satisfaction postoperatively. Secondary outcomes were postoperative pain (within the first 2 weeks and after 2 weeks), postoperative inflammation, and healing time. A total of 65 patients were included in this study: 44 patients (19 female and 25 male patients), with a mean age of 45.7 years (range, 16-83 years) underwent WG-M in the orthopedic surgery department, whereas a total of 21 patients (10 female and 11 male patients), with a mean age of 44.5 years (range, 13 to 75 years) underwent PNA-P in the podiatry department. In patients who underwent WG-M, there was one case of regrowth (2.3%) compared with no regrowth cases (0%) in the PNA-P group. There was no significant difference in regrowth rate between the two procedures (P = .494). The satisfaction rate was high for both procedures: 100% patients in the WG-M group rated themselves better than before surgery, compared with 95.7% in the PNA-P group. CONCLUSIONS: From our study, we conclude that both techniques (WG-M and PNA-P) are able to achieve similar clinical outcomes, with the PNA-P procedure being less invasive and less resource intensive, and also achieving a shorter healing time.

Lateral column osteotomy versus subtalar arthroereisis in the correction of Grade IIB adult acquired flatfoot deformity: A clinical and radiological follow-up at 24 months.

BACKGROUND: Adult acquired flat foot deformity (AAFD) is a spectrum of conditions which can be progressive if untreated. Surgical correction and restoration of anatomical relationship are often required in the treatment of symptomatic Grade II AAFD after a failed course of conservative treatment. There is a paucity of literature recommending best practice-especially in the adult population. The authors aim to compare radiological and clinical outcomes of two widely employed surgical techniques in the treatment of symptomatic AAFD. METHODS: A retrospective study of 76 patients with Grade IIB AAFD and had undergone either lateral column lengthening (LCL) or subtalar arthroereisis (STA) surgical correction of their symptomatic AAFD. Each technique was augmented with both bony osteotomy and soft tissue transfer as determined by on table assessment. Clinical and radiological outcomes were reviewed 24 months after surgery. RESULTS: LCL and STA groups had comparable radiological outcomes at 24 months after surgery. However, LCL group demonstrated superior American Orthopaedic Foot and Ankle Society (AOFAS) midfoot (90.3 ± 12.6 vs 81.1 ± 20.6, p < 0.001) as well as Visual Analogue Scale (VAS) midfoot scores (0.5 ± 1.6 vs 1.3 ± 2.4, p < 0.001) at 24 months compared to the STA group. STA had a higher complication rate (20.6% vs 4.4%), with all cases complaining of sinus tarsi pain requiring subsequent removal of implant. CONCLUSION: There is a role for either techniques in the treatment of symptomatic AAFD. LCL whilst more invasive has demonstrated superior outcome scores and lower complication rates at 24 months compared to STA. Patients need to be counselled appropriately to appreciate the benefits of each technique.

Distal radius fractures: an epidemiological review.

OBJECTIVE: Distal radius fractures are among the most common fractures encountered in clinical practice. Although multiple epidemiological studies have been done in Western populations, there is a lack of data within Asia. Our study aims to fill this knowledge gap. METHODS: This study included all patients aged 16 years and above with distal radius fractures seen between November 2008 and May 2009 by the Department of Hand and Reconstructive Microsurgery at the Singapore National University Hospital. A retrospective analysis was done. Information captured included clinical data, hand dominance, AO classification of fractures, mechanism of injury, associated injuries as well as treatment modalities. RESULTS: Of the 431 fractures, 238 were males, 181 were females. These fractures occur at all ages, peaking at the 50 to 60 years age group. The peak incidence of distal radius fractures in females occurred in the perimenopausal age group, whereas the incidence for males peaked between age of 30 to 50. By AO classification, 53% were type A; 13% were type B and 32% were type C. A fall on the outstretched hand from a standing position is the most common mechanism of injury. As the intensity of the injury mechanism increased, the percentage of type C fractures increased correspondingly. Older patients were more likely to be treated conservatively compared to younger patients. AO severity classification correlated well with the clinician's decision to surgically fix the fracture. No correlation between hand dominancy and fracture site found was found. CONCLUSION: We compared our data with that of previous similar studies, and found similarities as well as differences in results. Nevertheless, the epidemiogical data gathered in this study has added to our knowledge of distal radius fractures in an Asian population.