Third-Generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus.

BACKGROUND: Multiple operative techniques have been developed for hallux valgus with varying success. The most recent developments in minimally invasive surgery have evolved into the third-generation minimally invasive chevron Akin (MICA) osteotomy. Good results have been shown from originator centers, but this is one of the first series from a nonoriginator center, and the first to use a validated patient-reported outcome measure. METHODS: Forty consecutive patients undergoing third-generation MICA for hallux valgus were included. Primary outcome measures included Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society (AOFAS) scores and Coughlin satisfaction rates at 12 months. Secondary outcome measures included radiographic parameters, complications, and recurrence rates. RESULTS: At 12 months, the MOXFQ score improved from 58 to 10 and the AOFAS score improved from 48 to 93, with 70% of patients reporting excellent outcomes and 30% good ones. Two cases started as mild, 29 cases as moderate, and 9 cases as severe as defined by radiographic criteria. Hallux valgus angles improved from 32 degrees to 12 degrees, and intermetatarsal angles improved from 13 degrees to 7 degrees. There were 4 cases of Akin screw removal for soft tissue irritation. There were no other complications, including recurrence. CONCLUSION: The third-generation MICA technique was a safe and effective approach to treating hallux valgus. Further research should focus on long-term outcomes and comparative data with other commonly performed operative techniques. LEVEL OF EVIDENCE: Level IV, case series.

Improving dosing of gentamicin in the obese patient: a 3-cycle drug chart and case note audit.

OBJECTIVES: To assess the use of an electronic dose calculator to improve accuracy in the use of a complex Gentamicin prescription policy and assess turnaround time of blood sampling to dose delivery in an NHS hospital. DESIGN: Retrospective review of drug chart, case notes and hospital antibiotic database. SETTING: University Hospitals Bristol, UK PARTICIPANTS: Patients receiving once daily intravenous gentamicin using the trust protocol, during the same time window for 3 consecutive years. MAIN OUTCOME MEASURES: i) Accuracy of dose and frequency prescription of Gentamicin. ii) Time frame for measurement of serum Gentamicin levels. RESULTS: Following the introduction of the online calculator, prescribing errors in obese patients dropped from 43% to 20%, a similar level as in non-obese patients. Errors in frequency calculations dropped from 12.8% to 4%. On average, drug doses could be administered within 2.5 hours of a blood sample being taken. CONCLUSIONS: Online tools can be used to improve prescribing for the complex dosing policies that will increasingly been required to tailor prescribing in obese patients. Serum gentamicin levels can be measured within a 2.5 hour time frame in the environment of an NHS hospital.

Acute tendon injuries in the hand and their management.

Acute tendon injuries to the hand are common. In the UK, there are approximately 12000 inpatient admissions annually for injuries to the tendons and muscles of the hand and wrist (Dew, 2009). Hand injuries involving the dominant hand can cause long-term disability if not appropriately managed. Diagnosis of tendon injuries in the hand relies on careful clinical assessment, particularly if flexor and extensor tendon injuries are not to be missed. This article describes the tendon structure, explains the causes of tendon injury and discusses their assessment and management for a foundation level doctor who will face these injuries regularly whether in primary care or the emergency department.