Medullary Screw Fixation and the Pilot Hole Technique for the Correction of Hammertoe Deformity.

BACKGROUND: Historically, Kirschner wires have been used for fixation of the interphalangeal joints of the toe. They are still the most popular form of fixation, likely due to training patterns, ease of use, and decreased cost. Recently, numerous medullary fixation devices have become available, including medullary screws. METHODS: After performing various forms of fixation for the correction of toe deformities, the authors have developed a new pilot hole technique for screw fixation advancing on the previously described pilot hole technique for Kirschner wire fixation. RESULTS: The authors have found this method to provide intraoperative confidence that improper hardware placement has not occurred. CONCLUSIONS: The pilot hole technique described in this paper is a safe and effective technique that may be employed by surgeons using screw fixation for the treatment of hammertoe deformities. The technique reduces the possibility of surgeon error and helps to ensure that the screw is properly placed within the phalanges when properly employed.

Opioid prescribing habits of podiatric surgeons following elective foot and ankle surgery.

Prescription of opioids following surgery is commonplace in the United States, but with that has come increases in misuse, overdose and death. Evaluating prescribing habits in efforts to reduce the opioid epidemic is becoming more frequent. The purpose of the present study was to examine the self-reported practices of podiatric surgeons regarding their methods of post-operative pain management in adult, sensate patients, as well as assessing the frequency of use of adjunctive pain control modalities. A survey was created and distributed to Podiatric Surgeons electronically, across the United States. Results of this study show that Podiatric Surgeons prescribe hydrocodone/acetaminophen most commonly after surgery, with most prescribing opioids for less than 2 weeks. With regards to adjunctive pain management, two-thirds of respondents use regional anesthesia blocks, with only 13% using post-anesthesia delivery devices (PADD). Interestingly, those using PADDs prescribed significantly more opioids at the first prescription and were more likely to refill the prescription. Podiatric Surgeons are concerned with various negative outcomes for their patients when taking opioids, including addiction, non-adherence, and motor vehicle accidents. Podiatric Surgeons are less concerned about negative outcomes for themselves when prescribing opioids. This study is in agreement with previously published studies in other medical specialties regarding opioid prescribing habits and concerns. However, further research is needed to fully understand the role PADDs and regional anesthesia blocks play in reducing the amount of opioids prescribed following surgery. The Opioid Epidemic in the United States is multi-faceted, but over-prescription by providers is part of it. Continuing to assess and understand how opioids are prescribed will be paramount to curb the epidemic.