Enhancing Functional Rehabilitation Through Orthotic Interventions for Foot and Ankle Conditions: A Narrative Review.

Non-surgical, conservative approaches to foot and ankle conditions are of important consideration. Orthotics play a significant role in treating these conditions, preventing progression, and alleviating pressure on affected areas, thereby promoting normal gait. This article aims to assess the utility and effectiveness of various orthotic treatments in different clinical scenarios. We reviewed 27 peer-reviewed articles using electronic databases, employing keywords such as "orthoses," "orthotic treatment," "arthritis," "neuropathy," and "foot and ankle trauma." Studies conducted in recent decades have explored the effectiveness of orthoses in various conditions, including connective tissue disorders, tendon and ligament injuries, foot arthritis, neuropathic and inflammatory wounds, and sports-related recurrent injuries. Orthotic management has proven effective across diverse foot and ankle conditions. Integrating orthotic treatment with systemic approaches benefits patients with foot and ankle disorders. We believe this review can be utilised by clinicians in the management of foot and ankle disorders.

Surgical Fixation of Clavicle Shaft Fractures Using Superior Locking Plates With Lateral End Extension: A Retrospective Study.

Background  Reports of high rates of non-union with poor functional outcomes following non-operative management of clavicle fractures have resulted in a shift of opinion towards the promising outcomes of surgical fixation. Varied implant choices with varying reports of success and associated complications have resulted in no definitive consensus on the choice of the ideal implant. Materials and Methods  This is a retrospective study of clavicle shaft fractures stabilized using a Superior Clavicle Locking plate with lateral extension in 40 active adult patients, predominantly male, with an average age of 36.7 years. Results  Post-operatively, early mobilization was initiated and on final discharge, there were no complaints of pain. All patients returned to their pre-injury levels of activity by four months, with all having achieved, essentially, a full range of movement by eight weeks post-operatively. Radiological union was observed in all patients by 5 months, except one. The QuickDASH scores of all the patients were less than 25 on discharge. Conclusion  When surgical stabilization is considered in the management of active adults with clavicle shaft fractures, the superior clavicle locking plate with lateral extension appears to be a suitable implant by providing stable fixation lateral to the fracture, which is difficult with a regular locking plate.

Compliance With the Cauda Equina Pathway: Results of a Closed-Loop Audit.

Introduction The British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and operative intervention in patients with suspected cauda equina syndrome (CES). Due to the lack of a 24-hour MRI service and the centralisation of neurosurgery to large tertiary centres, there is a need for an evidence-based protocol for the referral of patients presenting with back pain, with red flags to specialist tertiary neurosurgical centres. Methods The standard operating procedure (SOP) at our local hospital outlines steps in the assessment, triage and onward referral of patients presenting with symptoms of acute CES. A closed-loop audit cycle was performed; the first cycle was between September and December 2020 and the second was between January and April 2021. Recommendations made after the first cycle were actioned prior to re-audit. Results There was 100% compliance regarding discussions with neurosurgery following MRI and appropriate management following neurosurgical advice. There was a 21.1% increase in appropriate discussions with neurosurgery by the emergency department (ED), increased accurate documentation of red flags (5% anal tone and 21% perianal sensation). There was a 53% decrease in senior ED doctor referral to neurosurgery, although 100% referrals were discussed with an ED senior prior to referral, and a 20% decrease in compliance regarding neurosurgery plan documentation. Conclusion We were able to improve our compliance with several aspects of the SOP using simple measures. We could not improve one aspect of SOP, namely, a discussion with the specialist centre being performed by a senior doctor. Since CES requires timely management and early scanning, we recommend a robust protocol at the admitting hospital. This paper presents the protocol at our hospital and the rationale behind it. We discuss what affects our compliance with the SOP and how simple interventions have helped us improve.