[Translated article] The effect of showing preoperative photographs on patient satisfaction following forefoot surgery.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our centre. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

The effect of showing preoperative photographs on patient satisfaction following forefoot surgery. / Influencia de la fotografía preoperatoria en el grado de satisfacción en pacientes postoperados de cirugía de antepié.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our center. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p-value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

[Functional results in the orthopedic treatment of acute ruptures of the Achilles tendon]. / Resultados funcionales en el tratamiento ortopédico de las roturas agudas del tendón de Aquiles.

OBJECTIVE: The purpose of this study is to assess the clinical and functional results of patients with acute middle third of Achilles tendon rupture treated conservatively by orthopedic boot and early weight-bearing. MATERIAL AND METHODS: This is a prospective observational study with 19 patients with acute Achilles tendon rupture treated by conservative treatment. Demographic variables, ATRS score, function using heel-rise test, calf circumference and Achilles tendon resting angle were analyzed. The clinical and functional registration was performed at six weeks, three, six and 12 months of injury. A statistical analysis was performed. RESULTS: At one year follow-up, the 94% of patients were capable of standing single heel rise, the mean of twin atrophy was 1.03 cm ± 0.51 compared to uninjured side and the difference of Achilles tendon resting angle was 5.63 degrees ± 4.17 compared to contralateral limb. The 83.24% of patients returned to play and the mean of ATRS score was 87.41 points ± 17.78. Two partial re-rupture (11%) were occurred at three months of follow-up, which continued with orthopedic treatment. CONCLUSIONS: Based on the results, functional orthopedic treatment using orthopedic boot and early weight-bearing presents good clinical and functional outcomes, considering it a valid treatment for acute Achilles tendon ruptures.

OBJETIVO: Analizar los resultados clínicos y funcionales de los pacientes con rotura aguda del cuerpo del tendón de Aquiles tratados de forma conservadora mediante bota ortopédica y carga precoz. MATERIAL Y MÉTODOS: Estudio observacional prospectivo con 19 pacientes con rotura aguda de tendón de Aquiles tratados de forma ortopédica. Se analizaron las variables demográficas, la escala ATRS (Achilles tendon Total Rupture Score), la función mediante el test de puntillas, masa muscular gemelar y el equino en reposo residual. Los registros clínicos y funcionales se realizaron a las seis semanas, tres, seis y 12 meses. Se realizó un análisis estadístico mediante Stata 14. RESULTADOS: A los 12 meses, 94% de los pacientes realizaban puntillas monopodales, la media de la atrofia gemelar fue de 1.03 cm ± 0.51 respecto a extremidad contralateral y la diferencia de equino residual respecto el lado sano era de 5.63 grados ± 4.17, 83.24% de los pacientes realizaban su práctica deportiva habitual previa a la rotura. La media de ATRS de la muestra era de 87.41 puntos ± 17.78. Se registraron dos rerroturas parciales (11%) a los tres meses de seguimiento que continuaron con tratamiento ortopédico. CONCLUSIONES: El tratamiento ortopédico funcional mediante bota ortopédica y carga precoz presenta buenos resultados clínicos y funcionales, considerándolo un tratamiento válido para las roturas agudas del tendón de Aquiles.

Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report. / Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos.

OBJECTIVE: We present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. MATERIAL AND METHOD: Retrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. EXCLUSION CRITERIA: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. RESULTS: In all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. CONCLUSIONS: of the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer. Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option.

Treatment algorithm for Charcot foot and surgical technique with circular external fixation.

BACKGROUND: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old. MATERIAL AND METHODS: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery¼ with circular external fixation. RESULTS: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery¼ using circular external fi xation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer. CONCLUSIONS: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.

ANTECEDENTES: La neuroartropatía de Charcot, comúnmente llamado «pie de Charcot¼, es una de las complicaciones más incapacitantes de la diabetes mellitus. Los pacientes con úlceras plantares y osteomielitis representan un gasto elevado para los diferentes sistemas de salud y la sociedad en general. El riesgo de amputación en estos pacientes es 12 veces más elevado que en la población general menor de 65 años. MATERIAL Y MÉTODOS: En el presente trabajo mostramos el algoritmo de tratamiento de nuestro centro y también presentamos de manera detallada la técnica quirúrgica de un solo tiempo con fijación externa circular. RESULTADOS: Nuestro algoritmo de tratamiento cubre la mayor parte de las presentaciones clínicas de esta complicación. Con la cirugía en un solo tiempo y el uso de la fijación externa circular se ha logrado desaparecer las úlceras, tratar satisfactoriamente la osteomielitis, corregir la deformidad, disminuir costos, prevenir recurrencias y evitar las amputaciones. CONCLUSIONES: El uso de un algoritmo de tratamiento basado en la literatura actual es de suma utilidad para este grupo de pacientes. La fijación externa circular ha demostrado ser una herramienta confiable en el tratamiento integral de estos casos.

In-hospital case-fatality of aged patients with hip fracture in Catalonia, Spain.

Hip fracture case-fatality in patients aged 65 years or older was studied in patients admitted to acute care hospitals in Catalonia over a 1-year period. 1222 femoral neck fractures and 1648 pertrochanteric fractures were identified. Women (76.9%) were most frequently and significantly older than men. Average age in pertrochanteric fracture was significantly higher than cervical fracture. The overall in-hospital case-fatality rate was 6.8%. Male gender, advanced age, pertrochanteric fracture and conservative management were associated with a significantly higher case-fatality rate. Multivariate logistic regression analyses demonstrated that previously seen associations showed univariate analysis. However, because interaction was observed, association within fracture and case-fatality was studied separately by gender. Men with pertrochanteric fracture showed the greatest association for in-hospital case-fatality (OR: 3.3; 95% CI: 2-5.5) compared with women with femoral neck fractures. In models with in-hospital case-fatality or no autonomy at discharge or in-hospital case-fatality or no autonomy at discharge or readmission as dependent variables, the odds ratio of death for conservative management of hip fracture were 3.7 (95% CI: 2.3-6) and 3.1 (95% CI: 1.9-4.9), respectively. This information should be taken into consideration for further analyses for long-term outcome and resource consumption by patients with hip fracture.