Aims

This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures.

Aims

Although absorbable sutures for the repair of acute Achilles tendon rupture (ATR) have been attracting attention, the rationale for their use remains insufficient. This study prospectively compared the outcomes of absorbable and nonabsorbable sutures for the repair of acute ATR.

Introduction. Isolated Weber B fractures usually heal uneventfully but traditionally require regular review due to the possibility of medial ligament injury allowing displacement. Following recent studies suggesting delayed talar shift is uncommon we introduced a functional treatment protocol and present the early results. Methods. 141 consecutive patients presenting acutely with Weber B fractures without talar shift between January and December 2015 were included. Patients were splinted in a removable boot and allowed to weight bear. ED notes and radiographs were reviewed by an Orthopaedic consultant. Patients without signs of medial injury were discharged with an information leaflet and advice. If signs of medial ligament injury were noted or the medial findings were not documented the patient was reviewed in fracture clinic at 4 weeks post-injury. If talar shift developed the patient was to be converted to operative treatment. Olerud and Molander scores were collected between 6 and 12 months post-injury. Results. 65 of 89 patients with signs of medial ligament injury or no documented medial findings attended fracture clinic. Of 51 patients without signs of medial ligament injury 23 were discharged according to protocol and 28 patients attended fracture clinic. One discharged patient re-accessed care. Of 93 patients reviewed in the fracture clinic none developed delayed talar shift. One underwent delayed ORIF for ongoing fibula discomfort and the remainder continued with non-operative treatment. 99 (70%) patients provided outcome scores. The mean score at a minimum of 6 months follow-up was 87 and the median score was 100. No significant difference was found between treatment arms. The scores were comparable to those in the published literature. Conclusion. We conclude the risk of delayed talar shift is low and satisfactory outcomes can be safely achieved with our functional protocol. Additional tests/imaging to establish the integrity of the medial ligament may be unnecessary

Introduction. Many common fractures are inherently stable, will not displace and do not require plaster casting to achieve union in a good position. Nevertheless, many patients with stable fractures are advised that they need a cast, despite the potential for stiffness, skin problems and thromboembolism. Attempts to challenge this practice often meet the argument that patients prefer a cast for pain relief. We analysed five years of a single consultant's fracture clinic to see how many patients with stable foot and ankle fractures chose a cast after evidence-based counselling. Materials and methods. All patients with stable fractures of the ankle or metatarsals seen between 1st June 2005 and 31st May 2010 were included. Displaced or potentially unstable ankle fractures, Jones fractures and fractures involving the Lisfranc joint were excluded. Patients were advised functional treatment but offered a cast if they wished. Patients were documented prospectively as part of a larger audit, including demographics, diagnosis and treatment in the emergency department and fracture clinic. Results. 93 patients had stable ankle fractures. One (1%) chose a cast, 77 an ankle brace and 14 the RICE regime. One was advised a cast for neurological deformity. 105 patients had fifth metatarsal fractures outside the “non-” zone. 19 (18%) chose casts and 86 followed the RICE regime. 50 patients had other stable metatarsal fractures 15 (30%) chose casts. 86% of patients had casts applied in the emergency department. Discussion. The majority of patients with stable foot and ankle fractures do not wish to wear a cast once they understand it will not affect their outcome. In many cases this decision could have been reached in the emergency department with appropriate guidelines and education, preventing patient inconvenience and possible adverse events. Conclusion. Most patients are happy with evidence-based functional treatment of stable fractures

Introduction. The dichotomy between surgical repair and conservative management of acute Achilles tendon ruptures has been eliminated through appropriate functional management. The orthoses used within functional management however, remains variable. Functional treatment works on the premise that the ankle/hindfoot is positioned in sufficient equinus to allow for early weight-bearing on a ‘shortened’ Achilles tendon. Our aim in this study was to test if 2 common walking orthoses achieved a satisfactory equinus position of the hindfoot. Methods. 10 sequentially treated patients with 11 Achilles tendon injuries were assigned either a fixed angle walking boot with wedges (FAWW) or an adjustable external equinus corrected vacuum brace system (EEB). Weight bearing lateral radiographs were obtained in plaster and the orthosis, which were subsequently analysed using a Carestream PACS system. The Mann-Whitney test was used to compare means. Results. Initial radiographs of all patients in cast immobilization showed a mean tibio-talar angle (TTA) of 55.67° (SD1.21) and a mean 1. st. metatarsal-tibia angle (1MTA) of 73.83° (SD9.45). There were 6 Achilles tendons treated in the FAWW. Their measurements showed a mean TTA of 27.67°(SD7.71) and 1MTA 37.00 (5.22). 5 tendons were treated using an EEB; there was a statistically significant (p< .05) increase in both the TTA 47.6° (SD5.90) and 1MTA 53.67 (SD5.77) compared to the FAWW group. Discussion. Plantar-flexion at the ankle was significantly greater in the EEB comparative to the FAWW, and very similar to the initial equinus cast. The use of wedges produced an equinus appearance through the midfoot, without producing equinus in the hindfoot as the heel pad rests on the top wedge. We express caution in the use of wedges for Achilles treatment as they do not shorten the Achilles tendon and may result in a lengthened tendon and reduced plantar-flexion power in the long-term

Objectives

The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.