As a result of reading this article, physicians should be able to: (1) Identify preoperative factors that may contribute to a patient's ability to return to driving after orthopedic surgery. (2) Understand the role of upper-extremity immobilization and how it may impair a patient's ability to operate a motor vehicle. (3) Recognize how various forms of lower-extremity immobilization (e.g., controlled ankle-motion boot, cast, and Aircast Walker) affect braking reaction times and total braking times. (4) Be aware of current guidelines about when it is appropriate to return to driving following arthroscopy, lower-extremity fracture, and hip and knee arthroplasty. Few guidelines are available to assist orthopedic surgeons in advising patients about when to return to driving after orthopedic surgery. A patient's surgical procedure, postoperative weight-bearing restrictions, immobilization, and other factors influence a patient's ability to drive after orthopedic surgery. Multiple studies have used driving simulators to predict when it may be safe to return to driving after orthopedic surgery. However, study conclusions and recommendations vary significantly. This article reviews the factors contributing to a patient's ability to return to driving after orthopedic surgery and reviews recommendations based on the available literature following fracture, arthroscopy, and arthroplasty.
Small-joint arthroscopy has supplanted open procedures because it offers the potential for improvement in joint visualization, reduced scarring, and accelerated recovery. Despite these advantages, arthroscopy of the first metatarsophalangeal joint is not commonly performed and reports of its use are lacking. The reason for this is not clear but may be because of perceived technical complexity and poorly defined indications. In our experience, however, arthroscopy of the first metatarsophalangeal joint is a versatile procedure that facilitates treatment of many different pathologic processes through a minimally invasive approach with few complications. We present our technique for arthroscopic management of osteochondral lesions of the hallux.
Category: Bunion Introduction/Purpose: One of the more common and versatile osteotomies to correct moderate hallux valgus deformities is the Ludloff osteotomy. This oblique osteotomy is typically stabilized with screws and patients kept non-weight bearing until healed. Complications include malunion, nonunion and loss of correction, which can occur due to poor compliance with non- weight bearing protocols. Elderly, obese and physically weak patients can have difficulty remaining non-weight bearing. A novel anatomic-locking plate and fixation method was developed that allows immediate weight bearing after a Ludloff osteotomy. We analyzed the results of a consecutive cohort of patients who underwent a Ludloff osteotomy stabilized with this method. The cohort included all patients presenting with a moderate to severe hallux valgus deformities. Complications, radiographic & clinical outcomes were studied. Methods: In this IRB approved retrospective cohort study, we analyzed clinical & radiographic data of all Ludloff osteotomies performed between 2010 and 2015. Preoperative and postoperative data included Foot Function Index, intermetatarsal & hallux valgus angles, complications, callus formation & clinical outcomes. 395 feet in 350 patients were examined. 6 patients (2.1%) were male. 43 feet were excluded due to incomplete films and 21 were excluded due to screw fixation only; requiring restricted post- operative weightbearing protocols. Three surgeons performed the surgeries and review/analyses conducted by a senior orthopedic resident, uninvolved with the care of any of the patients. Indications included symptomatic hallux valgus deformities (intramedullary angle greater than 10°), failure of conservative treatment and normal preoperative range of motion. Exclusion criteria included 1st tarsometatarsal joint arthritis/instability, peripheral neuropathy, vascular disease and 1st metatarsophalangeal joint arthritis. Preoperative and postoperative radiographs were weightbearing. Patients discharged when comfortable in normal shoes. Results: At an average of 8 months postop (2 - 43 months), there was an average hallux valgus (HVA) correction angle correction of 7.6° (p<.0001) and intermetatarsal angle (IMA) correction of 21° from initial to final radiographs. Patients were discharged when comfortable in normal shoes. In the 15 feet (4.6%) who formed hypertrophic callus, there was loss of IMA of 2.3° (p<.0001) and HVA of 4.6° (p<.0001). Superficial wound infection or mild cellulitis was noted in 16 feet (4.9°); no deep infections. 15 (4.6%) feet had hardware removal due to prominent and/or broken screws. These were in older women with thin feet. There was only 1 nonunion & 8 mal-unions. An average foot function index (in 70 patients) of 9.5/100 indicated low pain and disability. Conclusion: The data from this large series of patients (395 osteotomies) supports the use of an immediate weight-bearing protocol for Ludloff osteotomies fixed with anatomic locking plates, including patients with osteopenic bone. All...
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