We wanted to verify our clinical experience that the 5.5 mm screw was ideal in the majority of fifth metatarsal fracture fixation. The size of a screw is important for the successful surgical treatment of these fractures in order to obtain the maximal stability while reducing the risk for iatrogenic fracture.A sample of patients undergoing computer tomographic imaging of the foot for investigation other than fifth metatarsal pathology were recruited. The parameters of the fifth metatarsal bone anatomy were measured.These parameters of the 5.5 mm screw were correlated with this data. The upper parameter (the diameter of the threads) was 5.5 and the lower parameter (the diameter of the shank) was 4.0 mm.Twenty seven patients were recruited.The proximal third internal diameter ranged from 3.6 to 7.0 mm with a mean of 5.0 mm. 93% of the metatarsals could easily accommodate the 5.5 mm screw. Two of the metatarsals had an internal diameter of < 4 mm (7%).It is our belief that the 5.5 mm screw may be used safely in the majority of patients with fifth metatarsal fractures.
Background and objective
Low-molecular-weight heparin (LMWH) prophylaxis has now become the gold-standard practice in patients requiring lower limb immobilization. We had noticed an increase in the incidence of wound-healing problems at our center, and the severity of the problems was found to be worse in patients undergoing foot and ankle surgery since we had adopted this practice. In this study, we aimed to describe the incidence and severity of wound-healing problems in this group of patients.
Methods
This was a prospective study and we collected data on the frequency and severity of wound problems occurring in patients undergoing a variety of foot and ankle operations. All patients underwent a standard agreed-on method of wound closure and dressings. Wounds were reviewed after two weeks and wound characteristics were noted using a rigid proforma. The primary outcome measure was to determine the incidence of delayed wound healing (DWH) and wound infections requiring antibiotics. Secondary outcomes were the characteristics of each delayed-healing wound.
Results
A total of 158 patients met the inclusion criteria of the study. One patient was not given postoperative LMWH and was excluded from the final analysis. Seven patients (4.5%) were noted to have DWH and four patients (2.6%) had a wound infection at the two-week postoperative follow-up. None of the patients required a second operation. Among patients with wound-healing problems, wound contour irregularities were noted in 51% and margin separation was noted in 65%.
Conclusion
The overall incidence of wound-healing problems such as DWH and wound infections was low in patients receiving prophylactic LMWH for foot and ankle surgery. Where postoperative wound problems did occur, these were associated with poor wound characteristics such as margin separation or contour irregularity. Further studies should be conducted to ascertain if the use of LMWH leads to problems with wound appearance.
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