Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery

Continuous peripheral nerve blocks (CPNB) have a variety of indications and have been shown to be a safe and effective means of minimizing pain postoperatively. Early studies have indicated duration of catheter use greater than 48 hours as a main contributor to infection risk in CPNBs. Recent studies, though, have suggested that the risk of infection does not increase until 4 days after insertion. In the following case report, we recount our experience in using a continuous popliteal-sciatic peripheral nerve block for postoperative pain control in a pediatric patient following calcaneal and first metatarsal osteotomy. The catheter remained in place for 65 hours postoperatively without signs of local inflammation or infection. The prolonged CPNB use resulted in a significant decrease in postoperative opioid use and pain and increase in patient satisfaction when compared to the same procedure done one year prior on the opposite foot.

New method of surgical correction of lesser toes deformity

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.

Hallux Valgus Nonunion Correction in an Active Duty Military Member

ABSTRACT Hallux valgus is one of the most common conditions treated by foot and ankle orthopedists; over 140 surgical procedures have been developed for management of the condition. A rare complication of hallux valgus repair is nonunion, and the literature regarding nonunion after hallux valgus repair is correspondingly sparse. We present a 39-year-old active duty male who underwent operative management after developing nonunion and transfer metatarsalgia following a proximal oblique metatarsal osteotomy. The patient underwent nonunion correction and metatarsal lengthening via bone allografting. No complications were observed during the intra- or perioperative periods. At 2.5-years postoperatively, the patient’s symptoms had largely resolved. He expressed high satisfaction with his outcome and was able to continue activity duty. Our findings indicate that nonunion repair can have excellent clinical outcomes with high patient satisfaction, even in an active military population.