Peroneal muscle weakness is a common pathology in foot and ankle surgery. Polio, charcot marie tooth disease and spina bifida are associated with varying degrees of peroneal muscle paralysis. Tibialis Posterior, an antagonist of the peroneal muscles, becomes pathologically dominant, causing foot adduction and contributes to cavus foot posture. Refunctioning the peroneus muscles would enhance stability in toe off and resist the deforming force of tibialis posterior. This study determines the feasibility of a novel tendon transfer between peroneus longus and gastrocnemius, thus enabling gastrocnemius to power a paralysed peroneus tendon. 12 human disarticulated lower limbs were dissected to determine the safety and practicality of a tendon transfer between peroneus longus and gastrocnemius at the junction of the middle and distal thirds of the fibula. The following measurements were made and anatomical relationships quantified at the proposed site of the tendon transfer: The distance of the sural nerve to the palpable posterior border of the fibula; the angular relationship of the peroneus longus tendon to gastrocnemius and the achilles tendon; the surgical field for the proposed tendon transfer was explored to determine the presence of hazards which would prevent the tendon transfer.Introduction:
Method:
We retrospectively reviewed 220 patients following hip hemiarthroplasty, creating 2 demographically matched cohorts; Group 1: 3 doses of Cefuroxime (n=113) and Group 2: single dose Gentamicin and Amoxicillin (n=107). End points were evidence of infection, length of stay and Clostridium difficile (CD) rates. Considering antibiotic therapies administered; significant reductions in group 2 for the number of patients that required post-operative antibiotics (99/113 Vs 73/107 p=0.0005), the median antibiotic DDDs (Defined Daily Doses) in 1st 2 post-operative days (0.25 Vs 0 p=0.0000) and those that received Ciprofloxacin or Cefuroxime post-operatively (82/113 Vs 24/107 p=0.0000). No significant difference was found for median antibiotic DDDs, median antibiotic DDDs from 2nd post-operative day, patients that received Flucloxacillin post-operatively. Measured microbiological outcomes showed a significant reduction in the number of patients with confirmed growth requiring treatment with antibiotics in group 2 (21/23 Vs 12/22 p=0.0053). No difference was found between number patients with operation site swabbed and those with confirmed microbial growth. We demonstrate single dose Gentamicin and Amoxicillin significantly reduces length of stay, CD rates and the number of patients requiring post-operative antibiotics for wound infection, inferring a reduction in the rate of wound infection. We would recommend this as an effective alternative to the 3 dose Cefuroxime regime.
