seekerofwisdom
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Post by seekerofwisdom on Jul 11, 2009 13:57:33 GMT
Bill one for you?
Given a very common presentation of lets say 80 year old lady with advance HAV resulting in a subluxed 2nd toe with chronic sinused HD.
'bunion well accommodated.
What is the best surgical option?
a) bunion surgery and straightening and fixing of 2nd toe,
b) amputation of 2nd toe.
It would be good if you could explain your conclusion.
Shy.
( this is not a wind up but a common situation, me I would go for amputation, locally it's not popular)
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Post by billliggins on Jul 11, 2009 15:15:35 GMT
Hello Shy
My usual thinking process regarding surgery (abbreviated) is as follows
i) is the problem malignant?
ii) is the patient in pain?
iii) if non malignant and not painful then there are non-surgical treatments available
iv) if painful, is there going to be any predictable pain/secondary problems?
v) where is the site of pain?
vi) what do I need to do to deal with the presenting problem?
vii) what is the most likely outcome?
viii) what are the potential adverse reactions?
ix) will my planned intervention result in the best outcome for the individual patient?
You will understand that like everything else there is a framework of principles involved including communication, clerking, conceptualisation, planning, history & physical, studies etc. but these have all been written elsewhere.
Broadly, given the age of the patient, that the hallux valgus is not troublesome and the aim would be to have her rapidly mobile, I would tend towards amputation of the 2nd toe. The surgery is normally effective, not prone to adverse reactions, can be happily accomplished as day surgery under local anaesthetic and offers a good result. Having said that, there may be very fit and active 80 year olds who would benefit from hallux valgus correction if the deformity is causing problems.
I suppose like everything else it depends upon the presenting complaint and the individual patient.
ll the best
Bill Liggins
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