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Rethinking orthopaedic & forefoot management

This post continues the page Stop! Wrong way! in relation to orthopaedic management

Deformities of the forefoot. These include “bunions”, Morton’s “neuroma”, clawed toes and “flat foot”. It is unlikely that any group of elective procedures has been performed, in total ignorance of the causative factors, more often, by more people, in more ways, than various forms of surgery to the forefoot.

Fractures being “set” as soon as possible after the injury. This damaging policy produces significant, irreversible, complications. It will be addressed in a separate post on this site at a later date.

Finger-tip injuries. These common injuries produced a plethora of surgical treatments, from skin grafts and”rotational flaps” to “cross-finger flaps”. These required not-inconsequential surgery, sometimes under general anaesthetic, were expensive and incapacitating for various periods, and unnecessary. Harvest was taken from uninjured areas of the palm and other fingers, scarring those. The best results however have been shown to be obtained by doing nothing beyond usual wound care! The body’s capacity to heal itself at that site is not unexpected, being as easily and frequently injured as the fingers are.

“Traction” for so called “slipped discs” (mostly that diagnosis was incorrect, in the event). Tens of thousands of patient-days were lost by placing these unfortunates in hospital and attaching weights by cords to their legs, literally tethering them to their bed for days or weeks. This was entirely ineffective since the friction of the legs prevented transmission of any “traction” to the discs. The management was adversely effective, since most low back pain improves more rapidly with movement (ideally in water). Deep vein thrombosis would be expected to be increased by this form of immobility. I wonder how many died of resulting pulmonary embolisms.

 Osteomyelitis. Antibiotic usage and aggressive resection of bone is often counter productive and dangerous. The loss of the limb might result from some current management policies. This is addressed in a separate post on this site.

Sudden Infant Death Syndrome. (Cot death) Before 1993 parents were advised to nurse babies on their bellies. There were a few esoteric reasons for this (“better” sleep EEGs, “enhance development”, danger of changing skull shape), but they were all somewhat fanciful and were unlikely to be directing factors. More likely was the following pseudo-logic: Unconsious people vomit and inhale vomit. Unconsious people should therfore be turned on their stomachs. Sleeping babies resemble the unconsious, therefore they should be turned on their stomachs. However it has now been shown that the most important single factor in preventing cot deaths is to prevent the child from sleeping on its stomach. How many babies died as a result of that pseudo-logic? [Many years ago I postualted that the deaths were a suffocation caused by an inability of the child to orientate, and explained that in terms of the known risk factors. That paper was repeatedly rejected, eventually publised (and available) as a BMJ rapid response. Abnormalities of the audio-vestibular neuro-anatomy in cot death victims has been recently demonstrated. This might support the hypothesis]

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