Aloysius Mbako | University of Dundee (original) (raw)

Papers by Aloysius Mbako

Foot and Ankle Surgery, Jun 1, 2010

Injury-international Journal of The Care of The Injured, Feb 1, 2011

Several authors have identified on admission haemoglobin level as the most useful predictor of tr... more Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture.We could find no study in the English literature estimating the magnitude of this fall in haemoglobin after re-hydration prior to surgery.We conducted a prospective study to estimate the magnitude of fall in haemoglobin after rehydration prior to surgery by repeating the full blood count after at least 12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive at one centre and 52 consecutive at another).The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) (p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL (p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL (p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements for perioperative transfusion during this study. Their predicted average postoperative haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL.The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures,and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.

The journal of bone and joint surgery, Oct 1, 2011

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery ... more Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author's operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the 'sentinel' vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.

International Journal of Surgery, Nov 1, 2014

BMC sports science, medicine & rehabilitation, Apr 24, 2009

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.

Abstract: Foot ulcers and their attendant complications are disquietingly high in people with dia... more Abstract: Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, r...

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.

Care of the Critically Ill

The Bone & Joint Journal, 2011

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery ... more Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author’s operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the ‘sentinel’ vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.

International Journal of General Medicine, 2012

Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a m... more Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough) rather than what is put on the foot (adjuvant treatment).

Injury, 2011

Several authors have identified on admission haemoglobin level as the most useful predictor of tr... more Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture.We could find no study in the English literature estimating the magnitude of this fall in haemoglobin after re-hydration prior to surgery.We conducted a prospective study to estimate the magnitude of fall in haemoglobin after rehydration prior to surgery by repeating the full blood count after at least 12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive at one centre and 52 consecutive at another).The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) (p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL (p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL (p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements for perioperative transfusion during this study. Their predicted average postoperative haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL.The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures,and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.

Foot and Ankle Surgery, 2010

International Journal of Surgery, 2014

Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 2009

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.

Foot and Ankle Surgery, Jun 1, 2010

Injury-international Journal of The Care of The Injured, Feb 1, 2011

Several authors have identified on admission haemoglobin level as the most useful predictor of tr... more Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture.We could find no study in the English literature estimating the magnitude of this fall in haemoglobin after re-hydration prior to surgery.We conducted a prospective study to estimate the magnitude of fall in haemoglobin after rehydration prior to surgery by repeating the full blood count after at least 12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive at one centre and 52 consecutive at another).The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) (p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL (p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL (p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements for perioperative transfusion during this study. Their predicted average postoperative haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL.The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures,and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.

The journal of bone and joint surgery, Oct 1, 2011

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery ... more Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author's operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the 'sentinel' vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.

International Journal of Surgery, Nov 1, 2014

BMC sports science, medicine & rehabilitation, Apr 24, 2009

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.

Abstract: Foot ulcers and their attendant complications are disquietingly high in people with dia... more Abstract: Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, r...

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.

Care of the Critically Ill

The Bone & Joint Journal, 2011

Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery ... more Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author’s operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the ‘sentinel’ vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.

International Journal of General Medicine, 2012

Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a m... more Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough) rather than what is put on the foot (adjuvant treatment).

Injury, 2011

Several authors have identified on admission haemoglobin level as the most useful predictor of tr... more Several authors have identified on admission haemoglobin level as the most useful predictor of transfusion risk in patients with a hip fracture. A low postoperative haemoglobin unexplained by perioperative blood loss is not uncommon in these patients. The drop in haemoglobin after re-hydration prior to surgery should depend not only on the degree of dehydration but also on the amount of blood lost in the fracture.We could find no study in the English literature estimating the magnitude of this fall in haemoglobin after re-hydration prior to surgery.We conducted a prospective study to estimate the magnitude of fall in haemoglobin after rehydration prior to surgery by repeating the full blood count after at least 12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive at one centre and 52 consecutive at another).The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) (p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL (p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL (p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements for perioperative transfusion during this study. Their predicted average postoperative haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL.The on admission haemoglobin level was found to be falsely reassuring and could lead to a very low postoperative haemoglobin level. This could prove to be dangerous for many patients especially if remains undetected for several hours. We recommend that all patients with subtrochanteric fractures,and all patients with intertrochanteric or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.

Foot and Ankle Surgery, 2010

International Journal of Surgery, 2014

Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 2009

Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may pro... more Distension of joint with fluid is often used to facilitate insertion of arthroscope. This may prove difficult at times in the shoulder joint, as unlike the knee, it is deeply situated, making extravasation of fluid outside the capsule, a common occurrence. This is especially true in very tight joints and is often a problem for beginners. We describe here a very effective and simple technique where a needle is used to distend the shoulder before the insertion of the arthroscope.