The Foot
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Classical AO teaching recommends that a syndesmosis screw should be inserted at 25-30 degrees to the coronal plane of the ankle. Accurately judging the 25/30 degree angle can be difficult, resulting in poor operative reduction of syndesmosis injuries. The CT scans of 200 normal ankles were retrospectively examined. ⋯ This line was shown to pass through the fibula within 2.5mm of the lateral cortical apex of the fibula and the anterior half of the medial malleolus in 100% of the ankles studied. The results support the concept that in the operatively reduced syndesmosis, the anterior half of the medial malleolus can be used as a reliable guide for aiming the syndesmosis drill hole, provided that the fibular entry point is at/or adjacent to the lateral fibular apex. The screw should also remain parallel to the tibial plafond in the coronal plane.
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In this report, an osteochondral lesion of the tarsal navicular associated with a subacute stress fracture in a professional basketball player surgical treatment is presented. The surgical technique involved extra-articular curettage, bone grafting and plate stabilisation. Postoperative CT scan confirmed that both the osteochondral lesion and the stress fracture healed. ⋯ Clinical foot scores showed marked improvement after surgery. At 6 months patient managed to return to competitive play without pain in the foot and ankle. The outcome of this case indicates that the combination of curettage, bone grating and plate stabilisation works well for this rare and potentially career ending dual lesions.
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Ankle dislocation without associated malleolar fracture(s) remains a rare presentation, especially in adolescence. Identified and treated promptly, these injuries can result in good to excellent outcome. We present an anterior ankle dislocation in a 14 year old, missed for approximately 12 months, necessitating multiple surgical interventions to provide a pain-free and stable joint. A review of the current literature is also provided.
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Case Reports
Talar neck fracture-a rare but important complication following subtalar arthroereisis.
Subtalar arthroereisis is a technique for treating symptomatic flexible flatfeet by means of inserting an implant or stent into the sinus tarsi. The goals are to reduce pain, deformity and instability of the foot. However, there are recognised complications associated with this technique which include malposition of the implant, undercorrection/overcorrection of the deformity, persistent sinus tarsi pain, deep medial heel pain, foreign body synovitis, avascular necrosis of the talus, intraosseous cystic formation in the talus, migration of the implant, device extrusion and subtalar joint arthrosis. In this report an unusual complication of fracture of the neck of the talus in a teenager who competes recreationally in 'at risk'/impact sports, who had previously had arthroereisis screw insertion some years before is presented.
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Case Reports
Complete medial column dislocation at the cuneonavicular joint: an unusual Lisfranc-like injury.
Lisfranc injuries represent a wide spectrum of different injuries at the tarsometatarsal joint. Not all types fit the currently available classifications. ⋯ It is presented to create more awareness for midfoot injuries. This article reviews the literature and provides recommendations for the treatment of similar cases in the future.