The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Comparative Study
The radiographic fate of the syndesmosis after trans-syndesmotic screw removal in displaced ankle fractures.
The purpose of this study was to evaluate the radiographic changes of the tibiofibular position and the ankle mortise after removal of trans-syndesmotic fixation to determine if there is loss or maintenance of correction. In addition, the effect of the type of rotational injury, early weight bearing, and the number of trans-syndesmotic screws used on the integrity of the inferior tibiofibular articulation or ankle mortise after screw removal were evaluated. An analysis was conducted of 86 patients, with an unstable rotational ankle fracture requiring open reduction with syndesmosis screw stabilization. ⋯ Tibiofibular diastasis is commonplace upon removal of the syndesmotic hardware, but the ankle mortise remains unchanged. Based on the radiographic criteria described in this study, the postoperative change in medial clear space or tibiofibular diastasis has no bearing on fracture type, deltoid injury, or the use of 1 or 2 cortical screws. As such, other unknown mechanisms affecting the integrity of the syndesmosis after screw removal are in place.
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Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. ⋯ An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time.
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Case Reports
Bilateral os subtibiale and talocalcaneal coalitions in a college soccer player: a case report.
An os subtibiale is an accessory bone separated from the distal medial tibia proper. Subtalar tarsal coalition is a failure of joint formation between the talus and calcaneus during hindfoot maturation. The patient in this case report has large bilateral os subtibiale and subtalar coalitions, which were undiagnosed throughout his soccer career until recently when he began having anteriorlateral ankle pain. ⋯ This report will hopefully alert clinicians about these 2 rare anatomic findings and encourage them to use caution when evaluating suspected fractures of the medial malleolus that could be functional os subtibiale ossicles. In addition, we hope to shed some light on the complicated coupling of motion between the ankle and subtalar joint. These may have developed together to allow more normal coupled motion between the ankle and subtalar joint in this high-level college soccer player, and may be relevant to future reports or research in this area.
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Publication is the ultimate desired end point of scientific research. However, oral manuscript presentations of research studies are often referenced in textbooks, journal articles, and industry white papers, and, as a result, influence treatment care plans. No data exist for the actual publication rate of podiatric foot and ankle surgery oral manuscript presentations. ⋯ All journals except one (91.7%) represented peer-reviewed journals. The publication rate of oral manuscript presentations at the ACFAS Annual Scientific Conference is similar to or greater than orthopaedic subspecialties, including foot and ankle surgery, publication rates. Based on the above, attendees of the ACFAS Annual Scientific Conference should be aware that the majority of oral manuscript material presented at the ACFAS Annual Scientific Conference can be considered as accurate because they survive the rigors of the peer-review process more than two thirds of the time.