The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Lesser digital arthrodesis has become one of the most widely used techniques in foot and ankle surgery. When performing digital arthrodesis, surgeons have an abundance of options for implantable devices. ⋯ An intramedullary Kirschner wire is implanted into the proximal phalanx with the intermediate phalanx compressed over the wire for rigid internal fixation to avoid the use of an external device. We have had results similar to those from the published data of more expensive implants.
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Syndesmotic injuries of the ankle commonly occur by an external rotation force applied to the ankle joint. Ten fresh-frozen lower extremities from cadavers were used. A specially designed apparatus was used to stabilize the specimen and rotate the ankle joint from internally rotated 25° to externally rotated 35° at a rate of 6°/s for 10 cycles. ⋯ The sectioning of the syndesmostic ligaments and deltoid ligament resulted in a significant decrease in syndesmotic diastasis and foot torsional force (p < .05). The ligament-sectioned specimen lost 57% (externally rotated) and 17% (internally rotated) torsional strength compared with the intact specimen. Groups 1 and 2 provided similar biomechanical stability in this cadaveric model of a syndesmosis deficiency.
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The purpose of the present study was to evaluate the postoperative radiographic and functional outcomes of reduction and fixation of a posterior plafond fracture using a posterolateral approach. We included 38 patients with a tibial plafond fracture. Fixation was most commonly performed using screws, T plates, or meta plates. ⋯ One patient (3.1%) developed symptomatic post-traumatic arthritis. The posterolateral approach allowed for good exposure and buttress fixation of the posterior plafond fractures with few local complications. The anatomic repositioning and stable fixation resulted in good functional and subjective outcomes.
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Distal tibiofibular syndesmosis injury accounts for 1% to 11% of soft tissue injuries of the ankle. Some acute syndesmotic injuries will fail to heal effectively owing to inadequate treatment or misdiagnosis, eventually resulting in chronic instability, which can destroy the stability of the ankle joint. Various surgical techniques have been described for fixation of the syndesmosis. ⋯ However, the "relatively" long suture between buttons can gradually relax under continuous loading, resulting in fixation failure, which we have termed electric wire phenomenon. In the present report, we have described a modified technique for flexible fixation using the Endobutton CL ULTRA fixation device by tricortical fixation, instead of quadricortical fixation, to allow for robust and reliable fixation of the distal tibiofibular syndesmosis. The modified technique is devoid of the concern regarding the use of screw fixation and can reduce the risk of displacement or elongation and skin irritation associated with the suture button.