The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Comparative Study
Early Protected Weightbearing After Ankle Fractures in Patients With Diabetes Mellitus.
The traditional protocol for treatment after ankle fracture in the diabetic patient involves a period of prolonged non-weightbearing to reduce the incidence of complications. The goal of the present study was to identify the risk factors and complications associated with early protected weightbearing after closed ankle fractures in patients with diabetes. The data from 73 diabetic patients with operatively and nonoperatively treated ankle fractures were retrospectively reviewed. ⋯ No statistically significant differences were identified according to hemoglobin A1c, the presence of peripheral neuropathy, smoking status, fracture type, or the presence of end-stage renal disease. The results of the present study suggest that early protected weightbearing after closed ankle fractures in diabetic patients is fairly safe, with an acceptable complication rate. However, the patients selected for early weightbearing had low comorbidity profiles, which might have accounted, in part, for the low complication rate.
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Comparative Study
Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures.
Controversy is ongoing regarding the use of bone grafts to fill cavities that occur with collapse of the posterior facet in the joint and for repair of the calcaneal height with plating. The present study included 40 patients with 43 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation from March 2009 to November 2013. In the present case-control study, the patients were separated into 2 groups: group A received an allograft (20 patients, 22 calcaneal fractures) and group B did not (20 patients, 21 calcaneal fractures). ⋯ The comparisons between the 2 groups showed a loss of Böhler's angle and loss of calcaneal height that was significantly greater in group B (p < .001). No significant differences were observed between the 2 groups in the AOFAS ankle hindfoot scale scores (p > .05). In conclusion, although no differences were found in the clinical results between the 2 groups, more satisfactory radiologic results were obtained in group A, in which bone grafts were used.
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During the previous 2 decades, numerous surgical procedures have become available to treat osteochondral lesions of the talus. The objective of the present study was to use 7 Tesla (7T) magnetic resonance imaging (MRI) to quantify and compare T2 values (a marker of collagen architecture) of native tibiotalar cartilage and cartilage repair tissue in patients treated with a juvenile particulate allograft for osteochondral lesions of the talus. The institutional review board approved the present study, and all subjects provided written informed consent. ⋯ We compared the differences between groups using the paired t test. The talar cartilage repair tissue demonstrated greater mean T2 relaxation times compared with the native adjacent talar cartilage (64.88 ± 12.23 ms versus 49.56 ± 7.82 ms; p = .043). The tibial cartilage regions overlying these talar cartilage regions demonstrated a trend toward greater T2 relaxation times (77.00 ± 31.29 ms versus 59.52 ± 7.89 ms; p = .067). 7T MRI can detect differences in T2 values in cartilage repair tissue compared with native cartilage and could be useful for monitoring the status of cartilage health after surgical intervention.
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Surgeons are always searching for useful methods that enhance surgical accuracy. In the case of endoscopic plantar fasciotomy, identifying the optimal location for insertion of the endoscope for precise sectioning of the desired portion of the plantar fascia, without increasing the risk of injury to adjacent anatomic structures and without complicating the surgery in terms of time or costs, would be beneficial to patients and surgeons alike. In the present techniques report, a simple method for accurately determining the optimal location for placement of the endoscope for execution of plantar fasciotomy is described.