The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Comparative Study
Plates, Screws, or Combination? Radiologic Outcomes After Lisfranc Fracture Dislocation.
Traditionally, Lisfranc fracture dislocations have been treated with transarticular screw fixation. A more recent development has been the use of dorsal bridging plates. The aim of the present study was to compare the radiologic outcomes for these 2 methods. ⋯ No radiologic benefits were found when comparing plate or screw fixation for Lisfranc fracture dislocations (although screw fixation might be associated with a less planus foot and fewer complications). Instead, a good anatomic reduction was the only predictor of the radiologic outcome, and the Hardcastle classification of fractures did not predict the surgery type or radiologic outcome. Finally, treatment with combination plates and screws resulted in worse radiologic outcomes, possibly owing to more complex fracture patterns.
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Case Reports
Vacuum-Assisted Closure in the Management of Degloving Soft Tissue Injury: A Case Report.
We report the case of a patient with an extensive degloving injury to his right foot involving severe subcutaneous soft tissue disruption and contamination. The initial treatment consisted of debridement, which was kept to a minimum, copious irrigation, primary wound closure at a few sites, and coverage of the remaining skin defects with vacuum-assisted closure (VAC) dressings. After a few weeks of VAC therapy for wound bed preparation, definitive coverage with a meshed skin graft was possible. ⋯ This is of particular relevance if the graft recipient site is subject to heavy stress and the restoration of function is of paramount importance, such as in the present case. Vacuum therapy is an effective and safe treatment of degloving injuries. We achieved a very good functional outcome, which was particularly important in view of the high stresses and strains to which a foot is exposed.
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From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. ⋯ All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.
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In the present report, a new radiographic classification for distal shaft fractures of the fifth metatarsal is presented. The classification system is based on a review of 79 spiral oblique fractures of the distal shaft of the fifth metatarsal. The sample was grouped into "grades" of deformity according to the configuration of the fracture and the amount of displacement observed for each injury. ⋯ Grade I and III fractures accounted for 29% and 22% of the distal fifth metatarsal fractures, respectively. To our knowledge, a classification system for fractures of the distal shaft of the fifth metatarsal has not been previously reported. The radiographic classification that we have proposed is intended to aid surgeons treating and discussing fractures localized to the distal portion of the fifth metatarsal.