The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Placement of a screw from the lateral wall of the calcaneus into the constant sustentaculum tali fragment can be difficult when surgically repairing a calcaneal fracture. This screw serves to compress the fracture fragments and support the posterior facet. This difficulty results from the small landing zone of the sustentaculum tali with its nearby vulnerable soft tissue structures. We present an anatomic study of 10 cadavers to determine a starting point and angle of screw advancement when placing a constant fragment screw.
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The aim of the present study was to compare the outcomes of patients with a displaced calcaneal fracture treated by open reduction and internal fixation (ORIF), percutaneous treatment, or nonoperative methods. A retrospective cohort study was conducted at a level I trauma center of patients with a displaced intra-articular calcaneal fracture treated from January 1, 2002 to December 31, 2011. The patient-reported outcome measures included the Foot Function Index, American Orthopaedic Foot and Ankle Society hindfoot scale, Short Form-36, the EQ-5D from the EuroQol Group, and a 10-point visual analog scale. ⋯ The late intervention rate was significantly greater in the percutaneous group (n = 18; 30%) than in the ORIF group (n = 6; 12%) or the nonoperative group (n = 8; 13%; p = .030). Significantly more disability was reported in the nonoperative group (median Foot Function Index score, 40 points) than in the ORIF group (median, 16 points; p = .010) or in the percutaneous group (median, 21 points; p = .034). In conclusion, the operatively treated patients (ORIF and percutaneous treatment) reported better functional outcome scores (Foot Function Index and American Orthopaedic Foot and Ankle Society hindfoot scale) than did the nonoperatively treated patients.
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The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. ⋯ The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (p = .03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (p = .002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia.
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The purpose of the present prospective study was to analyze the predictors of outcome and review the quality of life of patients who underwent emergency fasciotomy for foot compartment syndrome after blunt trauma. A total of 14 patients were identified and followed for an average of 24 (range 14 to 33) months. The mean interval from initial presentation to decompressive fasciotomy was 5.8 (range 3 to 11) hours. ⋯ Finally, 4 (28.6%) patients required modified shoes or shoe inserts for comfortable ambulation. Our findings suggest that earlier fasciotomy results in better quality of life scores, American Orthopaedic Foot and Ankle Society scale scores, and visual analog scale pain scores and a greater likelihood of being able to wear all shoes comfortably, ambulate independently, and return to work. A shorter interval to fasciotomy, younger age, the absence of bony injury, the absence of other concomitant injuries, and a low velocity crush injury all tended to be predictors of good outcomes at the final review.
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The anatomy of the posterior tibial malleolus plays an important role in the structure and function of the ankle mortise. With specific respect to ankle fractures, the presence, size, and displacement of posterior malleolar fractures (Volkmann's fracture) helps determine which will be amendable to operative fixation. The objective of the present study was to increase the body of knowledge with respect to the ability of foot and ankle reconstructive surgeons to assess posterior malleolar ankle fractures using plain film radiography. ⋯ Accurate identification of the posterior malleolar fracture occurred on 86.67% (26 of 30) of standard lateral radiographs and 100% (30 of 30) of externally rotated lateral radiographs. Furthermore, the surgeons described the fracture with greater precision and had greater interclass correlation coefficient values with respect to measurement of sagittal plane displacement (0.977 versus 0.939) and percentage of involvement of the tibial plafond (0.972 versus 0.775) with an externally rotated lateral projection compared with a standard lateral projection. Our results provide evidence that an externally rotated lateral radiographic projection can provide surgeons with some additional information with respect to the presence, size, and displacement of posterior malleolar ankle fractures.