The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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During the past 15 years, tibiotalocalcaneal nail arthrodesis has become an established procedure for the treatment of specific disorders of the hindfoot and ankle. However, controversy exists regarding the proper starting point for obtaining and maintaining the correct hindfoot position to allow successful fusion. One of the challenges with this procedure is aligning the tibial canal with the central talus and calcaneus for placement of the intramedullary nail. ⋯ In our subjects, guide wires directed in an antegrade fashion down the tibial canal were more likely to enter lateral to the midline of the talus and miss the calcaneal body medially. These data have revealed a mismatch among the central axis of the tibia, talus, and calcaneus. Surgeons must pay careful attention to wire placement across these 3 bone segments during retrograde tibiotalocalcaneal nailing.
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The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. ⋯ For study and follow-up purposes, the ATRS seems reliable for comparisons of groups of patients. Its usability is limited for repeated assessment of individual patients. The development of analysis guidelines would be desirable.
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Review Meta Analysis
Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis.
Whether Achilles tendon rupture benefits from surgery or conservative treatment remains controversial. Moreover, the outcome can be influenced by the rehabilitation protocol. The goal of the present meta-analysis was to compare the rerupture rate after surgical repair of the Achilles tendon followed by weightbearing within 4 weeks versus conservative treatment with weightbearing within 4 weeks. ⋯ In conclusion, we found no difference in the rerupture rate between the surgically and nonsurgically treated patients followed by early weightbearing. Weightbearing after 4 weeks also resulted in no differences in the rupture rate in the surgical versus conservatively treated patients. However, surgical treatment was associated with a twofold greater complication rate than conservative treatment.
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Deep venous thrombosis (DVT) is a significant source of morbidity and mortality and is associated with many orthopedic procedures. Previous studies have reported highly variable DVT rates in patients with Achilles tendon rupture undergoing operative and nonoperative treatment. We performed a retrospective chart review for all patients who underwent Achilles tendon repair at our institution from January 2006 to February 2012. ⋯ We recommend a high level of suspicion for the signs and symptoms of DVT during the follow-up period. In addition, patient education and early mobilization should be advocated, especially for patients older than 40 years. Additional randomized controlled trials investigating any benefits to pharmaceutical DVT prophylaxis in this population are needed to establish evidence-based recommendations.
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Syndesmotic diastasis can occur as an isolated injury or with concomitant fractures. A review of 37 patients with 64 TightRopes® for syndesmotic repair was performed, with a mean follow-up of 23.6 ± 4.3 months, from 2007 to 2011. The patients' mean age was 40.67 (range 14 to 87) years. ⋯ The fracture types were as follows: 3 (8%) isolated syndesmotic injuries, 9 (24%) trimalleolar fractures, 10 (27%) bimalleolar fractures, 7 (18%) Weber B fractures, 3 (8%) Weber C fractures, 1 (3%) Salter Harris type 3 fracture, and 4 (11%) Maisonneuve fractures. TightRope® fixation was advantageous because it rarely required removal, allowed for physiologic motion of the syndesmosis, and resulted in an early return to weightbearing. In addition, we have concluded that the TightRope® provides long-term stability of the ankle mortise, which was confirmed by the radiographic criteria and excellent American Orthopaedic Foot and Ankle Society scores.