The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Open ankle dislocation without an associated fracture is an extremely rare injury. We present the case of a 24-year-old male athlete who had sprained his left ankle during volleyball playing. He sustained an open posteromedial dislocation of his left ankle, without an associated malleolar fracture. ⋯ At the 6-month follow-up visit, he returned to sports activities. At 9 months of follow-up, the patient participated in volleyball games at the same level as before his injury. At 2 years after the initial injury, he did not have any clinical complaints, and his ankle had no clinical or subjective signs of instability.
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Subtalar joint arthrodesis is a commonly used surgical procedure for the management of rearfoot pathologic features. We present a technique guide for a posterior incisional approach to subtalar joint arthrodesis for correction of a calcaneal deformity secondary to calcaneal fracture malunion. This technique uses a monolateral external fixation device for controlled distraction and intercallary allograft placement. ⋯ We have described the surgical technique and presented a case in which the posterior approach with distraction was successfully used in subtalar joint arthrodesis. At 12 weeks postoperatively, serial radiographs displayed incorporation of the graft, with distraction maintained at the subtalar joint arthrodesis site. At the 3-month follow-up visit, the patient had successfully transitioned to weightbearing in a CAM walker without any complications.
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The purpose of the present study concerning high-strength sutures was to determine whether increasing the number of locking loops with different size sutures or decreasing the suture size with increased suture strands would have any influence on the strength of Achilles tendon repair. A total of 32 fresh bovine Achilles tendon specimens were randomly assigned to 4 groups. For 3 of the groups, 1 suture was used (no. 2 or no. 5 FiberWire™ with 2 or 4 Krackow locking loops). ⋯ In the group with 2-0 suture with 4 strands and 2 locking loops, 6 failed during cyclic loading. The number of locking loops used might have had an influence on the strength of the Krackow suture configuration using the larger diameter, high-strength sutures. However, decreasing the suture diameter, with a simultaneous increase in the number of strands, failed to improve the initial strength of the repair.
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Combined talus and calcaneum fractures are rare in themselves. We report the case of an unusual fracture pattern of the talus and calcaneum in an otherwise, healthy 17-year-old male. Plain radiographic images of the foot revealed a fracture through the neck of the talus. ⋯ The calcaneal component was treated conservatively. The soft tissue injuries to the 2 tendons were also repaired. The patient made good progress with this management.
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The present study assessed the midterm results of reconstruction for rheumatoid forefoot deformity with arthrodesis of the first metatarsophalangeal (MTP) joint, scarf osteotomy, resection arthroplasty of the metatarsal head of the lesser toes, and surgical repair of hammertoe deformity (arthrodesis of the proximal interphalangeal joint). Special focus was placed on the sagittal alignment of the first metatarsophalangeal joint after arthrodesis. We retrospectively evaluated the postoperative clinical outcomes and radiographic findings for 16 consecutive female patients (20 feet) with symptomatic rheumatoid forefoot deformities. ⋯ The mean value of the American Orthopaedic Foot and Ankle Society and Japanese Society for Foot Surgery clinical scores significantly improved overall, except for 2 patients (10%), who complained of first toe pain at the final follow-up visit owing to sagittal misalignment of the fused first MTP joint. Sagittal alignment of the first metatarsal varies greatly because of the rheumatoid midfoot and hindfoot deformities. Therefore, inclination of the first metatarsal should be considered when determining the first MTP joint sagittal fusion angle.