The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Charcot medial column and midfoot deformities are associated with rocker bottom foot, recurrent plantar ulceration, and consequent infection. The primary goal of surgical intervention is to realign and stabilize the plantar arch in a shoe-able, plantigrade alignment. Different fixation devices, including screws, plates, and external fixators, can be used to stabilize the Charcot foot; however, each of these methods has substantial disadvantages. ⋯ No bolt breakage was observed, and no cases of recurrent or residual ulceration occurred during the observation period. Bolt removal was performed in 3 cases (37.5%), 2 (25%) because of axial migration of the bolt into the ankle joint and 1 (12.5%) because of infection. The results of the present review suggest that a solid intramedullary bolt provides reasonable fixation for realignment of the medial column in cases of Charcot neuroarthropathy.
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Central metatarsal malunion is sparsely described in the literature. There are differing opinions on the importance of open reduction and internal fixation for lesser metatarsal fractures and possible complications from lack of appropriate treatment for these common fractures. In general, little emphasis is placed on performing open reduction and internal fixation of displaced central metatarsal fractures. ⋯ In both cases, treatment consisted of metatarsal osteotomies with realignment and fixation. In each case, this treatment provided relief of pain, increased range of motion, and return to normal activity. In cases of painful metatarsal malunion, restoration of anatomic alignment may be necessary for resolution of pain and disability.
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Comparative Study
SmartToe® implant compared with Kirschner wire fixation for hammer digit corrective surgery: a review of 28 patients.
For many years, end-to-end arthrodesis of a proximal interphalangeal joint arthrodesis to correct hammer digit deformity has been fixated with a Kirschner wire (K-wire). For this particular hammer digit deformity correction, we attempted to determine the effectiveness of the SmartToe(®) intramedullary shape memory implant compared with the K-wire. ⋯ The SmartToe(®) outperformed the K-wire in all categories, with no evidence of significant complications, compared with multiple complications for patients in the K-wire arm of the study. This study demonstrates that the SmartToe(®) is a reasonable choice for fixation of proximal interphalangeal joint arthrodesis in hammer digit correction.
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Isolated dislocation of the medial cuneiform is a rare injury. A favorable outcome relies on an accurate and stable reduction. ⋯ Occult fracture of the medial cuneiform contributed to residual instability of the first ray and persistent and progressive symptoms and ultimately necessitated operative stabilization of the medial arch. We recommend the use of computed tomography as an adjunct to plain radiography for all midfoot dislocations to more accurately define the extent of the injury.
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Midfoot Charcot collapse commonly occurs through the tarsometatarsal and/or midtarsal joints, which creates the characteristic "rocker bottom" deformity. Intramedullary metatarsal fixation spanning the tarsus into the talus and/or calcaneus is a recently developed method for addressing unstable midfoot Charcot deformity. ⋯ These advantages include anatomical realignment, minimally invasive fixation technique, formal multiple joint fusion, adjacent joint fixation beyond the level of Charcot collapse, rigid interosseus fixation, and preservation of foot length. The goals of the intramedullary foot fixation procedure are to create a stable, plantigrade, and ulcer-free foot, which allows the patient to ambulate with custom-molded orthotics and shoes.