The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Case Reports
Underlying synovial sarcoma in a patient with a history of complex regional pain syndrome: a case report.
Synovial sarcoma, although commonly found in the lower extremities, is considered a rare neoplasm. One of the distinguishing features of a synovial sarcoma is its initial benign features that can later turn into a more aggressive lesion. Because of the subtle early features, synovial sarcoma can be mistaken for other pathologic entities that present with clinical signs of erythema, warmth, edema, and pain. ⋯ After magnetic resonance imaging and biopsy were performed, synovial sarcoma was diagnosed. The patient was referred to an orthopedic oncologist, who performed a transtibial amputation and chemotherapy. Although rare, neoplasm should always be considered in the differential diagnosis of a clinical presentation of a painful erythematous and edematous mass.
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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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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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Irreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular type of injury, known as a Bosworth fracture dislocation, was not appreciated on the initial radiographs taken in the emergency room but was identified at urgent surgical management. The trauma mechanism, radiographs, treatment, and relevant published data are discussed in the present report.