The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Displaced medial malleolus fractures are considered unstable and typically require open reduction and internal fixation for anatomic reduction and early joint range of motion. These fractures are usually fixated with either compression lag screws or tension band wiring depending on the fracture pattern, size of the distal fragment, and bone quality. When fracture fixation fails, it is typically in pullout strength. ⋯ The median force recorded at 2 mm of distraction using unicortical partially threaded cancellous screws was 116.2 N (range 70.2 to 355.5N) compared with 327.6 N (range 117.5 to 804.3 N) in the fully threaded bicortical screw (P = .04). The unicortical screw fixation displayed only 64.53% of the median strength noted with the bicortical screw fixation at clinical failure. The current study demonstrated statistically significantly greater pullout strength for 3.5-mm bicortical screws when compared with 4.0-mm partially threaded cancellous screws used to fixate medial malleolar fractures in a cadaveric model.
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Randomized Controlled Trial Comparative Study
A randomized controlled trial to compare two techniques for partial digital local anesthetic blocks.
The administration of local anesthetic before surgery to the great toe is often associated with significant difficulties, delaying surgery and increasing risk. Anxious patients can faint, refuse injection, or withdraw the foot while an anesthetic is being delivered. Such events led us to consider whether delivering a small amount of anesthetic throughout the injection site, before the main injection, may reduce pain intensity and duration. ⋯ In the 2-stage method, it is believed that they were due to the initial infiltration of a small quantity of the anesthetic solution throughout the injection site, with the remainder being administered, after a 2-minute interval, into tissue that was predominantly anesthetized. This differs from raising a traditional bleb where a small amount of anesthetic is infiltrated into superficial tissue. The 2-stage technique is therefore recommended as the method of choice for adults.
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The aim of this retrospective study is to evaluate the prognostic value of American Society of Anesthesiologists (ASA) classification with regard to perioperative variables of cardiac complications, pulmonary complications, and mortality in patients undergoing limb salvage procedures with monitored intravenous sedation and foot and ankle blocks. None of the ASA 3 or 4 patients experienced any pulmonary or cardiac complication; no patient required invasive monitoring or postoperative cardiac care unit admission. We suggest that the performance of peripheral foot and ankle blocks with monitored intravenous sedation appears to be a safe and useful option for ASA 3 and 4 patients undergoing limb-preservation surgery.
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Interphalangeal joint arthrodesis is a common procedure to correct fixed or semifixed lesser toe contracture. The authors present a simple modification to end-to-end interphalangeal joint arthrodesis that increases surface area and enhances construct stability. The technique is most commonly used for the proximal interphalangeal joint and may be combined with any number of fixation techniques.
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Comparative Study
The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results.
We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. ⋯ P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle joint, the risk of infection is minimized, and secondary plate fixation remains possible.