The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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We undertook a retrospective study to evaluate the hypothesis that complex regional pain syndrome (CRPS) I, known as the "new" reflex sympathetic dystrophy, persists because of undiagnosed injured joint afferents, cutaneous neuromas, or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II, which is known as the "new" causalgia. We used a research protocol, with institutional review board approval, to review medical records for the purpose of identifying 30 patients with lower extremity reflex sympathetic dystrophy, based on their history, physical examination, neurosensory testing, and response to peripheral nerve blocks, who were treated surgically at the level of the peripheral nerve. ⋯ Outcomes were measured in terms of decreased pain medication usage and recovery of function, and the results were excellent in 7 (55%), good in 4 (30%), and poor (failure) in 2 (15%) of the patients. Based on these results, we concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and chronic nerve compression, which is indistinguishable from CRPS II, and amenable to successful treatment by means of an appropriate peripheral nerve surgical strategy.
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Total talar extrusion is an extremely rare injury that occurs after a high-energy trauma. There are few reported cases in literature and there is no consensus as to the appropriate treatment of the extruded talus. Historically, the treatment options for open total talar dislocation have been limited to talectomy and fusion or reimplantation after thorough debridement. We report a case of an open dislocation of the talus with total talar extrusion. Immediate surgical debridement, reduction, and external fixation were performed under antibiotic coverage. Antibiotic-impregnated polymethylmethacrylate beads were implanted and the wound underwent a second debridement and delayed primary closure at 48 hours post injury. The patient remained in an external fixator for 6 weeks. She was subsequently placed in a cast and remained non-weight bearing for an additional 6 weeks. Her wound healed uneventfully and she was permitted to begin progressive weight bearing at 12 weeks. The patient did not develop an infection or avascular necrosis. Literature cites infection and avascular necrosis as the main complications associated with a talar extrusion. Good open fracture protocol can reduce the risk of infection. Reduction of the extruded talus is preferable to preserve function and maintain normal hindfoot anatomy. Talectomy should be reserved as a salvage procedure. ⋯ 4.
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The authors describe the case of a 13-year-old male with a Salter-Harris II fracture-subluxation of the fibula. Open reduction and internal fixation with a posterior antiglide plate achieved mortise stability and avoided penetration of the fibular physis by fixation devices. After searching the Medline, EMBASE, CINAHL, and the Cochrane Library databases, to our knowledge, there have been no published reports describing the advantages associated with the use of a posterior antiglide plate for fixation of the immature fibula.
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Peroneal tendon dislocation with recurrent subluxation over the lateral malleolus, both acute and chronic, is well documented in the literature. However, there remains a subset of patients who report symptoms similar to peroneal subluxation that do not actually display active or passive displacement of the tendon over the lateral malleolus. In this article, we describe 7 patients who were followed prospectively for the treatment of ultrasound-confirmed, retrofibular, intrasheath subluxation without the typical lateral subluxation or dislocation of the tendon over the malleolus. Six of the 7 patients had either a low-lying peroneal muscle belly or a peroneus quartus muscle and tendon, 6 experienced a tear of either 1 or both of the peroneal tendons, and 1 of the 7 had only a peroneus brevis tendon tear without any other muscle anomaly. Repair of concomitant tendon pathology and resection of the low-lying muscle belly to a point proximal to the fibro-osseous tunnel of the retromalleolar space resulted in elimination of the subluxation symptoms and improvement in American College of Foot and Ankle Surgery ankle scores in 3 patients who were treated operatively. ⋯ 4.