The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The purpose of this study is to recognize those young patients with symptomatic flexible flatfoot deformity who need treatment and to provide radiological evidence that arthroereisis is capable of relocating the talus properly over the calcaneus. We included 28 feet in 14 children who underwent subtalar arthroereisis in association with percutaneous triple-hemisection Achilles tendon lengthening. Selected for arthroereisis were children with symptomatic flexible flatfoot deformity who complained of foot and leg pain, had decreased endurance in sports activities and long walks, who did not respond to conservative treatment modalities for at least 6 months, and in whom at radiological assessment on stance position with the medial arch support orthosis the talonavicular joint lateral subluxation still remained, with Meary's angle in anteroposterior (A/P) and lateral view remaining increased. ⋯ The mean preoperative AFOAS ankle-hind foot rating score was 65.14 ± 7.16 (range 58 to 75) points. The mean postoperative AFOAS score was 88.851 ± 5.61 (range 83 to 97) points and the 2-tailed p value <.0001. After arthroereisis surgical treatment, all AOFAS scores and all foot angles improved significantly, except the calcaneal inclination angle which improved slightly.
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Comparative Study
Comparison Between Early Functional Rehabilitation and Cast Immobilization After Minimally Invasive Repair for an Acute Achilles Tendon Rupture.
The purpose of the present study was to compare the outcomes of patients with Achilles tendon rupture treated with minimally invasive repair and early functional rehabilitation with the outcomes of similar patients treated with cast immobilization. After undergoing minimally invasive surgery, a below-knee splint with the foot in 30° of plantarflexion was applied to each patient for the first week. Patients were then assigned to a cast immobilization group (IG; n = 25) or a functional group (FG; n = 16). ⋯ There was no clinically important difference between the 2 groups with regard to heel height, ROM, return to sports, calf circumference, visual analog scale, American Orthopaedic Foot and Ankle Society score, or Achilles tendon Total Rupture Score at every outpatient check except ROM difference at 6 weeks and heel height at 3 months. Rerupture occurred in 2 patients (1 [4%] in the IG and 1 [6.25%] in the FG). Early functional rehabilitation seemed to be as safe as traditional postoperative immobilization with a similar functional result and complications, but it was advantageous for the early phase of rehabilitation only.
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Venous thromboembolism is a condition that includes both deep vein thrombosis and pulmonary thromboembolism. Pulmonary thromboembolism is a condition that is familiar to forensic pathologists for its common cause of sudden unexpected death. Fatal pulmonary thromboembolism following deep vein thrombosis has been previously reported as a consequence of major ankle injury but not following minor ankle injury. Here, I report the case of sudden unexpected death in a 54-year-old female without known underlying risk factors for venous thromboembolism, except for a history of minor injury at her left ankle, which possibly caused local vascular wall damage with subsequent deep vein thrombosis and eventual massive pulmonary thromboembolism.
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We sought to determine the early range of motion, complication rates, and 1-year patient-reported outcomes following Achilles tendon repair, using a modified gift-box suture loop technique. Sixty consecutive patients (49 males, mean age 36.2 ± 9.9 years) who underwent Achilles tendon repair with a modified gift-box suture loop technique performed by a single surgeon were prospectively enrolled. The range of motion at the final follow-up visit (mean 6 months) and the Achilles tendon rupture score (ATRS) and the complication rates at 1 year were obtained with 83% follow-up. ⋯ The rerupture and overall complication rates by 1 year were low. The range of motion, particularly dorsiflexion, improved through at least 6 months. Diabetic patients had lower 1-year ATRS than nondiabetic patients using this technique.
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The purpose of this study was to compare the rates of readmission, reoperation, and mortality in patients with and without diabetes mellitus during the 30-day postoperative period after ankle fracture surgery. Patients who underwent operative management for ankle fractures between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program® database by using Current Procedural Terminology codes for ankle fracture surgery. A total of 17,464 patients undergoing ankle fracture surgery were identified. ⋯ Patients with diabetes had significantly higher rates of readmission (2.84% vs 1.05%, p < .0001), significantly higher rates of unplanned reoperation (2.3% vs 0.74%, p < .0001), and significantly higher rates of mortality (0.7% vs 0.2%, p < .0001) compared with patients without diabetes. Additionally, patients with diabetes had significantly greater age-adjusted odds ratios (ORs) of unplanned readmission (OR 2.40, 95% confidence interval [CI] 1.74 to 3.31, p < .0001), unplanned reoperation (OR 2.56, 95% CI 1.44 to 3.27, p < .0001), and mortality (OR 2.01, 95% CI 1.08 to 3.62, p = .0432) than did patients without diabetes after ankle surgery. In this large-scale retrospective study, we demonstrated that the presence of diabetes significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality during the 30-day postoperative period after ankle fracture surgery.