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 refine further the knowledge about the anatomic variability of the superficial peroneal nerve in the middle third of the leg. Approaching the superficial peroneal nerve in this location is required: 1) when either the deep or the superficial peroneal nerve must be resected for the treatment of dorsal foot pain; 2) when a neurolysis of the superficial peroneal nerve is required; 3) when a fasciotomy must be performed either for trauma or for exertional compartment syndrome surgery; and 4) during elevation of a fasciocutaneous or fibular flaps. ⋯ The superficial peroneal nerve was identified in the lateral compartment immediately adjacent to the fascial septum in 72% of the specimens (54 of 75), with a branch in both the anterior and the lateral compartment in 5% of the specimens (4 of 75), and located in the anterior compartment in only 23% of the specimens (17 of 75). The clinical implications of these anatomic findings are that the surgeon operating in the anterior and lateral compartments of the leg should be aware that the superficial peroneal nerve may be located in the lateral compartment and may also exhibit branches in both the anterior and lateral compartments.
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Comparative Study
Syndesmosis fixation: analysis of shear stress via axial load on 3.5-mm and 4.5-mm quadricortical syndesmotic screws.
The effect of shear stress on a fixated distal syndesmosis of the ankle was evaluated with a servohydraulic materials-testing machine. Eighteen syndesmoses were fixated in a quadricortical technique using 3.5-mm cortical and 4.5-mm cortical stainless steel screws. ⋯ The 4.5-mm quadricortical screws produced a higher yield load and peak load (484.3 +/- 93.8 N and 597.7 +/- 81.4 N) when compared with the 3.5-mm quadricortical syndesmotic screws (412.8 +/- 55 N, P = .033 and 511.2 +/- 64.4 N). These findings suggest that a larger diameter screw provides greater resistance to an applied shear stress at the distal syndesmosis.
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Comparative Study
The Webb-Bannister percutaneous technique for acute Achilles' tendon ruptures: a functional and MRI assessment.
This was a study of 57 patients treated for Achilles' tendon rupture between 1994 and 2002: 35 with an open repair and 22 with the Webb-Bannister percutaneous technique. The aim of the study was to evaluate this percutaneous method as compared to other percutaneous and open techniques, with respect to functional result and complications. In addition, postoperative MRI was performed on 40 patients in order to determine whether there were any correlations between clinical results and MRI findings. ⋯ In those patients with thicker tendon repair sites, the dorsiflexion tended to exceed the uninjured leg. The functional results of the Webb-Bannister technique were comparable to the open repair. This technique is an effective treatment for acute ruptures less wound complications.
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Randomized Controlled Trial
Peripheral foot blockade versus popliteal fossa nerve block: a prospective randomized trial in 51 patients.
The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. ⋯ Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.
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Jellyfish stings have become more prevalent on account of larger commercial presence along coastal waterways. Stings are referred to as envenomations, due to the process of a neurotoxic venom being injected into the victim at the site of the sting. These events are usually mild, and for the most part, confined to local hypersensitivity reactions at the site of the injury. ⋯ Most case reports of Portuguese man-of-war envenomations do not involve local soft tissue necrosis. The purpose of this case report is to present such a consequence after a jellyfish sting to the dorsum of the foot. A large area of skin necrosis developed after an envenomation that required extensive debridement and skin grafting.