The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The aim of this study was to evaluate 1) long-term results of ankle fractures with a posterior malleolar fragment, and 2) the need for fixation of fragments smaller than 25%. Forty-five patients with ankle fractures and a posterior malleolar fragment were evaluated. Mean follow-up was 13 years (range, 2-24). ⋯ There was no significant correlation between outcome and size of unfixated fragments. Fracture-dislocation was seen more often in combination with larger fragments (24% versus 15%) and resulted in statistically significant worse long-term outcome than nondislocated fractures, except for pain (Ankle Fracture Scoring System: 115 versus 134, Osteoarthritis-score: 1.7 versus 0.8). In conclusion, patients showed good results after 13 years follow-up and there was no evidence for the need for fixation of fragments smaller than 25%.
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Comparative Study
Distal tibiofibular syndesmosis fixation: a cadaveric, simulated fracture stabilization study comparing bioabsorbable and metallic single screw fixation.
Metal screws that are used for ruptured tibiofibular syndesmosis repair are often removed within 3 months of placement, suggesting the utility of bioabsorbable screws. A biomechanical study was performed to compare fixation of a simulated syndesmosis separation with a 5-mm oriented copolymer bioabsorbable (82:18 poly-L-lactic acid/poly-glycolic acid) versus a stainless steel screw. Eight pairs of cadaveric lower-leg specimens were cleaned and a pronation external rotation-type injury was created in each. ⋯ Application of 1000 cycles of axial load (90 to 900 N) resulted in a significant decrease ( P < .0001) in axial stiffness for each fixation method, but the relative decrease was equivalent for both ( P = .211). Failure torque (17.8 +/- 8.3 N.m copolymer, 21.0 +/- 11.5 N.m stainless steel; P = .238) and angle of rotation at failure (47.9 +/- 13.6 degrees copolymer, 42.0 +/- 11.5 degrees stainless steel; P = .199) were also nearly equivalent. It appears that the 5.0-mm diameter copolymer screw is biomechanically equivalent to the 5.0-mm diameter stainless steel screw for repair of syndesmosis disruption.
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Complex regional pain syndrome (CRPS) is a multifaceted, progressive, and potentially devastating disorder generally affecting the extremities. In addition, scant information is available regarding the types of patients who develop lower-extremity CRPS. This is a retrospective chart review study of 64 patients who presented to a pain clinic with CRPS of the lower extremity. ⋯ The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery. Referral to the pain clinic was delayed more commonly in trauma patients than in postsurgical patients, with a corresponding increase in pain clinic visits for treatment. This study may act as a guide for physicians treating the lower extremity to aid in the recognition of lower extremity complex regional pain syndrome and its characteristics.
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Comparative Study
Strength analysis of intraosseous wire fixation for avulsion fractures of the fifth metatarsal base.
The objective of this study was to gather pilot data of the pullout strength of intraosseous wire for fixation of fifth metatarsal avulsion fractures and to compare intraosseous wire fixation with tension-band wiring. Osteotomies consistent with fifth metatarsal avulsion fractures were created in 5 matched pairs of cadaver limbs. One limb of each pair underwent fixation with intraosseous wiring and the other with tension band wiring. ⋯ Tension-band wiring showed a mean strength of 164.5 +/- 103.7 N compared with a mean strength of 113.7 +/- 46.6 N for intraosseous wiring. No significant difference in strength was shown between methods of fixation. Although the power of this data is small (.143), the data indicate that intraosseous wiring shows similar pullout strength when compared with tension-band wiring for fixation of fifth metatarsal avulsion fractures.
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Review Case Reports
Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve: report of 2 cases and review of the literature.
Ganglia within the posterior tibial nerve is a rare condition. The authors report 2 cases of epineural ganglion of the posterior tibial nerve, causing tarsal tunnel syndrome. Both cases presented with numbness on the plantar surface of the foot. ⋯ Intrafascicular ganglia present beneath the epineurium and involve the nerve fibers, whereas epineural ganglia are located in the epineurium and do not involve the nerve fibers. A review of the literature discusses these concepts. The authors suggest that epineural ganglion should be clinically distinctive from an intrafascicular ganglion because of the differences in surgical treatment, postoperative nerve function, and the recurrence rate.