The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Comparative Study
Flexible flatfoot treatment with arthroereisis: radiographic improvement and child health survey analysis.
This study was designed to ascertain if there was a statistically significant correction in the foot and to determine the overall health of a child after an arthroereisis procedure. Thirty-seven patients (67 feet) who had undergone Maxwell-Brancheau arthroereisis were retrospectively reviewed at an average of 18.4 months after surgery. The pre- and postoperative lateral talo-first metatarsal and talar declination and the anteroposterior talo-first metatarsal and talocalcaneal angles were measured by using an X-Caliper device (Eisenlohr Technologies, Davis, CA); significance was determined with a t test. ⋯ The preoperative average anteroposterior talo-first metatarsal and talocalcaneal angles were 13.8 and 25.6, respectively, and were 6.4 and 19.4, respectively, postoperatively. The t test showed the postoperative angles had a statistically significant (P <.01) change from the preoperative angles. The results of the Child health questionnaire of our 34 pediatric patients (92%) showed scores in 3 domains (role emotional behavior, global behavior, parent time) that were better than population norms, and there was no difference in the remaining domains.
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Comparative Study
Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing.
Nineteen patients (20 feet) with severe hindfoot and ankle deformity underwent tibiotalocalcaneal fusion with a retrograde locked intramedullary nail as a limb-salvage procedure. The purpose of this study was to compare the complication rates of this procedure in diabetic versus nondiabetic patients. There were 8 men and 11 women with preoperative diagnoses including Charcot neuroarthropathy, primary osteoarthritis, rheumatoid arthritis, equinocavovarus, posttraumatic osteoarthritis, gouty arthritis, and ankle malunion. ⋯ Major complications included osteomyelitis (n = 2), Charcot arthropathy (n = 2), failure of fixation (n =1), soft-tissue necrosis (n = 1), cardiac arrest (n = 1), cerebral vascular accident (n = 1), and fatal pulmonary embolus (n = 1). All patients with major complications were diabetic, and 14 of 20 combined major and minor complications occurred in patients with diabetes. The complication rate was found to be high in diabetic patients with end-stage deformity undergoing a limb salvage
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A retrospective chart review of 555 patients who received elective foot and ankle surgeries between 1995 and 2001 at 1 outpatient podiatric hospital clinic was performed to evaluate the efficacy of preoperative intravenous antibiotic use. Only those patients who were having elective foot or ankle surgery for the first time, were being followed up at the hospital's outpatient clinic, and had a nontraumatic cause for their surgery were included in this study. A wound was considered infected when purulent material from the wound sites was noted and an organism(s) was cultured. ⋯ None of the study factors was predictive of postoperative wound infection or complication (P >.01). Preoperative antibiotic use was associated with surgical category and internal fixation use (P <.001) but not postoperative wound infection or complication (P >.01). The results suggest that prophylactic intravenous antibiotic use in routine elective foot and ankle surgery is not warranted.
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Comparative Study
Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments.
Foot and ankle surgeons often rely on the medial clear space to evaluate competency of the deep deltoid ligament when evaluating ankle fractures. This investigation assesses the integrity of the deep deltoid ligament after lateral malleolar fracture by using direct arthroscopic visualization and medial clear-space separation on plain film radiographs. The objectives of this study were to test the reliability of medial clear-space separation and the Lauge-Hansen classification scheme in predicting deep deltoid rupture in displaced lateral malleolar fractures. ⋯ Three fractures were not classifiable; another 3 fractures showed deltoid ligament integrity opposite the expected finding. The results indicate that, in isolated displaced fractures of the lateral malleolus, radiographic widening of the medial clear space is not a reliable indicator for deep deltoid rupture. Some fractures considered stable by the Lauge-Hansen classification may require careful scrutiny to rule out deep deltoid injury.
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Twenty-three patients with 25 intraarticular fractures of the calcaneus were treated during a 7-year period with minimally invasive open reduction of the posterior facet, external ring fixation, and early weightbearing. Skeletal traction and a minimally invasive lateral approach were used to elevate the posterior facet. Percutaneous wires, which were secured to an external ring fixator, were used to stabilize the reduction. ⋯ The average length of the treatment period with the fixator was 6.6 weeks (range, 5 to 9 weeks). The range of follow-up was 2 to 7 years. The results with this technique indicate that it is a viable alternative to traditional methods of open reduction and internal fixation for the management of intraarticular fractures of the calcaneus.