The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The necessity of prophylaxis for deep vein thrombosis (DVT) in those patients who undergo foot and ankle surgery remains poorly defined. The authors explore and review the low-molecular-weight heparin (LMWH) preparations for use by foot and ankle surgeons. ⋯ Many options are available for prophylaxis. This article presents a review of DVT with particular attention given to distinguishing risk factors, prophylaxis, and LMWH preparations.
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Review Case Reports
Preemptive analgesia in elective surgery in patients with complex regional pain syndrome: a case report.
Complex regional pain syndrome (CRPS) can be a complication of injury or surgery or have an obscure etiology. Special precautions are indicated (i.e., preemptive analgesia) when surgery is required with a patient who has been diagnosed with CRPS. The complex case of a 44-year-old female diagnosed with reflex sympathetic dystrophy (RSD) is discussed, including current treatment options. A brief review of the literature as well as the features of complex regional pain syndrome (CRPS I/RSD and CRPS II/causalgia) are presented.
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Osteochondral lesions of the talar dome are commonly the result of ankle trauma. While the technique of surgical repair of ankle fractures has been well reported, there are no studies that correlate the presence or absence of talar dome lesions. A possible explanation for this may be lack of intraoperative inspection of the talar articular surface. ⋯ While the bimalleolar and deltoid ligament tear type fractures exhibited more talar dome lesions, there was no significant difference between these two fracture types (p = .1111). There was no statistically significant difference among the three types (unimalleolar, bimalleolar, and trimalleolar) of supination-external rotation ankle fractures (p = .0804). The authors conclude that intraoperative inspection of the lateral talar dome should be a routine part of ankle fracture repair.
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Comparative Study
Autogenous bone grafting for the treatment of talar dome lesions.
This study evaluated a surgical bone grafting technique, which restores the talar dome weightbearing articular surface for the repair of a transchondral lesion. An autogenous bone graft combined with viable cartilage is used to recreate a normal talar articular surface. In a retrospective analysis of talar dome lesions, 14 patients surgically treated with bone grafts were compared to 17 patients treated with curettage and subchondral drilling. ⋯ Patients were also asked their perception of their own surgical outcome (considering pain frequency and ability to participate in sporting activities or walk at a similar level compared to before the surgery), and if they would have the surgery again. No differences in the patients' preoperative symptoms or their subjective assessment post surgery were detected between the groups. While curettage plus drilling is the most common surgical procedure for chronic symptomatic talar dome lesion, our results suggest that bone grafting of the lesion yields better long-term clinical results.
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Even when diagnosed early and treated appropriately, patients with complex regional pain syndrome (CRPS), a condition that can lead to severe painful dysfunction of the limb, may continue to have long-term pain. A retrospective study was conducted of 33 patients with a positive history of CRPS I, CRPS II, or sympathetically maintained pain (SMP) of the lower limb who were treated in either a clinical setting or a pain management center. The average age of individuals diagnosed with CRPS was 43.5 +/- 12.6 (mean +/-SD) years with 60% being female. ⋯ Thirteen patients were contacted for long-term follow-up with an average of 3.5 years after initial diagnosis. There was no difference when the pain rating at long-term follow-up was compared to the initial rating (6.2 +/- 1.2 vs. 7.3 +/- 0.6; p = .287), and 11 continue to have more than moderate pain. Thus, many patients with CRPS who seem to be successfully treated, and are discharged from care, still have severe pain years later.