The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Review Case Reports
Talar fracture/dislocation in the adolescent patient.
The authors report an 18-year-old patient who sustained a two-part injury involving his right ankle. The result of this traumatic episode was a fracture/dislocation of the talus. An interesting aspect of this injury is that the body of the talus dislocated laterally, distal to the fibular malleolus. ⋯ The patient was followed for 9 months, during which time a series of radiographs was taken. Nine months postoperatively, Hawkins sign was negative indicative of avascular necrosis. In review of the literature, no fractures with lateral dislocations of this nature were found.
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Review Comparative Study
Surgical hemostasis by pneumatic ankle tourniquet during 3027 podiatric operations.
A retrospective study was performed at the Denver Doctors Hospitals in which 3818 surgical cases on the foot and/or ankle were reviewed over a 4-year period from July 1986 through May 1990. From the 3027 ankle tourniquet cases reviewed, it was determined that pneumatic ankle tourniquets are safe and effective in providing hemostasis during foot surgery. There were five postoperative complications noted with ankle cuffs, with post-tourniquet syndrome being the most common (three cases). ⋯ Hg for thigh cuffs). Tourniquet ischemia lasted from 4 to 139 min.; the most common duration of ischemia noted for ankle tourniquets was 30 to 60 min. (60 to 90 min. for thigh tourniquets). A review of the potential complications associated with tourniquets, as well as safeguards, recommendations, and contraindications are presented.
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The authors present a system against postoperative pain in forefoot operations, which functions by continuous infusion of anesthetic in the malleolar internal space. The system (Single-Day Baxter Infusor) was utilized in 145 patients who had undergone forefoot surgery. The effectiveness of the method was evaluated by means of a numeric scale (0 to 5) reflecting pain level. The method was effective in controlling postoperative pain in 110 cases (score 0 to 1); 25 cases (score 2) reported pain in the dorsal hallux, in the deep peroneal area, whereas in 10 cases (score 4 to 5 on the scale), nonsteroidal anti-inflammatory drugs had to be administered.
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The authors radiographed and dissected 200 fresh frozen cadaveric specimens selected randomly from the general United States population. A 21% incidence of inferior calcaneal exostosis formation was identified. Of those specimens identified as having an inferior calcaneal exostosis, there was a 52.4% incidence of heel spurs that were in the plantar fascia and a 47.6% incidence of heel spurs that were identified superior to the plantar fascia. ⋯ By knowing these fascial measurements, the practitioner will be aided intraoperatively in determining what level of fasciotomy to perform. This could help obviate some of the postoperative biomechanical sequelae that can occur with total releases, and immediate postoperative excessive ambulation by the patient. This study may help to gain insight into the true etiology of heel spur syndrome/plantar fasciitis.
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The purpose of this study was to investigate factors that contribute to the development of osteomyelitis of the foot after a puncture wound in patients with diabetes. Forty-five male and 21 female adults with diabetes that were admitted to the hospital for a foot infection precipitated by a puncture were included in the study. Twenty-two (33%) patients had osteomyelitis (O) based on either a positive bone culture or pathology report. ⋯ A significant difference was identified when comparing the time interval from the time of the injury until patients were hospitalized and until they had the puncture wound surgically debrided, and when comparing the interval from when patients first received initial professional medical evaluation until they were hospitalized and until they had the puncture wound surgically debrided. Patients with punctures involving the forefoot (FF) and patients that wore shoes (S) at the time of the injury were more likely to develop osteomyelitis than patients that had rearfoot (RF) injuries O: FF = 20, 90%, RF = 2, 10%, ST: FF = 30, 70%, RF = 13, 30%, p < 0.05) and patients that were barefoot (B) at the time of injury (O: S = 15, 88%, B = 2, 12%, ST: S = 21, 57%, B = 16, 43%, p < 0.05). Osteomyelitis is a common complication in patients with diabetes with a foot infection following a puncture wound.(ABSTRACT TRUNCATED AT 250 WORDS)