Foot & ankle international
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
Treatment of fractures of the fifth metatarsal: a prospective study.
Successful treatment of avulsion fractures of the base of the fifth metatarsal has been achieved using both short leg casts and soft (Jones) dressings. Sixty patients who presented to our institution were prospectively randomized to be treated with either a short leg cast or a soft (Jones) dressing for the purpose of assessing the efficacy of each treatment modality. Our results demonstrated that radiographic evidence of fracture healing was present in all patients by 65 days with 44 days representing the average elapsed time for such change. ⋯ Significantly, the average length of recuperation for patients treated with a soft (jones) dressing was 33 days as compared to 46 days for those treated with a short leg cast. Also, the average modified foot score for patients treated in a soft dressing was 92 (excellent) compared to 86 (good) for patients treated in a short leg cast. We conclude that a soft dressing allows patients to return to pre-injury levels of activity faster than when treated in a short leg cast and without compromising clinical or radiographic union of avulsion fractures of the base of the fifth metatarsal.
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At the present time, syndesmotic screw fixation is recommended when there is a tibiofibular diastasis, a Maisonneuve fracture, or syndesmotic instability after fixation of distal tibia-fibula fractures. The aim/purpose of this study was to demonstrate the optimal level of syndesmotic screw placement before creation of a Maisonneuve fracture. Legs of 17 embalmed cadavers underwent knee disarticulation. ⋯ Two-tailed t-test comparing no fixation with fixation at 2.0 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.04). Two-tailed t-test comparing screw fixation at 2.0 cm and 3.5 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.07). It would seem reasonable to place a syndesmotic screw at 2.0 cm above tibiotalar joint.
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We first performed autogenous bone grafting for lesions of the hallux sesamoid in 1984. During the next 9 years, 21 patients (11 men and 10 women with an average age of 34 and 32 years, respectively) underwent this surgical procedure for symptomatic tibial hallux sesamoid non-unions. ⋯ The majority of patients obtained concomitant relief of preoperative symptomatology and returned to their preinjury level of activity. We believe that this procedure serves as an alternative to hallux sesamoid excision in selected cases.