Foot & ankle international
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Surgical treatment of ankle fractures in patients with diabetes mellitus is associated with a high complication rate. Diabetic patients with peripheral neuropathy are a particularly difficult group to treat because of their inability to sense deep infection, repeat trauma, and wound complications. The purpose of this study was to evaluate a protocol that included transarticular fixation and prolonged, protected weightbearing in the treatment of unstable ankle fractures in diabetic patients with peripheral neuropathy and loss of protective sensibility. ⋯ Although these fractures remain a treatment challenge, this study presents a successful, multidisciplinary protocol for treatment of unstable ankle fractures in the most challenging group of diabetic patients - those with loss of protective sensibility.
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Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. The mean time of follow-up was 36 months (range, 25-49). The average age at surgery was 22.7 years (range, 19-34). ⋯ A partial osteotomy of the medial malleolus or osteotomy of the distal lateral tibia was performed for all cases. Being evaluated by the Freiburg ankle score, 16 of 18 ankles (88.8%) had excellent and two (11.8%) had good results. "Second-look" arthroscopy of 16 ankles revealed consistency of the osteochondral grafts and congruity between grafts and native cartilage in 14 (87.5%), and a softening or fissuring of the osteochondral graft in two. Our results showed that this procedure provided an effective treatment for a symptomatic advanced-stage OCD of the talus.