Foot & ankle international
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Comparative Study
Quality of life of adults with unhealed and healed diabetic foot ulcers.
Diabetic foot ulcers cause major treatment morbidity and cost of care. This study evaluated quality of life in patients with unhealed and healed diabetic foot ulcers. ⋯ Individuals with diabetic foot ulcers experience profound compromise of physical quality of life, which is worse in those with unhealed ulcers.
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The reported fusion rates of revision arthrodesis for hindfoot nonunions are relatively low compared to primary procedures. Exogenous ultrasound has been shown to accelerate the healing process of acute fractures and fracture nonunions but has not been previously evaluated for the treatment of hindfoot pseudarthroses. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision hindfoot arthrodeses treated with postoperative low-intensity ultrasound. ⋯ When used to evaluate hindfoot arthrodeses, plain radiographs may be misleading. CT provides a more accurate assessment of the healing, and we have devised a new system to quantitate the fusion mass. Postoperative low-intensity ultrasound is easy to apply and administer, with no identifiable risks or contraindications. Although this modality may facilitate the fusion process, we cannot definitely conclude the specific relative value of low-intensity ultrasound because this was not a controlled series.
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Comparative Study
Results and outcomes after operative treatment of high-energy tibial plafond fractures.
The purposes of this study were to evaluate the clinical and radiographic results and the functional outcomes after operative treatment of tibial plafond fractures treated with internal or external fixation. ⋯ Tibial plafond fractures are difficult to manage and may have serious complications. We identified more complications, more secondary procedures, and worse outcomes in patients with articular and metaphyseal comminution (type C3). ORIF was associated with fewer complications and less post-traumatic arthritis when compared to EF, possibly reflecting a selection bias for open injuries and more severely comminuted fractures to be managed with EF. ORIF with appropriate soft tissue handling resulted in acceptable results in most patients. Severely damaged soft tissues and highly comminuted C3 fractures may be safely treated with EF. Loss of function and progression to post-traumatic arthritis are common after tibial plafond fractures. Assessment of long-term results and the efficacy of additional reconstructive procedures will refine the treatment algorithms for these fractures.
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Comparative Study
Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneal fractures.
For a fracture classification to be useful it must provide prognostic significance, interobserver reliability, and intraobserver reproducibility. Most studies have found reliability and reproducibility to be poor for fracture classification schemes. The purpose of this study was to evaluate the interobserver and intraobserver reliability of the Sanders and Crosby-Fitzgibbons classification systems, two commonly used methods for classifying intra-articular calcaneal fractures. ⋯ Although intraobserver kappa values reached substantial levels and the Crosby-Fitzgibbons system generally showed greater agreement, we were unable to demonstrate excellent interobserver or intraobserver reliability with either classification scheme. While a system with perfect agreement would be impossible, our results indicate that these classifications lack the reproducibility to be considered ideal.