Foot & ankle international
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Continuous perineural blocks are increasingly popular for postoperative pain control. While the reported incidence of neuropathic symptoms has been low, the experience of the lead author suggested it may be much higher. The objectives of this study were to elucidate the incidence of patient-reported neuropathic symptoms following continuous popliteal block (CPB) for postoperative pain control in patients undergoing foot and ankle surgery, to characterize these symptoms and to identify preoperative risk factors. ⋯ The incidence of neuropathic symptoms may be much higher than previously reported. Smoking may be a risk factor for the development of neuropathic symptoms.
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Secondary anatomical reconstruction of malunions or nonunions after talar fractures or fracture-dislocations with preservation of all three joints aims at maximal functional rehabilitation. A corrective osteotmy or revision of a pseudoarthrosis with axial realignment and internal fixation was carried out in 22 patients (aged 15 to 50) at a mean of 9 (range, 1.5 to 45) months after having sustained a fracture of the talar head, neck or body. 20 patients were followed for a mean of 4.8 (range, 1.5 to 14) years after reconstruction. No signs of development or progression of avascular necrosis (AVN) were observed in any case. ⋯ The mean AOFAS ankle/hindfoot score increased from 36.9 preoperatively to 87.5 after correction (p < 0.001). Secondary correction after talar fractures appears promising in active and compliant patients without symptomatic arthritis, with good bone stock, no or partial AVN (less than one-third of the talar body), and no infection. Late fusion with a well-aligned talus remains a salvage option in cases of progressive arthritis.