Foot & ankle international
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Nonoperative management has been the preferred treatment for displaced oblique spiral fractures of the fifth metatarsal shaft; yet a paucity of literature supports this claim. The purpose of this investigation was to report the incidence and long-term outcome in the largest cohort of these fractures reported to date. ⋯ Level II, prospective cohort study.
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Comparative Study
Biomechanical comparison of syndesmotic injury fixation methods using a cadaveric model.
There is growing interest in suture-button devices for syndesmosis injury, which are intended to offer less rigid fixation than screw fixation. ⋯ Suture-button devices provided torsional strength below that of screw fixation. However, all devices may provide failure torques well above 20 Nm, exceeding likely torques applied in casts during healing.(1,2,4) CLINICAL RELEVANCE: Suture-button devices appear to have provided adequate fixation strength for syndesmosis injuries.
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The standard treatment for hallux valgus in rheumatoid arthritis has been arthrodesis of the first metatarsophalangeal (MTP) joint. There is limited literature regarding the results of hallux valgus procedures which preserve the first MTP joint in rheumatoid patients. We investigated the radiographic and clinical outcomes of joint-preserving surgery for hallux valgus in a series of rheumatoid patients to evaluate the result of nonarthrodesis reconstruction. ⋯ Level IV, retrospective case series.
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Protected elevation represents a critical component of postoperative care, particularly in posteriorly located flaps, to prevent pressure on the flap's vascular pedicle and ensure a successful skin graft. Although several short case series and technique papers have described kickstand placement to prevent heel ulcers as an adjuvant to fixator placement for fracture management, there remains a paucity of reports describing external fixator placement solely for extremity elevation and pressure alleviation in the postoperative care of flap coverage procedures. ⋯ Level IV, retrospective case series.
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Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. ⋯ Level III, retrospective comparative series.