Foot & ankle international
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The results of 79 high resolution ultrasound examinations of the forefoot that were performed for suspected Morton's metatarsalgia were retrospectively assessed. Scans were only obtained if the pain was poorly localized or if there were atypical features that made the clinical diagnosis uncertain. Ultrasound detected 92 hypoechoic intermetatarsal web space masses in 63 patients. ⋯ The histopathology in 20 of 21 operated cases was that of Morton's neuroma; however, prominent mucoid degeneration was also found to involve the adjacent loose fibroadipose tissues in 19 of 20 neuroma specimens. Ultrasound was sensitive in the detection of web space abnormality (sensitivity, 0.95), but could not clearly separate Morton's neuroma from associated mass-like mucoid degeneration in the adjacent loose connective tissues. The implications of these observations for both diagnosis and treatment are discussed.
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Ankles from 100 cadavers were dissected to evaluate the risk of nerve injury from an arthroscopic procedure. A total of 65 cadavers (104 ankles) were examined to assess the course of the peroneal nerve, and 35 cadavers (77 ankles) were examined for the saphenous nerve (SN). ⋯ At the anteromedial portal site, between the medial border of the talocrural joint and the tibialis anterior tendon, the SN coursed an average of 6 +/- 5 mm medial to the medial border of the talocrural joint. SNs in this area were all terminal branches; therefore, anteromedial portal placement avoids nerve injury.
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Comparative Study
Use of ultrasonography versus magnetic resonance imaging for tendon abnormalities around the ankle.
A prospective study was performed on 28 patients who underwent surgery for tendon disorders around the ankle. Preoperatively, all patients had real-time, high resolution ultrasonography performed with a 7.5 or 10 mHz transducer. Twenty of these patients also had a preoperative magnetic resonance imaging (MRI) examination of the ankle. ⋯ Ultrasound produced results with a sensitivity measurement of 100%, specificity of 89.9%, and accuracy of 94.4%. MRI produced results with a sensitivity measurement of 23.4%, specificity of 100%, and accuracy of 65.75%. Ultrasound results were more sensitive and accurate than MRI in the detection of ankle tendon tears in our study.
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The juvenile Tillaux fracture is an avulsion fracture (Salter-Harris type-3) of the anterolateral comer of the distal tibial epiphysis. We present a case in which the severely displaced Tillaux fragment became incarcerated between the distal tibia and fibula, simulating a syndesmotic separation radiographically. ⋯ Open extrication of the fracture fragment was followed by spontaneous reduction of the syndesmosis. The Tillaux fracture healed following open reduction with pin fixation, and the patient had an excellent functional and radiographic result at 2-year follow-up.
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Review Case Reports
Plantar lateral dislocation of the medial cuneiform: a case report.
This case report describes an isolated plantar lateral dislocation of the medial cuneiform. We were able to find only one other similar case reported in the literature. That case had a delayed diagnosis of 5 months and with an associated an avulsion fracture of the second metatarsal base. ⋯ A distal and lateral dislocation of the medial cuneiform was reported in association with displacement of the second to fourth metatarsal and medial fractures of the navicular and cuneiform. The current report differs from previous cases. There was not an associated fracture; the direction of the dislocation was unique and could be reduced closed.