Foot & ankle international
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We report the occurrence of a bipartition and occult growth plate fracture in the medial cuneiform of a 5-year, 11-month-old traumatic amputee. Initial radiographs of the foot taken in an oblique projection revealed what appeared to be an osseous fracture of the medial cuneiform. Histologic examination of the pathologic specimen showed that the radiolucent cleft separating the two foci of ossification was actually a hyaline synchondrosis (growth plate) functioning in the normal endochondral transformation of the bone. ⋯ Yet, as with all growth plates of the chondro-osseous skeleton, occult injury to the growth mechanism should be suspected in instances of obvious trauma. Discriminating between normal development of the skeleton and skeletal pathology can be a challenge to the treating physician. Therefore, an awareness of possible anatomic variations will enhance diagnostic evaluations.
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Dislocation of the interphalangeal joints of the lesser toes is an uncommon injury, and complex (irreducible) dislocation has rarely been reported. All previous reports note that, during open reduction, the volar plate is interposed within the joint, thereby blocking reduction. ⋯ Clinically, these dislocations are difficult to appreciate. It is recommended that x-ray studies be performed so that this diagnosis is not overlooked.
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Metatarsophalangeal joint dislocations are unusual in children and usually occur in the hallux. We are reporting a case of irreducible traumatic dislocation of the fifth metatarsophalangeal joint. At open reduction, the metatarsal head was incarcerated under the flexor digitorum longus. After returning the flexor digitorum longus tendon to its anatomical position, the metatarsophalangeal joint reduced and was stable.
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Review Case Reports
Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis: a case report.
Tibiotalar dislocation without fracture is an unusual injury. Seventy-three cases have been reported in the literature. ⋯ A case of this unique injury is presented, along with a literature review of purely ligamentous ankle dislocations. The proposed mechanism and classification of these injuries are summarized.
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Review Case Reports
Acute rupture of the peroneal longus tendon in a runner: a case report and review of the literature.
Traumatic rupture of the peroneal longus tendon is rare and the diagnosis may be difficult. Swelling and tenderness about the lateral aspect of the ankle, increased hindfoot varus, and pain with active eversion are helpful clinical signs. ⋯ The tendon was repaired primarily and the patient was able to return to running. A high index of suspicion is required to prevent a delay in the diagnosis and further disability.