Foot & ankle international
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External rotation stress is used intraoperatively for diagnosing medial ankle and syndesmotic instability in rotational ankle fractures after reduction and fixation of the fibula. However, external rotation includes hindfoot, midfoot, and ankle motion. The purpose of this study was to determine the effect of hindfoot positioning when using the external rotation stress test. Isolated deep deltoid ligament (DDL) instability and combined DDL and syndesmotic instability were modeled. An intact fibula was used as a surrogate for an anatomically fixed fibula fracture. ⋯ These findings may lead to improved clinical detection of rotational ankle instability from combined DDL and syndesmotic disruption, which may affect decision making for using syndesmotic fixation when using intraoperative stress fluoroscopy images. Occult DDL instability may be underdiagnosed, and this may affect future directions of the treatment of rotational ankle fractures and severe sprains.
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Comparative Study
Relationship between glycosylated hemoglobin level and sciatic nerve block performance in diabetic patients.
The objective of the present study was to explore the effects of deficiencies in glucose regulation on the onset, regression, and block performance times in a group of patients with diabetes-related foot problems. ⋯ Level II, prospective comparative study.
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The incidence of Achilles rupture appears to be less in women, although this notion has not been specifically investigated in the literature. ⋯ Level III, retrospective comparative series.
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The aim of this study was to evaluate clinical outcomes after surgery for displaced intra-articular fractures using an external fixator and minimal internal fixation. ⋯ Level IV, retrospective case series.
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There is both increased interest and awareness in diabetes-associated Charcot foot arthropathy. The number of affected patients will likely increase as the incidence of both diabetes and morbid obesity increases. Many experts now favor surgical correction of the deformity rather than longitudinal management with accommodative bracing. In patients with open wounds and exposed bone and/or chronic osteomyelitis, it is controversial whether resolution of the bony infection should be achieved before attempting surgical correction of the acquired deformity. ⋯ A plantigrade noninfected foot can be achieved in patients with infected diabetic Charcot foot deformity with single-stage radical resection of osteomyelitis, correction of the deformity, maintenance of the correction with static external fixation, and culture-specific antibiotic therapy.