Foot & ankle international
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Nonunion following a proximal fifth metatarsal metaphyseal-diaphyseal or Jones fracture can cause considerable pain with high morbidity and loss of work. Treatment should aim for early union, thus allowing early return to activity. The present study evaluated the outcomes and the time required for union following closed intramedullary screw fixation for this condition. ⋯ Closed intramedullary screw fixation achieved an excellent union rate when used in the treatment of nonunion of a Jones fractures.
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When treating ankle fractures with associated syndesmosis injury, failure to anatomically reduce the syndesmosis may lead to poor outcome. While shortening and posterior subluxation of the distal fibula are readily detected by intraoperative fluoroscopy, it is unclear how well malrotation can be assessed. The ability of fluoroscopy to detect rotational malreduction of the fibula was the subject of this study. ⋯ In the setting of ankle fractures with syndesmosis disruption, fixing the fibula in as much as 30 degrees of external rotation may go undetected using intraoperative fluoroscopy alone.
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Comparative Study
Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol.
This study reports on the demographics of acute Achilles tendon rupture in our region and compares the results of a selective approach to operative and nonoperative treatment using an identical rehabilitation program with functional bracing. ⋯ In our region there is a high incidence of Achilles tendon rupture among women due to netball and results in a younger age of injury than previously reported. Our results support surgery in patients less than 40 years, particularly males, if there are no contraindications. Functional bracing as part of nonoperative treatment can result in low re-rupture rates in patients over 40, especially in females.
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Operative indications for surgical treatment of posterior malleolar fractures associated with fractures of the distal fibula and tibia are not currently well defined. The purpose of the present study was to determine the current practice among orthopaedic surgeons regarding the management of posterior malleolus fractures. ⋯ In this survey study of trauma and F&A surgeons, significant variation existed regarding most aspects of posterior malleolar ankle fracture treatment. Most notably, factors other than fragment size most impacted surgical indications. Newer techniques such as direct exposure and plating of the posterior malleolus are chosen more frequently than traditional techniques of indirect reduction and percutaneous screw fixation.
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Recently, a suture button device has been advocated as a simple and effective method of repairing the syndesmosis. Proponents of the device have cited earlier weightbearing and elimination of the need for device removal as potential advantages over metallic screws. However, the available reports generally have short followup. With longer followup, some concerns about the suture button device have surfaced. ⋯ The suture button device is an effective way to repair the syndesmosis. In our series, the reduction of the syndesmosis was maintained throughout the followup period. However, reoperation for device removal was more common than anticipated. Osteolysis of the bone near the implant and subsidence of the device may occur.