Foot & ankle international
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Comparative Study
Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes.
Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in hospital mortality, in-hospital postoperative complications, length of stay and non-routine discharges. The purpose of this study was to retrospectively compare the complications associated with operatively treated ankle fractures in a group of patients with uncomplicated diabetes versus a group of patients with complicated diabetes. Complicated diabetes was defined as diabetes associated with end organ damage such as peripheral neuropathy, nephropathy and/or PAD. Uncomplicated diabetes was defined as diabetes without any of these associated conditions. Our hypothesis was that patients with uncomplicated diabetes would experience fewer complications than those patients with complicated diabetes. ⋯ Patients with complicated diabetes have an increased risk of complications after ankle fracture surgery compared to patients with uncomplicated diabetes. Careful preoperative evaluation of the neurovascular status is mandatory, since many patients with diabetes do not recognize that they have neuropathy and/or peripheral artery disease.
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The purpose of our study was to determine the efficacy of a management algorithm that includes negative pressure wound therapy (NPWT) in diabetic feet with limb-threatening infection. ⋯ This study provides the outcome of a management algorithm which includes NPWT in salvaging severely infected diabetic feet. With emergent evacuation of abscess, early vascular intervention and appropriate debridement, NPWT can be a useful adjunct to the management of limb-threatening diabetic foot infections.
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Acute traumatic rupture of the tendoachilles is a common problem. Following a recent Cochrane review, operative treatment has been shown to have a lower re-rupture rate compared with conservative treatment, but is associated with a slightly higher rate of other complications. Debate concerning the method and duration of conservative treatment remains. We aimed to assess the effect of knee position on the gap in acute tendoachilles ruptures. ⋯ This study showed that knee position had no significant effect on the tendon gap at the rupture site. This study could have considerable implications on the rationale behind conservative treatment and splinting of acute tendoachilles ruptures with no apparent role for knee flexed immobilization.
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The Krackow stitch, commonly used for Achilles tendon repair, leaves the bulk of the stitch on the surface of the tendon as a possible nidus for adhesion. The proposed core weave stitch leaves a minimal amount of suture material on the tendon surface. The functional strength of the core weave stitch compared with the Krackow and the optimal number of throws, or stitches crossing the surface of the tendon, with this stitch are not known. ⋯ The proposed core weave stitch provides functional strength similar to that of the Krackow stitch for tendon repair with reduced suture material on the tendon surface.