Foot & ankle international
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Limiting postoperative pain and minimizing systemic narcotic complications are important considerations in foot and ankle surgery to maximize patient comfort and promote early discharge from the hospital. Nerve blocks are valuable additions to perioperative care. A variety of nerve blocks have been advocated, but few reports have evaluated a preoperative supine approach for popliteal block in foot and ankle surgery. ⋯ We suggest that a preoperative nerve block for a sedated patient in the operating room saves time, avoids patient discomfort, augments general anesthesia, provides good postoperative pain control, and has high patient satisfaction with no significant complications.
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The purpose of this study was to introduce a novel operative technique and to evaluate the clinical outcomes in a cohort of patients with missed or neglected Achilles tendon ruptures. ⋯ For patients with missed or neglected Achilles tendon rupture with a rupture gap of at least 5 cm, operative repair using V-Y lengthening and flexor hallucis longus tendon transfer through a single incision technique achieved a high percentage of satisfactory results.
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Comparative Study
Three-dimensional fluoroscopy for evaluation of articular reduction and screw placement in calcaneal fractures.
Anatomic reconstruction of the posterior calcaneal facet after intra-articular fracture is one of the critical factors in achieving a good functional result. Intraoperative evaluation of fracture reduction and implant placement relies on direct view by standard fluoroscopy. We hypothesized that three-dimensional (3D) fluoroscopy is more accurate than conventional fluoroscopy, and equivalent to CT for determining fracture reduction and screw position in calcaneal fractures. ⋯ This new technology may be particularly useful in assessing calcaneal fractures and may lead to improved fracture reduction, less implant misplacement, and improved patient outcomes.
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Peroneal tendon subluxation or dislocation is a relatively uncommon entity with multiple operative treatment methods described. This is a report of an indirect fibular groove deepening technique. ⋯ An indirect groove deepening technique is an effective way of treating peroneal tendon dislocation with good results. Patients with Worker's Compensation claims or other associated pathology have poorer outcomes.
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Lag screw fixation commonly is used to treat avulsion fractures of the posterior calcaneal tuberosity, but this method may not offer reliable fixation. This study compared the strength to failure of lag screws compared to lag screw fixation augmented with suture anchors in these fractures. ⋯ The use of suture anchor augmentation as described may improve the reliability of fixation in avulsion fractures of the posterior calcaneal tuberosity.