Foot & ankle international
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Randomized Controlled Trial Comparative Study
Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal.
Great variability exists in methods of stabilization for syndesmotic disruptions of the ankle. We hypothesized that syndesmotic screw fixation with 3.5-mm fully threaded cortical screws through either three or four cortices would have similar strength and rate of mechanical failure and that retention of screws after fracture healing would not result in adverse clinical symptoms. ⋯ The data suggest that either three or four cortices of fixation can be used when stabilizing syndesmotic injuries of the ankle. There was a trend towards higher loss of reduction in the group with tricortical fixation when weightbearing restrictions were not followed. Retention of the syndesmotic screws, even with mechanical failure, does not pose a clinical problem. Weightbearing can be allowed at 6 to 10 weeks without routine removal of screws.
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Comparative Study
Staged reconstruction for chronic rupture of both peroneal tendons using Hunter rod and flexor hallucis longus tendon transfer: a long-term followup study.
Long-term followup (over 5 years) of staged reconstruction for chronic ruptures of both peroneal tendons using a Hunter rod and the flexor hallucis longus (FHL) tendon is presented. ⋯ Staged reconstruction with excision of the remaining portion of the peroneal tendons and reconstruction with a Hunter rod and FHL transfer has been shown to be an effective long-term treatment for chronic peroneal tendon ruptures.
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Comparative Study
Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality.
Necrotizing fasciitis is a rare and often fatal soft-tissue infection. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections. The purpose of this study was to analyze the clinical presentation and evaluate factors that determine mortality associated with this uncommon surgical emergency. ⋯ The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain, especially if that person has diabetes mellitus or chronic liver disease. There was no difference in mortality rates between patients with or without amputation. The primary treatment is early and aggressive debridement of involved skin, subcutaneous fat, and fascia.