Foot & ankle international
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Tendon lengthening is an important cause of morbidity after Achilles tendon rupture. However, direct measurement of the tendon length is difficult. Ankle dorsiflexion has, therefore, been used as a surrogate measure on the assumption that it is the Achilles tendon that limits this movement. The aim of this investigation was to assess the relationship between Achilles tendon length and ankle dorsiflexion. The primary question was whether or not the Achilles tendon is the structure that limits ankle dorsiflexion. The secondary purpose was to quantify the relationship between Achilles tendon lengthening and dorsiflexion at the ankle joint. ⋯ The Achilles tendon is the anatomical structure that limits ankle dorsiflexion, even when the tendon is lengthened. There was a linear relationship between the length of the Achilles tendon and the range of ankle dorsiflexion in this cadaver model. Ankle dorsiflexion would appear to be a clinically useful indicator of tendon length.
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Percutaneous Achilles tendon lengthening is frequently done to treat gastrocsoleus equinus contracture. To our knowledge, no study has documented the proximity of tendinous or neurovascular structures to the nearest edges of each hemisection in a percutaneous Achilles tendon lengthening, the complication rates related to injury of such structures, or the Achilles tendon rupture rates from inaccurate cuts. Thus, our goal was to document these distances and determine the accuracy of this procedure. ⋯ In cadavers, reasonably accurate cuts can be made, with some vital structures less than 1 cm from the cut tendon.
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Effective treatment algorithms for open, displaced, intra-articular calcaneal fractures and their potential early complications have not yet been established. This is a retrospective review of the management of open displaced calcaneal fractures at a Level 1 trauma center and their resulting soft-tissue complications in an effort to establish guidelines for management. ⋯ Management of open calcaneal fractures and the risk of complications depend on the size and position of the traumatic wound. Lateral wounds are rare and in this review, two of the four had complications using this protocol. Medial wounds of less than 4 cm can be treated with open reduction and standard internal fixation if the wound can be closed and remain stable off antibiotics. Larger wounds (more than 4 cm) or unstable wounds should not be treated with open reduction and internal fixation but can be reduced and held in alignment with percutaneous wire fixation.
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Comparative Study
Results and outcomes after operative treatment of high-energy tibial plafond fractures.
The purposes of this study were to evaluate the clinical and radiographic results and the functional outcomes after operative treatment of tibial plafond fractures treated with internal or external fixation. ⋯ Tibial plafond fractures are difficult to manage and may have serious complications. We identified more complications, more secondary procedures, and worse outcomes in patients with articular and metaphyseal comminution (type C3). ORIF was associated with fewer complications and less post-traumatic arthritis when compared to EF, possibly reflecting a selection bias for open injuries and more severely comminuted fractures to be managed with EF. ORIF with appropriate soft tissue handling resulted in acceptable results in most patients. Severely damaged soft tissues and highly comminuted C3 fractures may be safely treated with EF. Loss of function and progression to post-traumatic arthritis are common after tibial plafond fractures. Assessment of long-term results and the efficacy of additional reconstructive procedures will refine the treatment algorithms for these fractures.