J Am Acad Orthop Sur
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Carpal tunnel syndrome is considered the most common of the chronic compressive neuropathies. Its cause is generally unknown. ⋯ Many rare and unusual causes have been described, including chronic conditions that may be associated with acute carpal tunnel syndrome, such as rheumatologic disorders and anomalous anatomy. In contrast to the more common chronic idiopathic form, the acute form of carpal tunnel syndrome requires urgent surgical intervention to avoid or diminish serious sequelae.
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Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. ⋯ Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.
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During the past three decades, internal fixation has become increasingly popular for fracture management and limb reconstruction. As a result, during their training, orthopaedic surgeons receive less formal instruction in the art of extremity immobilization and cast application and removal. ⋯ Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in the patient who is at high risk for complications with casting and splinting. Those at high risk include the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity.
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The pediatric triplane ankle fracture represents a unique spectrum of injury that does not fit neatly into the Salter-Harris classification of physeal injury. This fracture is particular to the pediatric population and often is termed a transitional injury. It is the result of the characteristic asymmetric closure of the distal tibial physis over a period of approximately 18 months. ⋯ Nondisplaced triplane fractures and extra-articular fractures can be managed with immobilization in a long leg cast. Displaced fractures are treated with open reduction and internal fixation performed through an anterolateral approach or an anteromedial approach. Intra-articular reduction to within 2 mm is required for optimal treatment of these unique pediatric ankle fractures.