The Journal of foot surgery
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A case presentation of a severe ankle sprain in which the patient was nonresponsive to routine therapies is presented. Repeat radiographs and computerized axial tomographic scans (CAT Scans) lead to the final diagnosis of a sagittal plane fracture of the talus. The clinical and radiographic evaluation leading to the diagnosis will be presented, and the surgical and postoperative managements will be discussed.
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The occurrence of septic shock in lower extremity surgery is rare. Its early identification and treatment are vital to its outcome. The authors present a case history of septic shock occurring in the surgical wound care patient, discuss the pathophysiology of septic shock, and then consider diagnosis along with treatment options.
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Case Reports
Fractures of the proximal phalanx of the hallux: the use of plates with displaced multifragment fractures.
Fractures of the proximal phalanx of the hallux are a common injury. Due to the important biomechanical function of the first ray, these injuries must be treated properly. Incorrectly treated, a fracture of the hallux can be debilitating. These injuries will be discussed, and several illustrative cases will be presented with the use of plate fixation.
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The authors present a descriptive report on medial column instability with Lisfranc's fracture dislocation injuries. Subtleties of recognizing and diagnosing this injury are emphasized within a literature review. Eleven cases of tarsometatarsal injuries were reviewed over an 18-month period. ⋯ Due to the instability of the medial column, failure in reduction methods for this injury consistently occurred. With proper sequential placement of Kirschner wires, reduction failure is minimized. A fixation method for medial column Lisfranc's injuries with Kirschner wire placement is described.
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Identification and management of the acutely fractured ankle is discussed by the authors. The Lauge Hansen classification system, and in particular, supination-external rotation injuries, is evaluated. Intraoperative technique, perioperative considerations, and generalized management of these pathologic conditions are reviewed, according to the authors' experiences.