Foot & ankle
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The use of a pneumatic ankle tourniquet applied to the supramalleolar ankle region is a useful method of obtaining a bloodless field in surgery of the foot. The pneumatic ankle tourniquet allows for more accurate and reproducible control of circumferential compression than the standard Esmarch bandage, when used in conjunction with the regional ankle block. Between March 1987 and October 1990, 84 foot surgeries were performed using the pneumatic tourniquet and ankle block technique on 76 patients by one surgeon. ⋯ Neither patient required deflation of the tourniquet to complete the procedure. The clinical and electrophysiologic evidence showed that no neurologic or vascular damage occurs. The use of the pneumatic tourniquet in conjunction with regional ankle block anesthesia provides a reasonable alternative to the standard thigh tourniquet for surgery of the foot.
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We present our experience with the use of regional anesthesia in 1295 of 1862 (69.5%) surgical procedures of the foot and ankle between 1986 and 1989. Regional anesthesia was used for surgical procedures of the forefoot, midfoot, hindfoot, and ankle in the setting of elective surgery and trauma. ⋯ There were four (0.3%) minor complications, one being lidocaine toxicity. With increasing experience, the expanded indications and uses of regional anesthesia for foot and ankle surgery are proving to be simple, safe, reliable, and well tolerated by the patient.
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Marginal fractures of the lateral malleolus in association with other fractures in the ankle region.
Eight cases of avulsion-type fracture of the distal fibula associated with fracture of the calcaneus, talus, or ankle region were identified. This avulsion fracture can be identified on routine radiographs as well as on CT scans of the ankle and is pathognomonic of rupture of the superior peroneal retinaculum with or without peroneal tendon displacement. Recognition of this avulsion fracture, with subsequent proper management of the underlying peroneal tendon pathology by immobilization or surgery, may prevent future tendon dysfunction. It may also alter the treatment of other associated injuries.
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Lesser toe dislocations are unusual injuries that are amenable to closed reduction in most cases. We present a case of an isolated lesser toe fracture-dislocation that required an open reduction due to soft tissue interposition.