Foot & ankle
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In order to analyze the value of operative treatment for tarsometatarsal injuries, 31 consecutive fracture-dislocation injuries from 1975 to 1988, and 11 cases of undislocated injuries were reviewed. Forty patients (41 injuries) could be contacted. The average follow up was 5 years. ⋯ Initially undislocated injuries had a better prognosis, with 8 of 11 having excellent or good results, and none receiving pension. These injuries should be treated aggressively with open reduction and fixation when there is any displacement. Despite this treatment, one-half of patients with dislocated injuries as well as one-fourth of those with initially undislocated injuries will still suffer from pain and permanent disability probably due to soft tissue damage and instability.
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First metatarsophalangeal joint arthrosis may be associated with hallux valgus deformity. In an attempt to address the pain and deformities of this disorder, silastic implant arthroplasty combined with soft tissue balancing and proximal first metatarsal osteotomy has been performed on 17 feet in 11 patients. ⋯ Infection remains as a significant postoperative complication. This technique may be a treatment option in the low demand patient with a hallux valgus deformity, painful arthritis of the first metatarsophalangeal joint, and a wide first intermetatarsal angle.
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A retrospective review was made of 30 patients who had disruption of the ankle syndesmosis that was treated at Santa Clara Valley Medical Center with a transfixation screw. Follow-up ranged from 3 months to 3 years. There were 21 pronation external rotation injuries and 9 Maison-neuve fractures. ⋯ In 6 patients, calcification of the interosseous membrane was seen and, in 4, this progressed to a distal tibiofibular synostosis. It was found that transfixation screws provided satisfactory stability of the syndesmosis to permit stable healing of the interosseous membrane and distal ligaments after ankle fracture. Motion between the tibia and fibula developed despite screw fixation, as shown by the lytic bony changes that occurred with time.
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A useful intraoperative technique to aid the surgical treatment of complex foot and ankle trauma is described. With mechanical distraction to help obtain bony reduction and improve exposure, it can be used in the acute or reconstructive situation. Indications and a step by step technique are outlined.
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Comparative Study
Experimental decompression of the fascial compartments of the foot--the basis for fasciotomy in acute compartment syndromes.
Surgical decompression of the foot by fasciotomy is the only effective means of preventing the late consequences of a compartment syndrome i.e., myoneural ischemia. In this study, a slit catheter system was used to monitor the compartment pressures in experimentally induced compartment syndromes of the foot. ⋯ However, it takes longer after effective fasciotomies for pressures to normalize via the dorsal approach (11 min versus 1 min; P less than 0.01). The double incision dorsal approach is easier to perform and may be the method of choice for fasciotomy associated with fractures of the forefoot requiring internal fixation.