Foot & ankle
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Case Reports
Lisfranc's fracture-dislocation with intercuneiform dislocation: presentation of two cases an a plan for treatment.
The following guidelines in the initial treatment of Lisfranc's fracture-dislocation with intercuneiform disruption are supported by a review of the literature and exemplified by our case presentations. The goal of initial treatment is anatomical reduction which is accomplished in the following sequence. 1) The foot must be brought to length by longitudinal traction. 2) The position of the second cuneiform as the keystone of the transverse arch of the foot must be established. 3) The second metatarsal is then restored as the tendon of the Lisfranc's joint within the mortise of cuneiforms. 4) Fixation of the fifth metatarsal is performed if it is unstable.
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One hundred seventy-two patients who underwent surgical correction of hallux valgus deformity were evaluated. The procedures chosen were: first metatarsal osteotomy in 96, Keller procedure in 42, metatarsophalangeal arthrodesis in 25, and simple bunionectomy in 9. This study allowed the establishment of the following guidelines for surgery. 1) Osteotomy alone yields a satisfactory result in patients under the age of 50 years who have minimal osteoarthritis of the metatarsophalangeal joint. 2) The Keller procedure is suggested in patients over the age of 50 who have significant osteoarthritis. 3) Metatarsophalangeal fusion is suggested in patients under the age of 50 with significant osteoarthritis. 4) Simple bunionectomy revealed poor results in the majority of patients. It should be reserved for the elderly patient with an infected bunion.
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The mechanics, anatomy, and pathomechanics of traumatic dorsal dislocation of the first metatarsophalangeal joint are discussed. There are two basic types of dislocations. ⋯ In Type II, there is either associated disruption of the intersesamoid ligament (Type IIA) or a transverse fracture of one of the sesamoids (Type IIB). In Type II, the sesamoid disruption usually permits closed reduction.