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Clinics in Podiatric Medicine and... Jul 2024Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally... (Review)
Review
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
Topics: Humans; Calcaneus; Intra-Articular Fractures; Fracture Fixation, Internal; Male; Fractures, Bone
PubMed: 38789165
DOI: 10.1016/j.cpm.2024.01.006 -
Clinics in Podiatric Medicine and... Jul 2024Fractures of the talus are life-changing events. The talus is of vital importance to normal gait. Given its importance, great care is needed in diagnosing and treating... (Review)
Review
Fractures of the talus are life-changing events. The talus is of vital importance to normal gait. Given its importance, great care is needed in diagnosing and treating these injuries. The threshold for operative treatment and accurate anatomic reduction should be low. Surgical tenets include the avoidance of extensive subperiosteal dissection to minimize vascular disruption. The complications with injuries to the talus are extensive and include avascular necrosis (AVN). Although AVN can prove to be a devastating sequela from this injury, it occurs less frequently than posttraumatic arthritis.
Topics: Humans; Fracture Fixation, Internal; Fractures, Bone; Osteonecrosis; Talus
PubMed: 38789164
DOI: 10.1016/j.cpm.2024.01.005 -
Clinics in Podiatric Medicine and... Jul 2024Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is... (Review)
Review
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
Topics: Humans; Talus; Arthroscopy; Cartilage, Articular; Ankle Injuries; Male; Female
PubMed: 38789163
DOI: 10.1016/j.cpm.2024.01.004 -
Clinics in Podiatric Medicine and... Jul 2024Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with... (Review)
Review
Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with conventional radiographs due to the irregularity and overlap of the midfoot bones. Advanced imaging is indicated if a fracture is of high suspicion or to further characterize a displaced fracture. Cuboid and navicular fractures can occur in isolation but are often associated with other midfoot injuries due to their anatomic relationships. Typically, nondisplaced fractures can be treated conservatively, whereas displaced fractures require surgical intervention to prevent future complications.
Topics: Female; Humans; Male; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Radiography; Tarsal Bones; Tomography, X-Ray Computed
PubMed: 38789162
DOI: 10.1016/j.cpm.2024.01.003 -
Clinics in Podiatric Medicine and... Jul 2024Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this... (Review)
Review
Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this perspective by highlighting a greater occurrence of low-energy injuries and reshaping the focus on open reduction internal fixation. This multifaceted process is guided by various factors, including the nature of the injury, specific anatomic considerations, and the involved joints. Our overarching goal remains to achieve anatomic reduction, with flexibility in hardware fixation methods. In cases of comminution, bridge plating may be warranted, potentially followed by arthrodesis in the future.
Topics: Humans; Male; Arthrodesis; Bone Plates; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Metatarsal Bones; Open Fracture Reduction
PubMed: 38789161
DOI: 10.1016/j.cpm.2024.01.014 -
Journal of Orthopaedic Case Reports May 2024The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of...
INTRODUCTION
The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of adequate recipient vessels when the tibial arteries result damaged. In this scenario, vein grafts can be interposed to connect a healthy recipient vessel to the ALT flap pedicle.
CASE REPORT
We present a report of a 19-year-old male who suffered a Gustilo fracture type IIIc after a road injury involving the right lower limb. After a failed first attempt of limb salvage with reconstruction of extensor tendons and a free ALT flap, a second procedure was performed using another ALT flap with interposed vein grafts to reach very proximal recipient vessels.
RESULTS
The patient demonstrated excellent recovery and restored ambulation. The effectiveness of the most complex reconstructive options for a high-demanding patient with no comorbidities is demonstrated in this case.
CONCLUSION
The key to success in even the most complex injury cases is early intervention, meticulous surgical planning, and a multidisciplinary approach.
PubMed: 38784885
DOI: 10.13107/jocr.2024.v14.i05.4450 -
Journal of Orthopaedic Case Reports May 2024The Bosworth fracture-dislocation is a rare injury originally described as an irreducible dislocation of a distal fibula fracture where the proximal fibular fragment...
INTRODUCTION
The Bosworth fracture-dislocation is a rare injury originally described as an irreducible dislocation of a distal fibula fracture where the proximal fibular fragment becomes incarcerated behind the distal tibia. There have since been a few cases described of an intact distal fibula with dislocation and similar difficulties in closed reduction attempts, typically seen with associated injuries to the ankle or proximal fibula. Regardless of the specific fracture or dislocation pattern, closed reduction attempts have consistently failed in the significant majority of these cases, which can lead to complications including soft-tissue compromise, severe post-traumatic arthritis, compartment syndrome, avascular necrosis of the talus, and neurovascular compromise. There is only one case in recent literature that describes an isolated distal fibula dislocation without associated fractures or dislocations of the lower extremity; however, it required an open reduction. Cases where a closed reduction was successful to achieve an anatomic reduction of a Bosworth-type injury are exceedingly rare.
CASE REPORT
We present a rare case of a purely ligamentous, isolated distal fibula dislocation in a 21-year-old male who underwent a successful closed reduction upon initial presentation and later underwent surgical fixation with a syndesmosis repair system. We describe the technique used for a successful closed reduction for this injury and present a 1-year follow-up with excellent outcomes.
CONCLUSION
This is the only known case report of a successful closed reduction in an isolated distal fibula dislocation, as well as demonstrating a minimally invasive technique for definitive treatment with a syndesmosis repair system. Accurate diagnosis, early treatment, and anatomic reduction are imperative for good clinical outcomes and reducing complications for Bosworth injuries. This technique may improve the rates of successful closed reductions of Bosworth injuries upon initial presentation, leading to decreased complications and improved patient outcomes.
PubMed: 38784881
DOI: 10.13107/jocr.2024.v14.i05.4438 -
Orthopaedic Journal of Sports Medicine May 2024Nearly 8 million high school students in the United States participate in sports each year. With the lack of recent population data, an update to previous studies on US...
BACKGROUND
Nearly 8 million high school students in the United States participate in sports each year. With the lack of recent population data, an update to previous studies on US high school athletes is needed.
PURPOSE
To update the epidemiology of sports injuries in high school athletes in the United States.
STUDY DESIGN
Descriptive epidemiology study.
METHODS
The data from the National Health School Sports-Related Injury Surveillance Study, including 100 nationally representative high schools, were obtained for 9 high school sports (boys' football, soccer, basketball, wrestling, and baseball and girls' soccer, basketball, volleyball, and softball) between the 2015 and 2019 academic years. Injury rates were calculated as the ratio of injuries per 1000 athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition. Data on injured body area, injury type (sprains/strains, concussions, contusions, and fractures), time loss, and need for surgery were also obtained. Rate ratios (RRs) with 95% CIs and values were calculated.
RESULTS
Athletic trainers reported 15,531 injuries during 6,778,209 AEs, with an overall rate of 2.29 injuries per 1000 AEs. Injury rates were highest in football (3.96), girls' soccer (2.65), and boys' wrestling (2.36). The overall injury rate was lower in girls' sports (1.86) compared with boys' sports (2.52) (RR, 0.74 [95% CI, 0.71-0.76]; < .001) and was higher in competition compared with practice (RR, 3.39 [95% CI, 3.28-3.49]; < .001). The most commonly injured body areas were the head/face (24.2%), ankle (17.6%), and knee (14.1%). Sprains/strains (36.8%) and concussions (21.6%) were the most common diagnoses. Overall, 39.2% and 34% of injuries resulted in a time loss of <1 week and 1 to 3 weeks, respectively. Surgery was required in 6.3% of injuries, with wrestling (9.6%), girls' basketball (7.6%), and boys' baseball (7.4%) being the sports with the highest proportion of injuries needing surgery.
CONCLUSION
Study findings demonstrated that boys' football, girls' soccer, and boys' wrestling had the highest injury rates, with boys' sports overall having higher injury rates than girls' sports. Sprains/strains and concussions were the most common diagnoses. Few injuries required surgery.
PubMed: 38784790
DOI: 10.1177/23259671241252637 -
The Orthopedic Clinics of North America Jul 2024Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with... (Review)
Review
Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans. There should be a low threshold for assessing vitamin D levels in such patients.
Topics: Humans; Vitamin D; Vitamin D Deficiency; Dietary Supplements; Orthopedic Procedures; Foot; Ankle
PubMed: 38782509
DOI: 10.1016/j.ocl.2024.01.002 -
BMJ Case Reports May 2024The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report...
The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report outlines a scenario involving a male in his 20s who suffered heel pad avulsion without a calcaneal fracture but with an ipsilateral medial malleolus fracture after a twisting injury to the ankle caused by a road traffic accident. Immediate action was taken within 24 hours of the injury, involving thorough debridement of the wound, fixation to the calcaneum using multiple K-wires, primary suturing and internal fixation of the medial malleolus with two cannulated cancellous screws. Postoperative care included PRP (platelet-rich plasma) injections into the wound twice, removal of K-wires after 6 weeks and allowing walking with full weight bearing after 8 weeks. A year later, the wound had completely healed, and the patient was comfortably walking pain-free with full weight-bearing capabilities.
Topics: Humans; Male; Bone Wires; Fracture Fixation, Internal; Platelet-Rich Plasma; Heel; Soft Tissue Injuries; Debridement; Calcaneus; Young Adult; Foot Injuries; Treatment Outcome
PubMed: 38782442
DOI: 10.1136/bcr-2023-259424