1/47. Clinical applications of the posterior rectus sheath-peritoneal free flap.Soft-tissue injuries involving the dorsum of the hand and foot continue to pose complex reconstructive challenges in terms of function and contour. Requirements for coverage include thin, vascularized tissue that supports skin grafts and at the same time provides a gliding surface for tendon excursion. This article reports the authors' clinical experience with the free posterior rectus sheath-peritoneal flap foil dorsal coverage in three patients. Two patients required dorsal hand coverage; one following acute trauma and another for delayed reconstruction 1 year after near hand replantation. A third patient required dorsal foot coverage for exposed tendons resulting from skin loss secondary to vasculitis. In all three patients, the flap was harvested through a paramedian incision at the lateral border of the anterior rectus sheath. After opening the anterior rectus sheath, the rectus muscle was elevated off of the posterior rectus sheath and peritoneum. When elevating the muscle, the attachments of the inferior epigastric vessels to the posterior rectus sheath and peritoneum were preserved while ligating any branches of these vessels to the muscle. Segmental intercostal innervation to the muscle was preserved. The deep inferior epigastric vessels were then dissected to their origin to maximize pedicle length and diameter. The maximum dimension of the flaps harvested for the selected cases was 16 X 8 cm. The anterior rectus sheath was closed primarily with non-absorbable suture. Mean follow-up was 1 year, and all flaps survived with excellent contour and good function in all three patients. Complications included a postoperative ileus in one patient, which resolved after 5 days with nasogastric tube decompression.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/47. Acute traumatic compartment syndrome of the foot in children.Acute traumatic compartment syndrome of the foot is a sequelae of serious injury to the foot, which, if unrecognized, may result in significant motor and sensory deficits, pain, stiffness, and deformity. It is nearly always associated with fractures, dislocations, and crush injuries to the foot. Vascular injuries and coagulopathic states are also risk factors for the development of an acute foot compartment syndrome. In children, the presentation of an acute foot compartment syndrome may be masked by the pain and edema caused by associated fractures and dislocations. A high index of suspicion is warranted in children presenting with foot injuries that are associated with foot compartment syndrome. Recognition of the signs and symptoms of compartment syndrome in the emergency room are paramount; the diagnosis is best confirmed by multiple compartment pressure readings. The urgency of diagnosis of a compartment syndrome must be underscored, as the complications of a missed foot compartment syndrome includes contractures, claw toe deformity, sensory loss, stiffness, and chronic pain. Prompt orthopaedic consultation is mandatory; urgent compartment fasciotomies are associated with a good clinical outcome.- - - - - - - - - - ranking = 196.66622123064keywords = fracture (Clic here for more details about this article) |
3/47. Intraosseous bioabsorbable poly-L-lactic acid screw presenting as a late foreign-body reaction: a case report.A 17-year-old woman complained of a localized painful swelling in her foot 30 months after internal fixation of a closed tarsometatarsal joint fracture with interfragmentary poly-L-lactic acid screws. Aspiration revealed a sterile abscess. Radiographs displayed an osteolytic lesion corresponding to a screw track in the first tarsometarsal joint. Formation of a draining sinus tract required surgical excision of a small granulomatous lesion. Histologic analysis found deposits of birefringent polymeric particles surrounded by a nonspecific foreign-body type reaction. This represents the first reported case of a draining sinus tract secondary to the use of polylactic acid screw fixation.- - - - - - - - - - ranking = 98.333110615319keywords = fracture (Clic here for more details about this article) |
4/47. Salter-Harris III stress fracture of the proximal first metatarsal: a case report.An intraarticular, dorsal, proximal epiphyseal stress fracture (Salter-Harris III) of the first metatarsal was identified in a 14-year-old boy. Successful fracture healing was achieved with a rocker sole shoe modification and activity limitation.- - - - - - - - - - ranking = 589.99866369191keywords = fracture (Clic here for more details about this article) |
5/47. Stress fractures associated with plantar fascia disruption: two case reports involving the cuboid.Stress fractures involving the cuboid are rare. We have encountered two patients who developed this abnormality as a complication of disruption of the plantar fascia, which likely produced lateral destabilization of the midfoot.- - - - - - - - - - ranking = 491.66555307659keywords = fracture (Clic here for more details about this article) |
6/47. Lisfranc fracture dislocations--an important and easily missed fracture in the emergency department.Two case reports are presented of Lisfranc fractures. There have been many incidents of missed injury in the past and the radiographs are reproduced here together with the important radiographic features. early diagnosis and orthopaedic referral are necessary because operative treatment is often required.- - - - - - - - - - ranking = 884.99799553787keywords = fracture (Clic here for more details about this article) |
7/47. The "floating ankle": a pattern of violent injury. Treatment with thin-pin external fixation.The "floating ankle" is an underappreciated pattern of injury that results from violent trauma and/or blast injuries in military personnel. It is characterized by an intact ankle mortise with a distal tibia fracture and an ipsilateral foot fracture, creating instability around the ankle. This pattern of injury may be the result of the military boot, which both protects the foot from immediate amputation or further injury and renders the distal tibia susceptible to fracture at the boot top. Four patients with open floating ankle injuries were treated with thin-pin circular fixation with good results. Two patients required bone transport for segmental loss. All patients are ambulatory without assistance or bracing. Thin-pin external fixation is a reasonable approach to this complex injury pattern, especially in the presence of marked soft tissue compromise with or without segmental bone loss.- - - - - - - - - - ranking = 294.99933184596keywords = fracture (Clic here for more details about this article) |
8/47. Determining foot and ankle impairments by the AMA fifth edition guides.The fifth edition of the Guides has been criticized for its failure to provide a comprehensive, valid, reliable, unbiased, and evidenced-based system for rating impairments and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation [8]. The lower extremity chapter utilizes numerous functional and anatomic methods of assessment, as well as diagnosis-based estimates. Though this process of using multiple approaches to measure impairment increases the chances that an underlying physical impairment may be detected, it is time-consuming and may increase rating variability [9]. McCarthy et al studied the correlation between measures of impairment for patients with fractures of the lower extremity. They found that the anatomic approach of evaluation was better correlated than functional and diagnostic methods with measures of task performance based on direct observations as well as the patient's own assessment of activity limitation and disability. Also, muscle strength assessment as described in the Guides was a more sensitive measure of impairment than range of motion [9]. The most elusive part of the foot and ankle evaluation is the inability to capture the added impairment burden caused by pain. The assessment of pain is the most problematic part of any evaluation. Pain is considered and incorporated into the impairment ratings found in the foot and ankle section, as well as the other individual chapters. chronic pain is often not adequately accounted for, however, and the examiner must evaluate permanent impairment from chronic pain separately. The examiner has the ability to increase the percentage of organ system impairment from 1% to 3% if there is pain-related impairment that increases the burden of illness slightly. If there is significant pain-related impairment, a formal pain assessment is performed. Chapter 18 provides guidance in making these determinations. Impairments for Complex Regional Pain syndrome (CRPS), type 1 (reflex sympathetic dystrophy), and CRPS, type 2 (causalgia) should incorporate the use of a formal pain assessment in addition to the standard methods of assessment. The formal pain evaluation relies mostly on self-reports from the individual and is most heavily weighted for ADL deficits. The physician must make assessments of the individual's pain behavior and credibility for this evaluation. The formal pain assessment classifies the pain-related impairment into categories of mild, moderate, moderately severe, or severe and determines whether this impairment is ratable or not. These categories do not have impairment percentages associated with them. The individual's symptoms or presentation should match known conditions or syndromes in order to be ratable. If not ratable, the examiner should report that the individual has apparent impairment that is not ratable on the basis of current medical knowledge. In the end, pain evaluations are used administratively and, depending on the situation, may be given equal weight with the standard evaluation or may be totally disregarded.- - - - - - - - - - ranking = 98.333110615319keywords = fracture (Clic here for more details about this article) |
9/47. Diabetic neuroarthropathy (Charcot joints): the importance of recognizing chronic sensory deficits in the treatment of acute foot and ankle fractures in diabetic patients.patients with diabetic neuropathy are at a higher risk of developing complications, especially Charcot arthropathy. early diagnosis and intervention is the key to optimizing outcome. Therefore, diabetic patients with a lower extremity injury should be screened with sensory testing using a 5.07 monofilament.- - - - - - - - - - ranking = 393.33244246127keywords = fracture (Clic here for more details about this article) |
10/47. Management of Lisfranc's fracture-dislocation.Lisfranc's joint injuries are rare and complex. A car driver who sustained a traffic accident, was admitted because of partial dorsolateral fracture-dislocation of the Lisfranc's joint. The diagnosis was made by physical examination and radiographs. Reduction and pin fixation were performed under general anesthesia. At the end of the ninth month, range of motion of the foot and ankle was full, with no pain on daily activities.- - - - - - - - - - ranking = 491.66555307659keywords = fracture (Clic here for more details about this article) |
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