Minimally invasive technique for acute fixation and subtalar fusion of displaced intra-articular calcaneus fractures.

Displaced intra-articular calcaneus fractures (DIACFs) are difficult injuries to treat and are often encountered by orthopedic surgeons. For DIACFs treated nonoperatively or with open reduction internal fixation (ORIF), a common complication is painful subtalar arthritis and the need for a secondary subtalar fusion, which prolongs the overall recovery time. One treatment option to address this sequela involves ORIF with subtalar fusion as the primary treatment. We describe a reproducible, minimally invasive surgical technique for primary ORIF with subtalar fusion when the calcaneal tuberosity is amendable to cannulated screw fixation to treat these complex calcaneal fractures. Our technique offers advantages compared to other techniques in that it avoids screw traffic, allows easy bony compression of the subtalar joint, and minimizes soft tissue damage via percutaneous screw fixation. Fourteen fractured calcanei in 12 patients underwent our technique and all achieved bony union with a median time to fusion of 107.5 days (range, 54-530 days). Eight patients returned to work with the remaining 4 patients having an unknown work status at last follow-up, although 2 of these 4 patients resumed normal activities. Only 1 patient experienced a complication, which was an infection after achieving bony union, and was treated with successful hardware removal and our infection protocol. Overall, we conclude our surgical technique offers a successful option in the treatment of DIACFs when the calcaneal tuberosity is amendable to cannulated screw fixation.

Skin Necrosis after Total Knee Arthroplasty Treated with Eschar Preservation and Prophylactic Antibiotic Measures: A Case Report.

Introduction: Skin necrosis following total knee arthroplasty (TKA) represents a rare, but serious complication that can lead to deep infection. In the setting of a lateral release performed during TKA, the incised retinaculum unveils a potential pathway to the joint should the superficial skin and tissue be compromised. Thus, the conventional treatment of debridement in this setting may risk infection to the joint, whereas eschar preservation may serve as a biological protective barrier to prevent infection. Case Report: We present a patient with end-stage tricompartmental knee osteoarthritis who underwent a TKA with a concomitant lateral release. The patient developed necrosis in two distinct areas measuring 14 cm × 2 cm along the length of the primary TKA incision, and 7 cm × 4 cm laterally. The patient was treated with eschar preservation, oral doxycycline, an antimicrobial silver dressing, and allowed to heal by secondary intention. The patient's skin necrosis healed fully at 12-week post-operatively, and they have had a successful TKA outcome at 5 years. Conclusion: Eschar preservation, oral doxycycline, an antimicrobial silver dressing, and allowing the wound to heal by secondary intention may represent a viable, less invasive treatment for skin necrosis following TKA with lateral release.

Os Trigonum Syndrome: A Cause of Posterior Ankle Pain.

BACKGROUND: Os trigonum syndrome represents a cause of posterior ankle pain that is predominantly seen in athletes. The os trigonum ossicle forms from a secondary ossification center of the talus and is located at its posterior aspect in an interval between the posterior lip of the tibial plafond and calcaneus. The os trigonum ossicle is often an incidental finding and asymptomatic. However, repetitive plantarflexion and push-off maneuvers can cause symptoms and lead a patient to pursue orthopedic care. MATERIALS AND METHODS: A review of the literature was conducted using the PubMed search engine with the following keywords: "os trigonum", "os trigonum ossicle", "os trigonum syndrome", "posterior ankle impingement", and "Stieda process". RESULTS: The pertinent anatomy, clinical presentation, diagnostic evaluation, and treatment of os trigonum syndrome were reviewed in the literature and are extensively discussed in this article. CONCLUSION: Os trigonum syndrome represents a potential cause of posterior ankle pain that needs thorough evaluation regarding history, physical examination, and imaging. Once diagnosed, treatment ranges from conservative to surgical interventions depending on surgeon preference and specific case presentation. [Orthopedics. 2024;47(2):e67-e72.].

How to get the most out of your gastrocnemius and soleus flaps.

Gastrocnemius and soleus flaps represent the workhorse local flaps to cover soft tissue defects of the proximal 1/3 and middle 1/3 of the leg, respectively. An important consideration before conducting a local flap is whether the flap can provide adequate coverage. The utility of the gastrocnemius flap can be increased using multiple techniques to increase the arc of rotation including the posterior midline approach, dissection at the pes anserinus and medial femoral condyle origin, scoring the fascia, and inclusion of a skin paddle. Concerning the soleus flap, the hemisoleus flap represents a technique to increase the arc of rotation. With a soleus flap, one must consider the soft tissue defect location, size, and perforator blood supply because these factors influence what soleus flap technique to use. This article discusses how to make the most out of gastrocnemius flaps and soleus flaps regarding maximizing coverage and ensuring successful flap outcome.