[Navicular bone fractures in horses: Prognosis after conservative and surgical treatment]. / Strahlbein-Frakturen beim Pferd: Prognose nach konservativer und chirurgischer Therapie.

INTRODUCTION: The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

INTRODUCTION: Le but de cette étude rétrospective était de décrire et de comparer le traitement conservateur et chirurgical des fractures de l'os naviculaires chez le cheval. Une tentative est faite pour identifier les points critiques qui peuvent influencer favorablement le pronostic de cette maladie orthopédique. Tous les chevaux traités pour une fracture de l'os naviculaire à la Clinique équine de la Faculté Vetsuisse de l'Université de Zurich entre 2005 et 2017 ont été inclus dans cette étude. La gravité de la boiterie lors de l'examen initial, l'évaluation radiographique, la conformation du sabot, le traitement (conservateur ou chirurgical), les complications et le résultat ont été déterminés à partir des dossiers médicaux. Le traitement conservateur et chirurgical consistait en un repos au box, un programme d'exercice contrôlé et un ferrage orthopédique thérapeutique. Au cours du traitement chirurgical, une réduction de la fracture a également été effectuée à l'aide d'une vis corticale. La chirurgie assistée par ordinateur a été utilisée sur cinq chevaux et la tomographie assistée par ordinateur sur trois chevaux. Les examens de suivi comprenaient des examens cliniques et radiographiques. Les résultats ont été divisés en trois catégories: 1 = très bon; 2 = bon; 3 = mauvais. Douze chevaux répondaient aux critères d'inclusion ; quatre chevaux ont été traités de manière conservatrice et huit ont été traités chirurgicalement. Après un traitement conservateur, deux chevaux (50 %) ont eu un très bon résultat et deux (50 %) un bon résultat. Après le traitement chirurgical, quatre chevaux (50 %) ont eu un très bon résultat et quatre (50 %) un mauvais résultat. Dans l'ensemble, 67 % des chevaux ont eu un très bon ou un bon résultat, bien que les signes radiographiques de guérison osseuse n'aient été présents dans aucun de ces cas. Diverses complications ont été identifiées, telles que la fracture d'une vis, la fragmentation du petit fragment de l'os naviculaire, le développement d'une arthrose dans l'articulation interphalangienne distale et une podotrochlose progressive. Cette étude montre que le pronostic des fractures de l'os naviculaire est généralement réservé et que les modifications dégénératives de l'appareil naviculaire aggravent le pronostic. Dans la présente étude, le traitement chirurgical n'a pas amélioré le pronostic des fractures du naviculaire malgré l'utilisation intra-chirurgicale de l'imagerie tridimensionnelle. Cependant, les progrès techniques pourraient réduire le taux de complications dans le futur.

Navicular and Cuboid Fractures.

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.

Vascularized Small-Bone Transfers for Fracture Nonunion and Bony Defects.

Vascularized small-bone grafting is an efficient and often necessary surgical approach for nonunion or necrosis of several bones in particular sites of the body, including scaphoid, lunate, distal ulna, and clavicle. The medial femoral condyle is an excellent graft source that can be used in treating scaphoid, ulna, clavicle, or lower-extremity bone defects, including nonunion. Vascularized bone grafting to the small bones, particularly involving reconstruction of damaged cartilage surfaces, should enhance subchondral vascular supply and help prevent cartilage regeneration. Vascularized osteoperiosteal and corticoperiosteal flaps are useful for treating nonunion of long bones.

Painful Accessory Navicular and Spring Ligament Injuries in Athletes.

Painful accessory navicular and spring ligament injuries in athletes are different entities from more common posterior tibialis tendon problems seen in older individuals. These injuries typically affect running and jumping athletes, causing medial arch pain and in severe cases a pes planus deformity. Diagnosis requires a detailed physical examination, standing radiographs, and MRI. Initial treatment focuses on rest, immobilization, and restriction from sports. Orthotic insoles may alleviate minor pain, but many patients need surgery to expedite recovery and return to sports. The authors review their approach to these injuries and provide surgical tips along with expected rehabilitation to provide optimal outcomes.

A review of the management and outcomes of tarsal navicular fracture.

Fractures of the navicular are uncommon. This review focusses on the anatomy, classification, surgical management, post-operative rehabilitation, and outcomes of tarsal navicular fractures, to better inform decision making for clinicians managing these injuries. This review does not discuss navicular stress fractures because of the differing aetiology compared to other fractures of the navicular.

Distraction Osteogenesis in Two Wild Raptors.

Distraction osteogenesis was used in 2 wild raptor patients for the repair of tibiotarsal fractures. The first case was a hatching year female peregrine falcon (Falco peregrinus) admitted with an open oblique right distal tibiotarsal fracture. The fracture was surgically managed with the external skeletal fixator intramedullary pin tie-in technique (ESF-IM pin tie-in). Appropriate healing of the fracture site occurred with the ESF-IM pin tie-in. However, there was significant pelvic limb shortening of the affected leg, and the bird consequently developed pododermatitis on the contralateral foot. The second case was an adult female great horned owl (Bubo virginianus) that was admitted with a closed, partially healed, overriding right tibiotarsal fracture. Because of the advanced stage of this fracture, which presented with a fibrous callus, and the already apparent pelvic limb shortening, the ESF-IM pin tie-in was not used. Both patients were fitted with a circular external skeletal fixator (CESF), and distraction osteogenesis was performed until the length of the pelvic limb was deemed anatomically adequate. It is critical that rehabilitated raptors be released without any physical conditions that may reduce their ability to survive and reproduce in the wild. Pelvic limb shortening can potentially predispose a raptor patient to pododermatitis, even with fatal consequences, in both captive and wild environments. The orthopedic technique used here proved useful to repair the limb shortening in both raptor cases, and each bird fully recovered and was released.

Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study.

PURPOSE: The purpose of this study was to define the fracture type and investigate the injuries related to single medial, intermediate, or lateral cuneiform fracture. METHODS: From January 2008 to December 2018, 30 consecutive patients (30 cases) who were treated in the single institution for the single cuneiform fractures were reviewed retrospectively. Each fracture was categorized by location and type (intra- or extra-articular avulsion, axial compression, and direct blow). We also investigated the related foot bone fractures or dislocations on the affected side. RESULTS: Twenty-one, one, and eight cases with single medial, intermediate, and lateral cuneiform bone fractures, respectively, were identified. More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. The single medial cuneiform fracture was associated with various types of foot injuries including Lisfranc injury, naviculo-cuneiform joint dislocation, or calcaneo-cuboidal dislocation. Single lateral cuneiform fractures were more frequently observed than single intermediate cuneiform fractures. CONCLUSION: More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. Most intra-articular avulsion fractures were associated with high-energy trauma. LEVEL OF EVIDENCE: 4.

Luxación expuesta de la primera y segunda cuña y fractura in situ de la tercera cuña del pie: caso clínico y revisión de la literatura / Exposed dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the foot: Clinical case and literature review

Resumen: Antecedentes: La fractura y la luxación aislada de los huesos cuneiformes son un evento no muy frecuente y sólo pocos casos han sido reportados en la literatura. Este tipo de eventos se presenta como una variación de las lesiones de Lisfranc. El presente reporte muestra un caso clínico poco frecuente de un paciente con luxación de la primera y segunda cuña y fractura in situ de la tercera cuña del pie izquierdo. Caso clínico: Mujer de 49 años de edad, que presentó traumatismo severo del dorso del pie con exposición de tejido óseo y blando como consecuencia de atropellamiento. La paciente fue sometida a cirugía en el Servicio de Urgencias, donde se realizó aseo quirúrgico, desbridamiento, reducción de la luxación de la primera y segunda cuña y fijación percutánea con clavillos Kirschner de 2.0 mm. Resultados: Posterior a la cirugía, la paciente se reportó con buen estado en general, orientada, sin facie de dolor, estable, consciente, sin huellas de sangrado activo por la herida y con presencia de clavillos Kirschner en adecuada posición. Discusión: Se recomienda una inspección exhaustiva de la lesión a través del análisis de las imágenes de rayos X, tomografía computarizada o imágenes de resonancia magnética, especialmente en lesiones no expuestas, pues con ello se puede aplicar el tratamiento adecuado y lograr una pronta recuperación del paciente.

Abstract: Backgrounds: The isolated fracture/dislocation of the cuneiform bones is a not very frequent event and only a few cases have been reported in the literature. This type of event is presented as a variation of the Lisfranc injuries. The present report shows a rare clinical case of a patient with dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the left foot. Case report: A 49-year-old female patient presented severe traumatism of the dorsum of the foot with bony and soft tissue exposure as a result of a car accident. The patient underwent surgery in the emergency department consisting of surgical cleaning, debridement, reduction of dislocation of the first and second cuneiform bones and percutaneous fixation with 2.0 mm Kirschner wires. Results: After the surgery, the patient was found to be in good general condition, oriented without pain, stable, conscious, without traces of active bleeding from the wound and with the presence of Kirschner wires in an appropriate position. Discussion: An exhaustive inspection of the injury is recommended through the analysis of X-ray images, CT scans or magnetic resonance imaging, especially in unexposed lesions in order to apply the appropriate treatment and be able to achieve a prompt recovery of the patient.

Effect of Surgeon and Hospital Volume on Complications After Operative Tarsal Fracture Repair.

OBJECTIVE: To determine whether increased surgeon and hospital volume is associated with lower rates of complications after tarsal fractures. DESIGN: Retrospective cohort study of the State Inpatient Databases. SETTING: Two hundred ninety-nine hospitals in Florida (2005-2012) and New York (2006-2008). PATIENTS/PARTICIPANTS: Four thousand one hundred thirty-two tarsal fractures that underwent fixation by 1223 surgeons. INTERVENTION: Surgical repair of tarsal fractures. MAIN OUTCOME MEASUREMENTS: Composite of readmission for infection requiring operative treatment, wound dehiscence, nonunion, avascular necrosis, or amputation within 2 years of the index procedure. RESULTS: The mean age was 44 (±15) years, a majority were men (70%) and white (69%), and the mean number of Charlson comorbidities was 0.21 (±0.58). Multivariable logistic regression demonstrated a reduction in the likelihood of complications by 9% for each 5 additional surgeries performed by the operating surgeon [odds ratio (OR), 0.91 per 5 surgeries; 95% confidence interval (CI), 0.82-0.99]. Other factors associated with complications included increased age (OR, 1.23 per 10 years; 95% CI, 1.10-1.36), male sex (OR, 1.56; 95% CI, 1.12-2.17), open fractures (OR, 2.84; 95% CI, 1.92-4.19), number of Charlson comorbidities (OR, 1.23; 95% CI, 1.02-1.48), income quartile (OR, 1.48; 95% CI, 1.00-2.17), uninsured (OR, 2.47; 95% CI, 1.39-4.39), and other government program insurance (OR, 1.52; 95% CI, 1.06-2.18). CONCLUSIONS: We observed a significant inverse relationship between surgeon volume and complication rates when controlling for patient and injury characteristics. In contrast to previous research, a volume-outcome relationship was not observed at the hospital level. These results suggest that such complex injuries should be triaged to the most experienced providers. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Subchondroplasty of the Foot: Two Case Reports.

Early avascular necrosis of metatarsal heads and cuboid injuries are uncommon conditions encountered by foot and ankle specialists. Treatment options are limited and typically include long periods of offloading or non-weightbearing. There is limited published information on alternative treatment approaches for such pathologies when conservative therapies fail. Presented are 2 patient cases treated with a percutaneous calcium phosphate injection after failure of standard therapy, persistent pain, and bone marrow edema in the foot.

Open Reduction and Internal Fixation Versus Primary Arthrodesis for the Treatment of Acute Lisfranc Injuries: A Systematic Review and Meta-analysis.

This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, a systematic review was carried out. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify both randomised controlled trials (RCTs) and nonrandomised studies comparing the outcomes of ORIF and primary arthrodesis for Lisfranc injuries. Random- and fixed-effect statistical models were applied to calculate the pooled outcome data. Two RCTs and 3 observational studies were identified, compiling a total of 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. Our results demonstrate that ORIF is associated with a significantly higher need for revision surgery (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.68 to 15.11, p < .0001) and a significantly higher rate of persistent pain (OR 6.29, 95% CI 1.07 to 36.89, p = .04) compared with primary arthrodesis. However, we found no significant difference between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society functional score, or rates of infection. Separate analysis of RCTs showed that ORIF was associated with a more frequent need for revision surgery (OR 17.56, 95% CI 5.47 to 56.38, p < .00001), higher visual analogue scale pain score (mean difference 2.90, 95% CI 2.84 to 2.96, p < .00001), and lower American Orthopaedic Foot & Ankle Society score (mean difference -29.80, 95% CI -39.82 to -19.78, p < .00001). The results of the current study suggest that primary arthrodesis may be associated with better pain and functional outcomes and lower need for revision surgery compared with ORIF. The available evidence is limited and is not adequately robust to make explicit conclusions. The current literature requires high-quality and adequately powered RCTs.

Complete Cuboid Dislocation With Associated Lisfranc Injury: A Case Report and Review of the Literature.

Cuboid dislocations are rare midfoot injuries that usually occur in the setting of high-energy trauma. Diagnosis can be challenging and optimal treatment remains unknown. This case report and review aims to summarize the recent literature on this topic.

Injuries involving the central tarsal bone in nonracing dogs: Short-term outcomes and prognostic factors.

OBJECTIVE: To describe traumatic injuries involving the central tarsal bone (Tc) in nonracing dogs. STUDY DESIGN: Retrospective multicenter study. ANIMALS: Thirty-two client-owned dogs. METHODS: Medical records from January 2010 to December 2016 were searched for dogs with Tc injury. Fracture classification, concurrent tarsal fractures, treatment, and perioperative management were tested for association with postoperative complications and short-term outcome. Outcome measures consisted of the latest lameness score reported in the record. RESULTS: The most common injuries consisted of type V fractures (22) and luxation of the Tc (8). Other injuries included 1 case each of type III and type IV fractures. Twenty-two concurrent fractures involved other tarsal bones. Complications were diagnosed in 18 (62.1%) dogs, consisting of 13 minor, 4 major, and 1 catastrophic complication. Lameness at final follow-up (median 7 weeks) in 28 dogs was scored as 0 of 5 in 14 (50.0%) dogs, 1 of 5 in 7 (25.0%) dogs, 2 of 5 in 4 (14.3%) dogs, 4 of 5 in 1 (3.5%) dogs, and 5 of 5 in 2 (7.1%) dogs. Major complications were associated with the presence of multiple tarsal fractures (risk ratio [RR] 3.94, 95% CI 0.80-19.37, P = .13), specifically when the calcaneus was involved (RR 5.78, 95% CI 1.53-21.88, P = .05). CONCLUSION: The most common diagnosis in this population of nonracing dogs consisted of type V Tc fractures. Fractures affecting other tarsal bones were common and were associated with a higher risk of major complications, especially those affecting the calcaneus. CLINICAL SIGNIFICANCE: Short-term outcomes seem favorable in nonracing dogs with isolated Tc fractures, but dogs with concomitant tarsal fractures are predisposed to major complications.

Osteochondral Defect of the Calcaneocuboid Joint: A Case Study.

Osteochondral lesions (OCLs) are injuries affecting the articular cartilage surface of a joint. OCLs are well reported in the literature to affect the knee, talus, tibia, navicular, and first metatarsal. This rare case of a bipolar osteochondral lesion of the cuboid and calcaneus presented as lateral heel pain after a traumatic injury. After an unsuccessful course of conservative therapy, the lesion was treated with curettage and application juvenile particulate cartilage allograft. Eight months postoperatively, the patient was ambulating in supportive shoe gear without pain. The mechanism of injury leading to calcaneocuboid joint osteochondral lesions is not clearly understood. It is also questionable whether anatomic variances are contributory. Regardless of causality, OCLs should be included in the differential diagnoses for patients presenting with calcaneocuboid joint or lateral hindfoot pain.

[Exposed dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the foot: Clinical case and literature review]. / Luxación expuesta de la primera y segunda cuña y fractura in situ de la tercera cuña del pie: Caso clínico y revisión de la literatura.

BACKGROUNDS: The isolated fracture/dislocation of the cuneiform bones is a not very frequent event and only a few cases have been reported in the literature. This type of event is presented as a variation of the Lisfranc injuries. The present report shows a rare clinical case of a patient with dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the left foot. CASE REPORT: A 49-year-old female patient presented severe traumatism of the dorsum of the foot with bony and soft tissue exposure as a result of a car accident. The patient underwent surgery in the emergency department consisting of surgical cleaning, debridement, reduction of dislocation of the first and second cuneiform bones and percutaneous fixation with 2.0 mm Kirschner wires. RESULTS: After the surgery, the patient was found to be in good general condition, oriented without pain, stable, conscious, without traces of active bleeding from the wound and with the presence of Kirschner wires in an appropriate position. DISCUSSION: An exhaustive inspection of the injury is recommended through the analysis of X-ray images, CT scans or magnetic resonance imaging, especially in unexposed lesions in order to apply the appropriate treatment and be able to achieve a prompt recovery of the patient.

ANTECEDENTES: La fractura y la luxación aislada de los huesos cuneiformes son un evento no muy frecuente y sólo pocos casos han sido reportados en la literatura. Este tipo de eventos se presenta como una variación de las lesiones de Lisfranc. El presente reporte muestra un caso clínico poco frecuente de un paciente con luxación de la primera y segunda cuña y fractura in situ de la tercera cuña del pie izquierdo. CASO CLÍNICO: Mujer de 49 años de edad, que presentó traumatismo severo del dorso del pie con exposición de tejido óseo y blando como consecuencia de atropellamiento. La paciente fue sometida a cirugía en el Servicio de Urgencias, donde se realizó aseo quirúrgico, desbridamiento, reducción de la luxación de la primera y segunda cuña y fijación percutánea con clavillos Kirschner de 2.0 mm. RESULTADOS: Posterior a la cirugía, la paciente se reportó con buen estado en general, orientada, sin facie de dolor, estable, consciente, sin huellas de sangrado activo por la herida y con presencia de clavillos Kirschner en adecuada posición. DISCUSIÓN: Se recomienda una inspección exhaustiva de la lesión a través del análisis de las imágenes de rayos X, tomografía computarizada o imágenes de resonancia magnética, especialmente en lesiones no expuestas, pues con ello se puede aplicar el tratamiento adecuado y lograr una pronta recuperación del paciente.

Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination.

INTRODUCTION: Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings. MATERIALS AND METHODS: The study comprised 54 adult patients. MF was defined as an ankle fracture-dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed. RESULTS: The fibular fracture-fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch-in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis. CONCLUSION: MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.

Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes.

BACKGROUND:: We report data on the largest cohort to date of patients who sustained a ligamentous Lisfranc injury during sport. To date, the prevalence of concurrent intercuneiform ligament injuries in the competitive athlete with subtle Lisfranc instability has not been reported. METHODS:: Eighty-two patients (64 males, 18 females) sustained an unstable Lisfranc injury (49 left, 33 right) and met inclusion criteria. Injuries were classified as traditional dislocation (TRAD, first to second TMT ligament tear), medial column dislocation (MCD, second TMT, and medial-middle cuneiform ligament tear), or proximal extension dislocation (PE, first, second, and medial-middle cuneiform ligament tear) and the injury pattern confirmed at surgery. All athletes underwent open reduction with internal fixation (ORIF) of each unstable midfoot segment. Fisher exact tests and 2-tailed t tests were used to analyze statistical significance according to injury pattern, sport, gender difference, hindfoot angle alignment, and injured side ( P < .05). RESULTS:: Average age of athletes was 21.0 ± 5.3 years old (range 12-40), and return to sports was 7.5 ± 2.1 months. Injury distribution was as follows: TRAD (n = 40), MCD (n = 17), and PE (n = 23). MCD trended toward a longer return to sport (8.4 ± 3.3 months, P = .074). Football was the most common sport at time of injury (n = 48). Wakeboard athletes (n = 5) were older (31.4 ± 3.2, P = .0002), and MCD tears were more prevalent among them ( P = .061). Basketball (n = 13) players were significantly younger (19.1 ± 2.5 years, P = .028) and returned to sports quicker (5.2 ± 0.7, P = .0002). Return to sport data indicated a typical population for athletes with Lisfranc injury in these sports. CONCLUSION:: Proximal extension disruption (intercuneiform ligament tear) occurred in 50% of these low-energy Lisfranc athletic injuries. MCD and PE may be more prevalent than previously understood. This is the first study to document the extent, pattern, and prevalence of associated intercuneiform ligament tears in the competitive athlete with a low-energy subtle, unstable Lisfranc injury. LEVEL OF EVIDENCE:: Level IV, retrospective case series.

Retrospective Evaluation of Tibiotarsal Fractures Treated With Tape Splints in Birds: 86 Cases (2006-2015).

Tibiotarsal fractures are a common presentation in small bird species and anecdotally have been reported to carry a good prognosis with proper treatment, such as external coaptation. For this retrospective study, the medical records of 5 institutions were reviewed for tibiotarsal fractures diagnosed in companion birds weighing less than 200 g. A total of 86 cases met the inclusion criteria. Cockatiels ( Nymphicus hollandicus) (24/86) and budgerigars ( Melopsittacus undulatus) (19/86) were the most frequently represented species. Median body weight of the birds included was 72 g (range, 16-182 g). Mid-diaphyseal (46/86) and closed (73/86) fractures with intact, deep pain sensation in the affected limb (69/76) were most frequent. A tape splint alone (79/86) or a tape splint in addition to an intramedullary pin (7/86) were applied in all cases. Median time to fracture stabilization based on palpation was 19 days (range, 7-49 days). In most cases (61/86), the initial splint applied was maintained until fracture healing was complete. A successful outcome was documented in 92% (79/86) of birds. Fractures caused by a dog or cat attack, birds presenting without deep pain sensation in the affected limb, and cases where the splint was removed before 14 days after fixation were associated with a significantly increased risk of complications, resulting in an unsuccessful outcome. The findings of this study indicated that a tape splint is an appropriate means for treatment of tibiotarsal fractures in birds weighing less than 200 g.

Effect of bandaging techniques on sub-bandage pressures in the equine distal limb, carpus, and tarsus.

OBJECTIVE: To determine the influence of 3 types of bandages on sub-bandage pressures over the distal limb, carpus, and tarsus. STUDY DESIGN: Observational study. ANIMALS: Eight healthy horses. METHODS: Each of the 6 following bandages was applied on each horse in randomized order: (1) distal limb compression bandage (DLC), (2) double layer bandage (DL), (3) inner sanctum bandage (IS), (4) carpal compression bandage (CC), (5) tarsal compression bandage (TC), and (6) adhesive elastic carpal bandage (C-ELA). Sub-bandage pressures were measured with the Picopress compression measuring system (Microlab Electonica, Nicolo, Italy) after bandage application. Carpal and tarsal bandage pressures were assessed before and after walking the horses approximately 50 m. TC pressures were also measured after creating a slit over the calcaneus. A generalized linear model was used to test the association of pressure with sensor location, bandage type, time, and potential interactions (P < .05). RESULTS: DLC (165 mmHg) and IS (167 mmHg) generated greater mean combined pressures compared with DL (146 mmHg; P = .0166). At application, CC (154 mmHg) created higher mean combined sub-bandage pressure compared with C-ELA (70 mmHg; P < .001). Pressures resulting from CC and TC decreased after walking (P < .001), whereas those associated with C-ELA were not affected. CONCLUSION: Variations to the standard DLC construct did not increase sub-bandage pressures. CC and TC pressures rapidly decreased with ambulation, whereas C-ELA pressures in healthy horses were not affected by walking. CLINICAL SIGNIFICANCE: Variations to the standard DLC offer no additional benefit in regards to increasing sub-bandage pressures. Carpal elastic bandages maintain sub-bandage pressures during ambulation and may be more appropriate for long term bandaging in ambulating horses. Creating a slit over the calcaneal tuber in TC bandages is discouraged due to rapid decreases in sub-bandage pressure.