Etiology, Clinical Assessment, and Surgical Repair of Plantar Plate Tears.

The plantar plate has recently gained more attention as an important structure contributing to lesser metatarsophalangeal joint stability. This has prompted a significant growth of interest in the anatomy and biomechanics of the plantar plate and in the diagnosis and treatment of its injuries. Improved understanding of plantar plate function and predictable patterns of degeneration and failure has led to the development of a clinical staging and surgical grading system of plantar plate lesions. Relatively recent innovations allow the surgeon to access and repair plantar plate tears directly with reinsertion onto the base of the proximal phalanx. The addition of direct plantar plate repair represents a significant advance in the surgical restoration of alignment and functional stability of the lesser metatarsophalangeal joint.

Sonographic assessment of suture artifact obscuring visualization of the digital nerve.

INTRODUCTION: The purpose of this study was to grade the severity of sonographic artifact produced by four suture materials and to determine whether these artifacts affect visualization of a digital nerve. METHODS: A needle was placed into a pig foot to mimic a normal volar digital nerve. Incisions superficial to the needle were closed with different suture types, specifically nylon (N), chromic (C), vicryl (V), and prolene (P). Sonographic images were obtained using a high-frequency transducer. Twenty radiology residents and attending physicians graded the severity of artifact and nerve obscuration. Two image types were shown: one suture type per image and a composite image of each suture type, adjacent to one another. RESULTS: Severity of nerve obscuration was as follows: composite image: P = N = V > C; individual images: P > N > V > C. Severity of artifact was: composite image: V = N > P > C; individual image: P > N > V > C. CONCLUSION: Although all sutures produced artifact, only C produced mild artifact, which did not significantly obscure visualization of the nerve model.

Sonographic assessment of volar digital nerve injury in the context of penetrating trauma.

OBJECTIVE: The purpose of this article was to report our experience using ultrasound to assess digital nerve integrity after penetrating hand trauma with sensory deficit. Ultrasound was performed in the long axis on 22 digital nerves in 11 patients using a 12-14-MHz linear array hockey stick transducer. CONCLUSION: Of 22 volar digital nerves evaluated by sonography, six were transected. All imaging findings were confirmed surgically. High-frequency ultrasound permits accurate imaging of intact and transected volar digital nerves.