Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report.

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.

A modified fixation technique for a decompressional shortening osteotomy: a retrospective analysis.

A long metatarsal and/or metatarsophalangeal joint dislocation associated with a digital contracture is a surgical challenge. Without appropriate surgical correction, the patient will be predisposed to numerous complications, including persistent subluxation or dislocation, recurrent metatarsalgia, dorsiflexory contracture of the digit, transfer lesions, and inadequate pain relief. The results of the present surgical treatment options have varied, with the most common complication being a floating toe. The purpose of our study was to introduce a decompression, shortening, lesser metatarsal osteotomy with a modified fixation technique using a T-plate and to report our results. Additionally, we have discussed trigonometric analysis of metatarsal declination and shortening. We retrospectively reviewed the outcomes of 30 consecutive patients with 33 osteotomies who had been treated surgically for pathologic features associated with a long metatarsal and varying biomechanical abnormalities. Before surgery, all the patients had been treated conservatively for a minimum of 3 months. The surgical procedure included a dorsal to plantar V-shaped shortening osteotomy of a lesser metatarsal that was fixated with a T plate. The patients were assessed radiographically and using the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale and visual analog scale. The mean age at surgery was 53 (range 37 to 75) years, with a mean follow-up period of 9.1 (range 6 to 15.4) months. The average shortening of the metatarsal was 2.7 mm. One patient (3%) had had asymptomatic delayed union and 2 patients (6%) hypertrophic nonunion. No incidence of malunion or avascular necrosis was identified. Five cases (15.2%) of hardware failure occurred. The mean American Orthopaedic Foot and Ankle Society score was 76.7 postoperatively. The visual analog scale score had improved from 6.7 to 1.7. Of the 30 patients, 72% rated the overall surgical experience as excellent or good. In conclusion, the modified fixation technique for decompression, shortening metatarsal osteotomy using a T plate is a viable option when choosing a procedure to address a long, prominent metatarsal and/or digital contracture at the metatarsophalangeal joint and results in a low incidence of floating toe complications.

Lateral leg compartment syndrome caused by ill-fitting compression stocking placed for deep vein thrombosis prophylaxis during surgery: a case report.

Isolated lateral leg compartment syndrome is a relatively rare event, with potentially devastating consequences. We present a case of a 44-year-old man with isolated lateral leg compartment syndrome caused by a compression stocking used for deep vein thrombosis prophylaxis during surgery. It was found to be excessively tight around the patient's proximal calf postoperatively. He underwent lateral leg compartment fasciotomy and delayed wound closure with a split-thickness skin graft. At the 7-month follow-up visit, he had returned to full activity, had no muscle deficits, and had numbness in the distribution of the intermediate dorsal cutaneous nerve.

A report of a rare phalangeal periosteal chondroma of the foot.

Periosteal chondroma is a benign, slow-growing cartilaginous tumor that typically occurs at the metaphysis of long tubular bones beneath the periosteal membrane. A case is presented of a 42-year-old male who developed a firm, tender, uneven mass encircling the lateral, dorsal, and medial aspects of the right second proximal phalanx following a traumatic event. The mass was excised en toto and histopathologic findings are presented.

Results of modified lapidus arthrodesis procedure using medial eminence as an interpositional autograft.

The Lapidus procedure has received wide acceptance as a valuable operation for correcting moderate to severe hallux valgus, especially in the presence of hypermobility. However, shortening of the first ray inherently occurs as the first metatarsocuneiform joint cartilage and subchondral bone are resected in preparation for arthrodesis. The purpose of this study was to radiographically compare the degree of shortening of the first ray with and without the use of the first metatarsal medial eminence as an interpositional autograft at the site of metatarsocuneiform fusion. Preoperative and postoperative radiographs were measured in 35 consecutive patients who underwent 37 modified Lapidus procedures for hallux valgus repair. In group A, 20 surgeries were performed without use of the interpositional autograft, and served as the control. In group B, 14 surgeries were performed using the medial eminence as an interpositional autograft. The mean amount of first ray shortening was 5.3 ± 1.66 mm in group A and 2.69 ± 1.56 mm in group B, and this difference was statistically significant (P < .001). All patients progressed to complete union, and the median follow-up was 6 months (range, 4-60). Based on these results, the use of the medial eminence as an interpositional autograft in conjunction with Lapidus arthrodesis resulted in a 49.2% reduction in the amount of shortening of the first ray and proved to be a useful source of readily available bone graft.

Disseminated intravascular coagulation, meningococcal infection, and ischemic changes affecting the lower extremities: a case study.

A middle-aged woman presented from an outside hospital with a diagnosis of Neisseria meningitidis and meningococcemia. A nonpalpable purpuric skin rash evolved into multiple wounds, with gradual necrosis of bilateral lower and upper extremities. Throughout the course of hospitalization, the patient developed ventricular tachycardia, normocytic anemia, thrombocytosis, Clostridium difficile infection, depression, and transient right eye blindness. The finding of decreased CH50 in the complement cascade was considered as the potential cause of the meningococcemia. The subsequent ischemia and necrosis of extremities were attributed to the systemic effect and trauma ensuing from N. meningitidis.