Nonresection triple arthrodesis: a retrospective analysis.

This case series examines triple arthrodesis using articular cartilage excision without bone resection. Due to the technically demanding nature of triple arthrodesis, the authors present a nonresection technique with its perceived advantages over joint resection triple arthrodesis in the presence of reducible deformity, such as minimal shortening of bone, ease of execution, and better bony apposition. Fourteen patients with nonresection triple arthrodesis from two medical centers are included in this report. Postoperative follow-up ranged from 6 to 36 months. Evaluation of results was performed subjectively and radiographically. There was a low incidence of nonunion (2% of joints) and minimal to no bone shortening (0.1 cm mean talonavicular shortening and 0.1 cm mean increase in talocalcaneal height). Mean time to fusion of joints fixed with screws was 9.91 weeks (SD = 3.61, n = 31), while fusion time for staple or pin fixation was 8.96 weeks (SD = 4.15, n = 10). There were no significant differences in time to fusion between screw and nonscrew fixation (p = .26) nor when comparing procedures within each patient (p = .30). At follow-up, five patients reported no pain at any time (36%); two patients reported mild occasional pain (14%). Moderate, daily pain was reported by seven patients (50%). While no direct comparison with resection triple arthrodesis was made, the positive subjective and objective results support this procedure.

Acute exertional compartment syndrome of the medial foot.

A review of compartment syndrome, both acute and chronic, is presented. The pathophysiology, anatomy, diagnosis, and treatment are presented in relation to a unique case report. The case is one of acute exertional compartment syndrome of the medial foot treated by fasciotomy. This condition is uncommon in both its nature and location.

Brachymetatarsia. Case report and surgical considerations.

The authors present a case of congenital idiopathic brachymetatarsia of the fourth metatarsal. A combination of techniques was used to address the components of the deformity and its correction, which include preoperative soft tissue stretching, Z-skin plasty, Z-tendon lengthening, Z-lengthening metatarsal osteotomy with internal screw fixation, and bone allografting. Conventional autograft harvesting complications and external fixation were avoided. This case demonstrates the correction of a brachymetatarsal using combined and modified techniques.

The Osteomed M3-X Fixation System: a new bone screw with applications in foot surgery.

The purpose of this article is to familiarize the reader with the Osteomed M3-X Fixation System. The authors present a description of the instrumentation and design characteristics of this system, as well as some comparisons to other similar fixation devices. The indications for the screw's use and the correct techniques of insertion are also discussed. In addition, a review of over 200 forefoot procedures utilizing this system, and performed by the podiatric surgeons at Hutzel Hospital, is presented.

Tibialis anterior transfer "into talus" for control of the severe planus pediatric foot: a preliminary report.

Transfer of tibialis anterior into the talus has been utilized for correction of the vertical talus, as well as for paralytic valgus foot deformities with the suggestion for its use in severe flatfoot deformities. The authors present transfer of tibialis anterior through the talus for controlling the severe planus pediatric foot. The procedure is presented, and six feet having undergone this procedure are analyzed. This procedure, in combination with others, has proven successful in reconstructing this pediatric deformity clinically and radiographically.

Repair of neglected Achilles tendon ruptures--procedure and functional results.

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. The authors present their preferred technique for delayed repair, and the results of four patients who were available for complete follow-up evaluation. The method of repair includes: V to Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, plantaris tendon weaving to reinforce the anastomosis, and use of a pullout-wire suture. Each of the four patients were interviewed, examined clinically, and examined via Cybex (Cybex Corporation, Long Island, New York) isokinetic strength testing. All patients related satisfaction with results, and no reruptures were encountered. All four patients have been able to return to their preinjury activities. Cybex isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 22% to 30% as compared with the unaffected limb. This deficit is believed to be the result of the gastrocnemius recession. The overall results of the described techniques indicate that very satisfactory function of a neglected tendo Achilles rupture can be obtained. A strong, clinically functional Achilles tendon complex is restored at the cost of some decrease in peak strength as detected by Cybex.