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.

Vascularized scapular free bone graft after nonunion of a tarsal navicular stress fracture: a case report.

Nonunion of a tarsal navicular stress fracture, although relatively uncommon, is often amenable to open reduction and internal fixation. Furthermore, avascular necrosis of the navicular whether intact or occurring after fracture is rare, secondary to the adequate blood supply it receives. However, persistent nonunion after primary surgical repair in conjunction with avascular necrosis often results in limited treatment options. Thus, the purpose of the present case report is to describe the surgical approach and complications of a vascularized scapular free bone graft for augmentation of revision talonavicular and naviculocuneiform arthrodesis.

Osteochondral lesions of the talus treated with fresh talar allografts.

BACKGROUND: Osteochondral lesions of the talar dome (OLT) can be devastating injuries. Many of these problems occur in younger adult patients and can cause permanent joint pain and stiffness. Several treatment methods have been used to treat the symptomatic lesion, including arthroscopic debridement and microfracture, transfer of autologous osteoarticular tissue from the knee or talus (OATS), autologous chondrocyte implantation (ACI), frozen and fresh allograft transplantation. MATERIALS AND METHODS: Eighteen patients underwent fresh talar allograft transplantation with internal fixation for an OLT. Fresh talar allograft transplantation involved arthrotomy of the ankle, often with malleolar osteotomy, and replacement of the talar dome defect with fresh talar allograft tissue and internal fixation. Thirteen of the 18 patients returned for clinical and radiographic examination in addition to completing two validated questionnaires. The other five patients did not return for followup evaluation. The 13 patients who were seen in followup had an average age of 30 (range, 15 to 44) years with a mean followup of 48 months. RESULTS: There was a significant difference (p < 0.01) between the patients' preoperative and postoperative pain and activity abilities as measured with the Foot Function Index and AOFAS Ankle-Hindfoot questionnaires. Clinical examination and X-rays confirmed healing of the graft. CONCLUSION: Based on these results, we conclude that this is a reasonable procedure for younger adult patients with focal osteochondral talar defects that cannot be corrected with curettage and microfracture.

Frostbite of the feet after cryotherapy: a report of two cases.

UNLABELLED: The use of cryotherapy for the reduction of postoperative swelling and pain has become commonplace in orthopedic, podiatric, and cosmetic surgery. Prolonged exposure to extreme cold may induce an injury nearly identical to that of frostbite. The authors report on 2 patients who underwent podiatric orthopedic surgery and were exposed to prolonged cold therapy, which resulted in limb-threatening problems. Both patients had prolonged and essentially uninterrupted application of cryotherapy for 4 to 7 days, resulting in rewarming injuries of tissue necrosis. A team of specialists used limb salvage therapy to successfully treat the patients. Because of the problems encountered with the cold therapy devices, the authors caution against unmonitored and prolonged cold exposure. Newer devices that prevent cold exposure below 65 degrees F for longer than 2 hours could be a better option in cases in which cryotherapy is used. LEVEL OF EVIDENCE: 4.

Bread mold osteomyelitis in the femur.

Rhizopus osteomyelitis is an uncommon and often fatal infection that usually occurs in immunocompromised patients. The infection is commonly referred to as "bread mold." The usual course of treatment is Amphotericin B, debridement, and, if needed, amputation of the affected limb. This article details a rare case of postoperative Rhizopus osteomyelitis in an otherwise healthy patient. The patient originally presented at another institution for anterior cruciate ligament repair after a ski injury. Postoperatively, he developed clinical evidence of infection. He was referred to our institution with stiffness and swelling in the knee as well as weight loss and decreased range of motion. Fluid collection was visible on magnetic resonance imaging. Arthroscentesis was cultured for fungus and bacteria, and the fungal cultures were positive for Rhizopus species. An attempt at limb salvage was made. Debridement, use of a cement spacer loaded with Amphotericin B, systemic antifungal therapy, and 23 hyperbaric oxygen treatments were used to eradicate the disease. Four surgeries were needed to eradicate the disease, and 10 months after initial presentation, the patient had a distal femoral endoprosthesis placed in his leg. Laboratory tests returned to normal and frozen sections were negative for fungus. At 3-year follow-up, the patient reported a musculoskeletal functional score of 50% and had no evidence of recurrent infection.