A proposed treatment algorithm for midfoot Charcot arthropathy.

Charcot arthropathy (CA) is an insidious, destructive, and disabling pathology of the foot and ankle. Efficient and effective treatment is therefore required to improve clinical outcomes and to reduce overall mortality risk. The purpose of this case series report is to propose a treatment algorithm for correcting deformity and restoring a plantigrade, shoeable foot in patients with midfoot CA. While there is no clear evidence in the literature favoring either internal or external fixation methods, it may be appropriate to use both techniques during most deformity correction cases. Depending on the presence of ulceration, single-stage and multi-stage reconstruction with either biplanar or aggressive resection can effectively address the presentation of nonviable tissue and a wide degree of variable deformity. Following midfoot reduction, medial column plating and circular external frame can be used together to effectively stabilize and protect the correction and construct. In all cases, the aim is to immediately place the patient into a Charcot Restraint Orthotic Walker boot, with the ultimate goal of transitioning to diabetic shoeing as quickly as possible.

The value of patient-matched instrumentation in total knee arthroplasty.

The purpose of the current prospective, randomized study was to compare the value of a new mechanically aligned patient-matched instrument system for total knee arthroplasty (TKA) (Visionaire; Smith & Nephew, Inc, Memphis, Tenn) (VIS) to that of standard TKA surgical instrumentation (STD). Twenty-nine primary TKA patients were enrolled and completed surgery (15 VIS and 14 STD). Postoperatively, mechanical alignment was significantly closer to neutral zero in the VIS group (1.7° vs 2.8°; P = .03). Furthermore, the VIS group demonstrated significant reductions in duration of hospital stay, operative time, incision length, and number of used instrument trays (P < .05). Although additional research is underway to confirm these preliminary results, this evidence suggests that patient-matched instrumentation may support repeatable improvements in surgical accuracy and hospital efficiency.

Effect of a liquid multivitamin/mineral supplement on anaerobic exercise performance.

The purpose of this study was to determine if supplementation with a liquid multi-vitamin/mineral would improve anaerobic exercise performance. Fourteen resistance-trained men performed a 30-second cycle sprint and one set of squat exercise on 2 separate days before and following 8 weeks of supplementation with either a liquid multi-vitamin/ mineral or a placebo. Heart rate, perceived exertion, blood lactate, peak and mean power, and rate of fatigue were determined for all tests. No differences were noted for any variable (P > 0.05). When controlling for presupplementation values, however, a decreased rate of fatigue was noted for both exercise tests following the multi-vitamin/mineral supplementation. These data suggest that in resistance trained men consuming a nutritionally sound diet, supplementation with a liquid multi-vitamin/mineral does not favorably impact most anaerobic exercise performances. Such supplementation, however, may result in a minor decreased rate of fatigue. It appears that, in terms of improved short duration anaerobic exercise performance, supplemental micronutrients may not be efficient ergogenic agents for well-trained individuals consuming an adequate diet.