Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware.

After 4 to 8 weeks of normal primary bone healing, rigid internal fixation is no longer required. Newer generation absorbable implants have become reliable and cost-effective alternatives to metallic hardware. Modern implants are formulated to have increased strength and smoother resorption over the course of 18 to 24 months, which decreases the possibility of local inflammation. Historically, bioresorbable screws can be time consuming to insert, but newer devices are being developed that help ease their insertion. A case of a bunionectomy is presented with double osteotomy on a 40-year-old nurse fixated with polyglycolic acid and poly-l-lactic acid copolymer screws.

Use of soft tissue matrices as an adjunct to achilles repair and reconstruction.

The Achilles tendon is the thickest and strongest tendon in the human body. In spite of this, it is also one of the most frequently ruptured tendons. This article reviews the history of and debate about the appropriate course of treatment. A case study of an Achilles repair illustrates that the use soft tissue matrices is a successful adjunct to both the primary repair and gastrocnemius recession, with full return to activity and no inflammatory response at long-term follow up. The authors anticipate that the use of soft tissue matrices for the repair of tendon and soft tissue defects will expand over time as this material has distinct advantages over synthetics and highly crosslinked biologic materials.

Diabetic foot infections: time to change the prognostic concept.

Patients with diabetic neuropathy are subject to ulcerations that may be complicated by infection and gangrene, with subsequent risk of amputation. It is the job of the foot specialist to identify and manage these problems early to avoid the unfortunate complication of amputation regardless of the presenting condition of the patient's limb. We shed light on the hypothesis that suggests that infection and gangrene in a diabetic patient aggravate the degree of ischemia (microvascular, macrovascular, or both) already present enough to endanger the viability of the surrounding tissues unless urgent drainage with decompression and debridement of the necrotic sloughs is performed, with consequent reduction of tissue pressure and improvement in circulation to the area. We present cases with severe infections leading to gangrene and ischemia, which were improved following surgical management with consequent improvement in tissue viability. In these cases, we demonstrate that immediate treatment of the wound despite the delayed presentation of the patients resulted in limb salvage with much less soft-tissue loss than expected before treatment.

The natural history of Charcot's neuroarthropathy.

The goal of this article is to outline the progression of Charcot's neuroarthropathy. A historical background is detailed, with an emphasis on the current trends in the literature. Acute Charcot's neuroarthropathy requires a prompt diagnosis with the proper practical offloading methods of the affected limb. This, coupled with directed medical and surgical approaches designed to prevent or mitigate deformities, may subsequently reduce the risk of amputation in this high-risk population.