Closed Pantalar Dislocation With Checkrein Deformity: A Unique Case Report and Literature Review.

Closed pantalar dislocations are a rare variant of an uncommon injury. Pantalar dislocations are typically caused by high-energy trauma resulting in an open injury with associated fracture of the articulating bones. Given its obscurity, the literature on closed pantalar dislocations is scarce, and no standard treatment protocol has been accepted. This case report chronicles the treatment and outcome of a 29-year-old man who presented with a checkrein deformity of all digits after a closed pantalar dislocation with 6-month follow-up. A comprehensive literature review found 28 articles representing 39 patients with closed pantalar dislocations without talar neck or body fractures. Roughly equal numbers of closed and open reduction techniques were performed with avascular necrosis occurring in 7 of 36 patients. Although outcome measures and follow-up were variable, what can be considered a suitable outcome was seen in approximately 83% of patients, with only 3 of 35 requiring a secondary operation. Long-term studies with well-defined outcome measures are needed to adequately predict the prognosis of this rare injury and efficacy of treatment protocols.

Reoperation, reamputation, and new ulceration following complete or partial toe amputation among diabetic and non-diabetic patients.

AIMS: To compare the number of reoperations, reamputations, and new ulcers following toe amputation in diabetic and non-diabetic patients with sub-group analysis on index amputation level. METHODS: One-hundred sixteen patients with a complete (CTA) or partial (PTA) toe amputation and minimum of 12-month (12 M) follow-up were identified in electronic medical records. The number of reoperations and reamputations, number and location of new ulcers, and final amputation level of the ipsilateral extremity were compared between diabetic and non-diabetic patients and between those with CTA and PTA at 12 M and final follow-up (FFU). RESULTS: Diabetic patients had significantly more reoperations, reamputations, and new ulcers than non-diabetic patients at 12 M and FFU. There were no differences in reoperations, reamputations, or new ulcer location between CTA and PTA; however, patients with PTA developed more new ulcers at 12 M and FFU and were more likely to have a distal final amputation level compared to those with CTA. CONCLUSIONS: Diabetic patients required significantly more reoperations and reamputations following a toe amputation and developed more new ulcers than non-diabetic patients regardless of index amputation level. These high rates among diabetic patients highlight the complications encountered following toe amputation and emphasize the need for close, multi-disciplinary care.

Free circulating DNA as a biomarker of prostate cancer: comparison of quantitation methods.

AIM: To identify a simpler method of free circulating DNA (fcDNA) quantitation that may improve the specificity of the prostate cancer prostate-specific antigen (PSA) screening test. MATERIALS AND METHODS: The patient group consisted of 241 men with elevated PSA/abnormal digital rectal exam (DRE), undergoing prostate biopsy. Serum fcDNA levels were measured by UV absorbance and PicoGreen. Results were compared to previously published quantitative polymerase chain reaction (qPCR) data. RESULTS: We found that levels of fcDNA measured by PicoGreen correlated well with those measured by qPCR (r=0.8552). In the patient group with PSA >4 to 10 ng/ml, those with fcDNA (PicoGreen) >53.1 ng/ml were at increased risk for prostate cancer compared to those with fcDNA ≤ 53.1 ng/ml. Moreover, we found that measuring fcDNA levels by PicoGreen does not compromise the negative predictive value, accuracy or specificity of the qPCR fcDNA test. CONCLUSION: If validated in larger studies, PicoGreen quantitation of fcDNA could serve as a simple method to aid in prostate cancer diagnosis.