Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report.

A neglected laceration of the extensor hallucis longus (EHL) tendon is rare. Retraction of the tendon ends often occurs when a laceration is neglected, leading to a substantial tendon deficit. A paucity of case reports is available describing the treatment of EHL laceration with a large area of gap secondary to retraction. Therefore, the treatment recommendations are limited. We present the case of a neglected EHL tendon laceration with a 10.5-cm gap in a healthy 22-year-old female. The EHL tendon laceration was repaired using a split peroneus longus tendon autograft that, to the best of our knowledge, has not been previously reported. At the 3-year follow-up evaluation, the patient retained full function of her hallux and was free of symptoms.

Analysis of weight change and Borg rating of perceived exertion as measurements of runner health and safety during a 6-day, multistage, remote ultramarathon.

OBJECTIVE: To determine the feasibility of using weight change and Borg score as tools for monitoring runner health and safety during a multistage, remote ultramarathon. DESIGN: Observational cohort study of feasibility on nonblinded event participants. SETTING: Six-day, multistage, remote ultramarathon in Utah. PARTICIPANTS: Twenty-seven athletes in the 2012 Desert R.A.T.S. (Race Across the Sand) ultramarathon. ASSESSMENT OF RISK FACTORS: Participant weight, health conditions that limited race participation, such as fatigue or exhaustion, and Borg score were reviewed. MAIN OUTCOME MEASURES: Inability to complete a stage of the race (Did Not Finish status) or development of a clinically significant health condition during the race. Potential prognostic risk factors, such as a high Borg score and weight loss, were analyzed. RESULTS: An overall decrease in weight was observed over the course of the event. Median percent weight changes were losses of 2.96% (day 1), 7.42% (day 2), 2.21% (day 4), and 3.35% (day 6). There was no statistically significant difference in percent weight change between the 14 runners who finished the race and the 13 runners who did not finish the race (U = 73; z = 0.189; P = 0.85). Runners' ability to complete the race was related to the development of adverse health conditions (P = 0.004). Median Borg scores reported were 15 (day 1), 17 (day 2), 13 (day 3), 16 (day 4), and 15 (day 6). Only 2 racers who finished the entire event without adverse events ever gave a Borg score of ≥ 18. CONCLUSIONS: The feasibility of weight change as a tool for monitoring runner health and safety in this setting is limited, but the Borg rating of perceived exertion warrants further study as a potential field expedient tool for monitoring runner health and safety during a multiday, remote ultramarathon.

Unilateral lateral rectus resection for horizontal diplopia in adults with divergence insufficiency.

BACKGROUND: Divergence insufficiency (DI) is an acquired comitant strabismus in aging individuals, characterized by esotropia and diplopia at distance. Treatment options include occlusion, base-out prism glasses, and a variety of surgical procedures to the horizontal rectus extraocular muscles. Here, we present a large cohort of patients with DI who underwent unilateral resection of the lateral rectus muscle. This is a simple procedure, typically performed under regional anesthesia and on the non-dominant eye. METHODS: Clinical characteristics and complaints were collected from patients with DI who underwent unilateral lateral rectus resection over a 6.5-year period. Treatment success was evaluated in terms of post-operative symptomatic deviation and the need for prisms in order to achieve sensory fusion. RESULTS: The cohort consisted of 57 patients (age 54-89 years). The majority sought surgical care after prism glasses were no longer tolerated, or after onset of a larger symptomatic deviation (typically 10 to 18 prism diopters). After surgery (minimum 6 weeks follow-up; median 10 weeks), 86.0 % showed successful results with no further treatment; an additional 10.5 % stayed free of diplopia with a post-operative prism (horizontal or vertical), and only two patients (3.5 %) required further surgery and were considered failures. CONCLUSIONS: Mild DI is usually treated with a base-out prism. Treatment of pronounced DI with unilateral lateral rectus resection was generally successful, with 96.5 % not requiring further surgery. Unilateral lateral rectus resection appears to be a valid option for treatment of DI.

Reconstruction of a Traumatic Partial First-Ray Amputation with the Use of an Induced Pseudosynovial Membrane and Corticocancellous Autograft.

Reconstruction of large bone defects of the metatarsals, whether resulting from trauma, infection, or a neoplastic process, can be especially challenging when attempting to maintain an anatomical parabola and basic biomechanical stability of the forefoot. We present the case of a 42-year-old man with no significant medical history who presented to the emergency department following a severe lawnmower injury to the left forefoot resulting in a large degloving type injury along the medial aspect of the left first ray extending to the level of the medial malleolus. The patient underwent emergent debridement with application of antibiotic bone cement, external fixation, and a negative-pressure dressing. He was subsequently treated with split-thickness skin graft and iliac crest tricortical autograft using a locking plate construct for reconstruction of the distal first ray. Although the patient failed to advance to radiographic osseous union, clinically there was no motion at the attempted fusion site and no pain with ambulation, suggestive of a pseudoarthrosis. The patient has since progressed to full nonpainful weightbearing in regular shoes and has returned to normal activities of daily living. The patient returned to his preinjury level of work and has had complete resolution of all wounds including his split-thickness skin graft donor site. This case shows the potential efficacy of the Masquelet technique for spanning significant traumatic bone defects of the metatarsals involving complete loss of the metatarsophalangeal joint.

Distraction First Metatarsophalangeal Arthrodesis With Tricortical Calcaneus Autograft: Technique Tips.

First metatarsophalangeal joint arthritis can stem from a biomechanical imbalance as in hallux abducto valgus, metabolic arthritidies such as rheumatoid or gout, and even in posttraumatic cases. Advanced arthritis in the foot and ankle can often become debilitating. Surgical intervention is often necessary. Revision of failed first metatarsophalangeal joint arthroplasty is often in the setting of bony erosion and lysis, cystic changes, and loss of bone stock. In this article, we describe first metatarsophalangeal distraction arthrodesis technique using tricortical calcaneus autograft with the aim of simplifying donor site graft harvesting and decreasing donor site morbidity while attaining successful osseous union. LEVELS OF EVIDENCE: Level V.