Comparing Clinical Characteristics and Short-Term Outcomes Between Adult and Geriatric Patients Undergoing Charcot Reconstruction.

Maintaining an acceptable quality of life following a lifetime of chronic diseases and resulting physiologic effects poses a challenge when treating an aging population. In those with Charcot neuroarthropathy, wounds, and infection complicate decision making when considering limb preservation versus amputation. The purpose of this investigation is to describe the clinical characteristics and short-term outcomes of geriatric patients undergoing Charcot reconstruction.

Are Biodegradable Calcium Sulfate Antibiotic Beads Effective and Safe Adjuvants for Diabetic Foot Osteomyelitis?

Introduction:  Diabetic foot osteomyelitis (DFO) is a highly morbid condition that commonly affects diabetic patients. Biodegradable calcium-sulfate antibiotic beads (CaSO4) are theoretical adjuvant agents to reduce morbidity in DFO. However, there is a paucity of research on the safety and effectiveness of CaSO4 beads in DFO.

Intraoperative Radiation Exposure During Midfoot Charcot Reconstruction.

While radiation exposure in foot and ankle surgery varies by procedure, attempts to minimize this hazard remain imperative to protect patients and surgeons. Hindfoot deformity correction employs significant radiation through intraoperative fluoroscopy, however, a paucity of data exists concerning Charcot reconstruction. This investigation describes and compares radiation exposure across varying Charcot pathology and fixation constructs.

Necrotizing Fasciitis in Charcot-Marie-Tooth Treated with Debridement, Free Flap, and Extra-Articular Reconstruction.

Necrotizing fasciitis of the foot is a relatively rare diagnosis and has traditionally been treated with distal amputation. A 30-year-old diabetic man with Charcot-Marie-Tooth muscular atrophy developed necrotizing fasciitis of the dorsal foot and underwent surgical debridement resulting in a significant wound with exposed tendons. Serial debridements were performed, eventually followed by a staged free flap reconstruction using an anterolateral thigh fasciocutaneous flap.

"No Care Pin Care" Following Charcot Reconstruction With Static External Fixation.

Charcot reconstruction with static external fixation provides stability in deformity correction. Concern for pin site health remains forefront to prevent premature fixator removal should infection develop. While previous investigations examined a spectrum of pin care protocol with a similar variation in outcomes, this study assesses results following a "no care pin care" routine.

The Navicular Cuneiform Joint: Updates on Avoiding and Managing a Nonunion.

Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the surgical treatment of progressive collapsing foot deformity, can develop nonunion. Addressing this condition hinges on the assessment of various parameters such as patient/host factors and recognition of the etiology of the nonunion. In this article, methods of optimizing this surgical intervention through anatomic and physiologic considerations are highlighted.

30-Day Readmission Following Outpatient Transmetatarsal Amputation in the Geriatric Population: An ACS NSQIP Analysis.

Whether secondary to deformity, traumatic injury, infection, neoplasm, or ischemic disease, the transmetatarsal amputation provides a functional means of limb preservation prior to major proximal amputation. With similar readmission rates following inpatient and outpatient surgery, prevention of an unnecessary admission among vulnerable patients, specifically geriatrics, proves beneficial. This investigation examines differences among geriatric patients admitted and not requiring readmission following outpatient transmetatarsal amputation.

Coronal Hindfoot Alignment in Midfoot Charcot Neuroarthropathy.

Coronal plane hindfoot malalignment produces abnormal compensatory forces within the midfoot and forefoot. The primary aim of this study is to compare radiographic hindfoot alignment in patients with a midfoot Charcot event, and identify patterns associated with breakdown. A retrospective review of 43 patients (48 limbs) with midfoot Charcot neuroarthropathy were compared between the coronal hindfoot alignments and Charcot joint involvement.

Double Versus Triple Arthrodesis Fusion Rates: A Systematic Review.

Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis.

Safety of Tibial Half Pins With Circular External Fixation for Foot and Ankle Reconstruction in Patients With Peripheral Neuropathy.

The primary aim of the study was to evaluate the rate of tibial fracture with half pin placement in conjunction with tensioned wires in Ilizarov static external fixator in patients with peripheral neuropathy. Concentric visualization through a rancho cube and careful identification of anterior, posterior, medial, and lateral borders of the tibia, the "perfect circle" technique was used to ensure avoidance of cortical breach. Bivariate analysis was performed comparing the rates of tibia fractures in those who did and did not employ the "perfect circle" technique for placement of tibial half pins; evaluating for demographics, rationale for external fixation use, and postoperative amputation and complication rates.

Screw Length Associated With Fracture Gapping of Fifth Metatarsal Base Fracture With Intramedullary Screw Fixation: A Cadaveric Study.

Intramedullary screw fixation is a well-established surgical treatment for fifth metatarsal Jones fractures, due to its minimally invasive nature, and potential early return to activity. Due to the curvature of the fifth metatarsal, optimal length of the screw is needed to prevent gapping at the fracture site. The placement of a straight screw induces straightening of a naturally curved bone.

Assessment of Pediatric Limb Length Inequality.

Limb length inequality or discrepancy (LLD) occurs when there is a difference in length between 2 limbs or when deviation exists from a normally expected length for a given age. The magnitude of the discrepancy is defined as the difference between the 2 extremities. Aside from congenital etiologies, LLD can also arise from infection, paralysis, tumors/neoplasm, and surgery.

Split Anterior Tibial Tendon Transfer to Dorsal Lateral Foot for Cavovarus Deformities With Neuropathic Ulcerations: A Case Series.

Cavovarus deformity leads to increased peak pressure on the plantar lateral foot, which can lead to ulceration, and can potentially progress to amputation. Techniques have been suggested in the treatment of cavovarus deformity, such as peroneus brevis or longus tendon transfer, anterior tibial tendon lengthening, posterior tibial tendon transfer, or boney resection. This case series shows split anterior tibial tendon transfer as a surgical reconstruction of cavovarus pedal deformity.

Updates on Bioengineered Alternative Tissues.

Over the past quarter century, the management of diabetic wounds and their sequelae has improved dramatically. One of the greatest areas of advancement includes the development of bioengineered alternative tissues that act as adjuncts to the deficits of chronic wounds and accelerate healing. The use of bioengineered alternative tissues will likely only continue to dominate the outpatient and perioperative management of chronic, recalcitrant wounds as new additional products continue to cut costs and improve wound healing expectations.

Current Advancements in Ankle Arthrodiastasis.

Ankle arthrodiastasis offers an option for patients with end-stage primary or posttraumatic ankle osteoarthritis. The process allows for a joint salvage procedure as an alternative to arthrodesis or ankle implant arthroplasty. The distraction within the joint optimizes the intraarticular environment to permit equilibration of hydrostatic pressure, promoting subchondral morphoangiogenesis, and decreases subchondral sclerosis, thereby mitigating pain.

Effect of Pedal Deformity on Gait in a Patient With Total Knee Arthroplasty.

The authors present the case of an 81-year-old man who, despite an anatomically aligned total knee arthroplasty, continued to have knee pain. The patient's ipsilateral rigid flatfoot caused by an earlier partial pedal amputation resulted in a valgus moment during gait, thus creating clinical symptoms in the total knee arthroplasty. Because of the deformity and scarring within the flatfoot, this valgus deformity was corrected through a varus distal femoral osteotomy.

Preoperative Planning and Intraoperative Technique for Accurate Translation of a Distal First Metatarsal Osteotomy.

We used preoperative radiographic and intraoperative anatomic measurements to predict and achieve, respectively, the precise amount of capital fragment lateral translation required to restore anatomic balance to the first metatarsophalangeal joint. Correlation was used to relate the amount of capital fragment translation and operative reduction of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), tibial sesamoid position (TSP), metatarsus adductus angle, and first metatarsal length. The mean capital fragment lateral translation was 5.

Pigmented Onychomatricoma: A Rare Pigmented Nail Unit Tumor Presenting as Longitudinal Melanonychia That Has Potential for Misdiagnosis as Melanoma.

Pigmented onychomatricoma is a rare nail unit tumor that can clinically mimic nail unit melanoma. We report the case of a 63-year-old male with new-onset longitudinal melanonychia involving his right second toe. An excisional biopsy was performed and demonstrated pigmented onychomatricoma.

Immediate weightbearing after Lapidus arthrodesis with external fixation.

A common surgical treatment of severe hallux abductovalgus deformity with coincident first ray hypermobility is metatarsal-cuneiform fusion or Lapidus procedure. The aim of the present study was to illustrate a reliable and novel method of fixation for Lapidus fusion using an external fixation device through a retrospective cohort investigation of consecutive patients. Twenty Lapidus fusions were performed in 19 patients, including 17 females (89.

Assessing vascular status and risk of latent ischemia with ankle fracture: a case report and algorithm for treatment.

A paucity of published studies and clinical recommendations are available regarding ankle fracture and its association with vascular injury, likely because of the lower incidence relative to the more commonly seen popliteal artery injury after knee dislocation. In the present case report, we describe a previously healthy patient who experienced a pilon type ankle fracture (AO 43C2) with fibular and syndesmotic involvement, followed by a subacute presentation of vascular ischemia weeks after the initial injury and repair, ultimately leading to a major amputation. The failure to identify an occult, vascular injury can have devastating consequences.

Subtalar joint septic arthritis in a patient with hypogammaglobulinemia.

The clinical presentation of a monoarticular, red, hot, and swollen joint has many possible diagnoses, including septic arthritis, which is 1 of the most devastating. The morbidity associated with this pathologic process involves permanent joint damage and the potential for progression to systemic illness and, even, mortality. The common risk factors for joint sepsis include a history of rheumatoid arthritis, previous joint surgery, joint prosthesis, intravenous drug abuse, alcoholism, diabetes, previous intra-articular steroid use, and cutaneous ulceration.

Effect of botulinum toxin on detrusor overactivity induced by intravesical adenosine triphosphate and capsaicin in a rat model.

Objectives: To assess the effects of intravesical injection of botulinum toxin type A (BTX) on a model of detrusor overactivity induced by intravesical infusions of adenosine triphosphate (ATP) and capsaicin. BTX has recently been used clinically to treat overactive bladder syndromes without a precise knowledge of the mechanism of action.

Methods: Twelve Sprague-Dawley rats underwent BTX injections.