Acute disruption of the posterior tibial tendon associated with open-fracture dislocation of the ankle.

A 27-year-old man with a high-energy, open-fracture dislocation of the ankle underwent debridement and open reduction of his injuries. During surgery a disruption-laceration of the posterior tibial tendon at the level of the fracture of the medial malleolus was found. Repair required location of the proximal muscle and tendon and controlled traction of the musculotendinous unit from its retracted position.

Malignant granular cell tumor mimicking herniated nucleus pulposus.

Peripheral nerve tumors may arise in any nerve, large or small. Their presence is readily apparent when they are superficial, but when they are located in a deep nerve, symptoms can mimic+ the nerve root pain of herniated nucleus pulposus. This case of malignant granular cell tumor, probably of Schwann cell origin, involved the sciatic and tibial nerves in the popliteal fossa.

Malignant epithelioid hemangioendothelioma arising in an intramuscular lipoma.

Background: A malignant epithelioid hemangioendothelioma (EH) developed within a peripheral intramuscular lipoma. It was seen as a painful calf mass. At the time of biopsy and en bloc resection, lung metastases were observed.

The hinged shoulder spica cast for management after shoulder surgery.

A shoulder spica cast is often required after major surgery to the shoulder. This type of cast is usually heavy and awkward. A lightweight fiberglass spica has proven to be useful after repair of the deltoid origin, repair of complete rupture of the rotator cuff, and shoulder arthrodesis.

Ankle reconstruction for malunion by fibular osteotomy and lengthening with direct control of the distal fragment: a report of three cases and review of the literature.

Malunion of ankle fractures will lead to severe osteoarthritis when the architecture and mechanics of the talocrural joint are deranged. When fibular shortening is present, ankle reconstruction can be achieved by fibular lengthening and can provide an alternative to early arthrodesis for deformity and pain. Acceptable clinical and radiographic results can be achieved, provided that accurate reconstruction is achieved and intra-articular osteochondral injury is minimal.

Squamous cell carcinoma complicating chronic osteomyelitis in a toe: a case report and review of the literature.

Squamous cell carcinoma arising from chronic osteomyelitis is uncommon. Although the majority of cases occur in the lower extremity, incidence in the foot is relatively rare, and in the toe, exceptional. This report illustrates a particularly unusual incidence of squamous cell carcinoma complicating chronic osteomyelitis of the hallux.

Combined anterior and posterior approach to the hip joint in reconstructive and complex arthroplasty.

The combined anterior and posterior approach permits access to the front and back of the hip joint for reconstruction and complex arthroplasty, usually without osteotomy of the greater trochanter, with minimal muscle release. There is ease of access to the anterior and posterior capsule, which can be resected under direct vision, thus permitting accurate hemostasis. The entire acetabular rim is exposed for bone grafting as required.

The technique of dynamic adhesive strapping for congenital clubfoot.

The use of dynamic adhesive strapping to correct congenital clubfoot in the immediate neonatal period is an effective method of treatment. The technique is described in detail, the steps are illustrated, and precautions and limitations are given. This type of treatment should shorten the amount of time required to correct congenital clubfoot.

Surgical management of late post-traumatic and ischemic neuropathies involving the lower extremities: classification and results of therapy.

Traumatic/ischemic events such as fractures, dislocations, lacerations, compression, vascular injuries, and embolus can result in several degrees of nerve injury with resultant sequelae of paralysis, sensory loss, and irritative phenomena (pain, hyperesthesia, and dysesthesia). Neuroma pain may prevent rehabilitation following amputation or nerve lacerations. Thirty-four patients with the late sequelae of traumatic/ischemic neuropathies underwent 36 neural operations using magnification techniques to define and repair neural lesions.

Evaluation and therapy after injury to peripheral nerves.

Peripheral nerve injuries from whatever cause should be classified according to the degree of axon, fascicle, and main nerve trunk damage. This approach is useful in assessing the chances for spontaneous recovery and planning for surgery directed at improving neural recovery. Evaluation over time may be required to better classify the degree of injury.

The anatomy and physiology of the peripheral nerve.

The anatomy and physiology of nerve tissue and the peripheral nerve are reviewed. The importance of the anatomical and physiological understanding of nerve tissue in the surgical repair of nerve injuries is discussed. This includes an outline of the light and electron microscopic histology of nerve and a short review of axoplasmic flow.