Treatment of Traumatic Degloving Injury of the Foot Using a Biologic Dressing in a Pediatric Patient.

Introduction: Degloving injuries of the foot involve the management of extensive soft tissue and osseous damage secondary to significant forced avulsion of soft tissue, which can present a major challenge for the surgeon. Surgical procedures on pediatric foot degloving involving split-thickness and/or full-thickness skin grafts and rotational flaps can result in negative consequences, such as donor site comorbidities and psychosocial implications when the pediatric patient returns to daily life.

Case Report: The authors report the case of a 16-year-old girl with no past medical history who sustained an extensive degloving injury to her right foot involving severe subcutaneous and muscular soft tissue disruption and contamination.

A Comparison of Split Peroneus Brevis Tendon and Semitendinosus Allograft Tendon for Lateral Ankle Ligament Reconstruction.

Lateral ankle instability is a debilitating condition that is often unresponsive to conservative therapy. Many techniques for operative repair have been proposed, most commonly performed as the Broström or modified Broström procedure. In patients with failed primary repair, hereditary collagen disorders, strenuous work activity, obesity, or ligamentous laxity, the Broström repair is less likely to be successful, and anatomic or nonanatomic reconstruction should be considered.

Freiberg's Infraction: Surgical Options.

Freiberg's infraction is an uncommon condition of the lesser metatarsophalangeal joints. Onset is usually between the 11th and 17th year of age. It is the only osteochondrosis that dominantly affects females with a reported female-to-male ratio of 5.

[Modified staging strategy in treatment of type C3 Pilon fractures].

Objective: To investigate the safety, feasibility, and effectiveness of modified staging strategy in treatment of type C3 Pilon fractures.

Methods: The clinical data of 23 patients with type C3 Pilon fractures treated with modified staging strategy between January 2012 and January 2018 was retrospectively analyzed. There were 14 males and 9 females with an average age of 47.

[Application of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures].

Objective: To investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures.

Methods: The clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.

Biomechanical Comparison of the Influences of 2 Proximal Metatarsal Osteotomies on First Ray Articular Contact Characteristics.

Background: An understudied area of proximal first metatarsal osteotomies is the effect on articular contact properties following the surgeries. Potential long-term risks include altered joint mechanics and possible arthritic progression. A biomechanical comparison of articular characteristics of the proximal opening wedge and Ludloff osteotomies was performed in this study.

Health economics for treatment of diabetic foot ulcers: a cost-effectiveness analysis of eight skin substitutes.

Aim: Skin substitutes are frequently used to treat chronic diabetic foot ulcers (DFU), and many different options are available. While the clinical efficacy of many products has been evaluated, a comprehensive cost-effectiveness analysis comparing the most popular skin substitutes and using the most recent cost data has been lacking.

Methods: This study compared eight skin substitutes using published efficacy rates combined with the Centers for Medicare and Medicaid Services (CMS) 2018 cost data.

How Does A Structured Review Instrument Impact Learning at Resident Journal Club?

Journal club article review is an integral aspect of graduate medical education. A structured review instrument (SRI) is a checklist form that serves to guide through critical appraisal of the literature. The goal of this study was to objectively evaluate the effect of an SRI on journal critical appraisal in foot and ankle residency programs.

Plantar Approach for Midfoot Wedge Resection to Reconstruct the Rocker Bottom Foot.

Chronic deformity of the foot can lead to ulceration, infection, and amputation. Midfoot wedge osteotomy for deformity correction has been described in the literature; however, most reports are case review or small series. Wedge osteotomy can be performed from a medial or plantar approach, but there are limited data on outcomes regarding these relatively uncommon procedures.

Outcomes of Primary Tibiotalocalcaneal Nailing for Complicated Diabetic Ankle Fractures.

Background: Ankle fractures in patients with complicated diabetes have significantly increased the rates of complications and poorer functional outcomes when treated nonoperatively, and there have been only modest reductions when treated operatively. We hypothesized that the minimally invasive, robust construct that tibiotalocalcaneal fixation with an intramedullary nail offers would result in high rates of limb salvage, acceptable rates of complications, and less loss of function, in this difficult patient population.

Methods: This was an institutional review board-approved retrospective study of 27 patients with complicated diabetes who underwent tibiotalocalcaneal nailing of their ankle fracture as a primary treatment without formal joint preparation.

Analysis of the Effect of Tibial Stem Length on Coronal Plane Deformity of the Tibial Component in Total Ankle Arthroplasty.

Background: Coronal plane deformity is common in patients who undergo total ankle arthroplasty. The correction of this deformity is paramount to the long-term survival of the implant. Coronal plane correction is achieved with soft tissue balancing and, in some part, is maintained through articular geometry constraint.

A Prospective, Multicenter, Single-Arm Clinical Trial for Treatment of Complex Diabetic Foot Ulcers with Deep Exposure Using Acellular Dermal Matrix.

Objective: This prospective, multicenter study evaluated the efficacy and safety of an acellular dermal matrix allograft, DermACELL (D-ADM; LifeNet Health, Virginia Beach, Virginia), in the treatment of large, complex diabetic foot ulcers (DFUs) that probed to tendon or bone.

Methods: Inclusion criteria were Wagner grade 3 or 4 DFUs between 4 weeks and 1 year in duration. All participants received one application of D-ADM at baseline and could receive one additional application if wound healing arrested.

Trends in Lower Limb Amputation in Patients with Diabetic Foot Based on Vascular Intervention of Peripheral Arterial Disease in Korea: a Population-based Nationwide Study.

Background: Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea.

Minimally Invasive Retrograde Method of Harvesting the Flexor Hallucis Longus Tendon: A Cadaveric Study.

Background: Use of the flexor hallucis longus (FHL) tendon is well described for several tendon augmentation procedures. Harvesting the FHL through an open medial approach is commonly done, but is associated with anatomic risks. Recently, several authors have described a minimally invasive (MI) technique to harvest the FHL tendon utilizing a hamstring tendon stripper commonly used in ACL reconstruction.

Single-Stage Tibiotalocalcaneal Arthrodesis With Use of an Antibiotic-Coated Intramedullary Nail for Limb Salvage Following an Open Pilon Fracture Complicated by Osteomyelitis: A Case Report.

Severe limb deformity can create a major disability, which can ultimately lead to a nonambulatory lifestyle. Limb deformities created by open fractures not only put a patient at risk for a nonfunctional lifestyle but also may lead to gross contamination and osteomyelitis of the osseous structures. At times, these deformities require amputation for better functionality.

Outcomes of the Extended Z-Cut Osteotomy for Correction of Adult Acquired Flatfoot Deformity.

Background: Medial displacement calcaneus tuberosity osteotomy and anterior process lengthening calcaneus osteotomy are traditional single-plane osteotomy techniques used in adult acquired flatfoot deformity reconstruction. More recently, 3-plane step-cut osteotomies were described for each of these and shown to offer improved rotational stability via the horizontal limb. However, a major technical challenge is achieving a sufficiently long horizontal limb to correct deformity through lengthening without losing bony apposition.

Ankle Arthrodesis With Structural Grafts Can Work for the Salvage of Failed Total Ankle Arthroplasty.

. Treatment options after failed total ankle arthroplasty (TAA) are limited. This study reports midterm outcomes and radiographic results in a single-surgeon group of patients who have undergone ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAA.

The Mini C-Arm Sock: A Novel and Simple Technique for Draping to Prevent Contamination and Penetration.

The mini C-arm is frequently used in foot and ankle surgery. However, its continuous manipulation introduces potential means of contaminating the sterile surgical field. A simple and effective draping technique of the mini C-arm is described to minimize risk of contamination and sharps penetration that can damage the C-arm.

Compensatory Function of the Subtalar Joint for Lower Extremity Malalignment.

It is important to evaluate the subtalar joint and hip-knee-ankle alignment to understand lower extremity alignment. In this review, we focused on the compensatory changes in the subtalar joint alignment for the deformity of the knee and ankle joint, reviewing previous research. The subtalar joint alignment was compensatory valgus in patients with varus knee and ankle deformity, whereas it was uncertain whether the subtalar joint alignment was compensatory varus in patients with valgus knee and ankle deformity.

Another Classification of First Metatarsophalangeal Joint Dislocation-Type 3: Review and Case Description of the Plantar Dislocation.

Plantar dislocation of the first metatarsophalangeal joint is a possible, albeit rare, injury to the foot. The mechanism has been attributed to a hyperflexion motion, with the hallux situated plantar to the first metatarsal head. In this article, we provide a case example of an open, plantar dislocation of the first metatarsophalangeal and perform a literature review of this rare injury.

The Incidence of Nonunion of the Naviculocuneiform Joint Arthrodesis:A Systematic Review.

Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been described for NC arthrodesis. Despite this, the available literature is scant and questions remain regarding nonunion rate and contributory factors.

A Comparison of Talar Surface Area Occupied by 2- Versus 3-Screw Fixation for Ankle Arthrodesis.

Ankle arthrodesis is a procedure utilized in the treatment of end-stage ankle arthritis. Internal fixation with screws is traditionally relied on to achieve union. Although the use of screw fixation alone has produced satisfactory outcomes, nonunion rates can range from 9% to as high as 35%.

Serum vitamin D and diabetic foot complications.

: Foot complications such as ulceration and neuropathy are common complications of diabetes mellitus (DM). Previous reports have demonstrated a possible increased risk of these complications in diabetic patients with low levels of serum vitamin D.: The purpose of this study is to compare serum vitamin D levels in diabetic patients with and without Charcot neuroarthropathy (CN), peripheral arterial disease (PAD), infection (DFI), ulceration (DFU), and peripheral neuropathy (DPN).

Osteochondral Defect of the Calcaneocuboid Joint: A Case Study.

Osteochondral lesions (OCLs) are injuries affecting the articular cartilage surface of a joint. OCLs are well reported in the literature to affect the knee, talus, tibia, navicular, and first metatarsal. This rare case of a bipolar osteochondral lesion of the cuboid and calcaneus presented as lateral heel pain after a traumatic injury.