Orthopedics
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A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. ⋯ No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.
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Over the past 2 decades, posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation has gained popularity. Anterior fusion techniques, however, have evolved over time and currently allow for minimally invasive anterior retroperitoneal diskectomy, interbody graft placement, and rigid instrumentation. A direct comparison of anterior lumbar interbody fusion (ALIF) with anterior tension band plating to that of instrumented PLIF has not been previously reported. ⋯ Posterior lumbar interbody fusion patients had significantly higher estimated blood loss and longer surgical time than ALIF-ATB patients. Oswestry Disability Index scores were similar between the 2 groups at all postoperative time points, except at 3 months postoperatively when PLIF patients had lower scores than ALIF-ATB patients. These findings suggest that ALIF-ATB has similar fusion and functional outcomes as PLIF, but with shorter surgical time and decreased blood loss.
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Case Reports
Radiologic case study: diabetic myonecrosis of the posterior compartments of both thighs.
Enhance your diagnostic skills with this "test yourself" monthly column, which features a radiograph and challenges you to make a diagnosis.
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The outcome of peritrochanteric fracture fixation is dependent on lag screw placement in the femoral head. The dynamic hip screw technique permits initial, independent lag screw placement, while the cephalomedullary nail dictates its positioning. The objective of this study was to compare the accuracy of lag screw placement for both implant types. ⋯ There was a trend toward a more favorable tip-apex distance in women for both implants. The accurate placement of the lag screw can be routinely achieved for both dynamic hip screw and cephalomedullary nail implants, and therefore should not a factor in the selection of these implants for adequate peritrochanteric fracture stabilization. These results represent the immediate postoperative setting, and a follow-up is warranted to establish their long-term clinical relevance.
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Treatment of distal clavicle fractures ranges from nonoperative to operative approaches. Various surgical procedures have been described in the literature, each with potential complications. For fractures treated operatively, the goal is to maximize stability and functionality while minimizing pain and deformity. This article describes a double-button suture system using a mini-open technique to repair a distal clavicle fracture providing stable fixation with minimal disruption of the surrounding anatomy.