Foot & ankle international
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Anatomic restoration of displaced fracture-dislocation of the tarsometatarsal junction of the foot is essential, as even "minor" disruptions of this joint complex leads to poor clinical results. In order to determine a "key" element associated with good or poor functional outcomes, 11 patients with excellent radiographic results following surgical treatment of unilateral closed Lisfranc fracture-dislocation of the tarsometatarsal joint of the foot were evaluated at an average of 41.2 (range, 14 to 53) months following their injury and surgery. Their average age was 40.6 (range, 21 to 58) years. ⋯ The goal of this study was to objectively analyze the components of vertical ground reaction force during walking in patients who had evidence of excellent surgical reduction measured on follow-up weightbearing radiographs following isolated injury to the tarsometatarsal joint complex. We hoped to detect some key element of gait altered by the injury, and responsible for why patients fare poorly following this injury. By dissecting out the components of mechanical loading and unloading of the foot during walking, we wished to determine if there was a "key" factor associated with either favorable or unfavorable subjective clinical outcomes.
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The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy. ⋯ Our results indicate that the Vacuum Assisted Closure negative pressure technique is emerging as an acceptable option for wound care of the lower extremity. Not all patients are candidates for such treatment; those patients with severe peripheral vascular disease or smaller forefoot wounds may be best treated by other modalities. Larger wounds seem to be better suited for skin grafting or two-stage primary closure.
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Case Reports
Floating lesser metatarsals associated with Lisfranc type C--total displacement injury.
We present a 30-year-old woman with a complex foot injury including floating lesser metatarsals, an intact base of second metatarsal and an irreducible fifth metatarsophalangeal joint. The recognition of potential associated injuries together with a Lisfranc fracture-dislocation must not be overlooked.
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Comparative Study
Healing of Achilles tendon, an experimental study: part 2--Histological, immunohistological and ultrasonographic analysis.
In 105 rabbits the course of healing was examined at one, two, four, eight and 12 weeks (21 rabbits per group) after an experimental Achilles tendon rupture. The following treatment modalities were compared: A) primary functional treatment; B) operative functional treatment (resorbable suture); and C) operative functional treatment with fibrin glue. For the functional (after)-treatment a special orthosis was applied. ⋯ The echogenicity of the tendon during the course of healing showed increasing homogeneity and parallelism in all groups. At 12 weeks the echogenicity was comparable in all groups. The experiment suggests the equivalence of primary functional treatment to a combination of operative and functional therapy in Achilles tendon rupture.