1/32. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results.New techniques for articular cartilage transplantation have become available recently for traumatic chondral injuries. Applications to the athlete have generated considerable interest in the sports medicine community. The autogenous osteochondral grafting mosaicplasty has been used to treat these injuries in the athlete population for the past six years. The rationale, indications, operative technique, results, and limitations of mosaicplasty in the athlete are presented and discussed.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
2/32. magnetic resonance imaging of growth plate injuries: the efficacy and indications for surgical procedures.In 23 patients with growth plate injuries, magnetic resonance imaging (MRI) studies were performed a total of 31 times to evaluate the physis which showed plain radiographic evidence of possible damage. Fourteen patients clinically showed growth arrest, and 10 patients required a Langenskiold operation. In 3 patients who underwent this operation, subsequent premature total fusion of the physis adversely affected the postoperative results. We propose that the merging shape of the arrest line with calcification of the provisional zone of the metaphysis shown by MRI indicates poor viability of the physis. MRI provided useful information on the appearance of the growth plate and changes in the metaphysis, both of which affected the prognosis and the results of the surgical procedures.- - - - - - - - - - ranking = 17864.449473402keywords = plate (Clic here for more details about this article) |
3/32. Explosive ordinance disposal team equipment and its use in diagnosing extremity trauma.A 31-year-old man presented to the Rakkasan battalion aid station, located at the Qandahar Airport, afghanistan, with complaints and physical findings consistent with those that would either support a grade III ankle sprain or fracture. The battalion aid station is an echelon I level of care. This facility does not have radiographic capabilities. With the closest radiology facility located in Seeb, oman the 710th Explosive Ordinance Disposal team, which was operating in the area, was contacted. This unit was able to perform radiographs in a timely manner to help aid in correctly diagnosing the injury.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
4/32. Chronic ankle instability and pain: a case report of a teenager with open epiphysis.The author discusses the treatment of chronic ankle instability in a young child of 14 years of age. A procedure is described that avoids drilling of the fibula and disruption of the epiphyseal plate. An autogenous graft procedure is described.- - - - - - - - - - ranking = 2977.4082455671keywords = plate (Clic here for more details about this article) |
5/32. talus fracture associated with a fracture dislocation of the distal tibia in an immature skeleton.A 12-year-old boy with a severe injury of his right ankle was treated in the accident unit. The local condition was an extensive open wound with parts of the fractured bones prominent. Radiographs showed a severely displaced fracture of the body of the talus associated with a Salter-Harris IV injury of the distal tibia and subluxation of the ankle. After proper debridement the fractured bones were reduced and fixed. Eleven years later both fractures are completely healed without any sign of avascular necrosis, the patient has full painless ankle movement and he can perform his demanding occupation without any problem.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
6/32. The bridge and barrel hoop plates as alternatives to external fixation techniques in the foot and ankle.External fixation is a useful tool for treating severe traumatic injuries to the foot and ankle. External fixation, however, does have associated complications, such as inadequate fixation and pin tract infections. Temporary bridge plating of the medial, lateral, or both columns is a useful alternative to external fixation for treating multilevel foot injuries. This article describes the technique of temporary bridge plating which may be used as an alternative to external fixation.- - - - - - - - - - ranking = 11909.632982268keywords = plate (Clic here for more details about this article) |
7/32. Salvage of failed neuropathic ankle fractures: use of large-fragment fibular plating and multiple syndesmotic screws.The purpose of this study was to develop a salvage procedure for failed fixation of ankle fractures that occurs in patients with sensory neuropathy. Six patients, with insensitivity to a 5.07 monofilament on the plantar surface of their foot (five with diabetes mellitus, one with alcoholic peripheral neuropathy) presented to a foot and ankle referral center with failed traditional fixation of their Weber B and C ankle fractures. Five fractures were the result of trauma. One fracture occurred without a discernable traumatic event. A laterally placed 4.5 DCP plate on the fibula with multiple 4.5-mm syndesmotic screws engaging both cortices of the tibia was used as fixation. All patients postoperatively were immobilized in a non-weight-bearing below-knee cast for a minimum of 3 months after surgery. At follow-up, all six patients were satisfied with their results as determined by aligned, functional, and asymptomatic limbs. The patients were especially pleased that after multiple attempts to provide stability to their fractured neuropathic ankles, they had retained their own legs and did not need an amputation. Fibular plate fixation using multiple large-fragment syndesmotic screws provides a reasonable salvage alternative for neuropathic patients with ankle fractures that failed using traditional hardware techniques.- - - - - - - - - - ranking = 5954.8164911341keywords = plate (Clic here for more details about this article) |
8/32. pronation-external rotation ankle fractures in 3 professional football players.We found no reports of ankle fracture management in professional football players in the orthopedic literature. In this small series of ankle fractures in professional football players, all 3 had the same pronation-external rotation injury pattern. Given the high demands placed on the ankle by these professional athletes, we chose to use a 4.5-mm screw for fixation of the syndesmosis and a 3.5-mm reconstruction plate for fibular fixation to provide the most stable fixation. All 3 athletes were able to return to preinjury levels of athletic participation in the NFL without residual pain or stiffness.- - - - - - - - - - ranking = 2977.4082455671keywords = plate (Clic here for more details about this article) |
9/32. Free flap reconstruction for infection of ankle fracture hardware: case report and review of the literature.BACKGROUND: Clinical management of orthopedic hardware infections related to ankle fracture fixation may present difficult therapeutic dilemmas. Typically, management includes removal of the hardware, debridement of necrotic tissue, and eventual placement of an alternative method of stabilization, usually, an external fixator or cast. However, problems arise when the fracture cannot be managed adequately with an external method. Such is the case with supination external rotation (SER) fractures, yet maintaining the hardware in the setting of infection typically is not considered an option. methods: Case report and review of pertinent English-language literature. RESULTS: The patient was a 47-year-old man with diabetes mellitus who sustained a type IV SER fracture that was treated with plate and screw fixation. Six weeks postoperatively, he presented with infection of the lateral ankle incision and the hardware. This was treated with debridement of the wound and dressing changes while leaving the hardware in place. It was decided to use a free muscle flap in an effort to preserve the ankle for a functional outcome versus the alternative of a below-knee amputation. With a free rectus abdominis flap, the lower extremity was preserved, and after four months, the patient was able to walk. One year postoperatively, the patient was ambulating without difficulty, and the hardware was still in place. CONCLUSIONS: This report examines the dilemma of SER ankle fractures and how management strategies must be tailored to the individual situation. In some cases, the hardware must be considered essential to avoid below-knee amputation.- - - - - - - - - - ranking = 2977.4082455671keywords = plate (Clic here for more details about this article) |
10/32. Management of severe open ankle injuries.BACKGROUND: Functional outcome after reconstruction of open ankle injuries has not been well presented in the literature. The authors present the functional results of 24 patients who sustained complex ankle injuries. methods: patients were assessed using three scoring systems (a modified A/O score, the Enneking score, and the AOFAS) and subdivided into two groups: those primarily treated at Charing Cross Hospital according to strict protocols combining orthopedic and plastic surgical techniques (group P) and those secondarily treated who were transferred to Charing Cross Hospital after initial management at a remote unit (group S). RESULTS: There were nine patients (37.5 percent) in group P and 15 (62.5 percent) in group S. Eighteen patients (75 percent) underwent free-tissue transfer. Sixteen patients (67 percent) were assessed (group P, n = 7; group S, n = 9) for return of function using the Enneking score. Mean time to assessment was 10.5 months for group P and 11.4 months for group S. Mean Enneking percentage score was 75 for group P and 72.2 for group S. There were no significant differences (p > 0.05) between these scores. The mean time to union was 19 weeks (n = 5) for group P and 24 weeks (n = 7) for group S. The mean AOFAS Ankle-Hindfoot Scores were comparable to the Enneking scores when independent observers undertook this assessment. Most patients in both groups reported difficulty with descent of stairs. CONCLUSIONS: Although the authors were able to achieve a similar return of function for both groups, group S patients needed at least one more operation. In cases of ankle fracture where there is significant soft-tissue injury (either closed or open), representing a complex injury, the authors recommend making no attempt to internally fix the fracture and instead referring the patient to a specialist center for combined orthoplastic attention. If this is not immediately at hand, screw fixation of the medial malleolus should be undertaken after open reduction. The lateral malleolus should not be internally fixed, but should it require control, external fixation is the preferred method of skeletal stabilization.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
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