Transverse Proximal Diaphysial Fracture of the Fifth Metatarsal: a Review of 12 Cases.

A review of 12 cases of transverse proximal diaphysial fractures 3.0 cm distal from the fifth metatarsal tuberosity with a 2-year follow-up is presented. Six cases treated with percutaneous pinning, cast, and partial weightbearing with crutches and six cases treated with cast, partial weightbearing, and crutches are analyzed by classification, age, and average time to union. The healing times were the same in both groups

The Jones Fracture—Transverse Proximal Diaphyseal Fractures of the Fifth Metatarsal: Frequency by Radiology.

1477 consecutive foot X-rays were reviewed over an 11-month period from the Lehigh Valley Hospital Center Emergency Services. 49 fifth metatarsal fractures were identified. Two transverse proximal diaphyseal fractures 3.0 cm distal from the fifth metatarsal tuberosity, the Jones fracture, were identified. The frequency of the Jones fracture in this group of fifth metatarsal fractures (n = 49) is 4%

Tendon Problems

This review highlights the structure, blood supply, and biomechanics of tendons. The basic science, diagnosis, and treatment of Achilles tendinosis and rupture are presented. Literature of the past year supports that diagnostic ultrasonography and treatment with steroid iontophoresis are cost effective. Data support the hypothesis that open repair of the Achilles tendon with early restricted plantar flexion range of motion and weight bearing shortens rehabilitation time. Percutaneous Achilles tendon lengthening in the adult stiff ankle is effective. Magnetic resonance imaging of posterior tibial tendinosis is reviewed. In the rheumatoid foot, there is a high correlation between flatfoot deformity and subtalar (sinus tarsi) synovitis, but low correlation to posterior tibial rupture. Several papers report that medial displacement calcaneal osteotomy and lateral column lengthening decrease forces on the medial column in the cadaver foot. The association of peroneus longus tendinosis with zones of compression around the fibula, calcaneus, and cuboid were reported. Magnetic resonance imaging studies correlate abnormalities of the ostrigonum, lateral talar tubercle, and flexor hallucis longus synovitis to posterior ankle impingement. Immunofluorescent antibody techniques quantitate that the anterior tibial tendon has an avascular area, on the anterior compressed half of the tendon, that corresponds to the area of clinical rupture. Lastly, three articles are presented that review the fields of tendon tissue engineering and collagen molecular biomechanics

Incidence of Associated Knee Lesions with Torn Anterior Cruciate Ligament: Retrospective Cohort Assessment

The records of 141 consecutive patients with confirmed complete anterior cruciate ligament injuries were reviewed retrospectively. One hundred and sixty-two associated injuries were divided into 25 injury complexes. Isolated injuries to the anterior cruciate ligament occurred in 40 cases (28.4%). Injuries of the medial meniscus occurred in 62 cases (38.2%), while injuries of the lateral meniscus occurred in 37 cases (22.8%). Injuries to the medial collateral ligament complex occurred in 42 cases (25.9%). Injuries to the lateral collateral ligament, posterior deep popliteus-arcuate ligament complex, and posterior cruciate ligament were found to be positively correlated (rho = .81, p = .001, and rho = .77, p = .001, N = 141, respectively). Injuries to the medial collateral ligament and the posterior oblique ligament were likewise positively correlated (rho = .45, p = .001, N = 141)

Intraarticular Pressures in a Gravity-Fed Arthroscopy Fluid Delivery System.

Seven consecutive patients undergoing arthroscopic surgery in a gravity-fed fluid delivery system were studied. The average minimum adequate intraarticular pressure (MAIP) was 55 mm Hg. The height of a saline bag above the knee necessary to achieve this average MAIP was 75 cm. There was a positive correlation between diastolic blood pressure and the minimum adequate intraarticular pressure in this study. There was no positive correlation between systolic blood pressure and the MAIP

Medial displacement calcaneal osteotomy reduces the excess forces in the medial longitudinal arch of the flat foot.

OBJECTIVE: The hypothesis tested was that the increased load on the medial arch of the flat foot can be reduced through a medial displacement calcaneal osteotomy. DESIGN: A three-dimensional, biomechanical, multisegment model was used in conjunction with experimental data from the literature. BACKGROUND: Biomechanical models have been used to study the plantar fascia, medial arch height, subtalar motion and distribution of forces in the foot. METHODS: Responses of a normal foot, a flat foot and a flat foot with a medial displacement calcaneal osteotomy to an applied load of 683 Newtons were analyzed, and the distribution of support among the metatarsal heads and moment about various joints were computed. RESULTS: Compared to the normal foot, our flat foot model shifts the distribution of support from the lateral to the medial side, decreasing support provided by the fifth metatarsal from 11% to 1% of the total load, increasing support provided by the first metatarsal from 12% to 22% and increasing the moment about the talo-navicular joint from 20 to 28 Newton-meters. A ten millimeter medial displacement calcaneal osteotomy shifts support back toward the lateral side, with 11% provided by the fifth metatarsal and 13% by the first metatarsal. The moment at the talo-navicular joint decreases to eighteen Newton-meters. CONCLUSION: Our analysis indicates that a ten millimeter medial displacement calcaneal osteotomy in a flat foot model decreases the load on the medial arch

Reemployment of Patients with Surgical Salvage of Open, High-Energy Tibial Fractures: an Outcome Study.

Between January 1, 1988, and December 31, 1990, 36 patients with 37 type III high-energy open tibial shaft fractures were treated at Lehigh Valley Hospital. Patients with primary amputations were excluded. All patients with high-energy open tibial fractures with an intact posterior tibial nerve, protective sensations of the plantar surface of the foot, and warm ischemia time of less than 6 hours were considered salvageable. A retrospective review of the charts was completed. Twenty-eight patients with 29 fractures were interviewed for work status, an average of 39 months after treatment. Twenty-five patients with 25 fractures were working at the time of the accident. Three patients with four fractures were not working at the time of the accident. Nineteen of 25 patients (76%) returned to work. Sixteen of 25 patients (64%) returned to work at a similar level of manual labor. The average delay between injury and return to work was 11 months (range, 3-18 months). Two of the 36 patients (5.5%) required secondary amputations. Twenty-five of 28 patients (89%) interviewed reported one or more subjective complaints. The two amputees reported no subjective complaints