Richard Hader Visionary Leader Award 2023 Visionary Leader Finalist Russell Kaiser.

The following manuscript, selected as a finalist for the 2023 Richard Hader Visionary Leader Award entry, was submitted to Nursing Management in recognition of Russell Kaiser, MSN, BSN, RN, the CNO at The Colony ER Hospital in The Colony, Tex.

Acute compartment syndrome of the foot following fixation of a pilon variant ankle fracture.

Acute traumatic compartment syndrome of the foot is a serious potential complication after fractures, crush injuries, or reperfusion injury after vascular repair. Foot compartment syndrome in association with injuries to the ankle is rare. This article presents a case of acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. A 16-year-old girl presented after sustaining a left ankle injury. Radiographs demonstrated a length-stable posterior and lateral malleolar ankle fracture. Initial treatment consisted of a bulky splint and crutches pending the improvement of her swelling. Over the course of a week, the soft tissue environment of the distal lower extremity improved, and the patient underwent open reduction and internal fixation of both her fibula and distal tibia through 2 approaches. Approximately 2 hours from the completion of surgery, the patient reported worsening pain over the medial aspect of her foot and into her calcaneus. Physical examination of the foot demonstrated a swollen and tense abductor hallicus and heel pad. Posterior tibial and dorsalis pedis pulses were palpable and her sensation was intact throughout her foot. Emergently, fasciotomy of both compartments was performed through a medial incision. Postoperatively, the patient reported immediate pain relief. At 18-month follow-up, she reported no pain and had returned to all of her preinjury athletic activities.

Patellar tendon repair with suture anchors using a combined suture technique of a Krackow-Bunnell weave.

Suture repair of the ruptured patellar tendon is the treatment of choice for patients requiring operative management. This standard technique includes fixation through transosseous tunnels in the patella. The use of suture anchor fixation has several advantages over the standard approach, including less dissection, decreased surgical time, more accurate suture placement, and a low-profile construct. Additionally, the pullout strength of suture anchors warrants consideration of this technique in these repairs. This article describes using suture anchors for repair of the acute ruptured patellar tendon with a combination of Krackow and Bunnell sutures.

Pectoralis major muscle injuries: evaluation and management.

Pectoralis major muscle tears are relatively rare injuries that primarily occur while lifting weights, particularly when doing a bench press. Complete ruptures are most commonly avulsions at or near the humeral insertion. Ruptures at the musculo-tendinous junction and intramuscular tears usually are caused by a direct blow. The patient may hear a snap at the time of injury and report pain, weakness, swelling, or muscular deformity. Physical examination can reveal ecchymosis, a palpable defect, asymmetric webbing of the axillary fold, and weakness on resisted shoulder adduction and internal rotation. A detailed history and physical examination can be augmented by radiologic studies, including magnetic resonance imaging. Nonsurgical treatment is now recommended only for the older, sedentary patient or for proximal muscle belly tears. Surgery, whether early or delayed, consistently yields superior results compared with nonsurgical management. Prompt diagnosis and timely intervention likely will produce improved results.

Transtibial and tibial inlay double-bundle posterior cruciate ligament reconstruction: Surgical technique using a bifid bone-patellar tendon-bone allograft.

Abstract The treatment of posterior cruciate ligament injuries is difficult and controversial. Reconstructive technique and graft design are 2 of the unsolved issues in posterior cruciate ligament reconstruction. We present a technique using a bifid bone-patellar tendon-bone allograft for reconstruction of the posterior cruciate ligament. This graft more closely mimics normal anatomy and may be used in both transtibial and tibial inlay reconstructions.

Meniscal repair compared with meniscectomy for bucket-handle medial meniscal tears in anterior cruciate ligament-reconstructed knees.

BACKGROUND: Repair of meniscal tears is generally preferred over meniscectomy. HYPOTHESIS: Repair of unstable bucket-handle tears of the medial meniscus leads to better outcomes than partial meniscectomy. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: We reviewed the records of 155 patients who had isolated bucket-handle medial meniscal tears and anterior cruciate ligament tears. Fifty-six menisci were repaired; 99 that were degenerative and crushed beyond repair were removed. Patients were evaluated at a mean follow-up of 6 to 8 years after surgery with the International Knee Documentation Committee examination and a modified Noyes questionnaire. RESULTS: The mean subjective scores were similar for patients in both the repair (N = 51) and meniscectomy (N = 87) groups. However, in the repair group, the mean subjective score of 93.9 for nondegenerative menisci was significantly better than the 87.1 for degenerative menisci. Objective grades for 25 patients in the repair group were normal or nearly normal in 22 patients (88%) and for 51 of 56 patients (91%) in the removal group. Radiographic subscores for the repair group were normal or nearly normal in 23 patients in the repair group and 49 in the removal group. CONCLUSION: Outcomes from meniscal repair were not superior to those from partial removal. Patients with repaired degenerative tears had significantly lower subjective scores than those with nondegenerative tears.

Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment.

A detailed history, thorough examination, and a high index of suspicion for associated injuries together are the cornerstone for diagnosing and treating a knee with multiple ligament injuries. Acute surgery in patients with combined ligament injuries of the knee can lead to stiffness, primarily with medial-side injuries. Knee dislocations with lateral-side injuries require acute repair to achieve a good long-term result. All knee dislocations should not be grouped together because of the difference in healing potential between medial- and lateral-side injuries. Patients likely prefer a knee that is mildly lax but functional with full range of motion as opposed to a stiff, painful, stable knee. Treatment is based on the individual healing potential of the injured structures and the natural history of these injuries, along with the following principles: (1) medial-side injuries can heal with proper nonsurgical treatment; (2) posterior cruciate ligament (PCL) tears with grade II laxity or less can heal with similar long-term results as PCL tears with grade I laxity; therefore, surgery may not be indicated. As surgical techniques are developed and improved upon, a more aggressive approach to PCL reconstruction may be warranted; (3) PCL laxity greater than grade II and a soft end point should be considered for semiacute reconstruction; and (4) anterior cruciate ligament injuries in combination with medial collateral ligament and/or PCL injury can initially be treated nonsurgically and reconstructed later as dictated by patient symptoms and activity level.