Antibiotic Use and Kirschner Wire Fixation in Forefoot Surgery: A National Survey.

In foot and ankle patients, the use of Kirschner wires is common, and the population in the typical foot and ankle practice has higher rates of comorbidities associated with infection. This study assessed national trends regarding the use of postoperative prophylactic antibiotic therapy in patients undergoing foot and ankle surgery treated with percutaneous Kirschner wires. Attending physicians at foot and ankle fellowships were mailed a questionnaire that included 3 clinical vignettes containing questions on the use of postoperative antibiotics in patients treated with percutaneous Kirschner wires. A total of 112 physicians were identified; 64 physicians (57%) returned the survey. In the first case of a nondiabetic patient, 16 physicians (25%) indicated they would place the patient on postoperative antibiotics for an average of 9.4 days with an average duration of Kirschner wire fixation of 35.1 days. In the second case of a non-neuropathic diabetic patient, 18 surgeons (28%) indicated they would place the patient on postoperative antibiotics for an average of 13.8 days with an average duration of Kirschner wire fixation of 35.4 days. In the third case of a diabetic patient with neuropathy, 19 physicians (32%) indicated they would place the patient on postoperative antibiotics for an average of 14.5 days with an average duration of Kirschner wire fixation of 36.7 days. Few attending physicians at orthopedic foot and ankle fellowships placed their patients treated with percutaneous Kirschner wires on postoperative antibiotic prophylaxis, even in diabetic patients for whom an increased risk of infection has been documented. [Orthopedics. 2017; 40(4):e594-e597.].

Arthritides of the foot.

Arthritis of the foot can be a difficult problem. It is initially managed with antiinflammatory medications and footwear modifications or bracing. However, a significant percentage of people with arthritis of the foot go on to require surgical intervention, which is most commonly arthrodesis.

An unusual case of chronic lateral foot pain following ankle inversion injury: osteoid osteoma of the tarsal cuboid bone.

Osteoid osteomas are common benign tumors normally seen in the femur, tibia, and spine. They rarely are seen in the foot. We present an unusual case of osteoid osteoma of the cuboid in a 26-year-old man. This was initially thought to be an ankle sprain, as its first presentation was after a sporting injury. It was then treated as an infection before the true diagnosis--that of osteoid osteoma--was obtained.

Giant cell tumor of the distal phalanx of the great toe: a case report.

UNLABELLED: Giant cell tumors are rarely seen in the foot. They can cause a significant amount of pain and deformity due to their aggressive and recurrent nature. We present the unusual case of a giant cell tumor of the distal phalanx of the hallux in a 39-year-old man. LEVELS OF EVIDENCE: Therapeutic Level IV, Case Report.

The management of ankle fractures in diabetics: results of a survey of the American Orthopaedic Foot and Ankle Society membership.

BACKGROUND: Ankle fractures in diabetics are challenging to treat, and only generalized clinical guidelines specific to their treatment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population. METHODS: We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle fractures that was sent via e-mail to the 895 active members of the AOFAS. In addition to providing demographic information, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status. RESULTS: Respondents' number of years in practice, number of ankle fractures treated monthly, and type of fellowship training did not correlate with management strategies. Enhanced fixation with syndesmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while casting was selected as the treatment for those that were nondisplaced. Prolonged periods of non-weight bearing were chosen by survey participants in all cases. CONCLUSION: We identified several treatment trends among AOFAS membership regarding ankle fractures in diabetics. However, it is pivotal that further investigation evaluate both optimal fixation strategies and the factors that influence surgeon decision making in the setting of diabetic ankle fractures, as the orthopaedic surgeon is encountering such patients more than ever before.

Subtle injuries to the lisfranc joint.

The tarsometatarsal joint complex is an osseous and capsuloligamentous network that includes the 5 metatarsals, their articulations with the cuneiforms and cuboid, and the Lisfranc ligament, a strong interosseous attachment between the medial cuneiform and second metatarsal. A multitude of injury patterns exist involving the tarsometatarsal joint complex; a Lisfranc injury does not delineate a specific injury, but instead a spectrum of processes involving the tarsometatarsal joint complex.

Treatment of ankle fractures in patients with diabetes.

Patients with diabetes mellitus have a higher risk of complications after sustaining an ankle fracture, including fracture displacement, superficial and deep infection, hardware failure, and neuropathic arthropathy. With the increased incidence of diabetes among the aged, the increased incidence of complications due to diabetes mellitus and its sequelae are important to keep in mind when treating ankle fractures.

Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone.

PURPOSE: This study evaluates the abrasion properties of different suture materials through the rotator cuff tendon and proximal humerus tuberosity bone. METHODS: Three types of sutures were compared: monofilament polypropylene, braided polyester, and braided polyblend polyester with a polyethylene core. For soft-tissue testing, the suture was passed through the infraspinatus tendons of 11 cadaveric shoulders. The suture was cycled with a fixed load, and the migration of the suture as it cut through the tissue was measured at intervals of 5 cycles, for a total of 50 cycles. For tuberosity testing, the sutures were passed through a transosseous tunnel created in the lesser tuberosity, and the suture was cycled with a fixed load until suture failure occurred. RESULTS: On soft-tissue testing, the monofilament suture showed the least amount of abrasion, followed by the braided polyblend and then the braided polyester suture (cutting rate of 0.06 +/- 0.11 mm/cycle, 0.99 +/- 0.44 mm/cycle, and 1.75 +/- 0.91 mm/cycle, respectively; P < .0001). On tuberosity testing, suture breakage for the braided polyblend suture occurred at 501.3 +/- 220.4 cycles. The braided polyester and monofilament sutures broke after 256.6 +/- 120.9 and 193.5 +/- 144.8 cycles, respectively. The difference between cycles to failure of the polyblend and latter 2 sutures was statistically significant (P < .0001). CONCLUSIONS: This study shows increased abrasion properties for braided sutures compared with monofilament sutures, as well as different abrasion properties among different types of braided sutures. Furthermore, the braided polyblend suture showed significantly increased cycles before suture failure through a transosseous tunnel. CLINICAL RELEVANCE: Although development of new suture materials has increased their failure strength, further advancements in suture material design should focus on decreasing soft-tissue abrasion properties and increasing strength to suture failure when cycled through bone.