Reconstruction of the Medial Malleolus With Iliac Crest Autograft After Traumatic Loss: A Case Report.

CASE: A 19-year-old woman sustained an open ankle fracture with complete destruction of the left medial malleolus and significant soft-tissue loss. After temporizing external fixation and coverage with a rotational posterior tibial artery perforator flap, the medial malleolus was reconstructed with an autologous iliac crest bone graft and direct repair of the deltoid ligament. The patient achieved excellent improvement in functional outcomes at 21 months with adequate restoration of ankle motion. CONCLUSION: This case shows reconstruction of the medial malleolus with autologous iliac crest bone graft after traumatic loss can be a viable treatment option for young patients.

Use of the Allgöwer-Donati suture technique for wound closure following transmetatarsal amputation.

INTRODUCTION: The Allgöwer-Donati suture technique reportedly has lower incision perfusion impairment compared with other suture techniques. The authors of the present case series hypothesized that suture technique selection to achieve lower incision perfusion impairment may result in improved healing rates and decreased incidence of wound complications in partial foot amputations, specifically TMAs. OBJECTIVE: To evaluate the efficacy of TMA with skin closure completed using the Allgöwer-Donati suture technique. MATERIALS AND METHODS: The records of 7 patients (8 limbs) who underwent closure with the Allgöwer-Donati suture technique after TMA between March 2021 and March 2022 were retrospectively reviewed. Only patients with a diagnosis of gangrene were included. RESULTS: Five of 8 limbs (62.5%) healed uneventfully, with an average time to healing of 3.3 weeks. Six of 8 limbs (75%) healed within 4 weeks, and 1 limb was lost to follow-up. CONCLUSIONS: The results of this small case series suggest that use of the Allgöwer-Donati suture technique may result in decreased incidence of wound complications by allowing improved perfusion at the amputation site.

Laterally Based External Fixation for Pott's Fractures.

In this article, we describe the construction and appropriate use of a lateral-based fixator for ankle fractures. This lateral-based frame is useful for treating Pott's fractures. With lateral ankle dislocations, the lateral frame places the hindfoot in alignment with the leg. Soft tissue trauma has been recognized as an early limiting factor in patients with ankle fractures, in addition to the need for obtaining and maintaining anatomic position. A kickstand is added for heel and medial soft tissue offloading. The lateral frame is a quick and reproducible technique with satisfactory results.Level of Evidence: Level V: Surgical Technique.

Failed Bilateral Total Silastic First Metatarsophalangeal Joint Implant Reconstructed with Osteochondral Allograft Implantation.

First metatarsophalangeal joint (MPJ) arthritis is a very common form of arthritis seen in the foot. Some signs and symptoms include pain, swelling, decreased passive and active range of motion, difficulty with shoe gear, and so forth. Surgically, options for alleviating symptomatic hallux limitus and arthritis fall into two broad categories: joint sparing and joint sacrificing. In this case study, we present a patient with a bilateral failed total silastic implant of the first MPJ and our proposed revision using an osteochondral bone allograft to fill the deficit left behind from silastic implant removal. The ability for immediate weightbearing and to perform this procedure bilaterally is an advantage to this surgical treatment option compared with other described revision techniques. Postoperatively, the patient has adequate range of motion and no pain when ambulatory. We believe this osteochondral allograft implant may be a viable option for revision first MPJ arthroplasty in select patient populations.