Fracture of the lateral process of the talus in snowboarders.

We investigated the clinical and radiological outcome after unilateral fracture of the lateral process of the talus in 23 snowboarders with a mean follow-up of 3.5 years (12 to 76 months). In this consecutive cohort study both operative and non-operative cases were considered. The mean American Orthopaedic Foot and Ankle Society hindfoot score was 94 (82 to 100). The non-operative group of seven with a minimally-displaced fracture scored higher (98 points) than the operative group of 16 with displaced or unstable fractures (93 points). In 88% of operative cases, significant concomitant hindfoot injuries were found at operation. All but eight (35%) patients (six operative and two non-operative) regained their pre-injury level of sporting activity. Subtalar osteoarthritis was present in nine (45%) of the 20 patients available for radiological review, including one late-diagnosed non-operative case and eight operative cases with associated injuries or fracture comminution. The outcome after fracture of the lateral process of the talus in snowboarders is favourable provided an early diagnosis is made and adequate treatment, which is related to the degree of displacement and associated injuries, is undertaken.

Intra-abdominal pressure: a reliable criterion for laparostomy closure?

BACKGROUND: Laparostomy is frequently performed in the surgical therapy of mechanical obstruction, peritonitis, or trauma to prevent abdominal compartment syndrome (ACS). Extended incisional hernia is inevitable when fascial closure is missed (up to 90% of cases). Intra-abdominal pressure (IAP) has not yet been evaluated as a criterion for the feasibility of fascial closure. PATIENTS AND METHODS: Over 12 months laparostomy was carried out in 40 patients. Definitive closure of the abdomen was performed after 4.4+/-3.7 days in 23 of these. Intravesical pressure was used to assess IAP before and after fascial closure. The resulting IAP was compared to the values of 90 patients undergoing elective abdominal surgery. Parameters of cardiocirculatory, renal, pulmonary, and liver function were also recorded. RESULTS: After closure of the laparostomy IAP increased significantly from 6.5+/-3.3 to 12.0+/-4.1 mmHg. Urine output decreased by 27% on the first postoperative day but regained normal levels thereafter. The central venous pressure increased by 31%. Other parameters of cardiocirculatory, renal, pulmonary, and liver function were unchanged. No case of ACS occurred. In the patients undergoing elective abdominal surgery IAP ranged from 6.5+/-2.1 to 10.0+/-4.0 mmHg. CONCLUSIONS: Fascial closure increased the IAP, which was accompanied by short-termed decrease in urine output. At these levels of IAP fascial closure appears to be harmless, but further prospective studies are needed to determine the critical level of IAP for allowing a safe repair of large fascial defects.