Joint sepsis of childhood.

The following report dealing with joint sepsis reviews the medical and surgical techniques employed in treating a traumatically induced septic joint in a 9-year-old male. Arthrotomy of the septic joint with continuous irrigation and parenteral antibiotics proved to be more effective than closed needle aspiration or antibiotics alone.

An alternative fixation technique when performing hallux interphalangeal joint fusions.

Fusion of the hallux interphalangeal joint has classically been performed by means of cancellous bone screws or crossed Kirschner wires. Although these techniques may be suitable for uncomplicated fusions, they may not be amenable to those cases requiring simultaneous total first metatarsophalangeal joint implant arthroplasty; therefore, a new technique is discussed that utilizes the Micks' external fixator.

Reduction of a fracture-dislocation of Lisfranc's joint by endoprosthetic implantation.

The medical literature demonstrates numerous documented cases of post-traumatic arthrosis following comminuted fracture-dislocations at the tarsometatarsal joint(s). Conventionally described reductions and methods of fixation, therefore, lend themselves to less than acceptable results. A newly devised, alternative method of approach to this disabling injury was indicated, and is presented by the authors in the hope of preventing the long-term sequelae commonly seen with this type of injury. After open reduction and remodeling of a severely comminuted fracture-dislocation at the second metatarsal-cuneiform articulation, a modified, double-stemmed Swanson Silastic implant was utilized in order to maintain second ray length and attempt prevention of the usual postinjury osseous consequences, i.e., fusion and arthritic changes. The case presented demonstrates that, after her last clinical evaluation 19 months postoperatively, the patient returned to her normal occupation, and at that time her foot was normal in appearance with no sign of traumatic arthritic change. This procedure thus far has proved to be very rewarding to the patient, and the authors believe it should be considered as an alternative approach in patients who present with injuries of this magnitude.

A two-stage delayed surgical approach to salvaging Essex-Lopresti tongue type calcaneal fractures.

Fractures of the calcaneus are one of the most challenging problems facing the podiatric physician today. Many attempts have been made to simplify this complex entity by categorizing calcaneal fractures and dictating treatment according to the fracture classification. However, it is now known that each calcaneal fracture injury must be given individual patient consideration for diagnosis and treatment. Included is a case presentation of a severe calcaneal fracture classified as an Essex-Lopresti tongue type with a discussion of the surgical management.

The utilization of the Richards Scaphoid compression device in performing abductory base wedge osteotomies.

The Richards Scaphoid compression clamp offers an alternative in the reduction and stabilization of many of the osteotomies and fractures treated by foot surgeons. The clamp provides a refinement of the technique of manual compression and has been used successfully in treating fractures of the fifth metatarsal base and osteotomies of the calcaneus and first metatarsal.

Overlapping fifth toe: a new surgical approach.

The authors introduce a new method of correction for overlapping fifth digits. With the advent of newer types of precision power surgical instrumentation, performance of an exacting wedge osteotomy is possible on small bones. Combining an abductory wedge osteotomy with previously described soft tissue revisions can now realign a common deformity--the overlapping fifth toe.

Surgical repair of lateral ankle instability by modification of traditional approaches.

Recurrent instability following ankle sprains which fail to respond adequately to conservative treatment has been the focal point of discussion among physicians in recent years. A variety of surgical regimens have been implemented primarily over the past 40 years in an attempt to control this problem. The authors discuss these modalities and present their successful approach in treating lateral ankle instability.

Interphalangeal joint hallux ossicle.

The interphalangeal joint hallux ossicles that podiatrists are concerned with are those which produce pain as a result of keratoma and bursal sac formation. The patient with interphalangeal ossicles usually has a well delineated, circumscribed, painful excrescence with surrounding soft tissue inflammation, underlying bursal sac formation, and atrophy of the facial planes inferior to the interphalangeal joint. Although an interphalangeal ossicle may be clinically palpable, radiographic examination will not always confirm the condition as many interphalangeal ossicles are fibrocartilaginous and therefore are radiolucent. Dr. Sharon discusses diagnosis and surgical approaches which may be used to correct the problem.

Delayed reduction of a dislocation at Lisfranc's joint: a case report.

An unusual case report of a chronic lateral dislocation at Lisfranc's joint has been presented. Immediate reduction was not performed due to inadequate diagnosis. An involvement of a peripheral neuropathy further marked the patient's symptoms. A delayed surgical reduction and arthrodesis of the tarsometatarsal joints were performed. The degree of dislocation and concomitant osseous changes that occurred over a prolonged period of time prevented excellent alignment of part of the tarsometatarsal articulations. However, a functional and asymptomatic foot was restored.