Management of hallux limitus with distraction of the first metatarsophalangeal joint.

This article describes a joint-preserving and joint-restoring procedure for the management of hallux limitus and hallux rigidus. The procedure uses a minirail external fixator to obtain distraction with or without arthrotomy of the first metatarsophalangeal joint. This procedure aims to restore joint function through elimination of the pathologic forces involved in hallux limitus and hallux rigidus. Both intrinsic and extrinsic muscular imbalances are reduced. Follow-up of 133 patients treated in this manner since 1997 demonstrates excellent long-term results.

Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing.

Twenty-three patients with 25 intraarticular fractures of the calcaneus were treated during a 7-year period with minimally invasive open reduction of the posterior facet, external ring fixation, and early weightbearing. Skeletal traction and a minimally invasive lateral approach were used to elevate the posterior facet. Percutaneous wires, which were secured to an external ring fixator, were used to stabilize the reduction. The patients were encouraged to bear weight on the first postoperative day and during the time the fixator was in place. A retrospective chart review was performed and the Maryland Foot Score was used. The patients ranged in age from 22 to 68 years (average, 43.8 years). Using the Sanders computed tomography classification, there were 17 (68%) type II, 6 (24%) type III, and 2 (8%) type IV fracture patterns. Thirty-two percent of the patients were rated excellent, 60% rated good, and 8% rated fair. Subtalar joint motion was >50% of the uninjured foot in 21 of 25 fractures. Eight of 23 patients (35%) experienced diffuse pain in the rear foot, whereas 4 (17%) complained of localized pain in the plantar heel. Few complications were observed, with the most common being superficial skin infection at a wire insertion site. No deep infections developed. The average length of the treatment period with the fixator was 6.6 weeks (range, 5 to 9 weeks). The range of follow-up was 2 to 7 years. The results with this technique indicate that it is a viable alternative to traditional methods of open reduction and internal fixation for the management of intraarticular fractures of the calcaneus.

Triple arthrodesis using external ring fixation and arched-wire compression: an evaluation of 87 patients.

From January 1995 to December 2000, 87 patients at a single medical center underwent triple arthrodesis using external rings and arched-wire compression as the method of fixation. A retrospective evaluation was conducted to assess the clinical results of this technique. Eighty-four patients (97%) achieved clinical and radiographic fusion in 6 to 8 weeks. All of the patients were partially weightbearing during the first postoperative week. Thirty-one patients (36%) developed a superficial infection at one or more wire insertion sites, and nine (10%) experienced dehiscence of an incision. Three patients (3%) developed an asymptomatic nonunion. This article describes the use of external ring fixation with arched-wire compression for triple arthrodesis and presents the findings from 87 patients who underwent this technique.

A modified technique for Morton's neuroma. Decompression with relocation.

Interdigital nerve decompression with relocation was performed on 82 feet in 78 patients. The primary indication for surgery was chronic neuritic symptoms that did not resolve with conservative treatment. All but four patients (95%) achieved complete resolution of preoperative symptoms within an average of 7 days following surgery, with full sensation restored at an average of 5 weeks. All of the patients could tolerate a shoe with a wide toe box within 8 days postoperatively. Interdigital nerve decompression with relocation provides for rapid resolution of neuritic symptoms and early return to normal activities. It is also a relatively easy surgical technique. As such, nerve decompression with relocation should be the procedure of choice for the treatment of Morton's neuroma or interdigital nerve compression syndrome.

Use of external fixation to correct deformities of the lower leg.

With the development of modern external fixation by Ilizarov and the modifications that have been made to his method, we now have another tool with which to surgically address a deformity of the lower extremity. It is widely recognized that a malaligned lower extremity is a major cause of the development and progression of arthrosis of the hip, knee and ankle. Early recognition of a [figure: see text] malaligned limb or joint, coupled with proper preoperative planning and realistic patient expectations, may significantly reduce the incidence of arthrosis and improve the overall quality of life for the patient.