Current Orthobiologics for Elective Arthrodesis and Nonunions of the Foot and Ankle.

A fusion rate of 100% would be ideal. Despite adhering to sound surgical principles, complete compliance, and no adverse comorbidities, that 100% fusion rate goal is elusive. Orthobiologics are a special class of materials developed to enhance the fusion rates in foot and ankle arthrodesis sites. Whether orthobiologics are used for the first fusion or reserved for a nonunion is debatable, especially when considering cost.

Rehabilitation after major extremity trauma.

Physical therapy is an integral part of rehabilitation after foot and ankle trauma. Workman's compensation may play a role in treatment, prognosis, and added bureaucracy. The foot and ankle surgeon needs to be able to determine when maximum medical improvement has been reached. Patients with foot and ankle trauma must have a coordinated care plan, which may include a case manager, a physician conducting an independent medical examination, and possibly, legal counsel.

Complications of heel surgery.

Surgical complications of the calcaneus are unique to that structure but do not have a greater incidence than in any other part of the foot or ankle. The first tenet of any complication, however, is to recognize it. When all is said and done, recognition is probably the most important step when a complication arises.

Dermatologic causes of heel pain.

There are many causes of heel pain. Not all are characterized as plantar fasciitis or osseous pathology. Sometimes patients present with heel pain caused by a dermatologic entity. This article describes some of the most common pathologies.

Strength of braided polyblend polyethylene sutures versus braided polyester sutures in Achilles tendon repair: a cadaveric study.

BACKGROUND: Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. METHODS: To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond (Ethicon Inc, Somerville, New Jersey) suture materials in Achilles tendon repairs, 12 Achilles tendons were harvested from cadavers aged 18 to 62 years (median age, 42 years). The tendons were transected and repaired using a modified Krackow suture technique. All of the right limbs were repaired with 2-0 FiberLoop, and the contralateral side was repaired with #2 Ethibond. The specimens were mounted to a materials testing system, and the repairs were pulled to failure in an anatomical direction. RESULTS: The mean +/- SD yield loads of 2-0 FiberLoop and #2 Ethibond were 233 +/- 48 N and 134 +/- 34 N, respectively (P = .002). The mean +/- SD ultimate load of 2-0 FiberLoop was 282 +/- 58 N, and that of #2 Ethibond was 135 +/- 33 N (P < .001). The cross-sectional area of one pass of 2-0 FiberLoop was calculated to be 0.21 mm(2), and one pass of #2 Ethibond was 0.28 mm(2). CONCLUSIONS: The smaller-caliber 2-0 FiberLoop was significantly stronger than #2 Ethibond. This study suggests that there is no advantage to using the traditional larger suture material for Achilles tendon repairs; however, further clinical testing is needed to determine the optimal repair technique.

Assessing the ecological and social benefits of private land conservation in Colorado.

Conservation of private land through conservation easements, development agreements, and clustered housing has increased greatly as have criticisms of the laws, public programs, and incentives that motivate landowners to use them. Rapid land-use change at the urban-rural interface in Larimer County, Colorado, has given rise to programs that provide a variety of land-conservation options for landowners. As of January 2005, roughly 60% of Larimer County was publicly owned, and 3% or 16,200 ha was privately owned with some form of protection. We used document analysis, a landowner survey, targeted interviews, and a landscape-level spatial analysis to analyze the patterns, quantities, and qualities of private land conservation. We created a jurisdiction-specific typology of desired benefits from local government-planning documents to help evaluate conservation parcels. Most easements and other conservation documents used general terms and did not describe the site-specific values of the land being conserved. Landowners were able to describe some benefits not included in parcel-specific documents, and our spatial analysis revealed parcel-specific and cumulative conservation benefits such as the amount of buffering, infill, connectivity, protected agricultural land, riparian protection, and other benefits not referenced by either documents or landowners. Conservation benefits provided by a parcel varied depending on its geographic location, the specific institution such as a land trust or open space program that a landowner worked with, and the conservation mechanism used, such as voluntary easement or residential clustering requirements. The methods we used provide a template for jurisdictions wishing to undertake a similar analysis. Our findings may assist other jurisdictions and institutions interested in improving how land-conservation benefits are described; justify and inform future investments in private land conservation; assist local governments and other institutions with the assessment of program effectiveness; and be useful for conservation planners who wish to become more involved in on-the-ground implementation of conservation actions.

Debridement of invasive diabetic foot infections.

Diabetes pedal infections are too prevalent and will become more so as the numbers of diabetic patients increase. The goal is to prevent amputations or at least to remove as little of the foot as possible. Prompt surgical intervention and better diabetic pedal education will go a long way to achieving that goal.

What is a residency? What is a resident?

Residency programs exist to train the next generation of podiatric physicians. A brief review of residency programs and what constitutes a "resident" is offered in a concise format.

Training a competent surgeon.

Residency education is evolving into a competency model. Defining and evaluating competence are new paradigms that must be rapidly inserted into residency programs to satisfy residency requirements.

In-training examinations.

In-training are one way to evaluate the residents during their training. Currently, the American Board of Podiatric Surgery supplies the examination. Various residency directors were questioned regarding its use and importance.

Pinpointing and preventing imminent extinctions.

Slowing rates of global biodiversity loss requires preventing species extinctions. Here we pinpoint centers of imminent extinction, where highly threatened species are confined to single sites. Within five globally assessed taxa (i.e., mammals, birds, selected reptiles, amphibians, and conifers), we find 794 such species, three times the number recorded as having gone extinct since 1500. These species occur in 595 sites, concentrated in tropical forests, on islands, and in mountainous areas. Their taxonomic and geographical distribution differs significantly from that of historical extinctions, indicating an expansion of the current extinction episode beyond sensitive species and places toward the planet's most biodiverse mainland regions. Only one-third of the sites are legally protected, and most are surrounded by intense human development. These sites represent clear opportunities for urgent conservation action to prevent species loss.

Indications for amputations.

Amputation may take a psychological toll on a patient. Proper documentation is paramount along with a lucid informed consent. Various pathologies may lead to an amputation. Tools to aid in the decision to amputate, in choosing the levels of amputation, and in the selection of the type of procedure are available. The key to any amputation is to be at a level that is most definitive.

Transmetatarsal amputations.

Transmetatarsal amputation is an excellent procedure in the face of nonhealing ulceration, infection, trauma, peripheral vascular disease, and tumors. This article discusses transmetatarsal amputations, the decision-making process, timing of surgery, operative techniques, postoperative management, and salvage of the failed transmetatarsal amputation.

Considerações sobre a Síndrome do Túnel do Carpo com ênfase no tratamento / Considerations about Carpal tunnel syndrome with emphasis on treatment

A síndrome do túner do carpo (STC) é uma neuropatia periférica cinco vezes mais freqüente no sexo feminino, causada pela compressão do nervo mediano na altura do punho. O sintoma marcante dessa síndrome é a parestesia matinal no território sensitivo deste nervo. O diagnóstico é basicamente clínico. Exames úteis para diagnóstico diferencial são a eletroneuromiografia e a RNM. O tratamento de escolha inicial deve ser conservador. Para os casos refratários está indicada a liberação cirúrgica do nervo mediano através da incisão do ligamento transverso do carpo, seja por via aberta ou endoscópica. É importante que o médico explique ao paciente as possíveis causas de tal patologia, pois a abstinência de atividades agravantes é fundamental para a cura definitiva