Limb salvage: revision of failed intramedullary nail in hindfoot and ankle surgery in the diabetic neuropathic patient.

Herein, we illustrate an operative technique to attain limb salvage after a failed intramedullary nail in the diabetic Charcot neuropathic patient. The use of the blade plate, or T-plate, in combination with external fixation, fastened into the body of the calcaneus allows for greater bone capture. Our experience has shown that this provides for a stable, long-lasting construct.

The use of Ilizarov technique as a definitive percutaneous reduction for ankle fractures in patients who have diabetes mellitus and peripheral vascular disease.

The patient who has a diagnosis of diabetes mellitus, diabetic peripheral neuropathy, peripheral vascular disease and experiences an unstable ankle fracture presents as a difficult case scenario for the treating physician. In addition, patients who have diabetes mellitus, along with the presence of multiple comorbidities, have been shown to have higher complication rates than patients who do not have diabetes mellitus. This article describes a relatively safe alternative surgical percutaneous technique using external circular ring fixation in the vascularly compromised diabetic patient with an unstable ankle fracture. This novel technique decreases the risk for soft tissue complications in the high-risk diabetic patient and serves as a definitive method of fixation without the need for additional surgery. It allows the patient to have early and full weight bearing when indicated in the postoperative period.

New and recurrent ulcerations after percutaneous achilles tendon lengthening in transmetatarsal amputation.

UNLABELLED: The purpose of the study was to review the incidence rate of new and recurrent ulcerations in transmetatarsal amputations after original ulcers healed with percutaneous Achilles' tendon lengthening as an isolated procedure. We reviewed 35 charts from period of January 1995 to March 2007, and 28 were included for the final review. Twenty-four ulcers were grade 1A, 2 were 0A and 1B, and 1 was 1C using the University of Texas Grading System. Time to heal of ulceration post-TAL was 9.4 weeks (range 3-72 weeks). For statistical analysis, we used binomial distribution for dichotomous variables. Results demonstrated 4 limbs did not heal, 10 patients had an ulcer recurrence (p<0.001), and 6 developed new ulcers. Of the 28 patients in which TAL was performed, 16 developed new neuropathic ulcers (including recurrent ulcers; p=0.0099). High recurrence and new ulcers formation exist after TAL in patients with an unbalanced metatarsal amputation, and extrinsic/ intrinsic factors may need to be addressed to prevent recurrence. LEVEL OF CLINICAL EVIDENCE: 4.

First metatarsophalangeal joint dislocation with open fracture of tibial and fibular sesamoids.

Traumatic dislocations of the first metatarsophalangeal joint were first described by Mouchet in 1931. The anatomical complexity of the first metatarsophalangeal joint makes this injury one of a kind. There have been only been a limited number of case reports of this injury, but none in combination with open fractures of both sesamoids. We would like to report 1 case of an open traumatic dislocation of the first metatarsophalangeal joint with open fracture of the fibular and tibial sesamoid. Open reduction and internal fixation of the injury led to a successful outcome.