Injuries to the midtarsal joint and lesser tarsal bones.

Injuries to the midtarsal joint and lesser tarsal bones occur relatively infrequently and often present with a benign appearance on imaging studies. These facts may lead to failure of diagnosis and/or inadequate and improper treatment, with subsequent disability for the patient. The clinician with a general knowledge of the various injury patterns to the midfoot is able to approach these injuries rationally and with an appreciation of their potential severity. This article reviews the mechanism, clinical and radiologic presentation, and treatment of midtarsal joint injuries and midfoot fractures.

Osteomyelitis in grade II and III open tibia fractures with late debridement.

The purpose of this study was to compare the incidence of infection in grade II and III open tibia fractures with respect to early and late debridement. All grade II and III tibia fractures treated between January 1988 and January 1992 were reviewed. Forty-seven fractures (25 grade II and 22 grade III) in 46 patients were eligible for entry into the study. In all grade II and III fractures, one of 15 fractures (7%) debrided in < or = 5 h became infected. Twelve of 32 fractures (38%) debrided > 5 h after injury became infected (p < 0.03). Overt manifestations of infection did not appear until an average of 4.8 months from the time of injury, and the infecting organisms correlated with the initial cultures in only 25% of the cases. Negative postdebridement cultures did not preclude subsequent infection. The Injury Severity Score did not appear to correlate with increased risk of subsequent osteomyelitis.