Management of ankle sprains.

Without adequate care, acute ankle trauma can result in chronic joint instability. Use of a standardized protocol enhances the management of ankle sprains. In patients with grades I or II sprains, emphasis should be placed on accurate diagnosis, early use of RICE (rest, ice, compression and elevation), maintenance of range of motion and use of an ankle support. Sprains with complete ligament [corrected] tears (grade III) may require surgical intervention. Although early motion and mobility are recommended, ligamentous strength does not return until months after an ankle sprain.

Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency.

Ten patients were identified with traumatic, complete common peroneal nerve palsy, with no previous foot or ankle surgery or trauma distal to the knee, who had undergone anterior transfer of the posterior tibial tendon to the midfoot. Six of these patients had a transfer to the midfoot and four had a Bridle procedure with tenodesis of half of the posterior tibial tendon to the peroneus longus tendon. Average follow-up was 74.9 months (range, 18-351 months). All patients' feet were compared assessing residual muscle strength, the longitudinal arch, and motion at the ankle, subtalar, and Chopart's joint. Weightbearing lateral X-rays and Harris mat studies were done on both feet. In no case was any valgus hindfoot deformity associated with posterior tibial tendon rupture found. It seems that the pathologic condition associated with a posterior tibial tendon deficient foot will not manifest itself if peroneus brevis function is absent.

Comparison of stability of proximal crescentic metatarsal osteotomy and proximal horizontal "V" osteotomy.

Proximal metatarsal osteotomies are often performed in patients with hallux valgus and significant metatarsus primus varus. The crescentic osteotomy is popular; however, some authors have reported malunion of the metatarsal shaft caused by dorsal angulation of the osteotomy in a significant number of cases. Recently, proximal transverse "V" osteotomies have been reported to have good results, with rapid healing and no dorsal malunions. We compared the stability of a transverse, proximal "V" osteotomy, using two 0.062-inch K-wires or a 3.5-mm cortical screw for fixation, with that of the proximal crescentic osteotomy, using a 3.5-mm cortical screw fixation. The three osteotomy/fixation techniques were performed on 30 fresh-frozen cadaver feet. The specimens were loaded to failure at the fixation site by applying a load through the plantar surface of the first metatarsal head. Force versus displacement curves were obtained to calculate the failure load and stiffness. Statistical differences among the three groups were determined by the nonparametric Mann-Whitney U-test and the standard t-test. The "V" osteotomy/screw group was more stable than either the "V" osteotomy/pin group or the crescentic osteotomy/screw group. Differences in failure strength between the "V"/screw group and the other two groups were significant at the P < .01 level and the differences in stiffness were significant at the P = .05 level. No statistical differences were found between the "V"/pins and the crescentic/screw groups.

Inflammatory response in retrieved noncemented porous-coated implants.

One hundred forty-six noncemented porous-coated hip and knee implants retrieved from 97 patients were evaluated histologically for the type, amount, and anatomic distribution of tissue ingrowth. The degree of inflammatory cell infiltrate present was also evaluated and the predominant cell type was identified. An inflammatory infiltrate was present in the components of 21 of 97 patients (22%). In 16 of the 21 cases the infiltrate was lymphocytes and histiocytes with a minor population of plasma cells. One of the remaining five cases had a predominately plasma cell reaction, and the other four had significant populations of plasma cells. Vascular proliferation was observed in nine of the 21 cases. Bone ingrowth was present in ten of the 21 cases. A 38% incidence of removal for persistent pain was present in cases with an inflammatory infiltrate. Seventeen of 87 patients (20%) with cobalt-chromium devices and four of ten patients (40%) with titanium devices were identified as having an inflammatory infiltrate. The origin of the inflammatory infiltrate is unclear. All patients with inflammatory infiltrates had noninfected implants, which were not loose roentgenographically or clinically at the time of removal. Hypersensitivity and allergic responses to metal ions may produce such infiltrates. It is impossible, however, in the present study to definitively determine the etiology of the infiltrates.