Technique tips: footings. Arthrodesis--talonavicular joint.
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Eighteen cadaver feet were used for radiographic evaluation of the calcaneocuboid joint. The articular surface of the cuboid on all specimens was painted with a radiopaque material. Fractures and 1-mm step-off of the fractures were simulated in six specimens. The articular surface line and joint space could be visualized maximally on an oblique radiograph without overlapping structures. The oblique view is good for assessing the extent of the minor fracture-displacement, which is normally obscured by overlapping projections in dorsoplantar and lateral radiographs. If there is any doubt on the routine radiographs or any injury involving the calcaneocuboid joint, an oblique view of the foot should be performed. The early diagnosis and treatment of calcaneocuboid joint injuries may minimize development of posttraumatic degenerative arthritis.
An 18-year-old girl with moderate joint laxity presented with recurrent dislocation of the calcaneocuboid joint in both feet. We achieved successful stabilisation on both sides by reconstruction of the ligaments and capsule using the plantaris tendons.
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Presented is a case of a delayed dislocation of the tarsometatarsal joints following an apparent simple strain with no displacement. Open reduction was successfully performed five weeks following the injury. The difficulties assessing these potentially unstable injuries are discussed.
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The authors introduce the peroneal tendon balance procedure and discuss normal and hypermobile function of the first ray. The procedure is based on the theory that the peroneus longus tendon is a primary retrograde stabilizer of the proximal portion of the first ray. The theory emphasizes that abnormal pronation results in a positional weakness of the peroneus longus tendon, which induces first ray hypermobility. This surgical procedure involves an anastomosis of the peroneus longus to the peroneus brevis tendon. It is designed to increase the force of the peroneus longus tendon in order to reduce first ray hypermobility.
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Dislocations and fracture-dislocations of the tarsometatarsal joints, fractures of the base of the fifth metatarsal bone, fractures of the shafts and necks of the metatarsal bones, dislocations of the metatarsophalangeal joints, fractures of the phalanges and dislocations of the interphalangeal joints each have a specific mechanism of injury, characteristic diagnostic feature, and requirement for treatment. Only by an accurate diagnosis established by careful physical and roentgenographic examination can complications be avoided.
INTRODUCTION: We present a rare case of plantar dislocation of the cuboid, fourth and fifth metatarsal joints. Fracture-dislocation in the midfoot region may be subtle and difficult to recognise at the emergency department. CLINICAL PICTURE: A 16-year-old girl presented with lateral foot pain and swelling following a fall from a height of 3 m. Initial radiograph revealed a third metatarsal shaft fracture; however, additional views reviewed a plantar direction of fourth and fifth metatarsal dislocation from the cuboid. TREATMENT: Open reduction and internal fixation with Kirschner wires followed by immobilisation in plaster was performed. OUTCOME: She made an uneventful recovery and the wires had since been removed. CONCLUSION: This case was unusual in that there was lateral tarsometatarsal disruption with neither diastasis between the first and second metatarsals nor injury to either the first or second tarsometatarsal joints. The plantar direction of dislocation was also unusual as these injuries are usually dorsal.
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The authors have observed 135 dislocations of the tarsus in leprosic feet. They recall the mechanism of the lesion and propose a classification. 42 cases were operated on to prevent further deformities. When early treated limited arthrodeses may be beneficial in some cases. In more severe cases rebuilding arthrodesis alone or associated to cancellous bone grafting is indicated. In very severe cases amputation is only indicated because the Wladimiroff-Mickulicz technique as well as grafts lead to failures related to the metatarsophalangeal joints stiffness.
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Range of motion of the lower extremity joints from the hip to the digits will be discussed including both active and passive axis of motion and their planes of motion. The author believes that the interpretation of these ranges of motion is essential in order to properly diagnose and to execute a treatment plan.
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