SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Fracture-dislocation of the tarsometatarsal joint is a major injury and can be associated with a chronic disability. The incidence is low, but the long-term results can be a devastating problem to the patient. This article reviews the anatomy, mechanism of injury, classifications, diagnostic procedures, treatment, and long-term results of a fracture-dislocation to the tarsometatarsal joint complex.
The authors describe a previously unreported anatomical structure in the calcaneocuboid joint of the foot and discuss the clinical significance. Fibroadipose synovial folds or labra are present in different locations throughout the calcaneocuboid joint of the foot. They appear to be wedge-shaped infections attached to the joint capsule in areas of incongruent joint spaces. Their surface is covered with synovial cells with a highly vascular loose connective tissue sublayer. Nerve fibers were seen in association with the joint capsule, but not within the V-shaped labrum. The clinical significance of the presence of the labrum is discussed, but their function is uncertain. These structures can project up to half the joint distance and have the possibility of producing impingement syndromes, or even tears. Since they are covered with two to three layers of synoviocytes, they also have the ability to produce a synovitis. The labrum can be identified using MRI, and once their presence is known arthroscopic repair of these structures is theoretically possible.
Injuries to the Lisfranc complex are fairly common. Delayed treatment or missed diagnosis of these injuries can lead to significant complications. Non-operative treatment and salvage surgery can help to relieve sequelae that are associated with tarsometatarsal arthritis following traumatic injury.
In selected patients, fusion of the talonavicular joint can be an effective treatment of adult flatfoot deformity. Restriction of motion and altered hindfoot mechanics, however, are a consequence of talonavicular fusion and can lead to accelerated arthrosis of adjacent joints. In patients with severe long-standing deformity, medial displacement calcaneal osteotomy may be a necessary adjunct to talonavicular fusion for adequate correction of heel valgus.
Tarsometatarsal dislocations or fracture dislocations represent infrequent, but severe injuries which endanger the structural and mechanical integrity of the midfoot if the diagnosis is missed initially. Delayed diagnosis may result in painful and disabling arthritis and the need for salvage reconstructive surgery. As such, the rationale of treatment should follow the principles of reconstruction of weight-bearing joint injuries. The degree of instability and dislocation will guide the decision for surgical intervention and anatomic reconstruction. As the clinical features of Lisfranc injuries are rarely conclusive an adequate radiographic examination of the foot employing three standard projections (dorso-plantar, lateral and 45 degrees oblique) usually supplemented by CT scans and/or MRI is decisive for a correct analysis of the injury components and an optimum selection of treatment options. Anatomic reduction and alignment are prerequisites for a good functional outcome. The reduction of the second metatarsal ray is the keystone and the first step of surgical reconstruction followed by the other structures involved. Since adequate stability is needed until definite healing has taken place the temporary transfixation of the corresponding tarsometatarsal joints employing small fragment positioning screws has substantial advantages compared with the traditional temporary K-wire arthrodesis.
Synovial osteochondromatosis arising in the foot is a rare condition. We report a 69-year-old woman with synovial osteochondromatosis of the Lisfranc joint. The patient presented with a 10-year history of left foot pain. Imaging studies showed multiple calcified masses around the Lisfranc joint. We performed a synovectomy and removal of the loose bodies in the dorsal, lateral, and plantar aspects of the Lisfranc joint by dislocating the bases of the fourth and fifth metatarsal bones. To our knowledge, this is only the second case report of synovial osteochondromatosis involving the Lisfranc joint.
The increasing range of of horseshoes and hoofpads makes it important to be able to evaluate their influence on performance and stress in the locomotor apparatus. The aim of this study was to describe the changes in ground reaction forces and locomotion pattern during the stance phase due to the application of a standard iron shoe. Six Swedish Warmblood horses were evaluated kinetically and kinematically before and after they were shod with an 8 mm iron shoe. Data were used to calculate ground reaction forces in the vertical and craniocaudal directions, point of application of the force, hoof segment angle and hoof joint, pastern joint, fetlock, carpal and tarsal angles. Finally joint angular velocity and landing velocity of the hoof were calculated. During the initial phase of the stance or the concussion phase, the horses altered the conditions of the limb, as reflected by hoof-landing velocities. Concussion-dampening mechanisms of the distal limb subsequently were altered. In the nonshod condition, the coffin and fetlock joints rotated more rapidly in the forelimb and less rapidly in the hindlimb, while earlier proximal off-loading by the carpus and tarsus resulted in a decrease in initial horizontal loading at the hoof. It was concluded that horses accustomed to standard iron shoes demonstrate slight but significant differences in the movement and loading of the distal limb due to shoeing. Though the main differences were related to the concussion phase of the stance, even mid-stance loading and roll-over were altered. The study provides a basis for further investigation of the effect of various farriery techniques on the hoof and movement of the horse.
We have studied the radiological features in 94 patients with early rheumatoid disease followed prospectively for 5 years. The changes appeared very early and occurred in up to 71-3% of patients. Erosive changes occurred in the feet much more commonly than in the hands and considerably earlier. Erosive changes were present before there was joint-space loss. Frequent x-ray examination of feet and hands in the first 2 years after presentation is required if we are to identify patients at risk for serious joint damage.
The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness.
Thirteen Swedish National classic ballet dancers were surgically treated for an "os trigonum syndrome."Their main symptom was an impingement pain in the hind foot while actively plantarflexing the ankle during ballet dancing. The surgical procedure included excision of an os trigonum or a prominent lateral posterior process of the talus, together with division of the flexor hallucis tendon sheath if it was thickened. This procedure was safe and resulted in return of the dancers to the same level of ballet dancing within 5 to 10 weeks.
The clinical details of six patients who developed spontaneous dislocations in the foot or ankle are presented. All were shown to have diabetic neuropathy. This previously unreported condition can occur with a short history of diabetes. Some cases can be managed without operation, though arthrodesis probably offers the best chance of obtaining a stable foot of satisfactory shape.
Pigmented villonodular synovitis has a variable histologic appearance, Jaffe and others propose this reflects maturation of the process with the early cellular hypervascular phase giving way to subsequent hyalinization and fibrosis. A case of avascular pigmented villonodular synovitis in the foot was encountered and surgically verified. Eight cases of the disease were then reviewed and graded subjectively for their cellularity, vascularity, and fibrosis. The avascular case was the most hyalinized and "mature" of the group. Two other cases with the typical findings of a hypervascular arteriogram were histologically less hyalinized. These findings suggest a possible role for arteriography in determining the natural history of the disease and support Jaffe's view of its evolution.
OBJECTIVE: To establish the route of infusion (IV or intraosseous) that results in the highest concentration of amikacin in the synovial fluid of the tibiotarsal joint and determine the duration of peak concentrations. ANIMALS: 21 horses. PROCEDURE: Regional perfusion of a limb on 15 horses was performed. Amikacin sulfate was infused into the saphenous vein or via intraosseous infusion into the distal portion of the tibia (1 g in 56 ml of lactated Ringer's solution) or proximal portion of the metatarsus (1 g of amikacin in 26 ml of lactated Ringer's solution). Amikacin concentrations were measured in sequential samples from tibiotarsal joint synovial fluid and serum. Samples were obtained immediately prior to release of the tourniquet and 0.5, 1, 4, 8, 12, and 24 hours after the tourniquet was released. Radiographic contrast material was infused into the same locations as the antibiotic perfusate to evaluate distribution in 6 other horses. RESULTS: Infusion into the saphenous vein produced the highest concentration of amikacin in the tibiotarsal joint, compared with the distal portion of the tibia (mean +/- SE, 701.8 +/- 366.8 vs 203.8 +/- 64.5 microg/ml, respectively). Use of a lower volume of diluent in the proximal portion of the metatarsus produced a peak value of 72.2 +/- 23.4 microg/ml. CONCLUSIONS AND CLINICAL RELEVANCE: For regional perfusion of the tarsus, IV infusion is preferred to intraosseous infusion, because higher concentrations are achieved in the synovial fluid, and the procedure is easier to perform.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The case of Lisfranc's dislocation in soldiers-skiers has been presented. The aim of the study is to realize the role of skiing equipment in generation of the injuries in soldiers-skiers. Early therapeutic intervention provides good results.
Studied were mass disease outbreaks on eight farms in calves intensively fed concentrate mixtures that were rich in phosphorus compounds. Clinically, there were selling and deformations of the joints with pains. The tarsal and carpal joints were chiefly involved. Kyphosis of the backbone, spastic paresis of the posterior part of the body as well as tetaniform spasms in the initial stage of the disease were also observed. Morphologically, the diseased animals manifested erosions and thinning of the joint cartilage, tearing of the Achilles tendon, and increased amounts of the joint fluid. The histologic study revealed edema of the cartilage cells, disorders in the structure of the hyalin cartilage, formation of cavities, and broadening of the lumen of the Haversian canals. In most cases the blood serum presented hyperphosphatemia (up to 15.67 mg% inorganic P) and relative or absolute hypocalcemia (up to 4.47 mg% Ca). On the farm both hypocalcemia and hypophosphatemia were observed. Good prophylactic results were obtained through correct Ca:P ratios in the diet that contained calcium additives as well as by the injection of vitamin D solutions, etc. It is believed that these cases should be referred to a distinctive form of rickets of a characteristic clinical course' the inadequate Ca:P ratios in the rations playing the main etiologic role. Subsidiary causes are probably vitamin D deficiency, restricted movement of the animals, and mechanical traumata caused by the animal's own bodyweight.