Since 1976, we have treated displaced intra-articular fractures of the calcaneus by open reduction through a lateral approach, temporary percutaneous fixation, and bone grafting. We assessed the results after a mean follow-up time of 98.9 (SD = 53) months in 30 patients with 35 fractures. In this report we review, clinically and radiologically, 35 fractures in 30 patients (five bilateral). Autografts was used in five cases (five patients) with an average follow-up of 145 months (SD = 43.7). Allografts were used in 19 cases (16 patients) with an average follow-up of 124 months (SD = 31.2), and hydroxyapatite was used in 11 cases (nine patients) with an average follow-up of 34 months (SD = 12.9). Clinical assessment was based on the Creighton-Nebraska Health Foundation scoring system and radiological measurements made from a lateral view. Seventy-seven percent of the patients had excellent or good clinical results and none had a poor result. Open reduction restored the "crucial angle" and the height of the calcaneus. The tuber joint angle described by Böhler was above 20 degrees in all the cases. There were no significant differences among the three groups of patients with regard to degree of residual pain, walking activities, range of subtalar movement, ability to return to their original jobs, hindfoot swelling, or change in footwear.

Adult↗

PubMedDate not supplied

Titanium anchors for the repair of distal Achilles tendon ruptures: preliminary report of a new surgical technique.

From January 1995 to July 1996, the authors used Mitek GIV titanium anchors to treat seven patients with acute rupture of the Achilles tendon (four men, three women; average age 52.42 years; range, 33-62 years). All subjects had a total rupture of the most distal aspect of the tendon; none had an avulsion fracture. After dissection down to the paratenon, the reinsertion site was selected and a 2 to 3-cm-long trough carved through the cortex. Three holes were drilled at a distance of 0.5 cm one from the other and 1 cm parallel and distal to the trough. The anchors were then threaded, inserted into the holes, and engaged. Surgery was completed by resection of the frayed ends, reparation of the tendon, and insertion of the terminal end into the trough. At 6 months postoperative, a modified Mandelbaum and Pavanini clinical assessment indicated five excellent and two good outcomes. There were no cases of deep of superficial wound infection or skin necrosis. Despite the small number of patients and the short follow-up period, the authors believe this technique shows promise and that in selected cases the use of titanium anchors can facilitate the task of the surgeon and enable patients to return to normal and sports activities within 5 months after surgery.

Achilles Tendon↗

PubMedDate not supplied

[Urinary secretion of D-glucaric acid in subjects exposed to styrene].

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Adult↗