Hypermobility of the first ray: a critical review of the literature

The authors provide a detailed review of the available literature regarding first ray sagittal plane direction and range of motion with special emphasis on whether or not hypermobility of the first ray can truly be supported as a definable clinical entity. They also describe a novel clinical test for assessing sagittal plane instability of the first ray. The authors believe that this test, when combined with previously defined clinical tests, helps to identify those few patients that would benefit from an arthrodesis procedure of the medial pillar of the foot for the treatment of the hallux valgus deformity.     

Preliminary Radiographic Findings and Sizing Implications on Patients Undergoing Bioabsorbable Subtalar Arthroereisis

Metallic subtalar arthroereisis implants can require removal. Similarly configured bioabsorbable "interference screws" placed alternatively to metal implants may obviate removal. Radiographic imaging may show the location and sizing of the implant, and evaluate for implant degradation. Patients undergoing subtalar arthroereisis were evaluated with magnetic resonance imaging (computed tomography in one patient) to measure the size of the tarsal canal. The tarsal canal length, along with medial height and lateral height, were assessed. The patient's actual implant size was also noted as well as any signs of implant degradation, bony deformation, granulomas, and so forth. Six patients met the inclusion criteria. The range of implants used was 9 to 12 mm. The radiographic measurements of the tarsal canal were as follows: medial to lateral length, 12.8 +/- 3.4 mm; medial height, 7.3 +/- 2.5 mm; and lateral height, 8.0 +/- 1.7 mm. Two patients underwent implant removal. No cystic or degenerative changes were noted on plain radiographs with bioabsorbable implants. Bioabsorbable interference screws for subtalar arthroereisis placed in the tarsal canal may still require removal, although no detrimental changes were noted radiographically to the surrounding bony structures. The size of the current metallic implants on the market appears larger than the tarsal canal configuration.     

Strength analysis of intraosseous wire fixation for avulsion fractures of the fifth metatarsal base

The objective of this study was to gather pilot data of the pullout strength of intraosseous wire for fixation of fifth metatarsal avulsion fractures and to compare intraosseous wire fixation with tension-band wiring. Osteotomies consistent with fifth metatarsal avulsion fractures were created in 5 matched pairs of cadaver limbs. One limb of each pair underwent fixation with intraosseous wiring and the other with tension band wiring. Metatarsals were then loaded to failure, defined as the maximum force achieved before the slope of the load curve moved from a positive to a negative value. Tension-band wiring showed a mean strength of 164.5 +/- 103.7 N compared with a mean strength of 113.7 +/- 46.6 N for intraosseous wiring. No significant difference in strength was shown between methods of fixation. Although the power of this data is small (.143), the data indicate that intraosseous wiring shows similar pullout strength when compared with tension-band wiring for fixation of fifth metatarsal avulsion fractures.     

Treatment of Lisfranc Fracture Dislocations with an Interosseous Suture Button Technique: A Review of 3 Cases

Lisfranc fracture dislocations are complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc fracture dislocations. This method is relatively fast, minimally invasive, and effective, and it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating these difficult injuries with the use of a suture endobutton, instead of traditional interfragmental screw fixation. In this report, we describe 3 cases in which this method was used with satisfactory short-term results. LEVEL OF CLINICAL EVIDENCE: 4.