Search

Talus necrosis complicated by osteomyelitis and extensive soft-tissue infection poses a difficult therapeutic challenge, and limb salvage is often difficult to achieve. Between 1986 and 1999, 23 patients were treated for talar osteomyelitis and infection of the soft-tissue envelope. Limb salvage with a tibiocalcaneal arthrodesis was attempted in 16 cases; seven patients had amputations. External fixation was used in all patients; four patients had a callous distraction. Thirty-seven additional procedures were necessary to treat the infection. There were eight complications in seven patients. After an average period of 31 months (range 13–81 months) follow-up evaluation was available in 12 of the 15 cases. Solid union of the arthrodesis was achieved in all patients and there were no infectious recurrences. The clinical results were excellent in one patient, good in six, fair in four and poor in one case. Considering the extent of infectious destruction, a tibiocalcaneal arthrodesis can be regarded as a limb salvage procedure, in selected patients, which yields satisfactory long-term results. [ABSTRACT FROM AUTHOR]

Vacuum-assisted closure (vacuum sealing) is a surgical procedure for the local treatment of severe soft-tissue damage. However, systemic consequences to the host are unknown. The aim of this study was to disclose the effects of vacuum sealing on the host’s immune response and to demonstrate the early time course of endotoxin, interleukin-6 (IL-6), C-reactive protein (CRP), haptoglobin, transferrin, orosomucoid, 6-keto-prostaglandin (6KPG), α1-antitrypsin and complement C3 and C4. A total of 35 patients with closed ankle fractures were randomized into two groups and operated on within 6 h after injury. After osteosynthesis, one group was treated by vacuum sealing (VS) and the other by immediate skin closure (IS). Blood was collected immediately after admission and regularly up to 96 h after surgery. Morbidity was checked during the first year after injury. Preoperative endotoxin plasma level was increased compared with that of voluntary individuals (0.06 ± 0.02 EU/ml versus 0.021 ± 0.001 EU/ml) and peaked in patients with immediate skin suture 0.5 h after the surgical procedure at 0.11 ± 0.03 EU/ml. However, in patients with vacuum sealing, this peak was absent (0.07 ± 0.02 EU/ml). Endotoxaemia decreased to almost normal values after 24 h. Plasma IL-6 peaked 12 h postoperatively, decreasing thereafter with no difference between the groups. The plasma level of 6KPG decreased immediately after the surgical procedure in vacuum-sealed patients (before operation, 415 pg/ml; 12 h later, 251 pg/ml), but increased first in patients with immediate skin suture. CRP peaked 48 h after injury (VS, 48 ± 6 mg/l; IS, 38 ± 7 mg/l) with no difference between the groups. Transferrin decreased postoperatively (pre-op: VS, 2.49 ± 0.14 g/l; IS, 2.85 ± 0.19 g/l; 24 h: VS, 2.16 ± 0.08 g/l and IS 2.33 ± 0.11 g/l), whereas haptoglobin (pre-op: VS, 2 ± 0.21 g/l; IS, 1.7 ± 0.18 g/l; 96 h: VS, 3.4 ± 0.25... [ABSTRACT FROM AUTHOR]

Summary The anatomical studies conducted by us have confirmed the finding that all the major nerves of the lower leg–the saphenous, tibial, sural, superficial peroneal, and deep peroneal nerve–are involved in the sensory innervation of the ankle joint. All these nerves contribute to the innervation of both the ankle joint and the talo-calcaneonavicular joint. The results obtained illustrate the vast inter- and intra-individual variation of the nerves’ pattern of distribution. It was noted in particular that certain rami for the ankle joint branch off from the main nerves quite proximally, such as at the beginning of the distal third of the lower leg. The interosseous branch as a terminal ramus of a muscular branch of the deep peroneal nerve is an observation which is of particular interest. [ABSTRACT FROM AUTHOR]

Summary The knowledge gained in anatomical studies on the sensory innervation of the ankle joint was applied to 11 patients suffering from post-traumatic arthrosis of the ankle joint who underwent denervation operations following successful test blocks. In order to achieve an ankle joint denervation as complete as possible while maintaining the sensitivity of the sole and dorsum of the foot, neurotomies away from the joint were performed in the saphenous, sural, and deep peroneal nerves as well as the interosseous branch, whereas the tibal nerve and the superficial peroneal nerve were skeletized by neurotomy of the branches to the ankle joint only. Good results were obtained in seven out of 10 patients examined in the follow-up. [ABSTRACT FROM AUTHOR]