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The tarsal navicular plays an integral role in hind-foot motion and gait, and is the keystone of the foot's medial longitudinal arch. As such, injuries to the navicular can be devastating. Acute avulsion, tuberosity, and body fractures have been described. Fractures of the body result from high-energy trauma and are often seen in conjunction with additional ipsilateral foot injuries. Plain radiographs are the gold standard for diagnosis, with computed tomography helpful in the presence of intra-articular fracture extension. Non-operative treatment is reserved for avulsion injuries and non-displaced body fractures. Open reduction and internal fixation must be performed for all other types, as failure to achieve an anatomic reduction can impede proper locomotion. Complications following operative intervention include pain, stiffness, posttraumatic arthritis, avascular necrosis, nonunion, and hindfoot deformity., (Copyright 2014, SLACK Incorporated.)

Background: Ankle fractures in diabetics are challenging to treat, and only generalized clinical guidelines specific to their treatment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population., Methods: We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle fractures that was sent via e-mail to the 895 active members of the AOFAS. In addition to providing demographic information, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status., Results: Respondents' number of years in practice, number of ankle fractures treated monthly, and type of fellowship training did not correlate with management strategies. Enhanced fixation with syndesmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while casting was selected as the treatment for those that were nondisplaced. Prolonged periods of non-weight bearing were chosen by survey participants in all cases., Conclusion: We identified several treatment trends among AOFAS membership regarding ankle fractures in diabetics. However, it is pivotal that further investigation evaluate both optimal fixation strategies and the factors that influence surgeon decision making in the setting of diabetic ankle fractures, as the orthopaedic surgeon is encountering such patients more than ever before.

Various modes of failure of primary and revision total hip arthroplasty have been well documented in the literature over the past 30 years. Concerns over polyethylene wear, osteolysis, and hypersensitivity reactions leading to component loosening and early revision have been evaluated and reported in the literature. Routine follow-up is important to monitor for postoperative issues that might lead to the subsequent need for revision.This article describes a case of a 64-year-old man who initially presented 11 years prior with an intertrochanteric fracture, which failed secondary to varus alignment and femoral head osteonecrosis. The fixation was converted to a total hip replacement using the S-ROM system (DePuy, Warsaw, Indiana). Subsequently, the patient was lost to follow-up after primary total hip arthroplasty and presented with a catastrophic fracture of the metal acetabular cup system. The failure was suggested by clinical presentation and confirmed by imaging studies showing a fractured acetabular shell with femoral head prosthesis resting in the superolateral ileum. The contributing factors that resulted in mechanical failure were polyethylene wear and component fracture. The acetabular component was revised with an in-growth cementless trabecular metal multihole cup (Zimmer, Warsaw, Indiana) with bone grafting of acetabular defects.Routine assessments help educate patients and allow careful monitoring by physicians while establishing a radiographic timeline for the identification, progression, or lack of postoperative complications., (Copyright 2012, SLACK Incorporated.)

Patients with diabetes mellitus have a higher risk of complications after sustaining an ankle fracture, including fracture displacement, superficial and deep infection, hardware failure, and neuropathic arthropathy. With the increased incidence of diabetes among the aged, the increased incidence of complications due to diabetes mellitus and its sequelae are important to keep in mind when treating ankle fractures., (Copyright 2011, SLACK Incorporated.)