Search

Transient osteoporosis is a clinical syndrome of unknown etiology characterized by the acute onset of pain gradually worsening over several weeks to months. Radiographic changes occur, but laboratory studies are generally unremarkable. Transient osteoporosis of the talus appears to have a similar clinical appearance, radiographic findings, and successful response to conservative management as transient osteoporosis found elsewhere in the body and can be treated similarly. Awareness of this syndrome is important to avoid confusing it with a variety of other disorders of the talus that may have similar clinical presentations.

A 32-year-old man experienced pain behind the medial malleolus and an inability to bear full weight after jumping approximately 3 feet during a basketball game. A diagnosis of fracture of the medial tubercle of the posterior process of the talus was made, and the patient was treated for 7 weeks in a nonweightbearing cast. Twenty-four-month follow-up demonstrated no limitation of activity. To our knowledge, this is the first reported case of fracture of the posterior process of the talus that was treated nonoperatively with a successful outcome.

From November 1992 to April 1993, the 212th Mobile Army Surgical Hospital (MASH) was deployed from Germany to Zagreb, Croatia, to provide medical support for the United Nations Protection Force serving in the former Yugoslavia. A 60-bed deployable medical systems hospital was established. The usual MASH 72-hour evacuation policy was extended to 30 days; the orthopedic equipment inventory and surgical capability were increased significantly. Eighty-three orthopedic surgical procedures were performed during a 5-month period on soldiers from 14 nations. Sixty-two (75%) of these procedures were non-emergent, including internal fixation of fractures, bone and skin grafting, and arthroscopy. There were no documented early infections; the complication rate was acceptable. Orthopedic aftercare was supplemented by physical therapy and the capability of prosthetic fitting for amputees. The majority of soldiers (60%) received definitive orthopedic surgical care in theater. The feasibility of performing non-emergent orthopedic procedures in a field environment was demonstrated. Expanded medical support for other similar missions may be required in the future.

The 212th Mobile Army Surgical Hospital was deployed from Germany to former Yugoslavia to provide medical support for approximately 25,000 United Nations soldiers. This medical unit was the first mobile army hospital ever to deploy with a capability for arthroscopic surgery, obtained 4 months into the deployment. During a 2-month period, five knee arthroscopies were performed for various indications. There were no complications. Three patients returned to duty, and two were repatriated to their home countries. This preliminary report suggests that knee arthroscopy is feasible in a forward deployed field hospital and often allows soldiers to return to duty quickly.

Twenty-two patients underwent 23 femoral and tibial lengthenings by the Wagner technique from 1977 to 1987. Average length gained was 5.8 and 5.2 cm, respectively. Long hospitalization in addition to multiple operative procedures and a high complication rate created a significant psychological impact. Fourteen of 22 patients experienced psychological problems, primarily adjustment disorders, all of which resolved without long-term sequelae. Parental/family and nursing staff support were identified as the most important during the lengthening process. Advances in limb lengthening techniques may lessen the overall impact of this procedure, but preoperative psychological preparation is important.