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Objectives: The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. Methods: Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. Results: In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. Conclusions: Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation. [ABSTRACT FROM AUTHOR]

Coverage of soft-tissue defects in the lower limbs, especially open tibial fractures, is currently a frequently done procedure because of the high incidence of high-energy trauma, which affects this location. The skilled orthopedic surgeon should be able to carry out an integral treatment of these lesions, which include not only the open reduction and internal fixation of the fracture fragments but also the management of complications such as local wound problems that may arise. There is a wide variety of muscular or pedicled flaps available for reconstruction of lower limb soft-tissue defects. These techniques are not commonly used by orthopedic surgeons because of the lack of familiarity with them and the potential for flap failure and problems derived from morbidity of the donor site. We present a coverage management update for orthopedic surgeons for complications after an open tibial fracture. We choose and describe the most adequate flap depending on the region injured and the reliable surgical procedure. For proximal third of the tibia, we use gastrocnemius muscle flap. Middle third of the tibia could be covered by soleus muscle flap. Distal third of the tibia could be reconstructed by sural flaps, lateral supramalleolar skin flap, and posterior tibial perforator flap. Free flaps can be used in all regions. We describe the advantages and disadvantages, pearls, and tips of every flap. The coverage of the tibia after a major injury constitutes a reliable and versatile technique that should form part of the therapeutic arsenal of all the orthopedic surgeons, facilitating the integral treatment of complex lower limb injuries with exposed defects. [ABSTRACT FROM AUTHOR]

Background: Infections that occur after the surgical management of pelvic fractures may involve potentially devastating complications. The broader approaches involving soft tissue dissection and a long operative time may increase the infection rate when compared with more conservative approaches. This incidence may be reduced with a better understanding of the approaches, lymph node sparing and antibiotic use. The purpose of this study is to assess the incidence and severity of local infections in a series of adult patients with pelvic ring lesions treated surgically., Material and Methods: This is a prospective observational descriptive study. A total of 49 patients operated on by a single surgeon from 2004 to 2008 were included., Results: Forty-four patients (90%) had no signs of infection during the treatment period. In the remaining 5 cases (10%), 5 episodes of infection were documented., Conclusions: The identification of a local postoperative infection warrants an aggressive and urgent assessment of the patient. The devitalized tissue should be removed and empiric antibiotic therapy should be instituted after taking culture samples. A deep infection rate after pelvic fixation ranging from 0 to 10% has been published. The prevalence is higher among the surgical teams with less expertise. The incidence rate in our review was similar to the one reported in the literature.