The decision to amputate or reconstruct after high-energy foot injuries is controversial. A 25-year-old male patient was admitted to our clinic with a complex injury to his left foot sustained during a mine explosion, and the second to fifth digits and metatarsals of the left foot had been traumatically amputated before admission to our facility. The complex left foot defect was reconstructed with an osteocutaneous fibula flap during a single session. An osteotomy was performed on the bone segment of the flap, and both lateral longitudinal and transverse arches were repaired. Both aesthetic and functional outcomes were very satisfactory, including independent ambulation, light jogging, and full performance of activities of daily living without limitation. Many factors, including comorbidities, should be considered during the decision-making process of amputating or reconstructing complex foot injuries.
The aneurysmal bone cysts, usually found in the tibia, femur, pelvis, or humerus, are expansile pseudotumor lesions of unknown etiology. An aneurysmal bone cyst is rarely seen in the medial cuneiform. In this case report, a 43-year-old man with an aneurysmal bone cyst in the left medial cuneiform is presented. The cyst was curetted, and the defect was filled with an en bloc iliac crest graft. A screw was placed to fix the graft in the proper position. In the 2-year follow-up of the patient, recurrence was not detected radiologically.
We report a unique case of the total loss of the intermediate cuneiform by posttraumatic avascular necrosis resulting from a left foot open fracture and dislocation of the navicular bone and medial and intermediate cuneiforms at the Chopart and Lisfranc joints in a 64-year-old woman. The injury was managed with open reduction and internal fixation with Kirschner wires and cannulated screws. During postoperative follow-up, we observed avascular necrosis of the intermediate cuneiform and the total loss of the bone. An extensive English literature search revealed only one case report published on this topic. Thus, we provide this case study to help guide clinical decision making in the future.
Primary bone lymphoma is a rare disease, accounting for less than 5% of all extranodal lymphoma. Although the femur is cited as being the most common site, primary bone lymphoma is rare, accounting for less than 1% of all non-Hodgkin's lymphoma. Herein we present a case of diffuse B-cell–type malignant lymphoma manifested as a large soft-tissue mass of the leg, via metastasis of primary non-Hodgkin's lymphoma of the femur, which went untreated. We highlight the advantages of various imaging modalities used throughout the process of diagnosis and treatment because accurate and early diagnosis are essential. This case gives us a unique opportunity to witness the rapid progression of metastasis and an atypical location.
The management guidelines of gunshot wound (GSW) injuries to the lower extremities have primarily been described more recently in the literature. A navicular fracture with adjacent joint involvement is presented from a GSW with initial external fixation management to prevent loss of anatomical alignment and successful staged definitive treatment with internal fixation. Based on previous experiences with rearfoot joint involvement from GSW injuries, we were able to direct definitive treatment with arthrodesis of violated joints. After a 1-year follow-up, the patient has returned to normal activities without any limitations. This case report demonstrates a stepwise approach to management of an open navicular fracture secondary to a GSW.
The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, if at all. Although plain radiography is known to be ineffective for demonstrating radiolucent foreign bodies, it is often the first imaging modality used. In such cases, complete surgical extraction cannot be guaranteed, and other imaging modalities should be considered. We present a case of a retained toothpick of the second metatarsal in a young male patient who presented with pain in the right foot of a few weeks' duration. Plain radiography showed an oval cyst at the base of the second metatarsal of the right foot. Magnetic resonance imaging revealed a toothpick penetrating the second metatarsal. The patient recalled stepping on a toothpick 8 years previously. Surgical exploration revealed a 2-cm toothpick embedded inside the second metatarsal.
Distal to its origination from the sciatic nerve, the common fibular (peroneal) nerve divides into the superficial and deep fibular (peroneal) nerves. Whereas the deep fibular nerve continues its course into the anterior compartment, the superficial fibular nerve (SFN) usually arises near the fibular neck and projects distally within the lateral crural compartment before entering the superficial fascia proximal to the ankle. In this report, we describe a unilateral case where the SFN arises within the anterior crural compartment and remains there for the remainder of its course deep to the deep fascia of the leg. Surgeons should be aware of anomalies such as this, for example, when performing fasciotomies to avoid inadvertently damaging an anomalously placed SFN.
We report an unusual case of adenocarcinoma of the lung metastasizing to the proximal phalanx of the third digit in a 56-year-old woman with overlying complex regional pain syndrome. The patient was initially treated for neuroma, fracture, and neuropathic pain with no improvement over a 4-month period before presenting to the emergency department for left third digit pain. Radiographic imaging showed substantial osteopenia and mottling; magnetic resonance imaging demonstrated an aggressive lesion to the proximal phalanx. The patient underwent excision of the lesion, revealing metastatic moderately differentiated adenocarcinoma.
This case report highlights a novel approach to strengthening the repair of a split peroneus brevis tendon tear with a peroneus quartus muscle autograft. We describe a 51-year-old woman with a longitudinal split tear of the peroneus brevis tendon confirmed by magnetic resonance imaging. Intraoperatively, a peroneus quartus muscle was appreciated, resected, and used as an autograft in the repair of the peroneus brevis tendon. Use of a peroneus quartus muscle as an autograft in peroneal tendon repair has not been documented in the literature, to our knowledge.
Rupture of the tibialis posterior tendon associated with ankle fracture is rare and difficult to diagnose. This rupture can be easily overlooked because the clinical examination is limited owing to acute pain related to a closed ankle fracture. Complete rupture of the tibialis posterior tendon can be identified by a loss of tension during ankle fracture fixation, but partial rupture is more difficult to detect because the tibialis posterior tendon can maintain its tension. A few cases of complete rupture of the tibialis posterior tendon combined with ankle fracture have been reported. It is well-known that failure to diagnose a rupture of the tibialis posterior tendon can lead to long-term disability and a planovalgus foot. However, to our knowledge, this is the first report of partial rupture of the tibialis posterior tendon in the English literature. Herein, we describe a patient with a neglected partial rupture of the tibialis posterior tendon combined with a medial malleolar fracture.