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The authors present an overview of post-traumatic foot compartment syndrome with an emphasis on the importance of relieving vascular compromise immediately. The incisional approach selected should not only effectively decompress the foot, but also allow for repair of concomitant osseous and soft tissue injury as well. Vascular considerations may dictate the course of simultaneous fracture management.
The authors present a review of the literature concerning the pathogenesis, diagnosis, and treatment of osteochondral defects of the lower extremity. A case of bilateral osteochondritis dissecans of the first metatarsophalangeal joint in a 43-year-old female is presented, including surgical treatment with 1- and 3-year follow-up examinations. The correlation between articular damage to the first metatarsal head and concomitant hallux limitus and hallux rigidus is discussed. The authors also propose that osteochondritis dissecans lesions almost always occur on the convex surface of a joint because of a convergence of impaction forces.
Cases must be treated on an individual basis, appreciating the complexity of the syndactyly, considering the patient compliance, and understanding the goals of the surgical correction. Extensive discussion with the patient and parents must occur to clarify the goals of the surgery, the expectations, and possible complications. Careful preoperative planning and incision design is paramount in obtaining satisfactory results. Skin grafting may be required, either full-thickness from a variety of donor sites or split-thickness grafting as in one case study reported. Adjunctively, manipulation and stretching of the web space for 2 to 3 months preoperatively may be helpful to achieve more laxity of the soft tissues. The choice of suture material is of particular concern when dealing with a small child. It is usually wise to use an absorbable suture material for skin closure in a small child to prevent undue emotional stress to the child or even further anesthesia upon suture removal. Vascular compromise caused by soft tissue tension in not an infrequent occurrence. As with any surgery that addresses largely cosmetic deformities, there is no substitute for exact prior planning, meticulous technique, and surgeon experience to optimize results.
