OKOJ

OKOJ, Volume 11, No. 4


Compartment Syndrome of the Foot

Compartment syndrome of the foot is a severe potential complication of foot trauma that can lead to significant levels of morbidity, including pain, contractures, neuropathy, and loss of function. Although compartment syndrome of the foot is less common than compartment syndrome of the leg or forearm, the consequences of this condition can be significant. Compartment syndrome of the foot can develop from a number of injury patterns, including crush injuries, vascular insults, reperfusion injuries, and high-energy foot trauma. Typical symptoms and signs of compartment syndrome of the foot are swelling and pain out of proportion to the injury. The diagnosis is primarily based on clinical findings, and should be focused and thorough, particularly because the foot has multiple myofascial compartments that potentially could be affected. A high index of suspicion coupled with early diagnosis and rapid decompression of affected compartments are therefore required for successful treatment. In this article, we review recent studies on compartment syndrome of the foot, highlighting current existing controversies regarding diagnosis and treatment.

    • Keywords:
    • acute compartment syndrome

    • foot compartment syndrome

    • fasciotomy

    • intracompartmental pressure measurement

    • Subspecialty:
    • Trauma

    • Foot and Ankle

Key Concepts and Techniques for Minimally Invasive Posterior Lumbar Surgery

The key principles that define minimally invasive spine surgery include:(1) avoid muscle crush injury caused by self-retaining retractors; (2) preserve tendon attachment sites of key muscles, particularly multifidus; (3) use known anatomic neurovascular planes; and (4) decrease collateral soft-tissue injury by limiting the width of the surgical corridor.With traditional posterior lumbar surgery, the tendon origin of the multifidus muscle is detached, the surgical corridor is exceedingly wide, and significant muscle crush injury occurs through the use of powerful self-retaining retractors. This combination of factors leads to well-described changes in muscle physiology and function. Minimally invasive posterior lumbar surgery is performed using table-mounted tubular retractors that focus the surgical dissection to a narrow corridor, directly over the surgical target site. The path of the surgical corridor is based on anatomic planes specifically chosen to avoid injury to the musculotendinous complex and the neurovascular bundle. The results achieved with minimally invasive spine surgery are comparable to those of traditional open techniques, but with less postoperative pain, less blood loss, and lower rates of deep infection. However, minimally invasive techniques remain technically demanding. As with other emerging technologies, improved surgeon education and training are needed.

    • Keywords:
    • minimally invasive spine surgery

    • MIS TLIF

    • transforaminal lumbar interbody fusion

    • lumbar decompression

    • percutaneous pedicle screw instrumentation

    • learning curve

    • Subspecialty:
    • Spine

Minimally Invasive Transforaminal Lumbar Interbody Fusion: "Skin-to-Skin" Technique Guide

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is well-suited for posterior lumbar reconstruction in which direct decompression, posterior interbody fusion, and pedicle screw instrumentation are needed. The primary goals of MIS TLIF are to avoid injury to the multifidus muscle through preservation of the tendon origin at the spinous process, particularly at the adjacent level above the fusion site, and to avoid aggressive retraction of the paraspinal muscles. Various techniques exist to successfully accomplish the intended goals of the procedure. The specific technique described in this article represents one variation used by the primary author (CWK). General concepts and techniques for minimally invasive posterior lumbar surgery are reviewed in a companion article that appears in this issue of . The video is used in accordance with the permission of Globus Medical, Inc.

    • Keywords:
    • minimally invasive spine surgery

    • MIS TLIF

    • minimally invasive transforaminal lumbar interbody fusion

    • lumbar decompression

    • spinal stenosis

    • Subspecialty:
    • Spine

Percutaneous Pin Fixation for Treatment of Distal Radius Fractures

Fractures of the distal radius are among the most frequently encountered injuries by the orthopaedic surgeon. The ideal definitive treatment of these fractures, however, remains a subject of debate. Closed reduction and percutaneous pinning offers a reliable, minimally invasive technique for fixation of two-part and three-part distal radius fractures, with excellent long-term results. The surgical technique is relatively straightforward, may be performed in a relatively short amount of time, and is relatively inexpensive compared with alternative surgical options for comparable fractures. In this article we present and demonstrate our surgical technique for percutaneous pinning of distal radius fractures, and provide an overview of reported outcomes and complications of this procedure.

    • Keywords:
    • surgical treatment

    • percutaneous pinnning

    • percutaneous fixation

    • K-wire fixation

    • Kirschner wire fixation

    • Colles fracture

    • distal radioulnar joint instability

    • DRUJ instability

    • functional outcomes

    • complications

    • Subspecialty:
    • Trauma

    • Hand and Wrist

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