OKOJ

OKOJ, Volume 12, No. 9


Necrotizing Fasciitis of the Upper Extremity

Necrotizing fasciitis, sometimes called flesh-eating bacterial disease, is a rare limb- and life-threatening soft-tissue infection that can involve the skin, subcutaneous tissue, fascia, and muscle. A variety of microorganisms is known to cause this infectious process. Although it can also affect the lower extremities, 38% of cases of necrotizing fasciitis involve the upper extremities. As in the lower extremities, the consequences of inadequate and untimely treatment of such infection in the upper extremities include high rates of morbidity and mortality. A high index of suspicion and timely treatment can be limb- and life-saving, and are essential for a satisfactory functional outcome of treatment of necrotizing fasciitis and other necrotizing soft-tissue infections. Although necrotizing soft-tissue infections can develop in normal, healthy individuals with relatively minor injuries, persons with immunocompromising illness are at greater risk of developing these infections. This article reviews the treatment of necrotizing fasciitis and other necrotizing soft-tissue infections of the upper extremities.

    • Keywords:
    • flesh-eating disease

    • necrotizing fasciitis

    • necrotizing soft-tissue infection

    • Group A streptococcus

    • MRSA

    • Subspecialty:
    • Hand and Wrist

Osteochondral Lesions of the Talus

An osteochondral lesion of the talus is a defect in the cartilage of the talus resulting from injury to the cartilage surface, underlying bone, or both, and leading to ankle pain and dysfunction. Such lesions are a significant source of ankle pathology that can lead to long-term disability and arthritis. They can affect the young and old alike, and may be related to acute trauma or chronic instability, or may be congenital, but are often related to a combination of these factors. Because of the relatively small surface area of the talus, loss of even a small area of its cartilage is poorly tolerated, and surgery is often required for lesions that do not heal primarily. Surgical options for the treatment of symptomatic lesions have been a subject of controversy. The simplest such option is arthroscopic excision of a loose fragment of cartilage and bone. However, inconsistent results of the simple excision of such fragments have led to a variety of treatments that vary with the type of lesion that exists. These are aimed at the stabilization of cartilage in situ or restoration of the articular surface of the talus when a defect is present. This article reviews the diagnostic and treatment options for osteochondral lesions of the talus.

    • Keywords:
    • osteochondral lesion

    • talus

    • talar cartilage defect

    • arthroscopic excision

    • articular cartilage restoration

    • subchondral bone

    • subchondral cyst

    • osseous ischemia

    • necrosis

    • chondral fracture

    • osteochondral fracture

    • tibiotalar joint

    • osteochondral graft

    • Subspecialty:
    • Foot and Ankle

    • Sports Medicine

Use of the Salto Talaris Total Ankle Prosthesis

The Salto Talaris Total Ankle Prosthesis (Tornier) is a two-component, fixed-bearing prosthesis that was approved for use by the FDA in 2006. The Salto Talaris is a modification of the mobile-bearing Salto prosthesis, which has been used in Europe since the late 1990s. The Salto Talaris design features a dual-radius talar implant that mimics the kinematics of the native ankle and a mobile-bearing tibial trial implant that rotates based on the position of the talar trial implant, in theory creating a more congruent tibiotalar relationship. This article reviews the indications for total ankle replacement, the key features of the Salto Talaris prosthesis, and the pertinent technical aspects of the surgical technique.

    • Keywords:
    • ankle arthritis

    • total ankle replacement

    • arthroplasty

    • Subspecialty:
    • Foot and Ankle

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