Reconstruction of Traumatic Composite Tissue Defect of Medial Longitudinal Arch With Free Osteocutaneous Fibular Graft

A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm × 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet.

Open mosaicplasty in osteochondral lesions of the talus: a prospective study

Osteochondral lesions of the talus present with symptoms of pain and painful motion, affecting the quality of the patient's daily life. We evaluated the 2-year short-term outcomes of patients whose large osteochondral lesions of the talus were treated with medial malleolar osteotomy and a mosaic graft harvested from the knee on the same side. A total of 32 patients who had cartilage lesions due to osteochondritis dissecans in the medial aspect of the talus underwent mosaicplasty after medial malleolar osteotomy. The patients were followed up for a mean period of 16.8 (range 12 to 24) months. The staging and treatment plan of the osteochondral lesions of the talus were made according to the Bristol classification. The follow-up protocol for the patients included direct radiography and magnetic resonance imaging. The American Orthopaedic Foot and Ankle Society scoring system was used to assess the patients during the pre- and postoperative periods. Of the 32 patients, 3 (9.4%) were female and 29 (90.6%) male, with a mean age of 27.5 (range 20 to 47) years. The mean preoperative American Orthopaedic Foot and Ankle Society score was 59.12 ± 7.72 but had increased to 87.94 ± 3.55 during the postoperative 2 years. The increase in American Orthopaedic Foot and Ankle Society score was statistically significant (p < .05). We have concluded that open mosaicplasty is a reliable and effective method for the treatment of osteochondral lesions with subchondral cyst formation in the talus, exceeding 1.5 cm in diameter.