The authors are presenting a new subtalar fusion technique for late complications of calcaneus fractures. These complications include pain, shoe wear difficulties, and foot deformity. The complex pathology includes incongruous subtalar joint, loss of calcaneal body height, and decreased lateral talocalcaneal angle. The latter two factors can result in tibiotalar neck impingement, a deformity that has received little attention in the literature. The subtalar fusion technique involves distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation. The distraction allows correction of the talocalcaneal relationship and regains lost hindfoot height. The clinical series involved 16 feet with an average follow-up of 19 months. Results were satisfactory in 13 feet. Pre- and postoperative radiographic analysis for tibiotalar impingement, lateral talocalcaneal angle, and talonavicular subluxation was performed, with improvement to a normal range seen in the cases analyzed. The results are encouraging but should be considered preliminary based on the length of follow-up.

Flatfoot (pes planus) is common in infants and children and often resolves by adolescence. Thus, flatfoot is described as physiologic because it is usually flexible, painless, and of no functional consequence. In rare instances, flatfoot can become painful or rigid, which may be a sign of underlying foot pathology, including arthritis or tarsal coalition. Despite its prevalence, there is no standard definition for pediatric flatfoot. Furthermore, there are no large, prospective studies that compare the natural history of idiopathic, flexible flat feet throughout development in response to various treatments. The available literature does not elucidate which patients are at risk for developing pain and disability as young adults. Current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flat feet. Painful flexible flatfoot may benefit from orthopedic intervention, such as physical therapy, bracing, or even a surgical procedure. Orthotics, although generally unproven to alter the course of flexible flatfoot, may provide relief of pain when present. Surgical procedures include Achilles tendon lengthening, bone-cutting procedures that rearrange the alignment of the foot (osteotomies), fusion of joints (arthrodesis), or insertion of a silicone or metal cap into the sinus tarsi to establish a medial foot arch (arthroereisis). It is important for a general pediatrician to know when a referral to an orthopedic specialist is indicated and which treatments may be offered to the patient. Updated awareness of the current evidence regarding pediatric flatfoot helps the provider confidently and appropriately counsel patients and families.

No abstract

Amid the coronavirus disease 2019 (COVID-19) pandemic, there have been anecdotal reports of a reduction in non-COVID-19 emergent diseases, including ischemic stroke 1 and myocardial infarction (MI), 2,3 and a general drop in emergency department volumes. 4 The concern is that patients, wary of contact with individuals with COVID-19, are reluctant to seek care, even in the face of acute, life-threatening conditions. Using data from 2 academic medical centers, we assessed the association of the COVID-19 pandemic with the incidence of 5 medical emergencies: acute MI, ischemic stroke, nontraumatic subarachnoid hemorrhage (ntSAH), ectopic pregnancy, and appendicitis. Methods | The online databases of Stanford University Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center (NYP) were queried using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to determine the number of patients with each diagnosis per month. Diagnoses of acute MI were extracted with ICD-10 code I21, ischemic stroke with I63, ntSAH with I60, ectopic pregnancy with O00, and appendicitis with K35. The monthly diagnosis total was divided by the number of days in each month to arrive at an average daily count. For acute MI, ischemic stroke, and ntSAH, patients younger than 18 years were excluded. Diagnoses were tallied between March 1, 2018, and May 22, 2020. Interrupted time-series single-group analysis was performed to assess if pre-COVID-19 trends in case volumes differed significantly from post-COVID-19 trends. Segmented Poisson regression models were constructed to analyze trends Letters E2 JAMA

This article describes a simple method using anterior and medial bone contact of the distal shaft piece to obtain a stable reduction for displaced intertrochanteric fractures of the hip. The technique is based on the observation that the anterior pathoanatomy of the intertrochanteric hip fracture involves a noncomminuted fracture plane that can be placed into contact. This reestablishes a normal neck shaft angle and prevents excessive collapse of the fracture site. The maneuver is described in the context of the fracture pathoanatomy and the use of a fracture table.