Summary: Severe foot and ankle injuries are complex and challenging to treat, often requiring multiple operations to salvage the limb contributing to a prolonged healing period. There is some evidence to suggest that early amputation for some patients may result in better long-term outcomes than limb salvage. The challenge is to identify the regional injury burden for an individual that would suggest a better outcome with an amputation. The OUTLET study is a prospective, multicenter observational study comparing 18-month outcomes after limb salvage versus early amputation among patients aged 18–60 years with severe distal tibia, ankle, and foot injuries. This study aims to build upon the previous work of the Lower Extremity Assessment Project by identifying the injury and patient characteristics that help define a subgroup of salvage patients who will have better outcomes had they undergone a transtibial amputation.

These results suggest a mechanism whereby impaired receptor-mediated removal of collagenase-3 in OA chondrocytes may lead to enhanced local degradation of the cartilage matrix. This work also implicates an LRP family member in endocytotic receptor-mediated collagenase-3 processing and suggests a novel therapeutic target for OA.

The optimal technique for a transtibial amputation in a young, active, and healthy patient is controversial. Proponents of the Ertl procedure (in which the cut ends of the tibia and fibula are joined with a bone bridge synostosis) argue that the residual limb is more stable which confers better prosthetic fit and improved function especially among high-performing individuals. At the same time, the Ertl procedure is associated with longer operative and healing time and may be associated with a higher complication rate compared with the standard Burgess procedure. The TAOS is a prospective, multicenter randomized trial comparing 18-month outcomes after transtibial amputation using the Ertl versus Burgess approach among adults aged 18 to 60. The primary outcomes include surgical treatment for a complication and patient-reported function. Secondary outcomes include physical impairment, pain, and treatment cost.

The purpose of this study was to compare the number and types of extremity injuries treated at civilian trauma centers (CIV CENs) versus military treatment facilities (MTFs) participating in the Major Extremity Trauma Research Consortium (METRC) and to investigate the potential benefits of a clinical research network that includes both civilian trauma centers and MTFs. Two analyses were performed. First, registry data collected on all surgically treated fractures at four core MTFs and 21 CIV CENs over one year were compared. Second, actual numbers and distribution of patients by type of injury enrolled in three METRC studies were compared. While MTFs demonstrated higher percentages of severe injuries including open fractures, traumatic amputations, vascular injuries, contamination, and injuries with bone, muscle, and skin loss when compared to CIV CENS, the CIV CENs treated a substantially higher number and, more importantly, enrolled patients in almost all categories. Comparison of service members to civilians was challenged by several differences between the two patient populations including mechanism of injury, the medical care environment, and confounding factors such as age, social setting and co-morbidities. Despite these limitations, in times without active military conflict, clinical trials will likely rely on civilian trauma centers for patient enrollment; only when numbers are pooled across a large number of centers can requisite sample sizes be met. These data demonstrate the benefits of maintaining a military-civilian partnership to address the major gaps in research defined by the Military.

Two-octyl cyanoacrylate is a popular skin adhesive used for closing surgical incisions. Since Food and Drug Administration approval in 1998, the few reports of adverse reactions following its use have primarily been limited to the nonorthopedic literature. The authors present a case series of contact dermatitis associated with 2-octyl cyanoacrylate following orthopedic surgery and a review of the literature on the diagnosis and treatment of this complication. All 3 patients presented with blistering around their incisions within 2 weeks of surgery and responded to treatment involving removal of the offending agent and use of oral diphenhydramine and hydroxyzine and topical triamcinolone. One case was complicated by a draining hematoma, requiring irrigation and debridement. Complete resolution occurred in all cases. This case series is intended to increase awareness in the orthopedic community of allergic contact dermatitis to 2-octyl cyanoacrylate and its appropriate treatment. [Orthopedics. 2018; 41(2):e289-e291.].