On the basis of the authors' results in treating avulsion fractures of the tuberosity, immobilization in a short leg weightbearing cast for 4 weeks is the preferred treatment. If still symptomatic at 4 weeks, some patients may require further immobilization for an additional 1 to 3 weeks. Rarely do these patients require surgery. In patients with these types of fractures, no angulation or displacement deformity was seen on x-rays, so open reduction was not warranted. Although the study does not strongly support the view that delayed healing of Jones fractures is associated with weightbearing cast treatment, the authors still tend to recommend treatment with a short leg nonweightbearing plaster cast for 6 weeks. Patients may not tolerate such treatment for this amount of time. To encourage better patient compliance, a minimum of 3 to 4 weeks in a nonweightbearing cast followed by 3 weeks in a weightbearing cast is recommended. Although open reduction was indicated in a few cases, all patients with Jones fractures, aged 20, 22, 24, 24, and 27 years, declined that option. Specifically, one patient had a delayed union of the Jones-type fracture (Fig. 4). In spite of being young and athletic, and thus at high risk for refracture, he decided against open reduction internal fixation and opted for prolonged casting.
The authors present an in-depth discussion of Lisfranc's fracture-dislocations, including classifications, mechanisms of injury, radiographic evaluation, and a literature review. Four cases are presented for review. Lisfranc's fracture-dislocation is a rare injury that can lead to prolonged disability if undiagnosed or if there is a delay in treatment.
In the case reported, M. fortuitum was sensitive in vitro to amikacin, erythromycin, tobramycin, and ciprofloxacin. Because the patient did not respond to long-term therapy with amikacin and erythromycin, an experimental antibiotic, ciprofloxacin, was tried. Only after extensive surgical debridement and 2 1/2 months of oral ciprofloxacin therapy was the infection eradicated and wound healing obtained. The authors conclude that a wound that has reopened, but remains indolent, exudes a clear, serous drainage and responds poorly to antibiotics should suggest a possible mycobacterial infection. Combination antibiotic therapy is recommended because of the high rate of relapse and development of resistance to drugs. Extensive surgical debridement of all infected tissue remains the primary treatment. The therapeutic value of ciprofloxacin and other newer antibiotics in the treatment of mycobacterial infection is promising.
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