We report the case of a 60-year-old woman with a schwannoma of the medial plantar nerve. She presented with the complaint of pain for about 2 years and a painful lesion in the medial plantar region of the left forefoot and on the second toe. Physical examination showed well-defined, firm tumor masses painful to palpation on the medial and plantar surface of the left forefoot and second toe. We surgically explored the area and excised 3 lesions, resulting in complete pain relief and no aesthetic complaints. Schwannomas of the medial plantar nerve are rare tumors, with only a few reports of cases extending to the forefoot. The finding of multiple schwannomas may be a red flag for the possible existence of local, painful, nerve lesions despite a negative Tinel sign. Appropriate surgical planning contributed to our successful intervention, without aesthetic, painful, or functional sequelae for the patient. Level of Evidence V; Therapeutic Studies; Expert Opinion.
RESUMOÉ frequente na rotina do atendimento em hospitais de médio e grande porte traumas em região distal dos dedos. Ainda que seja um trauma de baixa complexidade, é um importante fator causador de debilidade funcional, sobretudo, para pacientes exercem atividades que dependem exclusivamente de trabalhos manuais. O uso da prótese de polipropileno se torna uma boa opção uma vez que acelera o processo de cicatrização e promove a redução do tempo de reocupação pós operatória e as chances de infecção. Por ser uma técnica de fácil execução e de baixo custo, pode ser amplamente difundida.
Objective: To demonstrate fixation options for comminuted fractures of the medial malleolus. Methods: We retrospectively analyzed patients operated on for ankle fractures who had comminuted fractures of the medial malleolus between 2014 and 2018. Five patients were included in the study, 3 women and 2 men aged 19 to 37 years. Four cases were fixed with a tension-band wiring technique using Kirschner wires and cerclage, and 1 case with lag screws and buttress plate. Results: Four cases progressed satisfactorily (AOFAS >70), and 1 case progressed to ankle arthrodesis. Conclusion: Fixation with a tension-band wiring technique using Kirschner wires and cerclage may be an alternative to osteosynthesis in comminuted fractures of the medial malleolus with small fragments. Fixation with lag screws and buttress plate may be used in cases with larger fragments. Level of Evidence IV; Therapeutic Studies; Cases Series.
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