s published in the conference program. 497 ostectomy, it is important to remove an adequate amount of bone." When subtalar arthrodesis is selected, it may be done in situ or in combination with lateral exostectomy, calcaneal osteotomy, bone block arthrodesis or open reduction and internal fixation. 5 II. Foot and Ankle Injuries-Elite Athlete An MRI may be helpful in the diagnosis of occult lesions such as osteochondral defect (OGD), tears of the lateral ligaments, or peroneal tendon pathology. Ankle arthroscopy may be helpful as a diagnostic tool. 6 A general review of diagnosis and management of stress injuries in foot and ankle? was also followed by discussions of specific hindfoot fractures." Achilles tendon rupture may be managed with early rehabilitation." In the management of acute ankle sprains, and immobilization with dorsiflexion and weightbearing may bring together the ends of the ruptured anterior talofibular ligament and stabilize the talus. 10 1\1. Degenerative Pes Planus A discussion of congenital pes valgus followed a review of literature, definitions, and pathologic conditions." It was noted that heel cord tightness, subtalar facet hypoplasia, or ligament laxity may be present with this condition. Acquired flatfoot is more commonly a result of posterior tibial tendon insufficiency, plantar fascia rupture, or rheumatoid arthritis." Orthoses may be helpful in these instances." Surgical reconstruction may include osteotomy, arthrodesis, and other salvage procedures.P''!" II. Tarsal Arthrodesis I. Trauma SCIENTIFIC SESSIONS A. Triple Arthrodesis-Neuromuscular Imbalance. All patients after triple arthrodesis for neuromuscular imbalance had degenerative changes of the ankle 49 years on average after the procedure. Similar progressive changes were noted in the naviculocuneiform and tarsometatarsal joints. Of interest is that more than 90% of the patients were satisfied with the results of their surqery." B. Triple Arthrodesis-Structural Deformity. A 19year follow-up study for triple arthrodesis showed that the subjective outcome was satisfactory or very satisfactory in 81% of the feet. With 52% of the feet, there was difficulty walking on nonlevel ground, and with 43% there was difficulty running. Nineteen perA. Supramalleolar Osteotomy-Arthrosis. In a cadaver model of supramalleolar osteotomy in a loaded ankle, a 10° valgus osteotomy caused a reduction of medial talar dome force, whereas a 10° varus caused an increase of medial talar dome force. It was suggested that valgus supramalleolar osteotomy should be considered for treatment of medial ankle arthrosis. 6 B. Jones Fracture. In a simulated Jones fracture created by osteotomy and fixed with an intramedullary screw, average force at initial displacement was 70 N. Force at complete displacement was 500-600 N. There was no difference in these forces with a 4.5-mm malleolar screw or a 4.5-mm partially threaded, cancellous, cannulated screw.'" C. Chevron Osteotomy. The average hallux valgus angle improved by 7.1° in six feet treated with no fixation, by 6.3° in seven feet treated with temporary wire fixation, and by 9.5° in six feet treated with a screw. There was no difference in patient satisfaction between groups treated with or without fixation.i" D. Joint Motion. Roentgen stereophotogrammetric analysis was used with implanted markers to evaluate unloaded tibiotalar, talocalcaneal, talonavicular, calcaneocuboid, and naviculocuneiform joints in healthy volunteers. 29 ,3o Joint axis orientations varied between different individuals and different voluntary foot motions. With dorsiflexion-plantarflexion, the ankle joint had the largest maximum range of motion. With pronation-supination, the talonavicular joint had the Foot & Ankle InternationallVol. 19, No. 7/July 1998 cent had subjective results associated with painful arthrosis and varus hindfoot malposltlon." C. Acute Calcaneal Fractures-Subtalar Arthrodesis. At a mean 5-year follow-up evaluation after subtalar arthrodesis for posttraumatic arthritis, 80% of the patients had some residual pain. Outcome scores were independent of the method used for treatment." D. Outpatient Arthrodesis Under Regional Anesthesia. This method resulted in a reduced length of hospital stay, estimated blood loss, and a reduced cost for the procedure compared with inpatient arthrodesis using general anesthesia and iliac crest bone grafting. E. Arthrodesis-Acquired Flatfoot. Severe acquired flatfoot was managed with talonavicular arthrodesis and medial displacement calcaneal osteotomy in 14 patients. At an average of 25 months after surgery, 12 (86%) of the patients were satisfied with the results. All patients showed improvement on radiographic parameters. The average American Orthopaedic Foot and Ankle Society (AOFAS)score improved from 45 to 76 points postoperatively." III. Biomechanics TREPMAN ET AL. A. Intra-articular Calcaneal Fracture. A review was done of 117 cases of intra-articular calcaneal fractures. Good or excellent results were found in 69% of the cases with problems of sural nerve paresthesia, and major wound complications. Interestingly, the clinical outcome seemed to be independent of the fracture severity. 16 B. Calcaneal Fractures-Extended Lateral Approach. Complications from this approach included wound dehiscence in 40% of the cases. There was a correlation between smoking and wound complications, but delayed wound healing did not change the average time to weightbearing or the long-term outcorne.!" C. Calcaneal Fractures-Children. Remodelling of calcaneal fractures in children younger than 14 years did not compensate for displacement. Subtalar arthrosis was identified in 9 of 16 (56%) patients 13 years after follow-up. If anatomic reduction could not be obtained using closed or limited techniques, open reduction was aovlsed.!" D. Calcaneal Fractures-Worker's Compensation Related. In 30 displaced intra-articular fractures, there were greater average medical and compensation costs, and greater average time off work than there were in 18 nondisplaced tractures.!? E. Lisfranc Fractures. In patients treated with open reduction and internal fixation, the functional outcome was equal to the patients treated with partial, medial arthrodesis. In six patients (21.5%) treated with primary complete arthrodesis, four (67%) had forefoot stiffness and three (50%) had reflex sympathetic dystrophy."? 498

The cases of two patients in whom com- plete but transient quadriplegia developed after an in- jury that was incurred while playing football are presented. Both patients were found to have a congen- itally narrow cervical vertebral canal. Critical stenosis resulting in the transient quadriplegia occurred after a presumed injury to a cervical disc. In our opinion, a myelogram should be made for patients with a history of transient quadriplegia, numb- ness, or a burning sensation down the back or the lower extremities, even if other radiographic studies are in- terpreted as negative. Patients who have stenosis of the cervical spine should be advised to discontinue partici- pation in contact sports. within a few minutes. Neurological examination after this second episode revealed residual tendemess in the posterior area of the neck at the extremes of motion. subjective paresthesias, and buming pain at the base of the neck, the shoulders, and the anterior aspect of each arm. Cineradiographs and computerized tomographic scans of the cervical spine were interpreted as normal. The sagittal diameter of the mid-part of the cervical spine on plain lateral radiographs measured fifteen to seventeen millimeters. the widest diameter being found at the level of the fifth cervical vertebra. The radiologist interpreted this as a normal diameter. Metriza- mide-enhanced myelograms, however, revealed anterior and posterior nar- rowing and a filling defect at the level of the disc between the third and fourth cervical vertebrae (Fig. I . B). The widest sagittal diameter from the anterior border of the column of contrast medium to the posterior part of the laminar cortex measured fifteen millimeters. The diameter of the column of contrast medium averaged only six millimeters, and there was anterior and posterior constriction of the column at the third and fourth cervical levels. These findings were interpreted as indicative of possible compromise of the disc and ligamentum flavum of an already develop- mentally narrow cervical canal. The patient had hyperreflexia of the right biceps but otherwise re- mained neurologically normal when he was last seen. six years after he retired from professional football.