There is debate as to whether a home run screw (medial cuneiform to 2nd metatarsal base) combined... more There is debate as to whether a home run screw (medial cuneiform to 2nd metatarsal base) combined with k-wire fixation of the 4th & 5th tarsometatarsal joints is sufficient to stabilise Lisfranc injuries or if fixation of the 1st and 3rd tarsometatarsal joints is also required. Unlike the 2nd, 4th and 5th tarsometatarsal joints, stabilisation of the 1st and 3rd requires either intra-articular screw or an extra-articular plate which risk causing chondrolysis and/or osteoarthritis. The aims of this cadaveric study were to determine if routine fixation of the 1st and 3rd tarsometatarsal joints is necessary and to determine if a distal to proximal home run screw is adequate. Using 8 Theil-embalmed specimens, measurements of tarsometatarsal joint dorsal displacement at each ray (1st-5th) and 1st-2nd metatarsal gaping were made during simulated weight bearing with sequential ligamentous injury and stabilisation to determine the contribution of anatomical structures and fixation to stabili...
Background: Perpendicular access to the posterolateral talar dome for the management of osteochon... more Background: Perpendicular access to the posterolateral talar dome for the management of osteochondral defects is difficult. We examined exposure available from each of four surgical approaches. Materials and methods: Four surgical approaches were performed on 9 Thiel-embalmed cadavers: anterolateral approach with arthrotomy; anterolateral approach with anterior talo-fibular ligament (ATFL) release; anterolateral approach with antero-lateral tibial osteotomy; and anterolateral approach with lateral malleolus osteotomy. The furthest distance posteriorly allowing perpendicular access with a 2 mm k-wire was measured. Results: An anterolateral approach with arthrotomy provided a mean exposure of the anterior third of the lateral talar dome. A lateral malleolus osteotomy provided superior exposure (81.5% vs 58.8%) compared to an anterolateral tibial osteotomy. Conclusions: Only the anterior half of the lateral border of the talar dome could be accessed with an anterolateral approach without osteotomy. A fibular osteotomy provided best exposure to the posterolateral aspect of the talar dome.
The notion of self-preservation stands at the centre of Hobbes' account of mani and civil society... more The notion of self-preservation stands at the centre of Hobbes' account of mani and civil society. Hobbes connects self-preservation to the foundation of the commonwealth most explicitly at the beginning of Part II of Leviathan: "The finall Cause, End, or Designe of men, (who naturally love Liberty, and Dominion over others,) in the introduction of that restraint upon themselves, (in which wee see them live in Commonwealths ,) is the foresight of their own preservation, and of a more contented life thereby" (L II.xvii, p223).2 Note, however, that this formulation concerns not preservation as such but its foresight. The self for Hobbes is founded on the assurance of future time: a man's power is defined as "his present means, to obtain some future apparent Good" (L I.x, p 150).3 The identity of the self to be preserved is not simply physical existence, but seems to be modulated by men's judgements about what it amounts to. Man in "the condition of meer nature" is judge of what constitutes his life, as he * This paper was originally presented to the Hobbes 1588-1988 Research Symposium held at the University of New South Wales in July 1988, and has benefited from the discussion that followed.
There is debate as to whether a home run screw (medial cuneiform to 2nd metatarsal base) combined... more There is debate as to whether a home run screw (medial cuneiform to 2nd metatarsal base) combined with k-wire fixation of the 4th & 5th tarsometatarsal joints is sufficient to stabilise Lisfranc injuries or if fixation of the 1st and 3rd tarsometatarsal joints is also required. Unlike the 2nd, 4th and 5th tarsometatarsal joints, stabilisation of the 1st and 3rd requires either intra-articular screw or an extra-articular plate which risk causing chondrolysis and/or osteoarthritis. The aims of this cadaveric study were to determine if routine fixation of the 1st and 3rd tarsometatarsal joints is necessary and to determine if a distal to proximal home run screw is adequate. Using 8 Theil-embalmed specimens, measurements of tarsometatarsal joint dorsal displacement at each ray (1st-5th) and 1st-2nd metatarsal gaping were made during simulated weight bearing with sequential ligamentous injury and stabilisation to determine the contribution of anatomical structures and fixation to stabili...
Background: Perpendicular access to the posterolateral talar dome for the management of osteochon... more Background: Perpendicular access to the posterolateral talar dome for the management of osteochondral defects is difficult. We examined exposure available from each of four surgical approaches. Materials and methods: Four surgical approaches were performed on 9 Thiel-embalmed cadavers: anterolateral approach with arthrotomy; anterolateral approach with anterior talo-fibular ligament (ATFL) release; anterolateral approach with antero-lateral tibial osteotomy; and anterolateral approach with lateral malleolus osteotomy. The furthest distance posteriorly allowing perpendicular access with a 2 mm k-wire was measured. Results: An anterolateral approach with arthrotomy provided a mean exposure of the anterior third of the lateral talar dome. A lateral malleolus osteotomy provided superior exposure (81.5% vs 58.8%) compared to an anterolateral tibial osteotomy. Conclusions: Only the anterior half of the lateral border of the talar dome could be accessed with an anterolateral approach without osteotomy. A fibular osteotomy provided best exposure to the posterolateral aspect of the talar dome.
The notion of self-preservation stands at the centre of Hobbes' account of mani and civil society... more The notion of self-preservation stands at the centre of Hobbes' account of mani and civil society. Hobbes connects self-preservation to the foundation of the commonwealth most explicitly at the beginning of Part II of Leviathan: "The finall Cause, End, or Designe of men, (who naturally love Liberty, and Dominion over others,) in the introduction of that restraint upon themselves, (in which wee see them live in Commonwealths ,) is the foresight of their own preservation, and of a more contented life thereby" (L II.xvii, p223).2 Note, however, that this formulation concerns not preservation as such but its foresight. The self for Hobbes is founded on the assurance of future time: a man's power is defined as "his present means, to obtain some future apparent Good" (L I.x, p 150).3 The identity of the self to be preserved is not simply physical existence, but seems to be modulated by men's judgements about what it amounts to. Man in "the condition of meer nature" is judge of what constitutes his life, as he * This paper was originally presented to the Hobbes 1588-1988 Research Symposium held at the University of New South Wales in July 1988, and has benefited from the discussion that followed.
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