Complications of ring fixators in the foot and ankle

The current review reports the author's 12-year experience with the Ilizarov ring external fixator for the treatment of foot and ankle disorders. The complications caused by the use of this apparatus also will be presented. In the beginning, the complications were attributable to inexperience and the lack of literature available at that time (1987); afterward, the complications were attributable to excess of confidence and the belief that the external fixator could be the universal solution for all patients. The current review has two main purposes: to show the more frequent complications that arise during the use of the external fixators, and to present methods on how to prevent the complications and how to manage them once they occur. The majority of complications presented in the current review are related directly to the use of the external fixator. These complications could be called minor complications that frequently are seen during treatment. However, there are major complications that can be avoided with adequate application and control of the external fixator during treatment.     

Salvage or amputation after complex foot and ankle trauma

A treating surgeon must take all the aforementioned ideas and principles into consideration, make a reasoned decision in the first hour of patient evaluation, and proceed with the chosen treatment. When functional salvage is not thought to be possible, it is better simply to let the patient and family know, then proceed directly to the best possible reconstructive amputation. This approach saves the patient, family, friends, and treatment team an enormous amount of anguish and allows for the earliest possible acceptance and positive approach to rehabilitation.     

Perioperative management of foot and ankle trauma

This review covers the perioperative management of trauma to the foot and ankle. The goal when treating these injuries is to return the patient to a sensate, plantigrade, painless, and functioning foot and ankle. Depending on the nature of the trauma, realistic outcomes should be established for the patient, family, and surgeon. The importance of early recognition and treatment of foot and ankle injuries has been established and is paramount for the overall recovery of traumatized patient.     

External fixation in trauma of the foot and ankle

External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduction was sufficient, it can stay in place for definitive treatment. The external fixator can be used as an intraoperative distraction device and as a helpful tool for reduction, which can stay in place as a temporary immobilization. External fixation instead of plaster cast allows for better care of skin and soft tissues. External fixation also has its advantages as a minimally invasive external compression device in specific indications for arthrodesis, especially in infected cases.     

Magnetic resonance imaging of foot and ankle trauma

MRI is a useful diagnostic tool in the assessment of traumatic lesions of the foot and ankle. It is especially useful in demonstrating acute and chronic tendon and ligament injuries. Subtle fractures, including osteochondral, nondisplaced, and stress fractures, are well shown with MRI but may be difficult to detect on radiographs. A bone scan may also be used to detect these fractures; however, with MRI the fracture extent may be determined. MRI is also useful in diagnosing complication of trauma, such as ischemic necrosis and bone and soft-tissue infections.     

Advancements in percutaneous fixation for foot and ankle trauma

Operative fixation of foot and ankle trauma can be challenging. Often times, the soft tissue envelope can have extensive damage as a result of the fracture. In these cases, percutaneous fixation may be used. Percutaneous fixation can benefit both soft tissue and osseous healing when used correctly. Many techniques have been described in the literature that may help to preserve blood supply, minimize soft tissue dissection, and restore a functional limb. This article reviews general guidelines for fracture and soft tissue management, osseous healing of fractures, and how certain techniques influence fracture healing. It also illustrates certain techniques for specific fracture reduction.     

Application of external fixators for management of Charcot deformities of the foot and ankle

External fixators have been used effectively for a variety of traumatic, congenital, and neuromuscular conditions of the lower extremity for many decades. The transition to management of Charcot foot and ankle deformities in the diabetic neuropathic patient is a logical application. External fixation can address the unique challenges in the Charcot foot, including osteoporosis, osteomyelitis, wound healing, and compliance issues. The author's experience has lead to abandoning other methods of fixation in favor of external fixation for most infected and noninfected Charcot deformities of the foot and ankle.     

Incidence and risk factors for amputation in foot and ankle trauma

Mobility, especially in elderly patients, is often a proxy for overall health. It is thus of interest to understand the rates of lower extremity amputation and the risk factors for these procedures in the trauma population. We compared the rates of lower extremity amputation in low- versus high-level trauma by analyzing the National Trauma Data Bank. We also attempted to identify the risk factors in the low-level trauma population with foot and ankle trauma that predispose to lower extremity amputation. The factors associated with lower extremity amputation in foot and ankle trauma differed slightly from those in other multi-trauma patients. The factors associated with lower extremity amputation in the low-level foot and ankle trauma population that were statistically and clinically significant in this study included male gender, confounding injury, other trauma type versus blunt trauma, penetrating versus blunt trauma, occurrence of fracture, and occurrence of crush injury or wound. Understanding these risk factors will assist in educating patients and their family about their prognosis. Also, understanding these risk factors will assist surgeons with patient selection when considering salvage procedures.     

Reconstructive foot surgery following complex trauma of the foot

Compound post-traumatic foot deformity may follow indirect, direct, or combined trauma. This is demonstrated by a number of case reports. Particularly during adolescence, primary injuries to the soft tissue, with neurovascular injury or compartment syndrome, and post-traumatic skin contractures can cause severe growth deformity at the site of the injury and distal to it. Compression screw arthrodesis, using the 6.5-mm cancellous screw with the triple arthrodesis and the 3.5-mm cortical screw with the Lisfranc arthrodesis, has particular significance. It is stable, it allows functional treatment later, and bone union takes place rapidly. The most important surgical principles in post-traumatic foot surgery are: precise reconstruction of the foot axes, the medial and lateral foot length, and the longitudinal and transverse arches, i.e., restitution of the normal foot anatomy.     

Diagnostic imaging of trauma to the ankle and foot: I. Fractures about the ankle

Drs. Mitchell et al. provide a valuable radiologic perspective of trauma to the ankle. The review is divided into six parts. The initial presentation deals with ankle fractures. Subsequent dialogues will consist of ligamentous injuries, trauma to the talus, calcaneal fractures, midfoot, and forefoot injuries. Plain x-ray film, as well as sophisticated studies, will assist in recognizing these conditions.     

外固定支架在创伤骨科中的应用

随着AO理念和教育在中国的普及,我国创伤骨科医生对骨折内固定的使用逐步规范。由于肢体创伤的复杂性和严重性,仅靠内固定技术已很难满足创伤骨科临床的救治需求。随着外固定支架技术和理念的不断创新使得其适应证日趋广泛,很多内固定无法处理的开放性损伤、骨缺损、骨感染、骨畸形等通过外固定支架治疗均可获得满意的效果。     

Acute compartment syndrome and complex trauma of the foot

Acute posttraumatic compartment syndrome of the foot is generally the consequence of a severe foot trauma. If the compartment syndrome is left unrecognized and untreated foot deformities and a variety of different functional impairments will follow, making secondary surgical interventions necessary. At present 9 or 10 clinically relevant compartments can be defined anatomically. The early diagnosis particularly in the unconscious patient is based essentially on measurement of the tissue pressure in the corresponding compartments. An effective compartment release depending on the extent of injury and involvement of the specific compartments needs knowledge of three different approaches. A complex foot trauma represents a clearly defined term (Zwipp score or zones-of-injury concept) which still has a quite ominous prognosis if it is not treated according to a stringent regime based on a profound expertise in this quite variable injury entity. An interdisciplinary approach is often deemed to be essential for a reasonable outcome. None of the accepted scores have proven to be useful for primary decision-making of amputation or for the assessment of the long-term prognosis.     

Osteoarthritis of the ankle and foot complex in former Greek soccer players

Sports activities cause increased loads in elite athletes' joints. Current scientific knowledge highlights the importance of applied mechanical loads on the physiology and pathophysiology of the articular cartilage. Thus, it is possible that sporting activity has a role in the development of osteoarthritis (OA), a painful and damaging joint disease. The aim of the present study was to investigate and record osteoarthritic alterations in the ankle and foot complex in former Greek soccer players and also compare them with those in the general population. The study sample consisted of 170 male, former elite soccer players, aged between 42 and 55 years (mean = 49.8 years, standard deviation [SD] = 7.4). A control group of 132 men, aged between 42 and 55 years (mean, 50.7 years, SD = 9.9), with no regular athletic activity were examined. The development of osteoarthritic alterations was recorded through a questionnaire and clinical and radiological examination. Radiographic analysis of the images in former athletes group showed not only more signs of cartilage degeneration in comparison with the control group (P < .05) but also similar clinical manifestations (pain and impaired mobility; P > .05). Osteophyte formation is a frequent disease among former soccer players--with variations on radiographic images--but it does not appear in their clinical picture. However, it is likely that both spurs and subchondral sclerosis (main findings) are preclinical manifestations of OA. Levels of Evidence: Prognostic, Level II.     

外固定架在创伤骨科中的应用

在内固定的理念和操作技术已经被我国广大创伤骨科医生所熟悉的今天，《中华创伤骨科杂志》推出“外固定支架的应用”专刊，是对读者非常有意义的启迪。近10年来，很多创伤骨科医生把很大精力投入在内固定的学习与实践上，殊不知外固定是骨折治疗的极为重要的手段之一。仅依靠一种治疗方式治疗所有创伤骨科疾患已根本不能满足创伤骨科患者的需要。