Foot and ankle clinics
-
Foot and ankle clinics · Dec 2008
ReviewInjuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions.
Injuries to the distal tibiofibular syndesmosis are frequent in collision sports. Most of these injuries are not associated with latent or frank diastasis between the distal tibia and fibula and are treated as high ankle sprains, with an extended protocol of physical therapy. Relevant instability of the syndesmosis results from rupture of two or more ligaments leading to a diastasis of more than 2 mm and requiring surgical fixation. ⋯ Proper reduction and positioning of the screws are more predictive of a good clinical result than the material, size, and number of cortices purchased. Chronic injuries without instability are treated by arthroscopic or open debridement and arthrolysis. Chronic syndesmotic instability can be treated with a three-strand peroneus longus ligamentoplasty in the absence of symptomatic arthritis or bony defects.
-
Fractures and dislocations of the midfoot and Chopart complex are among the most difficult foot injuries to manage. The treating surgeon is faced with a wide array of treatment challenges. Plain radiographs often grossly underestimate the extent of injury. ⋯ Fractures can occur in isolation or as part of a more complex injury pattern. Misdiagnosis and under treatment can lead to severe alterations of both normal anatomy and function. This article discusses the rationales and techniques for treating these difficult injuries.
-
Foot and ankle clinics · Dec 2008
ReviewHigh-energy foot and ankle trauma: principles for formulating an individualized care plan.
Care of the patient with high-energy foot and ankle trauma requires an individualized care plan. Staged treatment respecting the traumatized soft tissue envelope is often advisable. ⋯ Amputation is considered a rational treatment option for the patient with severe injury and poor host biology. Despite the most appropriate management, many severe foot and ankle injuries have a guarded prognosis.
-
Talar head and fracture injuries are not easily recognized and can create significant long-term disability when missed. Careful investigation of any injury about the ankle requires both clinical and radiographic examination. ⋯ Prolonged non-weight bearing and immobilization is the norm. Despite aggressive management, complications involving avascular necrosis and posttraumatic arthritis to both the subtalar and tibiotalar joints occurs frequently.
-
Ankle fractures involve a spectrum of injury patterns from simple to complex, such that these injuries are not always "just an ankle fracture." By combining the injury mechanism and the radiographic findings, the surgeon can apply the Lauge-Hansen classification in taking a rational approach to the management of these fractures. Syndesmotic instability and atypical patterns are becoming increasingly recognized, in part through the judicious use of CT scans. The goal of surgical stabilization includes atraumatic soft tissue management, rigid internal fixation, and early range of motion exercises in maximizing return of function.