Foot and ankle clinics
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Foot and ankle clinics · Mar 2010
ReviewWar wounds of the foot and ankle: causes, characteristics, and initial management.
Foot and ankle trauma sustained in the Global War on Terror have unique causes and characteristics. At least one-quarter of all battle injuries involve the lower extremity. These severe lower extremity wounds require specialized early treatment. ⋯ Wounds are characteristically caused by blast mechanisms, but high velocity gunshot injuries are also common. The severe and polytraumatic nature of injuries sustained frequently call for damage control orthopaedics to be utilized. Cautious early treatment of irregular and highly exudative ballistic wounds with subatmospheric wound dressings may ease their early management.
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Foot and ankle clinics · Mar 2010
ReviewCompartment syndrome and lower-limb fasciotomies in the combat environment.
Prophylactic and therapeutic treatment of leg compartment syndrome with decompression by double-incision fasciotomy prevents progression of soft-tissue injury in high-energy trauma. This treatment is the standard of care in civilian trauma and combat settings. ⋯ The role for prophylactic fasciotomy of the foot is unclear and should be considered on a case by case basis. The surgeon must maintain a high degree of vigilance for the development of compartment syndrome in the combat casualty.
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Foot and ankle clinics · Mar 2010
ReviewUse of tourniquets and their effects on limb function in the modern combat environment.
Tourniquets have been called powerful lifesaving devices by some authors, whereas others say they cause more harm than good. Given recent emergency tourniquet developments in scientific design of devices, widespread user training, modern doctrine based on evidence, and thorough fielding to users within an integrated trauma system with rapid evacuation, tourniquets have shown minor morbidity and major lifesaving results. Trauma systems with poorly designed devices, inadequate user training, no tourniquet doctrine, or slow casualty evacuation, however, have repeatedly shown severe morbidity and mortality. Tourniquets may save lives if the right device is used in the right way at the right time for the right patient.
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Foot and ankle clinics · Sep 2009
ReviewTreatment of nonunion and malunion of trauma of the foot and ankle using external fixation.
Salvage of nonunion and malunion of trauma of the foot and ankle is often challenging surgery. Internal fixation provides the mainstay of most orthopedic surgeons' treatment of these conditions. Patient systemic factors, local factors, and the complex nature of these often multiplanar deformities may make external fixation a more viable option. This article provides an overview of the principles and results of the use of external fixation.
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Malunion of a first metatarsal osteotomy or fracture can result in dorsal angulation of the distal fragment and shortening of the metatarsal, among other deformities. Dorsal malunion can be caused by improper orientation of the osteotomy, poor intraoperative fixation, or loss of fixation post-operatively due to premature weight bearing or catastrophic failure. ⋯ However, treatment options would be similar as for malunion following an osteotomy. The treatment of malunions depends on how symptomatic the patient is, including pain, difficulty with ambulation, and whether they complain of transfer metatarsalgia.