Lower Extremity Complex Trauma and Complications, An Issue of Clinics in Podiatric Medicine and Surgery , livre ebook

Clinics Review Articles Clinics in Podiatric Medicine and Surgery
Lower Extremity Complex Trauma and Complications

Dr, John J. Stapleton, DPM, FACFAS
Foot and Ankle Surgery, VSAS Orthopaedics, Allentown, PA, USA
ISSN  0891-8422 Volume 31 • Number 4 • October 2014
Elsevier
Table of Contents
Cover image
Title page
Contributors
Consulting Editor
Editor
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
Foreword: Lower Extremity Trauma and Complications
Preface: Lower Extremity Complex Trauma and Complications
Open Fractures of the Foot and Ankle
Key points
Introduction
Classification of open fractures
Generalized management principles
Antibiotic delivery
Surgical debridement
Irrigation
Timing of debridement
Skeletal stabilization
Wound management
Open ankle fractures
Open hind-foot injuries
Open mid-foot and lisfranc injuries
Special cases
Summary
Diabetic Charcot Neuroarthropathy of the Foot and Ankle with Osteomyelitis
Key points
Introduction
Summary
Midfoot Crush Injuries
Key points
Introduction
Epidemiology of midfoot fractures
Functional anatomy of the midfoot joints
The soft tissue envelope
Compartment syndrome
Fracture blisters
Tarsometatarsal joint crush injuries
Chopart joint trauma
Navicular comminution
Isolated cuboid comminution
Global midfoot crushing
Rehabilitation
Summary
Fractures of the Talus
Key points
Introduction
Anatomy
Initial assessment
Initial management and timing
Management of specific fractures
Long-term results
Talar body fractures
Lateral process fractures
Summary
Management in High-risk Patients
Key points
Polytrauma and the foot and ankle injury
Fracture management in the diabetic patient
Management of foot and ankle fractures in the geriatric population
Summary
Surgical Treatment of Intra-articular Calcaneal Fractures
Key points
Preoperative evaluation and surgical planning
Open calcaneal fractures
Minimal incision versus extensile lateral approach
Postoperative complications
Discussion
Summary
Surgical Treatment of Tibial Plafond Fractures
Key points
Initial care plan
Stepwise approach
Fracture pattern and reduction techniques
Surgical incisional approaches
Osteosynthesis of the fibula
Postoperative complications
Summary
The Mangled Foot and Ankle
Key points
Preoperative assessment
Surgical treatment
Postoperative expectations
Summary
Acknowledgement
Strategies for Managing Bone Defects of the Lower Extremity
Key points
Plate fixation
Intramedullary nailing
The Papineau method
Mesh titanium cages
Porous tantalum cones and cylinders
External fixation methods
Vascularized fibular transport
Summary
Rehabilitation After Major Extremity Trauma
Key points
Introduction
Rehabilitation
Pain
Foot and ankle trauma at work
Case study
Workman’s compensation
Worker’s compensation benefits
The difference if injured on the job
A case study
Summary
Supramalleolar Osteotomy and Ankle Arthrodiastasis for Juvenile Posttraumatic Ankle Arthritis
Key points
Case report
Surgical technique
Discussion
Summary
Index
Contributors

Consulting Editor
THOMAS ZGONIS, DPM, FACFAS
Associate Professor, Externship and Fellowship Director in Reconstructive Foot and Ankle Surgery, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas

Editor
JOHN J. STAPLETON, DPM, FACFAS
Associate, Foot and Ankle Surgery, VSAS Orthopaedics, Chief of Podiatric Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania; Clinical Assistant Professor of Surgery, Penn State College of Medicine, Hershey, Pennsylvania

Authors
PATRICK BURNS, DPM
Assistant Professor, University of Pittsburgh Medical Center Mercy Hospital, Comprehensive Foot and Ankle Center, Pittsburgh, Pennsylvania
YURY BYKOV, MD
Orthopaedic Trauma Surgeon, Orthopaedic Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, Allentown, Pennsylvania
LAWRENCE A. DiDOMENICO, DPM, FACFAS
Ankle and Foot Care Centers, Youngstown, Ohio; Adjunct Professor, Director of Reconstructive Rearfoot and Ankle Surgical Fellowship, Kent State University College of Podiatric Medicine, Independence, Ohio; Teaching staff, Heritage Valley Health System, Beaver, Pennsylvania
GEOFFREY G. HALLOCK, MD
Division of Plastic Surgery, Sacred Heart Hospital and Lehigh Valley Hospital, Allentown, Pennsylvania; St Luke’s Hospital, Bethlehem, Pennsylvania
PETE HIGHLANDER, DPM, MS
PGY-3 UPMC, Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center Mercy Hospital, Comprehensive Foot and Ankle Center, Pittsburgh, Pennsylvania
KALLIOPI LAMPROPOULOU-ADAMIDOU, MD, MSc
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
SPIROS G. PNEUMATICOS, MD, PhD
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
VASILIOS D. POLYZOIS, MD, PhD
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
CRYSTAL L. RAMANUJAM, DPM, MSc
Assistant Professor/Clinical, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
SCOTT E. SEXTON, MD
Director of Orthopaedic Trauma, Department of Surgery, Lehigh Valley Hospital, VSAS Orthopaedics, Allentown, Pennsylvania
ANDREW B. SHINABARGER, DPM, MS
Legacy Medical Group - Foot and Ankle, Portland, Oregan
JOHN J. STAPLETON, DPM, FACFAS
Associate, Foot and Ankle Surgery, VSAS Orthopaedics, Chief of Podiatric Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania; Clinical Assistant Professor of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
IOANNIS P. STATHOPOULOS, MD, MSc
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
ZACHARY M. THOMAS, DPM
Ankle and Foot Care Centers, Youngstown, Ohio; Heritage Valley Health System, Beaver, Pennsylvania
ELIAS S. VASILIADIS, MD, PhD
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
JOHN VLAMIS, MD, PhD
3rd Department of Orthopaedics and Traumatology, KAT Hospital, Kifisia, Athens, Greece
GEORGE F. WALLACE, DPM, MBA
Director, Podiatry Service; Medical Director, University Hospital, Newark, New Jersey
THOMAS ZGONIS, DPM, FACFAS
Associate Professor, Externship and Fellowship Director in Reconstructive Foot and Ankle Surgery, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
Contents

Foreword: Lower Extremity Trauma and Complications xiii
Thomas Zgonis

Preface: Lower Extremity Complex Trauma and Complications xv
John J. Stapleton

Open Fractures of the Foot and Ankle 461
Scott E. Sexton
Open fractures of the lower extremity cover a wide gamut of injuries ranging from the mangled, pulseless leg necessitating amputation to the more innocuous pinhole open wounds associated with simple fracture patterns. Prompt diagnosis and appropriate care can make a dramatic difference in decreasing complication rates and improving ultimate outcomes. Principles of management of open fractures have been created with the main goal of decreasing infection rates, while providing for stabilization of the bone and soft tissue injury.

Diabetic Charcot Neuroarthropathy of the Foot and Ankle with Osteomyelitis 487
Crystal L. Ramanujam, John J. Stapleton, and Thomas Zgonis
One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis.

Midfoot Crush Injuries 493
Lawrence A. DiDomenico and Zachary M. Thomas
Treatment of midfoot injuries is surgical or nonsurgical, depending on the injury, the location, and the extent of the injury. Minor injuries usually heal with casting or bracing, whereas more unstable injuries typically need surgery for stability. Whether the injury is in a weight-bearing portion of the foot is also a consideration for surgery. The importance of treating midfoot injuries adequately is shown in how the midfoot is needed for function with weight bearing and its relationship between the front and the back of the foot. It is also important to ensure that the patient is able to