RESUMO
Pilon fractures are complex injuries that can be difficult to treat and lead to severe complications if not managed appropriately. A thorough examination for polytraumatic injuries, neurovascular status, and skin condition should be done. A variety of approaches can be chosen based on fracture pattern, including staging, incisional approach, and no-touch technique. This article discusses various ways to manage pilon fractures.
Assuntos
Fixação Interna de Fraturas , Fraturas da Tíbia , Humanos , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/terapiaRESUMO
Metatarsal fractures are some of the most common fractures reported in the human body. Recent advances in surgical techniques and fixation have helped facilitate healing and improved outcomes for our patients. The treatment goals of metatarsal fractures are to maintain the metatarsal parabola, sagittal position of the metatarsal heads, and a congruent metatarsophalangeal joint. Most of these injuries can be treated nonoperatively, but displaced fractures require surgical intervention to preserve normal gait biomechanics.
Assuntos
Fixação Interna de Fraturas , Fraturas Ósseas , Ossos do Metatarso , Humanos , Ossos do Metatarso/lesões , Ossos do Metatarso/cirurgia , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , MasculinoRESUMO
Currently, disagreement exists regarding the superior method for repairing a ligamentous Lisfranc injury regarding whether to use arthrodesis or open reduction internal fixation. The 2 procedures differ in the amount of articular cartilage destroyed. Arthrodesis removes all the articular cartilage, and open reduction internal fixation places transarticular screws, essentially destroying a portion of cartilage. We performed a review of 30 consecutive computed tomography scans that included both foot length and undamaged first, second, and third tarsometatarsal joints to quantify the amount of articular surface area destroyed by placement of standardized 4-mm diameter screws. Measurements were performed using a freeform tool. The calculated surface area of the screws was subtracted from the measured surface area of the joint to yield the amount of surface area occupied by the screws. Our results demonstrated that the average amount of articular surface area destroyed in the first, second, and third tarsometatarsal joints was 4.87%, 4.79%, and 4.86% respectively, with a standard deviation of <1% for each of the joints. Our results have demonstrated that screw placement accounts for only a small percentage of articular surface destroyed. They also showed that the articular surface damage was comparable among the first 3 tarsometatarsal joints. Additionally, our results were similar to the articular surface area calculated from cadaveric specimens in a previous biomechanical study, demonstrating that computed tomography can allow for reliable and accurate assessments of articular surface areas in the foot.
Assuntos
Artrodese/instrumentação , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Ligamentos Articulares/diagnóstico por imagem , Ossos do Metatarso/diagnóstico por imagem , Articulações Tarsianas/diagnóstico por imagem , Humanos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Ossos do Metatarso/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Articulações Tarsianas/lesões , Articulações Tarsianas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We present an interesting, but unfortunate, case of an 86-year-old female who sustained a trimalleolar ankle fracture dislocation that resulted in below-the-knee amputation after open reduction and internal fixation of the fracture. To the best of our knowledge, this is the first case report describing popliteal variants that ultimately resulted in critical limb ischemia and below-the-knee amputation after foot and ankle trauma. The anatomic variation altered the expected outcome from a relatively straightforward surgical case. We introduce the previously described lower extremity Allen test and describe how it can be a useful adjunct in the initial physical examination of lower extremity trauma. The ability to identify abnormal distal perfusion to the foot could provide enough insight to warrant evaluating the patient with angiography or computed tomography angiography.
Assuntos
Amputação Cirúrgica/métodos , Fraturas do Tornozelo/cirurgia , Arteriopatias Oclusivas/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Luxações Articulares/cirurgia , Artérias da Tíbia/anormalidades , Idoso de 80 Anos ou mais , Amputação Cirúrgica/reabilitação , Fraturas do Tornozelo/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Angiografia por Ressonância Magnética/métodos , Artéria Poplítea/anormalidades , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Doenças Raras , Tíbia/cirurgia , Artérias da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Repair of segmental bone defects is an enormous challenge for foot and ankle surgeons. This report describes the case of an unusual technique for managing segmental bone voids about the ankle, namely the use of a cylindrical titanium cage packed with bone graft, and an intramedullary nail. The technique was successful at bridging a large segmental defect, and biopsy specimens procured from the length of the healed graft confirmed osseous consolidation.
Assuntos
Pinos Ortopédicos , Transplante Ósseo/métodos , Osso e Ossos/anormalidades , Osso e Ossos/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas da Tíbia/cirurgia , Doenças Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Telas Cirúrgicas , TitânioRESUMO
The purpose of this retrospective study was to determine the outcome of bimalleolar equivalent ankle fractures in patients who were treated nonoperatively. The charts of 214 patients with isolated Weber B (supination-external rotation pattern) fibula fractures were reviewed. Fifty-one patients met the inclusion criteria and were administered the American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey by telephone or personal interview. The average medial clear space was 5.09 mm; the average American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score was 84.22. A medial clear space of 4, 5, 6, and 7 mm resulted in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores of 90.22, 89.4, 72.0 and 63.17, respectively. Further analysis showed significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between the 4 mm medial clear space group and the 6 mm and 7 mm medial clear space groups; the 5 mm medial clear space group and the 6 mm and 7 mm groups. Our results suggest that medial tenderness and ecchymosis alone are not sufficient to meet operative criteria, a higher medial clear space on stress gravity views correlates with a lower American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score, and that there are significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between groups with medial clear space 4 to 7 mm. ACFAS Level of Clinical Evidence: 2b.