Fractures of the Foot and Ankle: Diagnosis and Treatment of Injury and Disease

by Calhoun; Jason H.

• ISBN13: 9780824759162
• ISBN10: 0824759168
• Format: Hardcover
• Copyright: 2005-03-29
• Publisher: CRC Press

Summary

With contributions from an established team of experts on the subject, this reference illustrates current practices and techniques in the care of patients with foot and ankle fractures--demonstrating treatment methods for fractures and dislocations, pediatric injuries, soft tissue management, crush injury, and post-traumatic reconstruction.

Table of Contents

Ankle Fractures	1	(26)
Stuart D. Miller
Steven A. Herbst
Introduction	1	(1)
Anatomy	2	(2)
Classification of Ankle Fractures	4	(1)
Physical Examination	5	(1)
Radiographic Examination	6	(1)
Outcome of Ankle Fractures	7	(1)
Comparison of Operative and Nonoperative Results	8	(1)
Results of Operative Intervention	9	(1)
Historical and Research Considerations for Treatment of Ankle Fracture Subtypes: A Brief Review	9	(4)
Isolated Lateral Malleolus	9	(1)
Posterior Malleolar Fracture	10	(1)
Medial Malleolar Fracture	11	(1)
Syndesmosis Involvement	11	(1)
Talar Shift without Fracture	12	(1)
Osteochondral Injury	12	(1)
Open Fractures	12	(1)
Techniques of Closed Reduction and Subsequent Care	13	(1)
Surgical Techniques	13	(6)
Lateral Malleolus	13	(1)
Medial Malleolus	14	(1)
Bimalleolar	15	(4)
Trimalleolar	19	(1)
Osteoporosis and Ankle Fractures	19	(2)
Ankle Dislocation or Ligamentous Disruption	21	(2)
Conclusion	23	(4)
References	23	(4)
Pilon Fractures	27	(22)
Richard T. Laughlin
Introduction	27	(1)
Fracture Classification	28	(1)
Soft Tissue Classification	28	(2)
Temporary Fixation	30	(3)
Fixation of The Tibial Articular Surface	33	(3)
Plate Fixation	36	(1)
External Fixation	37	(6)
Postoperative Care	43	(1)
Results	44	(1)
Complications	45	(1)
Conclusion	46	(3)
Acknowledgment	46	(1)
References	46	(3)
Talar Fractures and Dislocations	49	(44)
Saul G. Trevino
Vinod K. Panchbhavi
Introduction	50	(1)
History	50	(1)
Anatomy	51	(4)
The Head of the Talus	51	(1)
The Neck of the Talus	51	(1)
The Body of the Talus	52	(1)
Blood Supply	52	(2)
Posterior Tibial Artery	54	(1)
Dorsalis Pedis Artery and Peroneal Artery	54	(1)
Intraosseous Circulation	54	(1)
Fractures of the Talar Neck	55	(7)
Clinical Features	56	(1)
Classification	56	(1)
Imaging Studies	56	(2)
Categories	58	(1)
Group I Fractures	58	(1)
Group II Fractures	59	(2)
Group III Fractures	61	(1)
Surgical Techniques	62	(3)
Hawkins III Open Fractures	65	(2)
Hawkins Type IV Injuries	67	(1)
Total Dislocation of the Talus	68	(2)
Shear Fractures of the Talar Body	70	(1)
Complications	70	(6)
Skin Problems	70	(1)
Osteomyelitis	71	(4)
Avascular Necrosis (AVN)	75	(1)
Nonunion	75	(1)
Malunions of the Talar Neck	76	(1)
Posttraumatic Arthritis	76	(1)
Surgical Treatment	76	(3)
Principles of Arthrodesis	76	(1)
Ankle Arthrodesis	77	(1)
Tibiotalar Fusion with Partial Talectomy	78	(1)
Talectomy and Tibiocalcaneal Fusion	78	(1)
Osteochondral Lesions (OCLS) of the Talus	79	(5)
Treatment	82	(2)
Prognosis	84	(1)
Fractures of the Posterior Process	84	(1)
Anatomy	84	(1)
Mechanism of Injury	84	(1)
Clinical Features	85	(1)
Treatment	85	(1)
Fracture of the Medial Tubercle (Cedell's Fracture)	85	(2)
Fractures of the Lateral Process	87	(2)
Clinical Evaluation	87	(1)
Mechanism of Injury	87	(2)
Clinical Evaluation	89	(1)
Treatment	89	(1)
Conclusion	89	(4)
References	89	(4)
Calcaneal Fractures	93	(24)
Paul J. Juliano
Hoan-Vu Nguyen
History	94	(1)
Anatomy	94	(1)
Mechanism of Injury	95	(3)
Classification	98	(3)
Initial Presentation	101	(1)
Initial Management	101	(1)
Radiographic Examination	101	(3)
Definitive Management	104	(4)
Extra-Articular Fractures	104	(2)
Intra-Articular Fractures	106	(2)
Surgical Approach	108	(1)
Lateral Approach	108	(1)
Medial Approach	108	(1)
Preferred Method of Treatment	108	(1)
Postoperative Management	109	(1)
Complications	109	(5)
Open Calcaneal Fractures	114	(1)
Salvage Procedures	114	(1)
Conclusions	114	(3)
References	115	(2)
Lisfranc Injuries and Midfoot Fractures	117	(48)
Kent Heady
Saul G. Trevino
Tarsometatarsal (TMT) (Lisfranc) Injuries	118	(27)
Introduction	118	(1)
History	118	(1)
Anatomy	118	(3)
Biomechanics	121	(1)
Mechanism of Injury	122	(2)
Classification	124	(2)
Diagnosis	126	(3)
Treatment	129	(1)
Principles	129	(1)
Timing of Surgery	130	(1)
Closed Reduction and Casting	131	(1)
Closed Reduction and Percutaneous Fixation	131	(1)
External Fixation	132	(1)
Open Reduction and Internal Fixation	132	(1)
Extensile Dorsomedial Approach to the Midfoot	132	(3)
Postoperative Care	135	(1)
Prognosis	136	(4)
Midfoot Sprains in Athletes	140	(3)
Salvage Procedures	143	(1)
Complications	143	(1)
Devascularization	143	(2)
Skin Compromise	145	(1)
Other Complications	145	(1)
Midfoot Fractures	145	(14)
Introduction	145	(1)
Anatomy	145	(1)
Navicular Fractures	146	(1)
Classification and Mechanism of Injury	146	(2)
Diagnosis	148	(2)
Treatment	150	(9)
Conclusion	159	(6)
References	159	(6)
Fractures of the Metatarsals and Phalanges of the Foot	165	(14)
Bryan J. Hawkins
Introduction	165	(1)
Anatomy	166	(1)
Mechanism of Injury	166	(1)
Radiographic Evaluation	166	(1)
Fractures of the First Metatarsal	167	(1)
Fractures of the Lesser Metatarsals	167	(8)
Shaft Fractures	167	(5)
Fractures of the Proximal Aspect of the Fifth Metatarsal	172	(3)
Phalangeal Fractures	175	(2)
Hallucal Fractures	175	(1)
Lesser Toe Fractures	176	(1)
Conclusion	177	(2)
References	177	(2)
Foot and Ankle Fractures in Diabetic Patients	179	(16)
Michael S. Pinzur
Introduction	179	(1)
Wound Healing in the Diabetic Patient	179	(1)
Fracture Susceptibility in the Diabetic Patient	180	(1)
Undisplaced Fractures	180	(2)
Displaced or Unstable Fractures	182	(3)
Charcot Foot	185	(1)
Fractures of the Calcaneus	185	(1)
Fractures of the Hindfoot	185	(3)
Fractures of the Midfoot (Tarsometatarsal)	188	(1)
Fractures of the Forefoot	188	(2)
Summary	190	(5)
References	191	(4)
Dislocations of the Ankle, Subtalar, and Great Toe Metatarsal--Phalangeal Joints	195	(16)
David A. Porter
Todd Arnold
Introduction	196	(1)
Ankle Dislocation	196	(3)
Historical Review	196	(1)
Epidemiology and Anatomy	197	(1)
Pathogenesis and History	197	(1)
Clinical Findings	197	(1)
Radiographic Findings	198	(1)
Treatment Options	199	(1)
Prognosis and Long-Term Follow-Up	199	(1)
Subtalar Joint Dislocation	199	(4)
Historical Review	199	(1)
Epidemiology and Anatomy	200	(1)
Pathogenesis and History	200	(1)
Clinical Findings	200	(1)
Radiographic Findings	200	(1)
Treatment Options	201	(2)
Long-Term Results and Prognosis	203	(1)
Great Toe MTP Dislocation	203	(4)
Historical Review	203	(1)
Epidemiology and Anatomy	203	(1)
Pathogenesis and History	203	(1)
Clinical Findings	204	(1)
Radiographic Findings	205	(1)
Treatment Options	205	(2)
Prognosis and Long-Term Outcome	207	(1)
Conclusion	207	(4)
References	208	(3)
Pediatric Foot and Ankle Fractures	211	(54)
Kelly D. Carmichael
Introduction	212	(1)
Ankle Fractures	212	(35)
Anatomy of the Distal Tibia and Fibula Region	212	(1)
Etiology, Prevalence, Diagnosis, and Natural History of Fractures about the Ankle Region	213	(1)
Classification Systems	214	(1)
Treatments	215	(1)
Distal Tibia Metaphyseal Fractures	215	(1)
Salter--Harris Type I Fractures	215	(1)
Salter--Harris Type II Fractures	215	(7)
Salter--Harris Type III and IV Fractures	222	(6)
Salter--Harris Type V Fractures	228	(1)
Isolated Fibula Growth Plate Injuries and Fibula Fractures	229	(1)
Transitional Fractures	229	(1)
Juvenile Tillaux Fractures	229	(7)
Triplane Fractures	236	(7)
Adolescent Pilon Fractures	243	(3)
Complications of Ankle Fractures	246	(1)
Pediatric Foot Fractures	247	(10)
Anatomy	247	(1)
Talus Fractures	247	(1)
General Features	247	(1)
Talar Neck Fractures	248	(3)
Body Fractures and Other Injuries of the Talus	251	(1)
Calcaneus Fractures	252	(1)
Lesser Tarsal Fractures and Tarsometatarsal Injuries	253	(1)
Metatarsal Fractures	254	(3)
Phalanx Fractures	257	(1)
Summary	257	(8)
References	257	(8)
Soft Tissue Coverage of the Foot and Ankle	265	(22)
R. Michael Johnson
Steven Schmidt
Introduction	266	(1)
Wound Evaluation	266	(1)
Patient Evaluation	266	(1)
Mechanism	267	(1)
Wound Management Principles	267	(1)
Reconstruction	267	(1)
Nonoperative Treatment	267	(1)
Nonoperative Coverage of Foot and Ankle Wounds	268	(1)
Platelet-Derived Growth Factor (PDGF)	268	(1)
Topical Negative Pressure	268	(1)
Hyperbaric Oxygen (HBO)	268	(1)
Operative Treatment	268	(14)
Primary Closure	269	(1)
Skin Grafts	269	(1)
Local (Pedicle) Flaps	269	(1)
Lateral Calcaneal Artery Flap	269	(2)
Medial Plantar Flaps	271	(1)
Sural Fasciocutaneous Flap	271	(1)
Flexor Digitorum Brevis	271	(1)
Extensor Digitorum Brevis	271	(2)
Dorsalis Pedis	273	(1)
Free-Flap Reconstruction	273	(1)
Vascular Disease and Free-Tissue Transfer	274	(1)
Diabetes and Free-Tissue Transfer	274	(1)
Sensitivity and Foot and Ankle Reconstruction	274	(1)
Free Flaps and the Elderly	275	(1)
Long-term Results of Free-Flap Foot Reconstruction	275	(1)
Failures and Revisions	275	(1)
Gait	275	(1)
Specific Free Flaps	276	(1)
Radial Forearm Flap	276	(1)
Rectus Abdominus	277	(1)
Latissimus Dorsi (LD)	278	(1)
Parascapular	279	(1)
Serratus Anterior	279	(1)
Gracilis	279	(1)
Lateral Arm Flap	280	(1)
Other Flaps	280	(2)
Conclusion	282	(5)
Acknowledgment	282	(1)
References	283	(4)
Burns to the Feet	287	(22)
Sidney F. Miller
Matthew R. Talarczyk
Introduction	288	(1)
Development of Modern Burn Care and the Burn Team Concept	288	(1)
Initial Evaluation	289	(2)
Inhalation Injury and Associated Injuries	289	(1)
Pathophysiology of the Burn Injury	289	(1)
Evaluation of the Burn Wound	289	(1)
Assessing the Extent and Depth of the Burn Wound	289	(2)
Treatment	291	(6)
Resuscitation	291	(1)
Escharotomy	292	(1)
Initial Wound Care	292	(2)
Definitive Wound Coverage	294	(2)
Hyperbaric Oxygen	296	(1)
Reconstruction and Rehabilitation, Hypertrophic Scars, and Contractures	297	(5)
Classification of Contractures	299	(1)
Treatment	300	(1)
External Fixators	300	(1)
Limb Suspension	301	(1)
Garments	301	(1)
Orthotics	302	(1)
Special Orthopedic Issues	302	(1)
Bone and Achilles Tendon Exposure	302	(1)
Fractures	302	(1)
Involved Joints	303	(1)
Complications	303	(2)
Dystrophic Calcification	303	(1)
Osteoporosis	303	(1)
Pigmentation	303	(1)
Marjolin's Ulcers	303	(2)
Special Types of Burns	305	(2)
Electrical Burns	305	(1)
Chemical Burns	306	(1)
Prevention	307	(1)
Summary	307	(2)
References	308	(1)
Tendon Ruptures and Lacerations	309	(36)
Lew C. Schon
Steven A. Herbst
Introduction	310	(1)
Anterior Tibial Tendon	310	(3)
Etiology of Rupture	311	(1)
Nonoperative Treatment	311	(2)
Operative Treatment	313	(1)
EHL Tendon	313	(4)
Etiology of Rupture	313	(1)
Nonoperative Treatment	313	(3)
Operative Treatment	316	(1)
EDL Tendon	317	(1)
Ruptures of the EDL	317	(1)
Achilles Tendon	317	(11)
Prerupture Conditions and Treatment	318	(1)
Nonoperative Treatment	318	(1)
Operative Treatment	319	(2)
Achilles Tendon Rupture	321	(1)
Conservative Treatment	322	(1)
Comparison of Operative and Nonoperative Treatment	322	(1)
Operative Treatment	323	(1)
Percutaneous Repair	323	(1)
Chronic Rupture	323	(2)
Operative Treatment	325	(3)
Peroneals	328	(8)
Anatomy	328	(1)
Peroneal Tenosynovitis, Attritional Tears, and Rupture	328	(1)
Peroneus Brevis Tears	329	(1)
Os Perineum and Peroneus Longus Tears	329	(2)
Peroneus Brevis Subluxation or Dislocation	331	(2)
Chronic Repairs	333	(3)
Flexor Digitorum Longus	336	(1)
Flexor Hallucis Longus	336	(2)
Etiology	337	(1)
Nonoperative Treatment	337	(1)
Operative Treatment	337	(1)
Posterior Tibial Tendon	338	(3)
Etiology	338	(1)
Nonoperative Treatment	339	(1)
Operative Treatment	339	(1)
Dislocation of the Posterior Tibial Tendon	340	(1)
Conclusion	341	(4)
References	341	(4)
Posttraumatic Infections in the Foot and Ankle	345	(26)
Maria Guidry
Brian Hutchinson
Richard T. Laughlin
Hongbao Ma
Jason H. Calhoun
Introduction	346	(7)
Classification	347	(1)
Microbiology	347	(1)
Diagnosis	347	(1)
Clinical Evaluation	347	(1)
Laboratory Evaluation	347	(1)
Evaluation for Blood and Oxygen Supply to Tissues	348	(1)
Imaging Studies	348	(1)
Management	349	(1)
Cultures	349	(1)
Antimicrobial Therapy	350	(1)
Surgical Treatment	351	(2)
Adjunctive Therapy	353	(1)
Posttraumatic Skin and Soft Tissue Infections	353	(4)
Puncture Wounds	353	(1)
Clinical Evaluation	353	(1)
Treatment	353	(1)
Necrotizing Fasciitis	354	(1)
Clinical Presentation	354	(1)
Diagnosis	354	(1)
Treatment	355	(1)
Postoperative Wound Infections	355	(1)
Pin Track Infections	355	(1)
Clinical Presentation	356	(1)
Diagnosis	357	(1)
Management	357	(1)
Foot and Ankle Osteomyelitis	357	(3)
Classification	357	(1)
Etiology	357	(1)
Postoperative Osteomyelitis	358	(1)
Posttraumatic Osteomyelitis	359	(1)
Principles of Osteomyelitis Management	359	(1)
Postoperative Infections Following Fractures	360	(5)
Fractures of the Plafond	360	(1)
Incidence and Risk Factors	360	(1)
Treatment	360	(1)
Ankle Fractures	361	(1)
Incidence and Risk Factors	361	(1)
Treatment	361	(1)
Talus	362	(1)
Incidence and Risk Factors	362	(2)
Treatment	364	(1)
Calcaneus	364	(1)
Incidence and Risk Factors	364	(1)
Treatment	364	(1)
Midfoot and Forefoot	364	(1)
Conclusion	365	(6)
References	367	(4)
Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy	371	(10)
William A. Vitello
Introduction	371	(1)
History	372	(1)
Definitions	372	(1)
Pathophysiology	372	(1)
Stages	373	(1)
Stage I (Acute)	374	(1)
Stage II (Dystrophic)	374	(1)
Stage III (Atrophic)	374	(1)
Clinical Diagnosis	374	(1)
Diagnostic Testing	375	(1)
Radiographs	375	(1)
Three-Phase Radionuclide Bone Scan	375	(1)
Sympathetic Blockade	376	(1)
Thermoregulatory Testing	376	(1)
Psychological Evaluation	376	(1)
Treatments	376	(2)
Pharmacological Treatment	376	(1)
Antidepressants	377	(1)
Narcotic Analgesics	377	(1)
Oral Nifedipine	377	(1)
Nerve Blocks	377	(1)
Intravenous Regional Blocks	377	(1)
Surgical Sympathectomy	378	(1)
Physical Therapy	378	(1)
Summary	378	(3)
References	378	(3)
Late Reconstruction	381	(12)
Mark D. Perry
Arthur Manoli II
Introduction	381	(1)
General Considerations	382	(1)
Late Reconstruction	382	(1)
Specific Injuries	383	(7)
Talus Fractures	383	(1)
Calcaneus	384	(3)
Midfoot	387	(1)
Cuboid	387	(2)
Syndesmotic Injuries	389	(1)
Compartment Syndrome	389	(1)
Flexion Contractures	390	(1)
Summary	390	(3)
References	390	(3)
Traumatic Amputations of the Foot and Ankle	393	(30)
Jason H. Pleimann
Robert B. Anderson
W. Hodges Davis
Bruce E. Cohen
Introduction	394	(1)
Initial Assessment and Acute Treatment	395	(3)
Foot Salvageability	395	(1)
Acute Management --- Preoperative	396	(1)
Acute Management --- Operative	397	(1)
Subacute Management	398	(3)
Chronic Management	401	(3)
Rehabilitation	401	(1)
Complications	402	(2)
Specific Amputation Levels	404	(16)
Terminal Syme	404	(1)
Technique	404	(1)
Complications	405	(1)
Orthotic and Prosthetic Issues	405	(1)
Great Toe Amputation	405	(1)
Technique	406	(1)
Complications	406	(1)
Orthotic and Prosthetic Issues	406	(1)
Lesser Toe Amputation	406	(1)
Technique	406	(1)
Complications	406	(1)
Orthotic and Prosthetic Issues	407	(1)
Ray Resections	407	(1)
Technique	408	(1)
Complications	408	(2)
Orthotic and Prosthetic Issues	410	(1)
Transmetatarsal Amputations	410	(1)
Technique	410	(3)
Complications	413	(1)
Orthotic and Prosthetic Issues	413	(1)
Lisfranc's Amputation	413	(1)
Chopart's Amputation	413	(1)
Technique	414	(1)
Complications	415	(1)
Orthotic and Prosthetic Issues	416	(1)
Syme's Amputation	417	(1)
Technique	417	(1)
Complications	418	(1)
Orthotic and Prosthetic Issues	419	(1)
Conclusion	420	(3)
References	421	(2)
Orthotic Management of Foot and Ankle Fractures	423	(16)
Geza F. Kogler
Introduction	423	(6)
Prefabricated vs. Custom-Molded	424	(1)
Mechanical Function and Control Mechanisms	424	(1)
Arch Support Mechanisms	424	(1)
Wedges	425	(1)
Heel Lifts and Elevations	425	(1)
Orthotic Principles and Biomechanical Considerations	425	(1)
Diagnostic Tests to Determine Pain Reduction Potential	426	(1)
Medial Column Load-Bearing Test	426	(1)
Lateral Column Load-Bearing Test	426	(2)
Hindfoot Load-Bearing Test	428	(1)
Negative Impression Technique Considerations	428	(1)
Orthotic Treatment of Fractures	429	(7)
Phalanges	429	(1)
Metatarsals	430	(1)
Stress Fractures	430	(1)
Sesamoid Bones of the Great Toe	430	(1)
Navicular, Cuneiforms, and Cuboid	431	(1)
Talus	432	(1)
Calcaneus	433	(1)
Ankle	433	(3)
Conclusion	436	(3)
References	437	(2)
Treatment of Foot and Ankle Deformities with the Ilizarov Fixator	439	(20)
Daniel M. Thompson
Jason H. Calhoun
Introduction	439	(1)
Classification of Deformities	440	(1)
Simple Deformities	440	(10)
Equinus Contracture	440	(3)
Distal Tibial Angular Deformity	443	(1)
Osteotomy with Internal Fixation	444	(2)
External Fixation Technique	446	(2)
Simple Nonunion	448	(2)
Arthrodesis	450	(1)
Complex Deformities	450	(7)
Complex Equinus Deformity	450	(1)
Cavus Deformity	450	(1)
Rocker-Bottom Deformity	451	(2)
Infection	453	(2)
Amputation	455	(1)
Special Patient Populations	455	(2)
Summary	457	(2)
References	458	(1)
Index	459