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Clinics in Podiatric Medicine and... Jul 2024Pediatric foot and ankle trauma includes a range of injuries affecting the lower extremities in children, typically aged from infancy to adolescence. These incidents can... (Review)
Review
Pediatric foot and ankle trauma includes a range of injuries affecting the lower extremities in children, typically aged from infancy to adolescence. These incidents can arise from various causes, including sports-related accidents, falls, and high-velocity injuries. Due to the dynamic growth and development of bones and soft tissues in pediatric patients, managing these injuries requires specialized knowledge and care. Early diagnosis and appropriate treatment are crucial to ensure optimal recovery and prevent potential long-term consequences. Treatment depends on severity and type of injury but may involve a combination of immobilization, physical therapy, or surgical intervention.
Topics: Humans; Child; Foot Injuries; Ankle Injuries; Adolescent; Child, Preschool; Infant; Fractures, Bone
PubMed: 38789171
DOI: 10.1016/j.cpm.2024.02.001 -
Clinics in Podiatric Medicine and... Jul 2024Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries... (Review)
Review
Ankle fractures are one of the more common musculoskeletal injuries that are treated by foot and ankle specialists. A thorough understanding of managing these injuries requires the ability to differentiate between stable and unstable fractures. The current literature supports the nonoperative management of stable Weber B ankle fractures, whereas unstable fractures have much better outcomes with surgical intervention. Specifically, we review the fixation strategies for the lateral, medial, and posterior malleolar fractures respectively. Finally, we discuss the current trends in postoperative management of some of the more common fracture patterns, and the safety in early weight-bearing protocols.
Topics: Female; Humans; Male; Ankle Fractures; Fracture Fixation; Fracture Fixation, Internal; Weight-Bearing; Practice Guidelines as Topic
PubMed: 38789168
DOI: 10.1016/j.cpm.2024.01.008 -
Clinics in Podiatric Medicine and... Jul 2024Syndesmotic ankle injuries, though rare in isolation, are complex destabilizing injuries often accompanied by fractures. Misdiagnoses, particularly overlooking posterior... (Review)
Review
Syndesmotic ankle injuries, though rare in isolation, are complex destabilizing injuries often accompanied by fractures. Misdiagnoses, particularly overlooking posterior malleolus fractures, are common in ankle sprains. Thorough physical examinations, emphasizing high fibular pain and anterior tibia palpation, aid in accurate diagnosis. Grading helps assess injury severity and guiding treatment. Initial imaging involves three ankle views, with stress radiographs enhancing accuracy. If conservative care fails, MRI reveals ligament and tendon damage. Physical therapy may suffice for functional instability; surgical intervention addresses mechanical instability. Syndesmotic fixation debates center on cortices, screw size, reduction methods, and optimal positioning.
Topics: Humans; Ankle Injuries; Fracture Fixation, Internal; Magnetic Resonance Imaging; Male; Ankle Fractures; Female; Joint Instability
PubMed: 38789166
DOI: 10.1016/j.cpm.2024.01.013 -
Clinics in Podiatric Medicine and... Jul 2024Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally... (Review)
Review
Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.
Topics: Humans; Calcaneus; Intra-Articular Fractures; Fracture Fixation, Internal; Male; Fractures, Bone
PubMed: 38789165
DOI: 10.1016/j.cpm.2024.01.006 -
Clinics in Podiatric Medicine and... Jul 2024Fractures of the talus are life-changing events. The talus is of vital importance to normal gait. Given its importance, great care is needed in diagnosing and treating... (Review)
Review
Fractures of the talus are life-changing events. The talus is of vital importance to normal gait. Given its importance, great care is needed in diagnosing and treating these injuries. The threshold for operative treatment and accurate anatomic reduction should be low. Surgical tenets include the avoidance of extensive subperiosteal dissection to minimize vascular disruption. The complications with injuries to the talus are extensive and include avascular necrosis (AVN). Although AVN can prove to be a devastating sequela from this injury, it occurs less frequently than posttraumatic arthritis.
Topics: Humans; Fracture Fixation, Internal; Fractures, Bone; Osteonecrosis; Talus
PubMed: 38789164
DOI: 10.1016/j.cpm.2024.01.005 -
Clinics in Podiatric Medicine and... Jul 2024Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is... (Review)
Review
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
Topics: Humans; Talus; Arthroscopy; Cartilage, Articular; Ankle Injuries; Male; Female
PubMed: 38789163
DOI: 10.1016/j.cpm.2024.01.004 -
Clinics in Podiatric Medicine and... Jul 2024Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with... (Review)
Review
Navicular and cuboid fractures can be complex and difficult to treat. Depending on the mechanism of injury, diagnosis of such fractures is not always possible with conventional radiographs due to the irregularity and overlap of the midfoot bones. Advanced imaging is indicated if a fracture is of high suspicion or to further characterize a displaced fracture. Cuboid and navicular fractures can occur in isolation but are often associated with other midfoot injuries due to their anatomic relationships. Typically, nondisplaced fractures can be treated conservatively, whereas displaced fractures require surgical intervention to prevent future complications.
Topics: Female; Humans; Male; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Radiography; Tarsal Bones; Tomography, X-Ray Computed
PubMed: 38789162
DOI: 10.1016/j.cpm.2024.01.003 -
Clinics in Podiatric Medicine and... Jul 2024Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this... (Review)
Review
Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this perspective by highlighting a greater occurrence of low-energy injuries and reshaping the focus on open reduction internal fixation. This multifaceted process is guided by various factors, including the nature of the injury, specific anatomic considerations, and the involved joints. Our overarching goal remains to achieve anatomic reduction, with flexibility in hardware fixation methods. In cases of comminution, bridge plating may be warranted, potentially followed by arthrodesis in the future.
Topics: Humans; Male; Arthrodesis; Bone Plates; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Metatarsal Bones; Open Fracture Reduction
PubMed: 38789161
DOI: 10.1016/j.cpm.2024.01.014 -
Journal of Orthopaedic Case Reports May 2024The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of...
INTRODUCTION
The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of adequate recipient vessels when the tibial arteries result damaged. In this scenario, vein grafts can be interposed to connect a healthy recipient vessel to the ALT flap pedicle.
CASE REPORT
We present a report of a 19-year-old male who suffered a Gustilo fracture type IIIc after a road injury involving the right lower limb. After a failed first attempt of limb salvage with reconstruction of extensor tendons and a free ALT flap, a second procedure was performed using another ALT flap with interposed vein grafts to reach very proximal recipient vessels.
RESULTS
The patient demonstrated excellent recovery and restored ambulation. The effectiveness of the most complex reconstructive options for a high-demanding patient with no comorbidities is demonstrated in this case.
CONCLUSION
The key to success in even the most complex injury cases is early intervention, meticulous surgical planning, and a multidisciplinary approach.
PubMed: 38784885
DOI: 10.13107/jocr.2024.v14.i05.4450 -
Journal of Orthopaedic Case Reports May 2024The Bosworth fracture-dislocation is a rare injury originally described as an irreducible dislocation of a distal fibula fracture where the proximal fibular fragment...
INTRODUCTION
The Bosworth fracture-dislocation is a rare injury originally described as an irreducible dislocation of a distal fibula fracture where the proximal fibular fragment becomes incarcerated behind the distal tibia. There have since been a few cases described of an intact distal fibula with dislocation and similar difficulties in closed reduction attempts, typically seen with associated injuries to the ankle or proximal fibula. Regardless of the specific fracture or dislocation pattern, closed reduction attempts have consistently failed in the significant majority of these cases, which can lead to complications including soft-tissue compromise, severe post-traumatic arthritis, compartment syndrome, avascular necrosis of the talus, and neurovascular compromise. There is only one case in recent literature that describes an isolated distal fibula dislocation without associated fractures or dislocations of the lower extremity; however, it required an open reduction. Cases where a closed reduction was successful to achieve an anatomic reduction of a Bosworth-type injury are exceedingly rare.
CASE REPORT
We present a rare case of a purely ligamentous, isolated distal fibula dislocation in a 21-year-old male who underwent a successful closed reduction upon initial presentation and later underwent surgical fixation with a syndesmosis repair system. We describe the technique used for a successful closed reduction for this injury and present a 1-year follow-up with excellent outcomes.
CONCLUSION
This is the only known case report of a successful closed reduction in an isolated distal fibula dislocation, as well as demonstrating a minimally invasive technique for definitive treatment with a syndesmosis repair system. Accurate diagnosis, early treatment, and anatomic reduction are imperative for good clinical outcomes and reducing complications for Bosworth injuries. This technique may improve the rates of successful closed reductions of Bosworth injuries upon initial presentation, leading to decreased complications and improved patient outcomes.
PubMed: 38784881
DOI: 10.13107/jocr.2024.v14.i05.4438