How to Get to the Distal Posterior Tibial Malleolus? A Cadaveric Anatomic Study Defining the Access Corridors Through 3 Different Approaches.

Objective: Our objective is to review the anatomy and exposure of the posterior column and posterior tibial malleolus (the posterior tibial plafond) by defining the access corridors through 3 different approaches-posteromedial, posterolateral, and modified posteromedial.

Methods: Cadaveric dissection with percentage of posterior tibial malleolus exposed, and strain gauge measurements to evaluate traction on the neurovascular bundle.

Results: The 3 different approaches are applicable for exposure of different portions of the distal posterior tibial malleolus.

[Lower limb amputation: indication, preoperative workup and complications].

The main causes of lower limb amputations are peripheral artery disease (92% of the cases) and trauma (7%). The selection of the amputation level aims at optimizing the chances of healing and the functionality of the involved limb. Foot preserving amputations offer the best functional outcome but the healing process is frequently slow and difficult.

Strategies for surgical approaches in open reduction internal fixation of pilon fractures.

Pilon or tibial plafond fractures usually result from high-energy injuries with rotation and/or axial compression. They occur in an area of relatively poor soft tissue coverage and frequently present a surgical challenge in deciding which incisions will be best for performing open reduction internal fixation. A variety of anterior and posterior approaches have been described based on the ease of fracture reduction and internal fixation with plates.

A modified posteromedial approach combined with extensile anterior for the treatment of complex tibial pilon fractures (AO/OTA 43-C).

The anterior approaches that have been described for open reduction internal fixation of multifragmentary pilon fractures are designed to reconstruct the comminuted and impacted anterior articular surface onto a stable posterior column. Thus, reduction of the posterior column, particularly proper length, is critical. There are differing opinions of how best to surgically approach the posterior pilon fracture.

[Metatarsalgia: diagnosis and treatment].

Metatarsalgias refer to pain localized in the forefoot and under the metatarsal heads. It is one of the main reasons for specialist consultation. Consequences of a wide array of different diseases, they require a biomechanical and systematic approach to fully understand their cause and presentation in a variety of clinical presentations.

[What's new in forefoot surgery].

New implants and instruments have recently emerged in foot surgery. However, an additional and important development is the technique of minimally invasive surgery. As a result of new surgical approaches some common foot deformities can be corrected in a percutaneous manner.

Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique.

Background: The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity.

Methods: From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity.

The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing.

Perhaps the most important advancement in the surgical treatment of high-energy pilon fractures has been the recognition of the need to delay primary surgery. However, at open reduction internal fixation an adequate incision must be made to clearly visualize the articular surface in an attempt to restore intraarticular anatomy. This article illustrates our extensile approach and its effect on soft-tissue healing.