Midfoot Trauma: Let's Get It Right the First Time.

Lisfranc injuries represent a wide variety of injury patterns, from stable midfoot sprains to grossly displaced fractures and fracture-dislocations. Obtaining and maintaining an anatomic reduction is critical in the treatment of these injuries. Considerable controversy remains as to the optimal method of treatment.

Revision Open Reduction and Internal Fixation of Ankle and Syndesmosis Malunions.

Malreduction of the fibula and syndesmosis remains a common complication associated with the surgical management of ankle fractures. This malreduction leads to profound alterations in the biomechanics of the ankle, leading to chronic pain and premature degenerative changes of the ankle. It is possible to correct many fibular and syndesmotic malunions with reconstructive surgical techniques, of which there are several for revising and salvaging the malreduced ankle mortise and tibiofibular syndesmosis.

Prevention of Avascular Necrosis with Fractures of the Talar Neck.

Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation.

Lisfranc injuries.

Purpose Of Review: The purpose of this review is to discuss key anatomic and pathoanatomic factors, treatment principles, and patient outcomes of Lisfranc injuries.

Recent Findings: Although open reduction and internal fixation (ORIF) remains the current gold standard of treatment, ORIF with primary arthrodesis has become increasingly popular in recent years, both for pure ligamentous and for bony-ligamentous injuries. Return to activity and competitive sports as well as overall patient outcomes have been further defined, suggesting that most patients are able to return to near pre-injury level if properly diagnosed and appropriately treated.

Managing Complications of Calcaneus Fractures.

Calcaneus fractures remain among the most complicated fractures for orthopedic surgeons to manage because of the complexity of various fracture patterns, the limited surrounding soft tissue envelope, and the prolonged rehabilitation issues impacting function after successful treatment. Despite this, appropriate management of complications associated with calcaneus fractures is critical for the complete care of this injury, whether treated operatively or nonoperatively. The authors present the common complications encountered with fractures of the calcaneus and management thereof.

Salvage of failed total ankle arthroplasty with fusion using structural allograft and internal fixation.

Background: The current study presents our experience with conversion of failed TAA to fusion.

Materials And Methods: A retrospective review of all failed total ankles converted to fusion from 1999 to 2009 was performed at our institution.

Results: Twelve total ankles were converted to isolated ankle fusions (Group I) and 12 converted to ankle-hindfoot fusions (Group II).

The anatomic compression arthrodesis technique with anterior plate augmentation for ankle arthrodesis.

The anatomic compression arthrodesis technique with anterior plate augmentation is an effective technique that results in a high union rate, improved functional outcome, and an acceptable complication rate. This technique can be used for both primary ankle arthrodesis and salvage cases with significant bone loss. The authors believe the anterior plate is a useful complement to standard multiplanar screw fixation, and the increased rigidity provided by the anterior plate effectively counters forces, particularly in the sagittal plane, that may otherwise lead to failure of multiplanar screw constructs.

Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique.

Background: Many patients with displaced intra-articular calcaneal fractures require subtalar arthrodesis for the treatment of posttraumatic arthritis. We hypothesized that patients who underwent initial operative treatment would have better functional outcomes as compared with those who underwent initial nonoperative treatment before undergoing a subtalar arthrodesis.

Methods: A consecutive series of sixty-nine patients with seventy-five displaced intra-articular calcaneal fractures underwent subtalar arthrodesis for the treatment of painful posttraumatic subtalar arthritis.

Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter?

Background: Many patients with displaced intra-articular calcaneal fractures require subtalar arthrodesis for the treatment of posttraumatic arthritis. We hypothesized that patients who underwent initial operative treatment would have better functional outcomes as compared with those who underwent initial nonoperative treatment before undergoing a subtalar arthrodesis.

Methods: A consecutive series of sixty-nine patients with seventy-five displaced intra-articular calcaneal fractures underwent subtalar arthrodesis for the treatment of painful posttraumatic subtalar arthritis.

Posttraumatic avascular necrosis of the talus.

Avascular necrosis of the talus is one the most challenging problems encountered in posttraumatic reconstruction of the hindfoot. Since the first description of the talus injury in 1608 by Fabricius of Hilden, our knowledge of the talar anatomy, injuries, sequelae, and management has increased significantly. Adequate knowledge of the etiology, the extent of the disease, and the degree of patient symptoms are required to determine optimal treatment.

Management of intra-articular fractures of the calcaneus.

The treatment of calcaneal fractures has evolved over time. Despite understanding the pathomechanics involved, these fractures remain difficult to treat. Advances in imaging and surgical technology have enabled experienced fracture surgeons to obtain consistent results.

A rational approach to ankle fractures.

Ankle fractures involve a spectrum of injury patterns from simple to complex, such that these injuries are not always "just an ankle fracture." By combining the injury mechanism and the radiographic findings, the surgeon can apply the Lauge-Hansen classification in taking a rational approach to the management of these fractures. Syndesmotic instability and atypical patterns are becoming increasingly recognized, in part through the judicious use of CT scans.

Anterior plate supplementation increases ankle arthrodesis construct rigidity.

Background: The success of ankle arthrodesis for the treatment of post-traumatic ankle arthritis depends on achieving and maintaining rigid fixation of the prepared tibiotalar interface. The purpose of this study was to examine the biomechanical effect of anterior plate supplementation of a popular three-screw fusion construct.

Methods: Six fresh-frozen cadaver ankles were prepared and instrumented with three partially threaded screws compressing the tibiotalar interface.

Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneal fractures.

Background: For a fracture classification to be useful it must provide prognostic significance, interobserver reliability, and intraobserver reproducibility. Most studies have found reliability and reproducibility to be poor for fracture classification schemes. The purpose of this study was to evaluate the interobserver and intraobserver reliability of the Sanders and Crosby-Fitzgibbons classification systems, two commonly used methods for classifying intra-articular calcaneal fractures.

Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.

Background: Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion affecting the function of both the ankle and the subtalar joint. The purpose of this study was to report the intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.

Methods: Seventy feet (sixty-four patients) with a malunion after nonoperative management of a displaced intra-articular calcaneal fracture were evaluated.

Preoperative considerations in ankle replacement surgery.

Total ankle arthroplasty continues to evolve as a viable treatment option for end-stage ankle arthritis. Proper patient selection is a critical aspect of promoting a successful result. Acceptable results have been reported in older, low-demand, nonobese patients who have osteoarthritis or rheumatoid arthritis.

Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds.

The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy.