Clinics in podiatry最新文献

Indications and contraindications for tenotomy, tenectomy, and capsulotomy have been cited and surgical procedures outlined. The importance of possible supplemental surgery and biomechanical follow-up have also been stressed.

Thus, we have briefly touched upon several sources of potential postsurgical complications. When these various conditions arise, they most often interfere with the overall healing process or total recovery period. In addition to causing aggravation and concern to the surgeon, they frequently complicate the operative impressions of the patient. The basic prevention techniques discussed should provide a substantial decrease in postsurgical complications. In summary, proper medical history and physical examination, vascular evaluation, biomechanical, radiographic, and laboratory studies are important. To employ good surgical preparation and sterile technique is also an important preventive measure. Plan your site of incision to maximize the approach to the bone correction while minimizing trauma to the underlying soft tissue structures. Always be prepared with adequate and back up instrumentation, including new surgical blades, burs, or Brophies. Use the instrumentation that best accomplishes the work proposed or contemplated. Good tissue handling and dissection along with adequate flushing of the wound site with sterile saline solutions are necessary. The well-informed patient can also reduce or prevent postoperative complications by the fact that they have been educated and informed about the pre-, intra-, and postoperative course of events. In conclusion, we have presented the most common postsurgical complications, their possible etiology, prevention, and management. Hopefully, these subjects will stimulate the practitioner to be more aware of such complications and therefore recognize and treat these less than desirable events appropriately.

A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described.

The lixiscope is a portable, low-intensity fluoroscopic device, which provides convenience and safety for doctor and patient in examination and surgery. It gives a real time image which allows motion of the object to be observed and manipulation or surgical procedures to be performed under continuous visual monitoring. By changing lines of perspective, an appreciation of the object can be gained in three dimensions. This is especially important in visualizing geometry-dependent flaws, such as fractures, or in bringing out low-contrast objects from the background by relative motion. lixiscopic foot surgery is a new kind of foot surgery, opening up previous "closed" or minimal incision surgery. It has the benefits of the previous minimal incision surgery, with direct visualization of sophisticated procedures for consistent results. Future directions in this technology may include a lixiscope which will not require isotope replacement, true stereoscopic vision, and specialized devices for various branches of medicine.

The unique structure and function of the pediatric patient lends them to patterns of osseous trauma not found in their adult counterparts. Epiphyseal anatomy, epidemiology, and classic fracture patterns are reviewed. Early restoration of joint and epiphyseal plate congruity is the objective with a goal of complete functional return and structural integrity at skeletal maturity.

A closed fracture is defined as a break in the continuity of the bone which does not communicate with the outside of the body. Management of the patient includes a thorough assessment of the fracture, evaluation of other injuries, and reduction as indicated. The patient is carefully observed for complications should problems arise.

The ability to classify ankle fractures allows one to determine which fractures will probably do well with nonoperative treatment and which fractures will fare best with open reduction because of their inherent instability. An understanding of the Lauge-Hansen system also allows one to predict the degree of ligamentous injury on the basis of the osseous pattern of the injury. Operative management of ankle fractures requires a thorough understanding of ASIF technique. Open reduction is best performed with a fracture that is not anatomically reducible or with a fracture type that has been historically proven unstable with closed treatment. Restoration of anatomic alignment of articular surfaces should be the goal of treatment. When anatomic reduction has been achieved, ankle fractures generally do well whether they have been treated with operative or nonoperative techniques. Early motion is helpful if rigid fixation can be achieved, but one should not sacrifice stability in an attempt to begin early movement if rigid fixation has not been obtained. Decisions concerning length of immobilization and early movement should be based upon the principles of bone healing physiology.

Fractures of the calcaneus account for approximately 60 per cent of all tarsal injuries and 1 to 2 per cent of all diagnosed fractures. The length of treatment and rehabilitation and disability has a marked effect on the working population. This helps to explain the great disparity in the classification and treatment of calcaneal fractures.

A detailed discussion of the often underestimated dilemma of digital fractures and dislocations is presented. Illustrations accentuate the important concepts. An aggressive attitude should be adopted to avoid mismanagement and prolonged convalescence. Should the need arise, surgical intervention is emphasized.

The incidence of midfoot fractures is probably higher than realized. Recognition of these fractures is enhanced by a high index of suspicion and diagnostic tests such as bone scans, tomograms, and CT scans. Treatment is mostly nonoperative. At times, closed reduction and percutaneous pinning, open reduction internal fixation, excision of fracture fragments, or primary fusion is indicated.