Clinics in podiatry最新文献

The unique anatomic, functional, and vascular aspects of the talus predispose the area to difficulty in the management of its injuries. This article provides a practical guide to the treatment of fractures and dislocations of the talus.

Identification of the mechanism of injury is the hallmark of dislocation management. If the mechanism can be established by history, anatomic disruptions can be logically explained and identified. Conversely, the injury pattern clinically may help deduce the mechanism. Once the mechanism is established, either historically or clinically, relocation maneuvers can be planned and executed. A review of pedal dislocations has been presented with emphasis on anatomic relationships and mechanism of injury. These principles encompass diagnosis, treatment, and management. They must be understood to manage not only the acute emergency situation but the chronic disability of post-traumatic arthritis.

The management of nonunion represents a complex clinical situation requiring an understanding of the pathophysiology. Before initiating treatment, the nonunion must be assessed radiographically. Further evaluation by radionuclide imaging and CT may be applicable. Only then can proper treatment, whether by immobilization, internal fixation with or without incorporation of bone grafts, or electrostimulation, be instituted.

The management of open fractures is a surgical emergency. This article discusses in detail the primary goals of obtaining fracture healing, preventing infection, and restoring optimum function of the injured extremity.

Fractures of the metatarsals are a common condition seen by all health care specialists. They may be precipitated by direct or indirect trauma to the specific area of concern. This article is a review of the angiology of the metatarsal. It provides a workable classification of metatarsal fractures and provides an insight into their proper treatment.

A description of the nonosseous considerations, both accidental and iatrogenic, in the evaluation and treatment of the traumatized foot has been presented. The brief description of the types of wounds encountered provided here should enable the reader to extrapolate the principles to be used in treating any type of pedal wound. A classification of wounds for better understanding of treatment alternatives is presented. Though it is obvious that classifying wounds may be simplistic, the myriad of treatment alternatives make the definitive treatment of the wounds a dynamic process. It is axiomatic that clean wounds can be closed and infected wounds cannot; however, clinicians are rarely presented with such clear-cut alternatives. The patient, the principles of wound healing, and the bacterial-host interface must all be considered in rendering an appropriate diagnosis and selecting the most effective treatment from the multiplicity of treatments available.

The Osteoclasp, a dynamic compression device for internal stainless steel fixation of bone, has been presented. The historical background of its creation and early experimentation for research and development of the Osteoclasp have been reviewed. Physical properties and dimensions of the Osteoclasp, in combination with instrumentation for implantation, has been presented to educate the reader on proper selection and implantation of the Osteoclasp. Specific indications and contraindications for the Osteoclasp have been discussed. Using proper surgical technique, the Osteoclasp will provide constant dynamic compression across an incomplete fracture to enhance bone healing through primary bone repair. Several case histories illustrate the various uses of the Osteoclasp in the lower extremity. Specific illustrations of improper technique will serve to amplify the necessity of appropriate selection of the Osteoclasp for internal fixation and illustration of proper surgical technique. The Osteoclasp has been, and will continue to be, a viable technique for bone fixation. New surgical techniques and bone fixation devices will continue to evolve and further enhance primary bone healing.

The basic concept of engineering applied to the biomechanical performance behavior of solids has been presented. Areas of conceptual disagreement in bone failure loading modes have been indicated and provide an excellent area for continuing investigation by the podiatric surgeon. Special application to bone tissue has been emphasized with several examples of functional loading seen in podiatric performance. The underlying requirements for primary bone union by the production of absolute stability have been discussed and some of the present problems with the use of A-O in podiatric surgery have been suggested.

Rigid fixation of osseous fragments with the ability to supply additional compression or distraction at will is achieved only by external fixation. Of course, the treatment of nonunions, infections, fixation of osteotomies, fusion of joints, and lengthening of bone can be accomplished by other satisfactory means with and without fixation. External fixation is only one method of fixation. From this list the practitioner can choose the method of fixation best suited to the contemplated procedure and the one with which the surgeon feels most comfortable. However, a good surgeon will have prepared alternative methods of fixation if, in fact, the first and preferable method of fixation fails. It would be wonderful if our plans became a reality; quite often they do not and this is what one must prepare for. External fixation in many of the cases presented was not the original form of fixation to be used; in a few cases it had not been seriously considered. Fortunately, however, it was considered and allowed a difficult situation to be remedied with relative ease. Although elaboration of the categories in which external fixation was employed has been brief, the numerous presentations lend themselves to further investigation into external fixation.