Clinics in podiatry最新文献

Electrical stimulation of fracture nonunions has become a viable alternative to bone grafting. The success rate is comparable but the morbidity rate is significantly lower. Individual fracture healing problems must be thoroughly assessed and the treatment designed for the individual patient.

The selection of metals and their alloys for implants and fixation devices represents a composite of desirable properties. The search for appropriate implantable materials began following the acceptance of internal fixation. Advances in the control of septic complications, together with recent metallurgical developments, have resulted in the safe application of metallic implants.

There are several ways to avoid the iatrogenic complications or hazards of internal fixation. The surgical approach should be planned well in advance. The instruments and materials to be used intraoperatively should be checked before beginning the operation to assure that there are adequate materials of appropriate length and thickness. Also, all materials should be checked for major defects (see Fig. 11A). Good tissue dissection and atraumatic surgical technique is essential to limit excessive tissue destruction. Reduction of the fracture fragments should be obtained prior to fixation. While applying fixation devices, the fragments should be held stable. Intraoperative radiographs are necessary to demonstrate appropriate positioning of the internal fixation device and the proper alignment of the fracture fragments. If the alignment is not satisfactory, repositioning of the devices can and should be made. Preoperative practice and familiarity with the fixation devices is an essential part of shortening the operative time and helping to assure optimum fixation stability. A poor time to learn the techniques for internal fixation is during surgery. Good postoperative care is essential to optimize fracture fragment healing results.

This article briefly reviews the literature regarding digital arthrodesis. It presents an in-depth description of the techniques presently used for such procedures at the California College of Podiatric Medicine.

Ankle fusion provides an excellent salvage for an otherwise intolerable deformity or painful joint derangement. It is the only available alternative for a failed ankle prosthesis. It produces a serviceable foot when done in proper perspective for the appropriate indication. It produces a good result when consolidation occurs and the remaining tarsal joints have preserved integrity. Improvement in occupational and daily activities can be anticipated when arthrodesis and correct alignment are obtained.

Talipes equinovarus is a complex triplane deformity of the foot and lower leg. Clubfoot should be treated early and aggressively--but gently. Conservative therapy is often successful if begun early. Surgery should follow a progressive approach.

The Ganley splint has been discussed in detail. The author has set forth a reliable protocol for the treatment of pediatric orthopedic deformities and has addressed the role of the Ganley splint in this regard. Finally, the use of the splint in specific disorders is discussed and suggestions for the practitioner have been made.

The perioperative management of children is important and the concepts should be reviewed regularly by all surgeons. This article emphasizes the overall aspects of physical and psychological care which begins at the first office visit and continues through the postoperative period. The podiatrist must assess the child's growth and development, emotional status, psychological needs, and the requirements of anesthesia and surgery.