RESUMEN
A review of the literature regarding the evaluation and management of osteomyelitis and discussion on clinical, radiographic, laboratory, and pathologic findings with both acute and chronic cases is presented. Cases illustrate the complexities that can typically present at an academic setting, which often require a stepwise approach and interdisciplinary collaboration. Surgical pearls and ancillary treatment of osteomyelitis highlight the technical challenges and surgeons' preferences.
Asunto(s)
Diabetes Mellitus , Pie Diabético , Osteomielitis , Amputación Quirúrgica , Tobillo , Articulación del Tobillo , Pie Diabético/complicaciones , Pie Diabético/cirugía , Humanos , Osteomielitis/diagnóstico por imagen , Osteomielitis/cirugíaRESUMEN
Wound healing in high-risk patients with diabetes is often lengthy and fraught with complications. Techniques in plastic and reconstructive surgery of the diabetic foot continue to develop as a result of advances in external fixation. This article highlights the surgical aspect of the diabetic foot with an emphasis on the indications, advantages, technical pearls, and complications with use of external fixation as an adjunct to plastic and reconstructive surgery of the diabetic foot.
Asunto(s)
Pie Diabético/cirugía , Fijadores Externos , Humanos , Cuidados Posoperatorios , Complicaciones Posoperatorias/prevención & control , Colgajos Quirúrgicos , Expansión de Tejido , Dispositivos de Expansión Tisular , Cicatrización de HeridasRESUMEN
Acute compartment syndrome is a known possible complication of calcaneal fractures and few case reports have documented a recurrent event after initial surgical fasciotomies. This article describes a rare case demonstrating a recurrence of acute compartment syndrome within days of initial fasciotomies and surgical repair of a comminuted calcaneal fracture.
Asunto(s)
Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Fracturas Óseas/complicaciones , Complicaciones Posoperatorias , Adulto , Calcáneo/lesiones , Calcáneo/cirugía , Fasciotomía , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Humanos , Masculino , RecurrenciaRESUMEN
Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a unique case report of Stevens-Johnson syndrome and associated toxic epidermal necrolysis in a 61-year-old man after treatment for a peripherally inserted central catheter infection with trimethoprim-sulfamethoxazole. This case report reviews a rare adverse reaction to a commonly prescribed antibiotic drug used in podiatric medical practice for the management of diabetic foot infections.
Asunto(s)
Antiinfecciosos/efectos adversos , Síndrome de Stevens-Johnson/inducido químicamente , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Antiinfecciosos/administración & dosificación , Pie Diabético/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugía , Síndrome de Stevens-Johnson/etiología , Combinación Trimetoprim y Sulfametoxazol/administración & dosificaciónRESUMEN
We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up.
Asunto(s)
Pie , Sarcoma Sinovial/diagnóstico , Membrana Sinovial/patología , Adulto , Amputación Quirúrgica/métodos , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Sarcoma Sinovial/cirugíaAsunto(s)
Artrodesis/métodos , Artropatía Neurógena/cirugía , Fijadores Externos , Úlcera del Pie/cirugía , Colgajos Quirúrgicos , Articulaciones Tarsianas/cirugía , Artropatía Neurógena/complicaciones , Deformidades Adquiridas del Pie/complicaciones , Deformidades Adquiridas del Pie/cirugía , Úlcera del Pie/complicaciones , HumanosRESUMEN
During the last few decades, electrical current stimulation has gone from an investigational modality to an accepted method of treatment to assist with bone healing. This article provides an overview of electrical bone stimulation for nonunions in the foot and ankle.
Asunto(s)
Artrodesis , Terapia por Estimulación Eléctrica , Traumatismos de los Pies/terapia , Fracturas no Consolidadas/terapia , Humanos , UltrasonidoRESUMEN
Complications with hallux valgus surgery can manifest in a variety of ways, but ultimately preventing them depends on the surgeon's expertise in patient and procedural selection, ability to perform the surgery selected, and knowledge in dealing with postoperative care and complications if present. In this article, the authors discuss common diagnostic and treatment dilemmas when dealing with recurrent hallux valgus, hallux varus, malunion, and avascular necrosis following bunion surgery.
Asunto(s)
Hallux Valgus/cirugía , Complicaciones Posoperatorias , Hallux Varus/etiología , Hallux Varus/cirugía , Humanos , Osteonecrosis/etiología , Osteonecrosis/cirugía , Recurrencia , Reoperación , Cicatrización de HeridasRESUMEN
The authors present a minimally invasive procedure for harvesting a split thickness skin graft (STSG) from the plantar surface of the foot. This is another option to consider for soft tissue reconstruction of diabetic foot wounds to help restore form and function and to prevent amputation. The authors do not recommend this technique for all soft tissue wounds of the toes and plantar aspect of the foot but believe it is a viable option for selected small diabetic foot wounds that may benefit from a STSG.
Asunto(s)
Pie Diabético/cirugía , Pie/cirugía , Colgajos Quirúrgicos , HumanosRESUMEN
Talar osteochondral defects (OCDs) are a challenge for treating physicians because they frequently are missed or diagnosed incorrectly, often resulting in severe degenerative arthritis of the ankle joint. Surgical intervention becomes a viable option in the presence of larger OCDs associated with loose bodies or osteochondral lesions that have failed conservative treatment. The successful use of autologous osteochondral autograft in the knee has promoted the applicability in the ankle. This report describes a unique technique for the treatment of large talar osteochondral lesions using a local osteochondral autograft combined with an ankle arthrodiastasis.
Asunto(s)
Articulación del Tobillo/cirugía , Cartílago Articular/trasplante , Osteocondritis/cirugía , Osteogénesis por Distracción/métodos , Astrágalo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Terapia Combinada , Fijadores Externos , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Osteocondritis/diagnóstico por imagen , Osteocondritis/patología , Osteogénesis por Distracción/instrumentación , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Medición de Riesgo , Astrágalo/diagnóstico por imagen , Astrágalo/patología , Recolección de Tejidos y Órganos , Trasplante Autólogo , Soporte de PesoRESUMEN
Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis.
Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis/métodos , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Disfunción del Tendón Tibial Posterior/cirugía , Articulación Talocalcánea/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Artrodesis/instrumentación , Clavos Ortopédicos , Placas Óseas , Calcáneo/cirugía , Terapia Combinada , Fijadores Externos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Osteogénesis por Distracción/instrumentación , Osteotomía/instrumentación , Dimensión del Dolor , Disfunción del Tendón Tibial Posterior/diagnóstico , Radiografía , Recuperación de la Función , Medición de Riesgo , Índice de Severidad de la Enfermedad , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/fisiopatología , Transferencia Tendinosa/métodos , Resultado del TratamientoRESUMEN
Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.
Asunto(s)
Desbridamiento , Pie Diabético/cirugía , Técnica de Ilizarov , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Enfermedad Crónica , Antepié Humano/cirugía , Humanos , Cuidados Posoperatorios , Cicatrización de HeridasRESUMEN
The surgical management of calcaneal fractures presents with several obstacles to the treating physician. Many experienced surgeons acknowledge a steep and significant learning curve in the operative management of calcaneal fractures. Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion, thereby affecting the function of the ankle and subtalar joint. Although some calcaneal fractures can be treated conservatively, a majority of them require operative intervention. The goal of this article is to bring some insight into the realm of revisional surgery on residual deformity of the calcaneus after operative intervention and also provide a rationale approach to successfully manage failed surgeries for calcaneal fractures.
Asunto(s)
Calcáneo/lesiones , Calcáneo/cirugía , Fracturas Óseas/cirugía , Fracturas Mal Unidas/cirugía , Procedimientos Ortopédicos/métodos , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/etiología , Desviación Ósea/cirugía , Calcáneo/diagnóstico por imagen , Deformidades del Pie/etiología , Deformidades del Pie/cirugía , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Fracturas Mal Unidas/diagnóstico por imagen , Humanos , Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/efectos adversos , Podiatría/métodos , Radiografía , Reoperación/métodos , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/cirugíaRESUMEN
Charcot neuroarthropathy is often a devastating diabetic foot complication that poses a great risk for limb loss and can have a significant impact on a patient's quality of life in the presence of multiple existing comorbidities. It is a progressive and debilitating condition characterized by joint dislocation, pathologic fracture(s), and extensive destruction of the foot or ankle architecture secondary to dense peripheral neuropathy. This pathologic process can be idiopathic, secondary to acute trauma or previous surgery, or attributable to repetitive "microinjury." Once the Charcot process has been initiated, continued ambulation results in progressive collapse and deformity. Severe deformities can have an impact on the patient's ambulatory status, and when associated with instability, ulceration, or infection, there is greater risk for a major limb amputation.
Asunto(s)
Articulación del Tobillo/cirugía , Artropatía Neurógena/cirugía , Articulaciones del Pie/cirugía , Procedimientos Ortopédicos/métodos , Podiatría/métodos , Tendón Calcáneo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Artropatía Neurógena/complicaciones , Artropatía Neurógena/diagnóstico , Errores Diagnósticos , Falla de Equipo , Deformidades del Pie/diagnóstico , Deformidades del Pie/etiología , Deformidades del Pie/cirugía , Articulaciones del Pie/diagnóstico por imagen , Humanos , Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/instrumentación , Osteomielitis/etiología , Osteomielitis/cirugía , Podiatría/instrumentación , Radiografía , Reoperación/métodos , Prevención Secundaria , Úlcera Cutánea/etiología , Úlcera Cutánea/cirugía , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/cirugía , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this study was to identify and report the complications associated with the use of circular ring fixation in diabetic patients, and to compare the frequency of complications in patients without diabetes. We hypothesized that complications with circular ring fixation occurred more frequently in patients with diabetes than patients without diabetes. MATERIALS AND METHODS: Institutional Review Board approval was obtained and patient charts were retrospectively reviewed from June 2004 and February 2007. Fifty six consecutive patients undergoing midfoot, hindfoot and/or ankle surgery were treated with circular ring fixation which included 33 diabetic patients in the study group and 23 non-diabetic patients in the control group. Patient demographics, the duration of treatment with the external fixator, and complications were recorded. RESULTS: Males had a greater number of complications compared to females (p = 0.0014). The total number of complications was statistically greater in diabetic patients (study group) versus non-diabetic patients (control group) (p = 0.003). In multivariate logistic regression, diabetes and male sex were the only significant variables associated with wire complications (OR 7.35, 95% CI 1.93-28.04 and OR 0.22, 95% CI 0.05-8584111, respectively). CONCLUSION: Women are protected from wire complications with a risk reduction of 78% compared to males. Diabetics have a 7-fold risk for any wire complication compared to patients without diabetes. We found no adverse effects of BMI, obesity, age, smoking, neuropathy, or Charcot neuroarthropathy on a satisfactory recovery.
Asunto(s)
Articulación del Tobillo/cirugía , Complicaciones de la Diabetes , Técnica de Ilizarov/efectos adversos , Anciano , Artropatía Neurógena/cirugía , Estudios de Casos y Controles , Femenino , Fracturas Mal Unidas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores SexualesRESUMEN
The Charcot foot (osteoarthropathy) is a significant lower extremity complication of diabetes mellitus that can result in significant deformity, ulceration, and subsequent limb loss. A result of even unrecognized trauma to an insensitive foot, continued weight bearing on the injured foot promotes the evolution of the disorder that is often diagnosed only after significant deformity has occurred. Although this entity is considered a rare complication of the diabetic population, it has profound implications for those persons affected. Greater awareness of the frequency, distribution, determinants, and natural history of Charcot foot can help clinicians establish an earlier diagnosis and institute effective treatment before the onset of limb-threatening deformity.