RESUMEN
Pin tract infections are virtually universal complications with the use of external fixation. While most are superficial and respond to oral antibiotics and local care, septic loosening may occur at the bone-pin interface, which may lead to instability of the fixator, catastrophic failure, fracture, and long-term osteomyelitis. Classification systems and prevention protocols have been developed to address this ubiquitous complication. Treatment of severe pin tract infections often requires debridement, parenteral antibiotics, and removal of the offending pin or the entire external fixator. In cases of osteomyelitic pin tracks, a sizable cavity is often present. We describe a simple technique for treatment of deep bone pin tract infection through the use of debridement, irrigation, and an antibiotic "sparkler," which is a specially prepared percutaneous implant of antibiotic laden bone cement.Levels of Evidence: Level 5.
RESUMEN
Learning the essentials of deformity planning is the basis for the treatment of simple and complex deformities. Understanding the planes of deformity, radiographic correlation, and clinical correlations allows the surgeon to treat the condition with deeper knowledge of deformity, leading to improved deformity correction.
Asunto(s)
Deformidades del Pie/diagnóstico por imagen , Deformidades del Pie/cirugía , HumanosRESUMEN
Neurogenic contracture often results in spastic, nonreducible equinovarus deformity. Rigid contracture leads to pain, instability, and bracing difficulties. This case report details the utilization of the modified Lambrinudi triple arthrodesis intended to create a plantigrade, functional limb that is amenable to an extremity brace in a case of an acquired neurologic clubfoot. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case Report.
Asunto(s)
Artrodesis/métodos , Pie Equinovaro/cirugía , Articulaciones Tarsianas/cirugía , Accidentes de Tránsito , Adolescente , Pie Equinovaro/etiología , Femenino , Humanos , Neuropatías Peroneas/complicaciones , Neuropatía Tibial/complicacionesRESUMEN
Deep infection in the presence of an implant after open reduction and internal fixation is usually treated with removal of the implant, serial débridement procedures, lavage, intravenously administered antibiotics, and occasionally, placement of antibiotic-impregnated beads. If infection occurs during the early stages of bone healing, fracture stabilization might be compromised after implant removal. Osteomyelitis, unstable owing to a bone deficit or fracture, was treated with an antibiotic cement-coated (tobramycin and vancomycin) plate. The goal was successful eradication of infection with the patient remaining infection-free for 1 year. Four patients were treated with antibiotic-coated plates for osteomyelitis and all have achieved successful union, clinically free of signs of infection for more than 1 year. One patient experienced a prominent and painful plate, necessitating removal. Based on our experience, early aggressive débridement coupled with broad-spectrum antibiotic cement-coated plate insertion, provides fracture stability and helps eradicate the infection with 1 surgical procedure.
Asunto(s)
Antibacterianos/administración & dosificación , Cementos para Huesos/uso terapéutico , Placas Óseas , Fracturas Óseas/terapia , Osteomielitis/terapia , Adulto , Materiales Biocompatibles Revestidos , Desbridamiento , Remoción de Dispositivos , Femenino , Fijación de Fractura , Fracturas Óseas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/etiología , Irrigación TerapéuticaRESUMEN
Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.