Clinics in podiatric medicine and surgery
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Clin Podiatr Med Surg · Apr 2018
Review Case ReportsParadigm Shift for the Surgical Management of Calcaneal Fractures?
Calcaneal fractures account for up to 75% of all foot fractures and 1% to 2% of all fractures. Approximately 75% of calcaneal fractures are intraarticular, resulting in a prolonged recovery, more pain, and disability. ⋯ The literature continues to support surgical intervention; however, these injuries can still be managed nonoperatively in certain clinical scenarios. This article focuses on the surgical management of intraarticular calcaneal fractures and highlights the sinus tarsi approach.
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Clin Podiatr Med Surg · Apr 2019
ReviewJoint-Sparing Surgical Management of Sanders IV Displaced Intra-Articular Calcaneal Fractures.
Displaced intra-articular calcaneal fractures represent life-altering injuries. Difficulty obtaining and maintaining calcaneal morphology and the significant risk of wound healing complications with an extensile lateral incision exist. ⋯ Spontaneous conversion to primary subtalar joint arthrodesis using the same instrumentation remains unique to this system. This article reviews open and percutaneous approaches for joint-sparing and primary arthrodesis procedures to treat Sanders IV fracture patterns.
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Surgical treatment of the elderly can be a very difficult and complex endeavor. Appropriate and thorough evaluation of this group of patients is essential to identify surgical candidates who may be at increased risk for developing age-related problems, such as cognitive impairment or postoperative delirium. ⋯ In order to optimize surgical results, communication of goals of surgery and expectations of patients in order to achieve these goals is paramount. Physical therapy assessment of the elderly will give input on patients' capacity to perform needed changes in ambulatory status after surgery.
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Clin Podiatr Med Surg · Apr 2019
ReviewSinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures.
Treatment of displaced intra-articular calcaneal fractures has changed numerous times in the last decades. Currently, less invasive surgery has reemerged and is increasingly used. The sinus tarsi approach is most commonly used. ⋯ The results in the literature show overall similar functional outcome compared with the extended lateral approach, however with a significant reduction in wound complications. This article deals with the sinus tarsi approach in which the reduction is fixated using screws only. Indications, surgical technique, and possible pitfalls are discussed.
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The literature for prevention of surgical infection related primarily to foot and ankle surgery is sparse, with most attention on total joint replacement and abdominal surgery. Attention should be paid to preoperative, intraoperative, and postoperative elements, which can have an effect on the development of postoperative infection. Although antibiotic prophylaxis typically is discussed in isolation, inclusion of this step into the process enhances the overall evaluation of surgery with respect to infection. This evolution provides for better patient outcomes and decreases the likelihood of an infection incurred after foot and ankle surgery.