Intraarticular Fractures of the Foot (original) (raw)

Fractures and Dislocations of the Tarsal Navicular

Journal of the American Academy of Orthopaedic Surgeons, 2016

Fractures of the tarsal navicular are commonly the result of trauma or chronic overload. Because of its complex anatomy and blood supply, the tarsal navicular is susceptible to osteonecrosis, and injury to this bone can lead to posttraumatic arthrosis of the surrounding joints. Diagnosis of the injury, especially in patients with stress fractures, can require a high index of suspicion and the use of advanced imaging. The treatment of stress fracture is controversial and ranges from immobilization in a non-weight-bearing cast or boot to internal fixation with or without bone grafting. Traumatic fractures are treated with open reduction and internal fixation with or without external fixation for medial and lateral column stabilization. To avoid a poor outcome, concomitant injuries must be recognized and treated. Despite appropriate treatment, patients may ultimately require fusion procedures to address ongoing pain and disability.

Management of Complex Open Fracture Injuries of the Midfoot With External Fixation

The Journal of Foot and Ankle Surgery, 2006

Ten patients (11 feet) with severe, high-velocity, open injuries to the midfoot were treated with uniplanar external fixation. The mean patient age was 38 years. Five wounds measured Ͼ10 cm, and 3 had extensive degloving of the foot extending into the lower leg. All had grossly comminuted fractures of the tarsal and metatarsal bones: 9 patients had a fractured cuboid; 6 had a fractured navicular; 7 had a fractured cuneiform; and all had metatarsal fractures. Lisfranc joint dislocations were present in 7 feet, and intertarsal dislocations were seen in 3 cases. Six patients underwent split-thickness skin grafting, and 1 required a myocutaneous flap. The average duration of fixator use was 9 weeks (range, 6 -15 weeks). Clinically, patients were evaluated 1 year after fixator removal for any residual pain in the foot, ability to stand on tiptoe, presence of a limp, deformity of an arch, and range of motion at the ankle, subtalar, and metatarsophalangeal joints. Each parameter was graded as good, fair, or poor. All patients had sensate plantigrade feet, with 2 patients who experienced pain on weight bearing, 5 who had difficulty standing comfortably on tiptoe, and 2 who limped because of pain. Three patients exhibited flatfoot deformity, whereas 4 had cavus deformity. All demonstrated stiffness at the midfoot and restriction of subtalar and forefoot motion, with 5 also having restricted ankle motion. Radiographically, all fractures were healed at the time of follow-up; 4 were malunited, with 1 demonstrating ankylosis across the tarsometatarsal joint. These results suggest that crush injuries to the midfoot often result in persistent morbidity despite early comprehensive management with external fixation.

Physiotherapeutic procedure after injuries of soft tissues of tarsal-crural joint

The Journal of Orthopaedics Trauma Surgery and Related Research, 2008

Physiotherapeutic procedures in soft tissues injuries of tarsal joint are presented in this paper. Meaning of the early procedure “RICE” and the extended procedure “PRICEMM” in acute injuries of tarsal joint is underlined. Rules of physiotherapy in directed conservative or operative treatment procedures are presented. Procedure was adapted to the kind and degree of soft tissues injuries. After termination of standard immobilization of the limb or during immobilization in orthesis, it is necessary to start physiotherapy, isometric exercises, techniques of lymphatic drainage, education of walking with crutches at partial or total load of the limb in dependence on the kind and degree of injury of soft tissues of joint and coexistent injuries. In the second stage, after basic period of healing of soft tissues and after removal of immobilization, exercises directed on return to function of joint and then the whole limb are recommended. Exercises of proprioception play particular role. Ma...

Surgical Treatment of Tarsal Navicular Stress Fractures

Operative Techniques in Sports Medicine, 2006

The tarsal navicular is part of the medial column of the foot. It articulates with the talus as well as the cuneiforms. The navicular can be injured with repetitive loading, such as in an athlete, resulting in a stress fracture. Patients complain of pain over the medial midfoot, especially with axial load. Plain radiographs may be normal, and MRI, CT or bone scan may be necessary to confirm the diagnosis. Nonoperative management can be successful with cast immobilization. For competitive athletes with delayed union or nonunion, surgical repair may be indicated. This is accomplished with interfragmentary screws and autogenous cancellous bone graft. Cast immobilization is important to prevent motion at the fracture site during the postoperative healing period. Nonweightbearing restrictions are used for eight to twelve weeks, or until radiographic bony union is verified. Using a comprehensive rehabilitative program, full motion and strength can be expected with eventual return to full athletic activity.

Minimally Invasive Technique For The Management Of Communited Fracture Of The Tarsal Navicular Bone

The Internet Journal of Orthopedic Surgery

Closed fracture dislocation of navicular is a rare injury. All 8 reports in the current literature, which we could find, describe treatment by open reduction and internal fixation of this injury. In this case report we describe how this injury was managed successfully by closed reduction using ligamentotaxis with an external fixator and supplemented by percutaneous internal fixation of the fracture of the navicular.

Temporising external fixation for hind foot trauma

2020

Objective: The use of temporizing external fixation for distal tibia and ankle fracture not in the damage control set-up is debatable. The current paper highlights the outcome of this practice.Methods: Fifteen patients treated for isolated ankle, Pilon and distal tibial fracture with a temporising external fixation in Scarborough York teaching hospital were included in this study. The fixator became a definitive fixation in three patients. Hoffman triangular bar technique was used.Results: Mazur clinical rating was used on follow-up at a mean follow-up of 13 months. The outcome was excellent (1), good (4), fair (6), poor (3). Loss of reduction, pin tract infection, union problems were some of the complication. The overall complication outweighs the benefits using temporising external fracture in the isolated hind foot trauma. The swelling and blister of the soft tissue can be treated otherwise with elevation and plaster immobilization without the justification for using the external...

Injuries of the tarsometatarsal joints: treatment and outcome

Collegium antropologicum, 2011

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and ...