Cancelloplasty for Treatment of Osteomyelitis of the Calcaneus: A Novel Technique and Case Report.

Calcaneal osteomyelitis has the potential to cause limb- and life-threatening complications. The anatomic and biomechanical attributes of the heel make limb salvage in the setting of bone infection complex. Current treatment options include surgical resection of part or all of the calcaneus, lower extremity amputation, or prolonged intravenous antibiotic usage. Each modality has its own inherent disadvantages. We present a novel surgical technique using antibiotic-impregnated calcium phosphate as an alternative treatment option coupled with ultrasonic bone dissection as a method for enhancing delivery of antibiotics, while mitigating tissue damage and maintaining osseous integrity. The details of the surgical technique are discussed along with a single case example.

Management of Distal Fibular Fractures With Minimally Invasive Technique: A Systematic Review.

Ankle fractures are extremely common, with isolated distal fibular fractures being the most common variant. The current gold standard in treating unstable distal fibular fractures is open reduction internal fixation. However, with potential risk of wound complications, minimally invasive techniques have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of varying minimally invasive techniques including minimally invasive plate osteosynthesis, intramedullary (IM) nailing, and IM screw fixation. A comprehensive English literature search on PubMed was performed yielding 543 studies. With specific study selection criteria, a total of 13 articles were selected. After studying the reference of each of the 13 studies, an additional 7 articles were included, resulting in a total of 20 studies reviewed. A total of 8 articles reviewed used IM nailing as the fixation of choice with a total of 211 patients. Of the 211 patients, 33 experienced complications. Six articles using minimally invasive plate osteosynthesis were reviewed with a total of 264 patients. Of the 264 patients, 39 experienced complications. IM screw fixation was used in 6 articles reviewed with a total of 219 patients. There were 30 cases of complications from the 132 patients. Additionally, mean American Orthopedic Foot and Ankle Society hindfoot-ankle scores among all fixation types was 88.4 ± 3.40 whereas the mean Olerud and Molander Score among all fixation types was 76.7 ± 16.58. The results of this study indicate that minimally invasive techniques for fixation of distal fibular fractures can provide excellent functional results with low complication rates compared with traditional open reduction internal fixation.

The Gradual and Acute Correction of Equinus Using External Fixation.

Equinus is one of the most common deformities noted in foot and ankle biomechanics that, at times, if not identified and managed properly may lead to significant lower extremity pathology. With that being said, this deformity is also one that may be both underdiagnosed and undertreated. Treatment for equinus can range from conservative therapy to more aggressive surgical therapy. The purpose of this article is to review the clinical workup to properly identify the deformity and to explore the various treatment options for its timely management, which include gradual or acute correction of equinus using external fixation.