Prevention and management of complications of the Ilizarov treatment method.

Serious orthopaedic conditions such as nonunions and pilon, calcaneal, and Lisfranc fractures, as well as leg lengthening, correction of angular deformities, resection of osteomyelitis, and bone transfer, can be treated successfully with the Ilizarov system. However, complications such as contractures, loss of range of motion, neurologic deficits, articular damage, contractures, and pin track infections can occur. This article describes the costs of limb salvage with the Ilizarov system compared with amputation as well as possible complications and their prevention; it also provides a treatment protocol.

Disorders of the Achilles tendon and its insertion.

This article describes disorders of the Achilles tendon and its insertion.

Charcot osteoarthropathy in a case of Klippel-Trenaunay-Weber syndrome.

A case of a patient with Klippel-Trenaunay-Weber syndrome (KTW) with Charcot osteoarthropathy is presented. A medline literature review was performed using the words Klippel-Trenaunay, orthopaedic, ankle, foot, and Charcot joint. Seven articles reported orthopaedic manifestations of KTW. They included limb hypertrophy and atrophy, limb-length discrepancies, digital anomalies, ulcerations, and spine and hip abnormalities, but no mention of Charcot osteoarthropathy. After many years of chronic nonhealing ulcers and repeated incision and drainage procedures the patient developed Charcot osteoarthropathy of the ankle without evidence of osteomyelitis or peripheral neuropathy but with severe deformity that required transtibial amputation.

Imaging modalities of the diabetic foot.

Charcot osteoarthropathy is a devastating process that occurs in the diabetic foot. It must be distinguished from other conditions, such as osteomyelitis, with efficiency and accuracy. The prognosis and treatment depends on it. Charcot progresses along four radiographically identifiable stages; therefore, plain films should be the first step in the evaluation. When osteomyelitis is suspected, a three-phase bone scan may allow clear enough anatomic detail to diagnosis bony involvement compared with soft tissue in the forefoot. In the midfoot, a three-phase bone scan alone is not specific enough to distinguish between Charcot and osteomyelitis. Enhancing the bone scans by adding an additional phase (four-phase) or tracer (gallium) does not appear to improve specificity significantly. Computerized bone flow studies may be more helpful in making the distinction, particularly in acute presentation. A CT scan is not indicated because the MR image will better define the anatomic extent of the process for preoperative planning. The combined WBC scans and sulfur colloid marrow scans show improved specificity and can distinguish between Charcot and osteomyelitis. Combined leukocyte scan with bone marrow imaging is superior to leukocyte and bone scan alone or in combination for detecting infection in the neuropathic foot. The combined leukocyte scan and bone marrow imaging is the current gold standard for evaluating the presence of diabetic foot infection versus osteoarthropathy, and MR imagine is the anatomic gold standard that may be used to define the extent of the process.

Endoscopic decompression of the retrocalcaneal space.

BACKGROUND: Pain in the retrocalcaneal space can be incapacitating. Patients who do not respond to nonoperative treatment may seek a surgical solution. The first purpose of this paper was to describe and evaluate the efficacy of a minimally invasive procedure to address retrocalcaneal pain caused by retrocalcaneal bursitis, a Haglund spur, and impingement. The second purpose was to compare the endoscopic technique with a standard open technique. METHODS: Our prospective study included thirty-three heels in thirty consecutive patients with chronic pain in the retrocalcaneal space for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-nine years (range, nineteen to seventy-nine years). This group was compared with a group of seventeen heels in fourteen patients with the same diagnostic criteria who were treated with an open technique. Both groups of patients were evaluated preoperatively and postoperatively with the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot Scale, and the patients treated with the endoscopic procedure were also evaluated postoperatively with the University of Maryland 100-point Painful Foot Center Scoring System. RESULTS: In the endoscopic group, the AOFAS scores averaged 61.8 points preoperatively and 87.5 points postoperatively (p < 0.001). The endoscopic procedures yielded nineteen excellent, five good, three fair, and three poor results at an average of twenty-two months postoperatively. (Three patients were excluded from the study.) In the open-treatment group, the AOFAS scores averaged 58.1 points preoperatively and 79.3 points at an average of forty-two months postoperatively (p = 0.006). The scores after the endoscopic procedures were numerically, but not significantly (p = 0.115), better than those after the open procedures. The time to recovery was the same in the two groups. The endoscopic procedures were performed more quickly than the open procedures (forty-four compared with fifty-six minutes) and were associated with fewer complications (a 3% compared with a 12% rate of infection, a 10% compared with an 18% rate of altered sensation, and a 7% compared with an 18% rate of scar tenderness). CONCLUSIONS: Endoscopic decompression is a feasible and efficient procedure for the treatment of retrocalcaneal disorders. It produces final results equal to or better than those of an open technique, with a similar recovery time, fewer complications, and a better cosmetic appearance.