Ronald Belczyk

Surgical Treatment of Calcaneal Fracture Malunions and Posttraumatic Deformities

The surgical management of calcaneal fractures presents with several obstacles to the treating physician. Many experienced surgeons acknowledge a steep and significant learning curve in the operative management of calcaneal fractures. Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion, thereby affecting the function of the ankle and subtalar joint. Although some calcaneal fractures can be treated conservatively, a majority of them require operative intervention. The goal of this article is to bring some insight into the realm of revisional surgery on residual deformity of the calcaneus after operative intervention and also provide a rationale approach to successfully manage failed surgeries for calcaneal fractures.

Complications and Revisional Hallux Valgus Surgery

Complications with hallux valgus surgery can manifest in a variety of ways, but ultimately preventing them depends on the surgeons expertise in patient and procedural selection, ability to perform the surgery selected, and knowledge in dealing with postoperative care and complications if present. In this article, the authors discuss common diagnostic and treatment dilemmas when dealing with recurrent hallux valgus, hallux varus, malunion, and avascular necrosis following bunion surgery.

Combined Midfoot Arthrodesis, Muscle Flap Coverage, and Circular External Fixation for the Chronic Ulcerated Charcot Deformity

If the FDB muscle is not clearly visualized, then another method of closure should be considered.” “ L ateral column plantar ulcerations associated with chronic Charcot foot deformity are often difficult to heal and can be complicated in the presence of osteomyelitis. Charcot neuroarthropathy of the foot may result in rigid varus malunion deformities that may ulcerate frequently despite aggressive attempts in offloading with bracing or accommodative shoe gear. Collapse of the lateral column of the Charcot foot is a difficult pathological entity to treat, and longstanding ulcerations frequently become complicated with soft tissue and/ or osseous infection. These patients often present after failure of prior surgical debridements and soft tissue coverage attempts. Proper management of an ulcerated Charcot foot deformity and concomitant osteomyelitis involve removal of all infected bone and soft tissue, eradication of dead space, and prolonged antibiotic therapy. Adequate debridement of soft tissue can be aided by quantitative soft tissue cultures because greater than 10 organisms per gram of tissue cannot sustain a skin graft or flap and will require further debridement before definitive coverage. Chronic osteomyelitis is frequently associated with significant surrounding soft tissue loss and a tunneling, draining ulceration. When osteomyelitis involves the cortical surface and the medullary cavity, sequestrae are typically present. Infected nonunion or malunions of Charcot foot deformities may be treated with isolated resection of the infected bone, but sufficient debridement of plantar lateral midfoot ulcers may result in potential destabilization of the longitudinal arches of the foot. In addition, suboptimal resection of necrotic or infected bone will preclude successful resolution of infection, contribute to chronic nonhealing ulcers, and ultimately result in failure of attempted reconstruction. Resected joint space from osteomyelitis can be managed initially with locally placed antibiotic beads or spacers, vacuumassisted negative pressure therapy, or soft tissue coverage with pliable vascularized local flaps. Antibiotic beads or spacers can be placed beneath a flap after saucerization to help decrease bacterial counts and may be later replaced with

A case report of a double advancement flap closure combined with an Ilizarov technique for the chronic plantar forefoot ulceration.

Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.

Trimethoprim-sulfamethoxazole-induced stevens-johnson syndrome: A case report

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a unique case report of Stevens-Johnson syndrome and associated toxic epidermal necrolysis in a 61-year-old man after treatment for a peripherally inserted central catheter infection with trimethoprim-sulfamethoxazole. This case report reviews a rare adverse reaction to a commonly prescribed antibiotic drug used in podiatric medical practice for the management of diabetic foot infections.

Recurrent Acute Compartment Syndrome of the Foot Following a Calcaneal Fracture Repair

Acute compartment syndrome is a known possible complication of calcaneal fractures and few case reports have documented a recurrent event after initial surgical fasciotomies. This article describes a rare case demonstrating a recurrence of acute compartment syndrome within days of initial fasciotomies and surgical repair of a comminuted calcaneal fracture.

A case report of a simultaneous local osteochondral autografting and ankle arthrodiastasis for the treatment of a talar dome defect.

Talar osteochondral defects (OCDs) are a challenge for treating physicians because they frequently are missed or diagnosed incorrectly, often resulting in severe degenerative arthritis of the ankle joint. Surgical intervention becomes a viable option in the presence of larger OCDs associated with loose bodies or osteochondral lesions that have failed conservative treatment. The successful use of autologous osteochondral autograft in the knee has promoted the applicability in the ankle. This report describes a unique technique for the treatment of large talar osteochondral lesions using a local osteochondral autograft combined with an ankle arthrodiastasis.

Synovial sarcoma of the foot: a case report.

We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up.

Combined Medial Displacement Calcaneal Osteotomy, Subtalar Joint Arthrodesis, and Ankle Arthrodiastasis for End-stage Posterior Tibial Tendon Dysfunction.

Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis.

Plantar Foot Donor Site as a Harvest of a Split-Thickness Skin Graft

The authors present a minimally invasive procedure for harvesting a split thickness skin graft (STSG) from the plantar surface of the foot. This is another option to consider for soft tissue reconstruction of diabetic foot wounds to help restore form and function and to prevent amputation. The authors do not recommend this technique for all soft tissue wounds of the toes and plantar aspect of the foot but believe it is a viable option for selected small diabetic foot wounds that may benefit from a STSG.