Debridement of Infected Bone of the Foot and Ankle



Debridement of Infected Bone of the Foot and Ankle


Michael C. Holland

Scott L. Hansen





ANATOMY



  • The ankle is formed by the distal aspect of the tibia (medial) and fibula (lateral) articulating with the talus of the foot.


  • The foot is composed of 26 bones functionally homologous to bones of the hand and wrist.


  • The hindfoot is composed of the talus, which is seated on the calcaneus.


  • The midfoot articulates with the bones of the hindfoot and is composed of the cuboid navicular and three cuneiform bones (medial, intermediate, and lateral).


  • The forefoot is composed of the 5 metatarsal bones and 14 phalanges.


  • Two sesamoid bones underlying the first toe metatarsal phalangeal joint also are present in adults, with infrequently found accessory sesamoid bones at other joints.2


PATHOGENESIS



  • Infection most often arises from soft tissue wounds, open fractures, complications from orthopedic reduction of closed fractures, hematogenous seeding from bacteremia or endocarditis, or inoculation from trauma


PATIENT HISTORY AND PHYSICAL FINDINGS



  • History of diabetes mellitus, vascular insufficiency, venous hypertension, peripheral neuropathy, immunodeficiency, prior fracture, presence of hardware, prior surgery, and prior podiatric procedures are important to identify preoperatively in order to determine whether or not adjuvant therapy may be beneficial to precede operative intervention.


  • Diminished sensation, paresthesias, and claudication are symptoms that may indicate the presence of these above comorbidities.


  • Presence of open wounds with or without visible bone, erythema, fluctuance, and bony tenderness can indicate active infection.


  • Decreased Semmes-Weinstein monofilament test, prior scars, palpable hardware, and venous ulceration are physical exam findings that may indicate higher-risk populations for developing osteomyelitis.


IMAGING

Nov 24, 2019 | Posted by in Aesthetic plastic surgery | Comments Off on Debridement of Infected Bone of the Foot and Ankle
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