Foot and Ankle Trauma Injuries: Atlas of Surgical Procedures

134 Pages·2018·17.19 MB·English

by  Walter Daghino

Foot and Ankle
Trauma Injuries
Atlas of
Surgical Procedures
Walter Daghino
Alessandro Massè
Daniele Marcolli
123
Foot and Ankle Trauma Injuries
Walter Daghino · Alessandro Massè
Daniele Marcolli
Foot and Ankle Trauma
Injuries
Atlas of Surgical Procedures
Walter Daghino Alessandro Massè
CTO Hospital CTO Hospital
University of Turin CTO Hospital University of Turin CTO Hospital
Turin Turin
Italy Italy
Daniele Marcolli
Orthopedic division
Azienda Ospedaliera Ospedale Civile di L
Milano
Italy
ISBN 978-3-319-69616-4 ISBN 978-3-319-69617-1 (eBook)
https://doi.org/10.1007/978-3-319-69617-1
Library of Congress Control Number: 2017964099
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Foreword 1
Orthopaedics, like all surgical specialties, has definitely evolved versus sub-specialization.
Foot and ankle surgery is one of these established sub-specialties. The impressive increase
in knowledge and techniques justifies this evolution. Comprehensive textbooks offer the
generic knowledge for every surgeon, while monographs offer the superspecialists the details
they need. Thanks to information technology (IT), the access to scientific data is no longer a
problem. On the contrary, we are confronted to an information overload. We need a sound
selection of information based on clinical experience. A given clinical problem has usually
many different possible solutions. To illustrate all of them with all details needed for practical
implementation is impossible in a conventional publication and would only produce uncer-
tainty. A group of surgeons, in one or more institutions, can and has to choose and define a
“house doctrine” taking into account the local circumstances. This is the basis of what can
become an ideal monograph, like the present one about foot and ankle trauma. The vast amount
of available data is “filtered” and based on clinical experience of the group. This does not mean
to present only “the single and only solution” to a given problem but a limited number of alter-
natives for which the group of authors have solid experience. To know that there are different
solutions to a given problem and that science evolves continuously, i.e. that there is no defini-
tive certitude, is a fundamental attitude to be transmitted to younger surgeons. This open-
mindedness is crucial to allow progress and avoid “blindly following fashion”.
This monograph covers the relevant topics of foot and ankle trauma. The described solu-
tions, validated by experience, are well illustrated. Therefore, the authors satisfy the wish of
today’s users for application in daily practice. The decisional algorithms proposed are very
useful in this respect. All chapters include detailed and useful paragraphs about classification,
indication, timing and access.
The iconography consists of a sound balance between instructive drawings and clinical
photos. It is meritorious to have also included nonskeletal trauma like Achilles tendon
ruptures.
Lugano, Switzerland, AO Foundation Honorary Trustee Pietro Regazzoni
v
Foreword 2
My friendship with Walter started about 20 years ago, at the time he was a young neo-special-
ist, and I had a few more years, both busy with the daily activity of a Hospital Orthopedic
Division. Already at that time, I was struck by his manner to face the clinical problems: preci-
sion, rigour and extremely schematic, clear and defined paths, in a word: “method”. During the
time, we had the opportunity to share the interest in the pathologies of the foot and the ankle;
after his reassignment to the CTO Hospital of Turin, Walter continued to deepen the topic and
in particular the aspects related to traumatic lesions.
Over the years, Walter gained considerable practical experience on the subject, becoming a
real point of reference; this amount of work has allowed the creation of a well-designed theo-
retical and practical annual course that allows participants to have a complete overview on the
problems related to the traumatology of foot and ankle. I was therefore very pleased to dis-
cover this book, Foot and Ankle Trauma Injuries: Atlas of Surgical Procedures, that is the
graphic translation of the course.
It is a truly interesting and original volume, in which all the traumatic injuries from the
ankle to the forefoot are described, with a very appealing graphic presentation. For each topic,
the general aspects are discussed (traumatic mechanisms, classifications, pathological anat-
omy, etc.), but the presentation is mainly focused on the surgical treatment that has the greatest
space. The reader is accompanied step by step in the planning and execution of the surgical
procedure, from the patient’s positioning, to the surgical access, to osteosynthesis; each pas-
sage is presented in a meticulous way, with many tips and tricks useful for optimizing the
result. A very strong asset of this book is related to the illustrations, carried out in collaboration
with the anatomical drawing course of the “Accademia Albertina di Belle Arti” of Turin; the
drawings result at once schematic and full of details that make the already clear exposition
even more explicit. The operating theatre images are particularly beautiful: in these, the artists
have masterfully rendered the three-dimensionality and depth of the illustrations describing
the surgical fields. Reading the texts and looking at the illustrations, the exposure is so clear
and detailed that one gets the feeling that even the most complex surgeries (and very often they
are “really” complex procedures) are indeed easy and within everyone’s reach.
Therefore, most sincere congratulations to my friend Walter for the well-done work, which
goes to fill a gap in medical publishing on the subject; we all know how much effort and time
taken away from rest and family is required to accomplish a work of this kind.
Good reading and good consultation!
Alba (CN), President of Italian Society of Foot and Ankle (SICP) Luigi Milano
vii
Preface
Professor Giacomo Pisani, one of the founding fathers of foot surgery in Italy and around the
world, usually presented his courses, always appreciated and attended by many surgeons, with
a simple and effective formula; it has proposed them as “… his home kitchen …”; this formula
left the participants free to express a more or less complete acceptance to the presented tech-
niques, introducing the concept of taste, clearly personal and subjective.
But all participants knew well that given the great fame that the “Prof.” had gained over the
years following his scientific value and the consolidated results of his surgical activity, those
he presented as advices were indeed precious information that would necessarily become para-
mount guides in their daily clinical activity.
When I first time took into consideration this work, immediately and automatically I
remembered those words, and I realized that it was possible only by proposing the result with
the same humility, considering this book like our home recipes.
This is the goal of this volume: systematize and organize over 15 years of activity in a
superspecialist field such as foot and ankle traumatology in a particularly favourable environ-
ment such as the Orthopedic Traumatology Center of Turin, so to easily transmit the results. In
this centre, the continuous peer review and consideration of scientific literature, the coexis-
tence with high professionalisms also in disciplines related to orthopaedics and the availability
of the best technology and the most modern instrumental equipment for surgeons have possi-
bly made very specific experiences to mature, extensively tested on the field over time, which
have been collected in these pages.
We don’t think that these “recipes” are the only way to behave, but we hope that they can
be a useful assistance to the surgeon who must treat difficult cases in the challenging field of
orthopaedic surgery.
In the “2.0 era”, it is not possible to approach the traditional book without a clear target to
pursue: our aim was to give support to surgeons who approach these injuries through pictures
that can help them in order to understand and simplify the problems. The previous statement
clarifies the choice of creating not a text but an atlas, with many didactic pictures that, through
the effort made with the artists, will deliver to the surgeon a clear message. For this reason, all
surgical illustrations use colours to underline what the surgeon should see and transparencies
to indicate the anatomical structures that the surgeon should not see, but he must know that
they run near the surgical field, for the best execution of the procedure.
Before I conclude this introduction, it is appropriate to make some acknowledgements. First
of all, I would like to thank Prof. Alessandro Massè, co-author of this work. I am grateful to
him not only because he recognized and shared my efforts but mainly because he also taught
me the importance of essentiality and sharpness in the surgical gesture, of the rigour in the
scientific method and of the clarity during transmission of information and knowledge. I would
like to thank Dr. Daniele Marcolli, a young coworker in the English version of this book, who
accurately solved all translation problems from the Italian version.
I then would like to thank Prof. Paolo Belgioioso, a fundamental referent for the images of this
volume, who has coordinated the work of illustration in a perfect manner, with full integration
between different skills. I also thank the collaborators of Professor Belgioioso: Fabrizio Lavezzi,
ix
x Preface
Kim SooGyeong and Debora Quaglino, and I congratulate them for the ability to adapt the
graphic sign to the difficult requests of illustration.
Again, I would like to thank Prof. Pietro Regazzoni, one of the most important trauma sur-
geons in the world, who honoured me by writing a foreword of this book. I yet thank another
friend, Dr. Luigi Milano, now president of Italian Society of Foot and Ankle (SICP), who has
realized the Preface, from which I learned the passion for foot surgery and which represented
a point of reference over time for my technical growth, with his always valuable advices and
lessons. I also thank all the great Italian surgeons who converge in this prestigious Specialistic
Society: they always have been my models and now they honour me with their friendship; I
thank them also for their continuous stimulus to the comparison and discussion that they trans-
mit not only at official scientific meetings of the society, which represent the state of the art of
this surgery in Italy, but on every occasion of meeting, also if informal.
Finally, I thank all the collaborators of this book and all the colleagues with whom I have
worked with over the years: they have participated and contributed to the daily management of
this specific and specialized surgical activity, and it is right and due to share with them the
results achieved.
The last thought necessarily goes to my dear ones who always gave me strength to get
through every trouble: I apologize for the time I took from them for the realization of this
work.
Turin, Italy Walter Daghino
Acknowledgement
We acknowledge those who have assisted us in the preparation of this work.
xi
Contents
1 Tibial Pilon Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Tibial Pilon Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.2 Treatment and Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.3 Temporary Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1.4 Definitive Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2 Malleolar Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1 Malleolar Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1.1 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1.2 Indications and Surgical Timing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1.3 Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.1.4 Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3 Subcutaneous Rupture of the Achilles Tendon . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1 Subcutaneous Rupture of the Achilles Tendon . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1.1 Injury Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.1.3 Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.1.4 Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4 Surgical Treatment of Traumatic Injuries of the Talus . . . . . . . . . . . . . . . . . . . . . 47
4.1 Traumatic Injuries of the Talus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.1.1 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.1.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.1.3 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.1.4 Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5 Surgical Treatment of Calcaneal Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.1 Calcaneal Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.1.1 Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.1.2 Type of Treatment and Indications (Planning). . . . . . . . . . . . . . . . . . . . 66
5.1.3 Percutaneous Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.1.4 External Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
5.1.5 Open Reduction and Internal Fixation (ORIF) . . . . . . . . . . . . . . . . . . . 75
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
6 Surgical Treatment of Midfoot Traumatic Injuries . . . . . . . . . . . . . . . . . . . . . . . . 89
6.1 Traumatic Injuries of the Midfoot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
6.1.1 Diagnostic Help Orientated to Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 89
xiii