OKOJ, Volume 14, No. 11

Ankle and Hindfoot Fractures

Fractures of the ankle and hindfoot present unique challenges for trauma and foot and ankle surgeons. All facets of the preoperative evaluation, surgical indications, intraoperative management, and postoperative rehabilitation continue to evolve as the field strives to improve the functional outcomes of patients and decrease complications, which can be particularly unforgiving in the ankle and hindfoot.

    • Keywords:
    • ankle fracture

    • calcaneus fracture

    • pilon fracture

    Coagulation and Blood Management

    Despite the considerable emphasis on guidelines for prophylaxis against venous thromboembolic disease, this complication still can occur after any orthopaedic surgery. Therefore, the general principles and methods of prophylaxis need to be understood by all orthopaedic surgeons to ensure proper implementation. Variations in the recommendations of different guidelines have been observed, however. Often, the type of prophylaxis is dictated at the orthopaedic surgeon's discretion on a case-by-case basis. In addition, blood management and the control of perioperative blood loss remain serious issues. Given the complications and infection risk associated with transfusions, a shift has been seen toward the greater use of antifibrinolytics to manage perioperative blood loss.

      • Keywords:
      • blood products

      • complications

      • prophylaxis

      • venous thromboembolic disease

      Vertebral Compression Fractures

      Vertebral compression fractures are very common, and knowledge about the etiology and treatment of compression fractures is essential for physicians. Compression fractures may result from osteoporosis, tumors, and trauma. The treatment of most compression fractures is nonsurgical, and nonsurgical care typically incorporates physical therapy, bracing, and oral medications. Surgical intervention is necessary in cases of intractable pain, instability, and neurologic compromise, however. Another important aspect of treatment is the prevention of future fractures. Patients with osteoporosis should be identified, and prophylactic treatment should be instituted. In the past, calcium, vitamin D, and diphosphonates were the mainstays of osteoporosis treatment. Teriparatide is a relatively new medication that is being used more frequently in patients with osteoporosis. The surgical treatment of osteoporotic compression fractures using vertebral augmentation recently has become controversial. It is important to review the recent literature on the evaluation and treatment of patients with osteoporotic compression fractures and on the surgical treatment of osteoporotic compression fractures with vertebral augmentation.

        • Keywords:
        • osteoporosis

        • fracture

        • vertebral augmentation