FOOT & ANKLE CENTER FOR TRAUMA (F.A.C.T)

The Foot & Ankle Center for Trauma is the center for all types of foot & ankle injuries.  Every bruise, burn, muscle tear, tendon pull, cut, fracture, laceration, functional loss, scar, shock, sore, sprain, swelling, trauma, wound, sliver, and suffering involving the foot & ankle.  See the specialists and surgeons first.  Get answers.  Get going!

Foot & Ankle injuries are common.  They are never convenient and never easy; but they are always recoverable. 

Come by for fast access to a specialist assessment of your foot or ankle trauma.  We have all that you will need.  Casts, boots, braces, crutches, and knee scooters.  Your one-stop-shop for foot and ankle trauma or injury.  If additional imaging is needed, it is quickly accessible.  If surgery is necessary, it can be coordinated quickly. 

Expertise.  Experience.  Recovery.  Results.

ANKLE FRACTURE SPECIAL CONSIDERATIONS:

PEDIATRIC

Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation, and treatment of pediatric ankle fractures. Correct diagnosis and management rely on appropriate exam, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, CT. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity.

OSTEOPOROTIC

The management of Osteoporotic ankle fractures is still considered to be a challenge by many surgeons. One of the issues seems to be a lack of data focused on this special subgroup, with truly little evidence of decent quality.

The current review of the literature has brought to light some interesting facts. Despite limited data there seems to be an increase in the incidence of these fractures. Although it could not demonstrate, a clear distinction between geriatric and osteoporotic ankle fractures from the available literature; all geriatric fractures are not necessarily osteoporotic, and neither is the reverse true. The evidence to associate osteoporotic ankle fractures with poor outcomes is weak, and factors other than osteoporosis may have a stronger influence. From this analysis, we could not establish a higher incidence of implant failure for this specific fracture group, although many modifications in technique have been proposed due to the fear of fixation failure. Hook plating and Tibia-pro fibula fixation have weak evidence in support, but posterior fibular plating is preferred due to soft tissue protection. There is weak evidence in support of Locking plates for these fractures, as publications focused on this are limited; nevertheless, some advantages have been documented. Augmentation by calcium-based bone graft substitutes has been reported to improve pull out strengths of screws, but again the evidence of its role in Osteoportic fractures is limited. Fibular nailing has been proposed with specific advantages in osteoporotic fibular fractures, but the concept is new, and it is indicated only in a select subgroup of cases. Some evidence exists for the use of trans-articular nails in geriatric subgroups with limited pre-injury mobility, but the technique must be used with caution to prevent other complications.

DIABETIC:

Ankle fractures and diabetes mellitus are both increasing in prevalence. Patients with both diabetes and an ankle fracture have been shown to have an increased rate of complications which can be catastrophic. 

Non-operative management of unstable ankle fractures in patients with diabetes results in an unacceptably high rate of complications. Operatively managed patients with uncomplicated diabetes seem to be fair as well as patients without diabetes. Thus, it is important to recognize patients as either complicated or uncomplicated at the onset of their treatment based on comorbidities.