ABSTRACT
CONTENTS I. Introduction ...................................................................................................................... 346
A. Classification.............................................................................................................. 347
B. Microbiology ............................................................................................................. 347
C. Diagnosis ................................................................................................................... 347
1. Clinical Evaluation.............................................................................................. 347
2. Laboratory Evaluation........................................................................................ 347
3. Evaluation for Blood and Oxygen Supply to Tissues.......................................... 348
4. Imaging Studies................................................................................................... 348
D. Management .............................................................................................................. 349
1. Cultures ............................................................................................................... 349
2. Antimicrobial Therapy........................................................................................ 350
3. Surgical Treatment .............................................................................................. 351
4. Adjunctive Therapy............................................................................................. 353 II. Posttraumatic Skin and Soft Tissue Infections.................................................................. 353
A. Puncture Wounds ...................................................................................................... 353
1. Clinical Evaluation.............................................................................................. 353
2. Treatment............................................................................................................ 353
B. Necrotizing Fasciitis .................................................................................................. 354
1. Clinical Presentation ........................................................................................... 354
2. Diagnosis............................................................................................................. 354
3. Treatment............................................................................................................ 355
C. Postoperative Wound Infections................................................................................ 355
D. Pin Track Infections .................................................................................................. 355
1. Clinical Presentation ........................................................................................... 356
2. Diagnosis............................................................................................................. 357
3. Management........................................................................................................ 357 III. Foot and Ankle Osteomyelitis........................................................................................... 357
A. Classification.............................................................................................................. 357
B. Etiology ..................................................................................................................... 357
C. Postoperative Osteomyelitis ....................................................................................... 358
D. Posttraumatic Osteomyelitis ...................................................................................... 359
E. Principles of Osteomyelitis Management ................................................................... 359 IV. Postoperative Infections Following Fractures ................................................................... 360
A. Fractures of the Plafond ............................................................................................ 360
1. Incidence and Risk Factors ................................................................................. 360
2. Treatment............................................................................................................ 360
B. Ankle Fractures ......................................................................................................... 361
1. Incidence and Risk Factors ................................................................................. 361
2. Treatment............................................................................................................ 361
C. Talus .......................................................................................................................... 362
1. Incidence and Risk Factors ................................................................................. 362
2. Treatment............................................................................................................ 364
D. Calcaneus................................................................................................................... 364
1. Incidence and Risk Factors ................................................................................. 364
2. Treatment............................................................................................................ 364
E. Midfoot and Forefoot ............................................................................................... 364 V. Conclusion ........................................................................................................................ 365 References .................................................................................................................................. 367
I. INTRODUCTION
Infections following foot and ankle trauma remain a diagnostic and therapeutic challenge. Traumatic injuries such as nail punctures, lacerations, burns, and fractures are often contaminated with microorganisms introduced during the time of injury. The paucity of soft tissue coverage providing protection to the foot and the proximity of the skin to the bone increases the predisposition to posttraumatic infections, particularly to osteomyelitis. The risk for infection and inoculation of the organisms directly into bone is increased in open fractures, external and internal fixation, and during other surgical procedures. Therefore, early recognition of the infection and prompt management are essential to preserving a functional limb and preventing complications, such as sepsis and amputation.
