[Foot injuries in the polytraumatized patient].
Foot injuries in polytraumatized patients are not critical for survival but for the later quality of life. Closed fractures or dislocations of the foot are frequently overlooked or misinterpreted in association with polytrauma, which leads to severe functional impairment in those patients who survive. Repeated clinical examinations and early radiographic examinations are essential in the unconscious patient after resuscitation. Emergent indications for surgery even in the presence of multiple injuries are open injuries, incarcerated soft tissues, manifest compartment syndrome of the foot, and neurovascular injury. The decision on limb salvage or amputation has to be individualized with respect to the patient's overall condition and the severity of local trauma to the foot. The "life before limb" principle has to be respected. Emergent reduction of fracture dislocations of the talus, calcaneus, Chopart's and Lisfranc's joints via direct approaches and temporary transfixation with K-wires should be attempted in a first step whenever possible. Additional external fixation facilitates wound care and prevents soft tissue contractions until definite internal fixation becomes feasible. Early soft tissue coverage is always sought in order to avoid infection.
Rammelt
S
S
Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum "Carl Gustav Carus", TU, Dresden. strammelt@hotmail.com
Biewener
A
A
Grass
R
R
Zwipp
H
H
D000671:Amputation, Surgical / Q000379:methods*; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000379:methods / Q000639:trends; D018409:Foot Injuries / Q000175:diagnosis / Q000601:surgery*; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome