Complications of the Foot by Dr. Ford

• Osteomyelitis
  • High risk groups: Substance abusers, Diabetics, open fractures
  • Bone biopsy is gold standard for diagnosis
  • Get a deep culture (with a piece of tissue or bone) before initiating abx
  • Bone mineral loss of 30% is required for changes to be visible on X-ray
• Charcot neuroarthropathy
  • Progressive noninfectious condition
  • 2 etiologies: neurovascular and neurotraumatic (microfractures)
    • Neurovascular: massive amounts of blood flow “water log” the bones. Caused by autonomic dysfunction
  • Initial phases can look like cellulitis but erythema is DEPENDENT (resolves with 10min of elevation)
  • Consolidation (chronic) phase = rocker bottom foot. Mid foot bony deformity
  • DISCHARGE if no WBC or open wound. Normal to have elevated ESR, CRP, temperature.
  • ADMIT if open wound present to r/o infection with biopsy
  • Treatment is offloading with total-contact cast
• Gout
  • Gouty arthritis can break down bone and mimic osteo. Differentiate with history.
  • Uric acid level will be elevated

Lightning Lectures

Gout

• Monosodium urate crystal deposition
• Elevated uric acid levels
• Monoarthritis often involving first MTP or knee joint
• US can demonstrate “double contour sign”
• Treatment options: NSAIDs, Prednisone, Colchicine

Septic Arthritis

• <35yo: N gonorrhea; >35yo: S. aureus
• Pain with ROM
• Arthrocentesis with synovial fluid analysis is diagnostic

Pharmacology in Open Fractures and Reductions

• In antibiotic selection in open fractures consider Gustilo Classification and environmental exposures.
• Grade I & II fractures: gram positive coverage w/ Cefazolin
• Grade III fracture: gram positive and negative coverage w/ cefazoline and gentamicin