Intermediate Learning Pathway: Trauma 2 – Rearfoot: Soft tissue, Navicular, Calcaneus, & Talus

Learning Objectives of this Pathway:

• Describe fractures/dislocations of the navicular including etiology, anatomy, clinical workup, common patterns/classifications, surgical approach(es), fixation, and unique complications.
• Describe fractures/dislocations of the calcaneus including etiology, anatomy, clinical workup, common patterns/classifications, surgical approach(es), fixation, and unique complications.
• Describe fractures/dislocations of the talus including etiology, anatomy, clinical workup, common patterns/classifications, surgical approach(es), fixation, and unique complications.
• Describe soft tissue injuries and areas of particular risk of the rearfoot including the anatomy, surgical approach(es), specific complications.
• Understand the significance of soft-tissue assessment and management in surgical timing and specific surgical technique(s) used to decrease risk of complication.
• Understand patient comorbidities and risk factors relevant to surgical decision making.

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Day 1: Soft Tissue

Clinical Sessions:
Deltoid Ligament-When and How Do We Repair?

None

Podcasts:
Deltoid Ligament Injuries

Ch 2: Soft-Tissue Envelope: Assessment and Timing

JFAS Articles:

• Compartment Syndrome of the Foot: An Evidence-Based Review
• Sequelae of Underdiagnosed Foot Compartment Syndrome after Calcaneal Fractures

Outside Journal Articles:

• The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome
• Vascularity of the Lateral Calcaneal Flap: A Cadaveric Injection Study
• Fracture Blisters: Clinical and Pathological Aspects
• Blisters Associated with Lower-Extremity Fracture: Results of a Prospective Treatment Protocol

Day 2: Navicular

Clinical Sessions:
None

Surgical Techniques:
Open Reduction Internal Fixation of Navicular Fracture (Tuberosity and Body)

Podcasts:
None

Ch 8: Navicular Fractures

JFAS Articles:

• Navicular Stress Fracture Outcomes in Athletes: Analysis of 62 Injuries
• Results of Treatment of 22 Navicular Stress Fractures and a New Proposed Radiographic Classification System
• A Unique Procedure for Treatment of Osteochondral Lesions of the Tarsal Navicular: Three Cases in Athletes
• Complete Medial Dislocation of the Tarsal Navicular without Fracture: Report of a Rare Injury
• Relationship of the Dorsalis Pedis Artery to the Tarsal Navicular
• Navicular Body Fractures: Computerized Tomography Findings and Mechanism of Injury
• Vascularized Scapular Free Bone Graft after Nonunion of a Tarsal Navicular Stress Fracture: A Case Report
• Custom-Made Total Talonavicular Replacement in a Professional Rock Climber

Clinical Sessions:
Talar Neck Fractures: Pitfalls in Treatment

Surgical Techniques:
Open Reduction Internal Fixation of Talar Neck Fracture

Podcasts:
None

E-Book Chapters:
Trauma eBook
Ch 9: Osteochondral Fractures and Injuries of the Talus

JFAS Articles:

• (Encourage to Review)-JFAS Collections:Talus Fracture
• Talar Body Fractures
• Talar Neck Fractures and Rates of Avascular Necrosis
• Lateral Process Fracture of the Talus: A Case Series and Review of the Literature
• Open Talus Fractures: Early Infection and Its Epidemiological Characteristics
• Talar Neck Fractures Treated Using a Highly Selective Incision: A Case-Control Study and Review of the Literature
• The Results of Physical, Radiologic, Pedabarographic, and Quality-of-Life Assessments in Patients with Surgically Treated Intraarticular Calcaneus Fractures
• Operatively Treated Talus Fractures: Complications and Survivorship in a Large Patient Sample
• Complications of Talar Neck Fractures by Hawkins Classification: A Systematic Review

Day 4: Calcaneus

Clinical Sessions:
Calcaneal Fracture: Decision Making

Open Reduction Internal Fixation of Calcaneal Fracture

Podcasts:

• Calcaneal Fracture
• Calcaneal Fracture Management Open vs Closed

E-Book Chapters:
Trauma eBook
Ch 10: Calcaneal Fractures

JFAS Articles:

• (Encourage to Review) - ACFAS Classic Article Series: Calcaneal Fractures
• (Encourage to Review) - JFAS Collections: Calcaneal Fracture
• Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-Analysis
• Radiographic Union Scoring Scale for Determining Consolidation Rates in the Calcaneus
• Open Calcaneus Fractures and Associated Injuries
• Screw Placement Relative to the Calcaneal Fracture Constant Fragment: An Anatomic Study
• Early Clinical and Radiographic Outcomes after Treatment of Displaced Intra-articular Calcaneal Fractures Using Delta-Frame External Fixator Construct
• The Treatment of Intra-articular Calcaneus Fractures with Severe Soft Tissue Damage with a Hinged External Fixator or Internal Stabilization: Long-term Results
• Open Versus Closed Operative Treatment for Tongue-Type Calcaneal Fractures: Case Series and Literature Review

Outside Journal Articles:

• Open Tongue-Type Calcaneal Fracture Treated with the External Fixation Bent Wire Technique
• Early Weight Bearing of Calcaneal Fractures Fixated with Locked Plates: A Radiographic Review

The ACFAS learning pathways are a tool to be used by residency directors, fellowship directors and school faculty to aid with didactic learning during the COVID-19 crisis. They are not intended to replace a curriculum, but to supplement student and resident education during this time of need. The learning pathways are divided into basic, intermediate, and advanced categories. Pathways have been organized into specific topics that have a variety of educational materials from the ACFAS On Demand course content. They also include journal articles with links primarily from The Journal of Foot & Ankle Surgery (JFAS).