Author: Steve

Brodsky classification for Charcot arthropathy

Posted on August 12, 2023 by - B, Classification systems, Diabetes

The Brodsky Classification is used to categorize different stages of Charcot arthropathy, a condition that involves progressive joint destruction and deformity, typically affecting the feet of individuals with neuropathy (nerve damage), often due to diabetes. This classification system helps healthcare professionals assess the severity of Charcot arthropathy and guide treatment decisions.

The Brodsky Classification for Charcot arthropathy consists of five stages:

Stage 0: Pre-Charcot: No visible deformity, but inflammation and edema may be present. The underlying bone may show increased density on X-rays.

Stage 1: Coalescence: Bone fragmentation and dislocation, often leading to a “mushroom-like” appearance of the joint on X-rays.

Stage 2: Reconstruction: Decrease in inflammation, with attempts at joint repair leading to sclerosis (hardening) of bone ends and remodeling.

Stage 3: Consolidation: Further healing and remodeling occur, leading to a more stable joint.

Stage 4: Reconstitution: Final healing and remodeling result in a stable, consolidated joint. However, deformities and chronic changes are often present.

Charcot arthropathy requires careful management to prevent complications such as joint destruction, ulcers, and infections. Treatment may involve immobilization, offloading, custom footwear, and in some cases, surgical intervention to correct deformities or address complications. Early detection and intervention are crucial to achieving the best outcomes in Charcot arthropathy.

Torg classification for fifth metatarsal fractures

Posted on August 12, 2023 by - Classification systems, Fractures, Midfoot, T

The Torg Classification, developed by Dr. J.W. Torg, is a classification system for fractures of the fifth metatarsal bone. This classification is primarily used to categorize fractures in athletes and guide treatment decisions based on the location and characteristics of the fracture.

The Torg Classification divides fifth metatarsal fractures into three zones:

Zone 1: Avulsion Fractures

  • Involves an avulsion of the tuberosity of the fifth metatarsal due to pull of the peroneus brevis tendon.
  • Often referred to as a “dancer’s fracture” or “pseudo-Jones fracture.”
  • Typically has a good prognosis and usually heals well with conservative treatment.

Zone 2: Jones Fractures

  • Occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal, approximately 1.5 to 3 cm distal to the tuberosity.
  • These fractures are more prone to delayed or non-union due to limited blood supply in this area.
  • Often requires more aggressive treatment, including immobilization and sometimes surgical intervention.

Zone 3: Diaphyseal Fractures

  • Involves fractures of the diaphysis (shaft) of the fifth metatarsal, occurring more distally than Zone 2.
  • Generally has a better prognosis and often heals well with conservative treatment.

Wagner classification system for diabetic foot ulcers

Posted on August 12, 2023 by - Classification systems, Diabetes, W

The Wagner Classification System is a widely used system for classifying diabetic foot ulcers based on their severity and depth of tissue involvement. This system is primarily used to help healthcare professionals assess the severity of diabetic foot ulcers, guide treatment decisions, and monitor the progress of healing. Diabetic foot ulcers are a common complication of diabetes and can lead to serious infections and other complications if not properly managed.

The Wagner Classification System consists of the following grades:

Grade 0: No open lesions, but may have deformity or cellulitis (inflammation of the skin and underlying tissue).

Grade 1: Superficial ulcer involving only the skin and possibly the subcutaneous tissue.

Grade 2: Deeper ulcer that extends to ligaments and muscle, but without abscess, osteomyelitis, or joint sepsis.

Grade 3: Deep ulcer with cellulitis, abscess, osteomyelitis, or joint sepsis.

Grade 4: Localized gangrene involving the toes or forefoot.

Grade 5: Extensive gangrene involving the entire foot.

This classification system helps healthcare providers communicate the severity of the diabetic foot ulcer and aids in determining appropriate treatment strategies. Less severe ulcers may be managed with local wound care, offloading, and infection control, while more severe ulcers may require surgical intervention, including debridement (removal of dead tissue), antibiotics, and even amputation in the most severe cases.

It’s important to note that timely and appropriate management of diabetic foot ulcers is crucial to prevent complications and improve outcomes. People with diabetes should receive regular foot screenings and take steps to prevent ulcers, including proper foot care, blood sugar control, and using appropriate footwear. If you have diabetes and notice any foot issues or ulcers, it’s essential to seek prompt medical attention to prevent further complications.

Coughlin & Shurnas classification system for hallux rigidus

Posted on August 12, 2023 by - C, Classification systems, Forefoot


The Coughlin and Shurnas classification system is used to categorize different stages of hallux rigidus, a degenerative condition of the big toe joint (first metatarsophalangeal joint) that leads to stiffness and limited motion. This classification system helps surgeons and medical professionals assess the severity of hallux rigidus and determine appropriate treatment strategies.

The Coughlin and Shurnas classification for hallux rigidus consists of four stages:

Stage 0: No arthritic changes are present. The joint has normal or near-normal function, and there is no pain or stiffness.

Stage 1: Mild or early-stage hallux rigidus. Some joint space narrowing and osteophyte formation (bone spurs) are present. There might be mild pain and stiffness with movement.

Stage 2: Moderate hallux rigidus. The joint space is further reduced, and larger osteophytes are present. Joint motion is more restricted, and pain is more pronounced, especially during push-off while walking.

Stage 3: Severe hallux rigidus. The joint space is significantly narrowed or obliterated, and osteophytes are prominent. Joint motion is severely limited, and the patient experiences significant pain and dysfunction, even during walking.

Hardcastle & Myerson classification for Lisfranc injuries

Posted on August 12, 2023 by - Classification systems, H, Midfoot

The Hardcastle and Myerson classification system is used to categorize injuries to the Lisfranc joint complex, which involves the tarsometatarsal joints in the midfoot. This classification system helps surgeons and medical professionals assess the severity of Lisfranc injuries and guide treatment decisions. Lisfranc injuries can range from mild sprains to severe fractures and dislocations.

The Hardcastle and Myerson classification system is divided into three main categories, which are further sub-divided based on the severity of the injury:

Type A: Homolateral Fracture Dislocation

  1. Type A1: Fracture of the base of the second metatarsal.
  2. Type A2: Fracture of the first and second metatarsals.
  3. Type A3: Fracture of all three medial metatarsals.

Type B: Isolated Lisfranc Ligament Injuries

  1. Type B1: Sprain or rupture of the Lisfranc ligament with or without fractures.

Type C: Divergent Dislocation

  1. Type C1: Dislocation of one or two metatarsals.
  2. Type C2: Dislocation of three or more metatarsals.

Each type is associated with varying degrees of instability and severity. Treatment options and outcomes depend on the specific type of Lisfranc injury.

It’s important to note that Lisfranc injuries can be complex and may require careful evaluation by a medical professional, often including imaging studies like X-rays or CT scans. Treatment can range from non-surgical approaches (such as casting or bracing) for less severe injuries to surgical intervention (such as stabilization with screws or plates) for more severe injuries.

If you suspect a Lisfranc injury, it’s crucial to seek prompt medical attention to ensure an accurate diagnosis and appropriate management to prevent potential long-term complications, such as chronic pain and instability in the midfoot.

Ankle sprain classification

Posted on August 12, 2023 by - A, Ankle, Classification systems

Ankle sprains are common injuries that occur when the ligaments around the ankle joint are stretched or torn due to excessive force or twisting. There are various classification systems used to describe and categorize ankle sprains based on the severity and location of the injury. One of the commonly used classification systems is the Grading System:

  1. Grade I (Mild): In a Grade I ankle sprain, the ligaments are stretched but not torn. There may be mild pain, swelling, and minimal loss of function. The ankle joint remains stable.
  2. Grade II (Moderate): A Grade II ankle sprain involves partial tearing of the ligaments. This can cause moderate pain, swelling, and difficulty walking. The ankle joint may feel unstable.
  3. Grade III (Severe): In a Grade III ankle sprain, the ligaments are completely torn. This results in significant pain, swelling, bruising, and instability of the ankle joint. Walking and weight-bearing are usually impaired.

Another classification system used specifically for lateral ankle sprains is the Anatomic Grading System, which focuses on the specific ligaments involved:

  1. Stage I: Mild sprain with microscopic tearing of the ligament fibers.
  2. Stage II: Moderate sprain with partial tearing of the ligament fibers.
  3. Stage III: Severe sprain with complete rupture of the ligament.

Additionally, there’s a classification system that considers the location of the injury within the lateral ankle ligament complex:

  1. Anterior Talofibular Ligament (ATFL) Sprain: The most common type of ankle sprain, often occurring in inversion injuries. It involves the ligament on the front and outside of the ankle.
  2. Calcaneofibular Ligament (CFL) Sprain: This involves the ligament on the outside of the ankle and is commonly associated with more severe sprains.
  3. Posterior Talofibular Ligament (PTFL) Sprain: This ligament, located on the back of the ankle, is less frequently injured.

Lauge-Hansen classification system for ankle fractures

Posted on August 12, 2023 by - Ankle, Classification systems, L

The Lauge-Hansen classification system is a widely used method for describing and categorizing different types of ankle fractures based on the mechanism of injury. It was developed by Danish orthopaedic surgeon Lauge-Hansen in the mid-20th century.

This classification system takes into account two main factors: the position of the foot at the time of injury (pronation or supination) and the direction of the force applied (medial or lateral).

The Lauge-Hansen classification system consists of four main fracture patterns:

  1. Supination-Adduction (SA) injuries: These occur when the foot is in a supinated (turned inward) position and a force is applied in an adduction (inward) direction. This typically results in a fracture of the lateral malleolus (fibula) and possible rupture of the deltoid ligament on the medial side of the ankle.
  2. Supination-External Rotation (SER) injuries: These occur when the foot is in a supinated position and a force is applied in an external rotation (outward) direction. This can result in a fracture of the fibula, followed by a rupture of the anterior talofibular ligament and the calcaneofibular ligament.
  3. Pronation-Abduction (PA) injuries: These occur when the foot is in a pronated (turned outward) position and a force is applied in an abduction (outward) direction. This can lead to a fracture of the medial malleolus (tibia) and possible rupture of the lateral ligaments.
  4. Pronation-External Rotation (PER) injuries: These occur when the foot is in a pronated position and a force is applied in an external rotation direction. This can result in a fracture of the medial malleolus, followed by rupture of the deltoid ligament and the syndesmosis (the ligaments that hold the tibia and fibula together).

The Lauge-Hansen classification system helps surgeons and medical professionals better understand the specific patterns of ankle fractures, which can guide treatment decisions and surgical approaches.

Podiatric surgery integration

Posted on April 17, 2023 by - P

Podiatric surgery has increasingly integrated with other specialties and mainstream hospital systems around the world in recent years. This integration has been driven by the growing recognition of the importance of foot and ankle health in overall patient care and the need for a multidisciplinary approach to managing foot and ankle conditions. Here are some ways in which podiatric surgery has integrated with other specialties and mainstream hospital systems:

  1. Collaborative care models: Podiatric surgeons often work collaboratively with other healthcare providers, such as orthopedic surgeons, vascular surgeons, plastic surgeons, dermatologists, endocrinologists, and other specialists, as part of a multidisciplinary team approach to managing complex foot and ankle conditions. This collaborative care model allows for comprehensive evaluation, diagnosis, and treatment planning, leading to better patient outcomes.
  2. Inclusion in hospital systems: Podiatric surgery has been increasingly integrated into mainstream hospital systems, with podiatric surgeons gaining privileges to perform surgical procedures in hospitals alongside other surgical specialties. This integration allows for streamlined patient care, access to advanced surgical facilities, and coordination with other medical services, such as radiology, pathology, and anesthesia.
  3. Education and training: Podiatric surgeons receive extensive education and training in foot and ankle surgery, which is on par with other surgical specialties. This has helped establish podiatric surgery as a recognized specialty within the broader surgical community, leading to increased collaboration and integration with other specialties in hospital systems. Podiatric surgeons may also participate in interdisciplinary conferences, seminars, and workshops to enhance their knowledge and skills and foster collaboration with other specialties.
  4. Research and innovation: Podiatric surgeons contribute to research and innovation in foot and ankle surgery, leading to advancements in surgical techniques, implant technology, and treatment protocols. This research is often published in peer-reviewed journals and presented at national and international conferences, fostering collaboration and integration with other specialties.
  5. Patient-centered care: The focus on patient-centered care has also led to increased integration of podiatric surgery with other specialties. Many foot and ankle conditions, such as diabetic foot ulcers, Charcot arthropathy, and peripheral arterial disease, require a multidisciplinary approach involving podiatric surgeons, vascular surgeons, endocrinologists, and other specialists to provide comprehensive care to the patient.
  6. Improved patient outcomes: The integration of podiatric surgery with other specialties has been shown to improve patient outcomes. Collaborative care models, inclusion in hospital systems, and interdisciplinary approaches allow for better coordination of care, leading to more accurate diagnoses, optimal treatment plans, and improved patient outcomes.

In summary, podiatric surgery has integrated with other specialties and mainstream hospital systems around the world through collaborative care models, inclusion in hospital systems, education and training, research and innovation, patient-centered care, and improved patient outcomes. This integration has facilitated a multidisciplinary approach to foot and ankle health, leading to better patient care and outcomes.

Surgery considerations for paralysed patients

Posted on April 17, 2023 by - Neurology, S

Patients with paralysis, whether due to spinal cord injury, nerve injury, or other causes, require special considerations when undergoing surgery to ensure their safety and optimal outcomes. Here are some important surgery considerations for paralyzed patients:

  1. Preoperative evaluation: A thorough preoperative evaluation should be conducted to assess the patient’s overall health, level and extent of paralysis, functional status, and any specific considerations related to their paralysis. This may involve reviewing the patient’s medical history, conducting a physical examination, and performing relevant diagnostic tests, such as imaging studies, as needed.
  2. Neurological assessment: A detailed neurological assessment should be performed to assess the level and extent of paralysis, as well as any associated sensory deficits, motor function, reflexes, and autonomic function. This information will guide the surgical team in planning the surgery and managing the patient’s perioperative care.
  3. Anesthesia considerations: The choice of anesthesia should be carefully considered in paralyzed patients. Close communication and collaboration between the surgical team and the anesthesiologist are crucial to ensure appropriate anesthesia management. Depending on the type of surgery and the patient’s specific needs, regional anesthesia or monitored anesthesia care may be considered, taking into account any potential risks related to the patient’s paralysis.
  4. Positioning and pressure management: Special attention should be given to the positioning of the paralyzed patient during surgery to avoid additional trauma or pressure-related injuries. Care should be taken to protect the areas of the body that may be at risk for pressure ulcers, such as bony prominences, and appropriate pressure-relieving devices, such as pads or cushions, may be used to minimize the risk of pressure-related injuries.
  5. Musculoskeletal considerations: Paralyzed patients may have altered musculoskeletal function due to paralysis, muscle atrophy, and other related factors. The surgical team should be mindful of this and take appropriate measures during surgery to protect and manage the musculoskeletal system, such as avoiding excessive manipulation of limbs or joints, and providing appropriate postoperative care to minimize the risk of complications.
  6. Bowel and bladder management: Paralyzed patients may have impaired bowel and bladder function due to their paralysis. Proper bowel and bladder management should be established prior to surgery and maintained during the perioperative period to prevent complications, such as constipation, urinary retention, or bladder overdistention. This may involve implementing appropriate bowel and bladder care protocols, including use of medications, catheterization, and/or bowel management techniques.
  7. Skin integrity: Paralyzed patients may be at increased risk of skin breakdown and pressure ulcers due to immobility and sensory deficits. Care should be taken to protect the skin during surgery and postoperatively, including the use of appropriate padding, repositioning, and skin care protocols.
  8. Postoperative care: The postoperative care of paralyzed patients should be tailored to their specific needs, including appropriate pain management, monitoring for any signs of complications such as infections or deep vein thrombosis, and facilitating early mobilization and rehabilitation as appropriate.
  9. Communication and patient support: Communication with paralyzed patients and their caregivers is crucial to ensure their comfort, understanding, and participation in the perioperative care. Patient support and education regarding postoperative care, mobility, and potential complications should be provided, and appropriate resources and assistance should be available as needed.

In summary, surgery considerations for paralyzed patients require careful assessment, planning, and coordination among the surgical team, anesthesiologist, and other healthcare providers involved in the perioperative care. Special attention should be given to neurologic, musculoskeletal, bowel and bladder, skin integrity, and postoperative care aspects to ensure the best possible outcomes for these patients.

Surgery considerations for patients with high blood pressure

Posted on April 17, 2023 by - H, S

Patients with high blood pressure (hypertension) require special considerations when undergoing surgery to manage their blood pressure during the perioperative period and minimize the risk of related complications. Here are some important surgery considerations for patients with high blood pressure:

  1. Preoperative evaluation: A thorough preoperative evaluation of the patient’s blood pressure should be conducted to assess the severity of hypertension, identify any associated risk factors or comorbidities, and optimize blood pressure control prior to surgery. This may involve reviewing the patient’s medical history, conducting a physical examination, and performing relevant diagnostic tests, such as blood tests, electrocardiogram (ECG), and echocardiography, as needed.
  2. Blood pressure control optimization: It is important to optimize the patient’s blood pressure control prior to surgery to reduce the risk of perioperative cardiovascular events. This may involve adjusting the patient’s antihypertensive medications, such as diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors, to ensure optimal blood pressure management during the perioperative period. Patients with poorly controlled hypertension may require postponement of elective surgery until their blood pressure is better controlled.
  3. Anesthesia considerations: The choice of anesthesia should be carefully considered in patients with hypertension. General anesthesia may be associated with hemodynamic changes, such as changes in blood pressure and heart rate, which can impact patients with hypertension. Therefore, close communication and collaboration between the anesthesiologist and the surgical team are essential to ensure appropriate anesthesia management tailored to the patient’s blood pressure condition. The use of regional anesthesia or monitored anesthesia care may be considered, depending on the type of surgery and the patient’s blood pressure control.
  4. Medication management: Medication management in patients with hypertension should be carefully reviewed and optimized during the perioperative period. This may involve continuing the patient’s regular antihypertensive medications, avoiding triggers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), that may worsen blood pressure control, and having a plan in place for managing blood pressure during and after surgery. In some cases, additional medications, such as short-acting antihypertensive medications, may be used as part of the perioperative management plan.
  5. Intraoperative monitoring: During surgery, close monitoring of the patient’s blood pressure, heart rate, and other relevant hemodynamic parameters should be performed to promptly detect any changes and intervene as needed. This may involve using invasive blood pressure monitoring or continuous noninvasive blood pressure monitoring to ensure optimal blood pressure control during surgery.
  6. Postoperative care: Patients with hypertension may require special postoperative care to manage their blood pressure and prevent cardiovascular complications. This may involve continuing the patient’s regular antihypertensive medications, monitoring blood pressure closely, and providing appropriate pain management that does not negatively impact blood pressure control. Early ambulation, deep breathing exercises, and other preventive measures may also be encouraged to reduce the risk of postoperative complications.
  7. Lifestyle modifications: Patients with hypertension should be encouraged to adopt and maintain healthy lifestyle habits, such as regular exercise, a healthy diet, weight management, stress management, and avoiding tobacco and excessive alcohol consumption. These lifestyle modifications can help improve blood pressure control and overall cardiovascular health, which can have a positive impact on the perioperative management of patients with hypertension.

In conclusion, surgery considerations for patients with high blood pressure require careful evaluation, optimization of blood pressure control, anesthesia considerations, medication management, intraoperative monitoring, postoperative care, and patient education on lifestyle modifications. Collaborative care among the surgical team, anesthesiologist, and other healthcare professionals, along with effective patient education and adherence to blood pressure management protocols, is essential to ensure safe and successful perioperative care for patients with hypertension.