[Management of injuries of the distal tibia and foot]

The complex injury of the foot requires immediate decisions. At first the question of vital danger and amputation should be ruled out. The criteria for the conservation of the extremity will be shown. For the most severely injured, primary amputation is indicated, since all attempts of preservation in this group hardly survived. The two-step amputation is recommended: i.e. "Guillotine"-amputation in the acute phase and muscle plastic stump formation in the regeneration phase. Important principles of treatment are: immediate anatomic reduction and retention of fractures and unstable joints, open wound treatment, delayed closure and reconstructive plastic intervention. A planned "second-look"-operation is obligatory.