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Letizia S, Mario M, Isabella P, Giulia F, Danya F, Michele R, Antonio G. Foot fractures and complex trauma of the foot: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1077-1085. [PMID: 33392757 DOI: 10.1007/s00590-020-02840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Foot fractures are common injuries. This retrospective study evaluates their frequency, incidence, treatment and outcomes with emphasis on complex trauma of the foot (CTF), an injury that affects soft tissue as well as bone. From 2005 to 2015, 506 patients with foot fractures were treated at our institution; of these, 27 had CTF. The Zwipp score was applied to diagnose CTF, the Gustilo-Anderson classification to grade open fractures and the Tscherne classification to grade closed fractures. Twelve months after the trauma, 20 CTF patients underwent the final X-ray assessment and clinical evaluation with the Visual Analogue Scale Foot and Ankle (VASFA), the Foot Function Index (FFI) and the 12-Item Short Form Survey (SF-12). Data were analyzed with the Spearman rank correlation test. The forefoot was the most frequently involved compartment both in patients with foot fracture and in those with CTF. At 12-month follow-up, the CTF patients showed a VASFA score of 51.5, an FFI of 47.5 and SF-12 scores of 37.9 (physical component summary) and 45.2 (mental component summary). The VASFA score and the FFI showed a significant correlation (rs = 0.84; p = 0.001). CTF is the cause of considerable residual disability and deeply affects quality of life.
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Affiliation(s)
- Senesi Letizia
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Marinelli Mario
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Ponzio Isabella
- UO Ortopedia e Traumatologia, Ospedale San Salvatore, Piazzale Carlo Cinelli 4, 61100, Pesaro, Italy
| | - Facco Giulia
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Falcioni Danya
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Riccio Michele
- Department of Reconstructive Surgery and Hand Surgery Unit, Ancona Teaching Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, 60126, Ancona, Torrette di Ancona, Italy
| | - Gigante Antonio
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
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Godoy-Santos AL, Schepers T. SOFT-TISSUE INJURY TO THE FOOT AND ANKLE: LITERATURE REVIEW AND STAGED MANAGEMENT PROTOCOL. ACTA ORTOPEDICA BRASILEIRA 2019; 27:223-229. [PMID: 32788854 PMCID: PMC7405111 DOI: 10.1590/1413-785220192704221240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Complex trauma of the foot and ankle is characterized by fractures with severe
soft tissue damage associated with neurovascular injury and joint involvement.
These injuries are frequently present in the polytraumatized patient and are a
predictor of unfavorable clinical outcome. In the initial approach to a patient
with complex foot and ankle trauma, the decision between amputation and
reconstruction is crucial. The various existing classification systems are of
limited effectiveness and should serve as tools to assist and support a clinical
decision rather than as determinants of conduct. In the emergency department,
one of two treatment options must be adopted: early complete treatment or staged
treatment. The former consists of definitive fixation and immediate skin
coverage, using either primary closure (suturing) or flaps, and is usually
reserved for less complex cases. Staged treatment is divided into initial and
definitive. The objectives in the first phase are: prevention of the progression
of ischemia, necrosis and infection. The principles of definitive treatment are:
proximal-to-distal bone reconstruction, anatomic foot alignment, fusions in
severe cartilage lesions or gross instabilities, stable internal fixation and
adequate skin coverage. Level of evidence III, Systematic review of
level III studies.
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Ozcan Akcal A, Ünal K, Gorgulu T, Akif Akcal M, Bigat Z. Reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and latissimus dorsi muscle flap and short perforator-based skin flap following gunshot injuries: Report of two cases. Microsurgery 2016; 36:598-603. [DOI: 10.1002/micr.30099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Arzu Ozcan Akcal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Kerim Ünal
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Akdeniz University; Antalya Turkey
| | - Tahsin Gorgulu
- Medical Faculty, Department of Plastic and Reconstructive Surgery; Bulent Ecevit University; Zonguldak Turkey
| | - Mehmet Akif Akcal
- Department of Orthopedic and Traumatology; Ataturk State Hospital; Antalya Turkey
| | - Zekiye Bigat
- Faculty of Medicine, Department of Anesthesiology and Reanimation; Akdeniz University; Antalya Turkey
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Kinner B, Roll C. [Modified Pirogoff's amputation]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:335-44. [PMID: 27339219 DOI: 10.1007/s00064-016-0452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel. INDICATIONS Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities. CONTRAINDICATIONS Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel. SURGICAL TECHNIQUE The incision runs from dorsal, 1-2 cm distal of the Chopart joint, to plantar, 5-6 cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws. POSTOPERATIVE MANAGEMENT No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2-4 weeks and definitive prosthesis after 2-3 months. RESULTS From January 2010 to December 2014 six patients were treated with a modified Pirogoff's amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.
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Affiliation(s)
- B Kinner
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - C Roll
- Zentrum für Ambulante Rehabilitation, Regensburg, Deutschland
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Roll C, Forray M, Kinner B. [Amputation and exarticulation of the lesser toes]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:345-51. [PMID: 27259483 DOI: 10.1007/s00064-016-0451-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes. INDICATIONS Necrosis, trauma, infection, tumor, deformity. CONTRAINDICATIONS Conditions where amputation/exarticulation of a toe is insufficient, e. g., in progressing peripheral arterial disease. SURGICAL TECHNIQUE The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint. POSTOPERATIVE MANAGEMENT Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating. RESULTS Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.
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Affiliation(s)
- C Roll
- Zentrum für Ambulante Rehabilitation, Regensburg, Deutschland
| | - M Forray
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Deutschland
| | - B Kinner
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Deutschland.
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Santanelli di Pompeo F, Pugliese P, Sorotos M, Rubino C, Paolini G. Microvascular reconstruction of complex foot defects, a new anatomo-functional classification. Injury 2015; 46:1656-63. [PMID: 26004168 DOI: 10.1016/j.injury.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/25/2015] [Accepted: 05/01/2015] [Indexed: 02/02/2023]
Abstract
Up until recently severe foot defects have been underestimated and amputation considered the treatment of choice. Inadequate treatment of foot defects is generally responsible for impaired deambulation resulting in physical and psychological handicap to the patient and producing a negative impact on social life. Foot reconstruction represents a recent advancement but is still a great challenge to the plastic surgeon; indeed the absence of a comprehensive anatomical classification of foot defects makes sharing clinical experiences difficult, slowing down the progress in this field. We report a single surgeon experience on a consecutive series of 47 complex foot reconstructions performed on 45 patients with microvascular free flaps over a 27-year period. A retrospective review of the cases was performed, a detailed analysis of the defects is presented and possible solutions debated so as to outline the key points in the diagnosis and treatment of foot defects. In the decision making process, soft tissue defect location, dimension, and functional relevance have proven to be as important as the exact definition of the bone defect. A new anatomical classification scheme for composite defects of the foot, involving both bone and soft tissue, is proposed in order to allow for a correct evaluation of the wound and an easier identification of the ideal treatment.
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Affiliation(s)
| | | | - Michail Sorotos
- Faculty of Medicine and Psychology, Sant'Andrea Hospital of Rome, "Sapienza" University of Rome, Italy
| | - Corrado Rubino
- Department of Medicine and Surgery, Plastic Surgery Unit, Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Guido Paolini
- Faculty of Medicine and Psychology, Sant'Andrea Hospital of Rome, "Sapienza" University of Rome, Italy.
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Kinner B, Kerschbaum M, Bley C, Spiegel A, Roll C. Bionic plate design for calcaneal fracture treatment. A biomechanical analysis and first clinical results. INTERNATIONAL ORTHOPAEDICS 2014; 39:111-7. [PMID: 25315027 DOI: 10.1007/s00264-014-2561-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Calcaneal fracture treatment is challenging. Implant failure is one problem encountered with plate osteosynthesis. Therefore a new "bionic" plate was developed, which imitates the trabecular orientation of the human calcaneus. The aim of this study was to biomechanically test this new plate in comparison to a "standard" calcaneal locking plate and present the first clinical results. METHODS Six "bionic" and six "standard" calcaneal plates were biomechanically tested for stability and fatigue using synthetic calcanei. Between 4/2012 and 04/2013 the first ten consecutive patients meeting the inclusion criteria were treated with the novel implant and followed-up clinically and radiologically. The 12-month follow-up results are reported. RESULTS The "bionic" plate design showed significantly higher fatigue life (68%), load to failure (100%) and reduced displacement under load (90%) if compared to a "standard" locking plate. No major complications were seen; most notably there was no implant failure and no loss of reduction. Mean AOFAS/hindfoot score was 79 (69-86). CONCLUSIONS The novel plate architecture offers higher stability and load tolerance while being more resistant to fatigue. The preliminary clinical results are promising. These findings will have to be proved by larger clinical trials.
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Affiliation(s)
- Bernd Kinner
- Department of Orthopaedic and Trauma Surgery, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany,
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[Pedobarographic results of Girdlestone-Taylor tendon transfer in flexible small toe deformity]. DER ORTHOPADE 2013; 42:1062-6. [PMID: 24145966 DOI: 10.1007/s00132-013-2201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to analyze the biomechanical effects of flexible claw toe correction by tendon transfer with the Girdlestone-Taylor approach using dynamic pedobarography. MATERIAL AND METHODS In the study 12 patients were examined preoperatively and 12 months postoperatively. The results obtained by pedobarography 12 months postoperatively were compared with those of a healthy control group of matched age and body mass index (BMI). For clinical evaluation the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue pain scale (VAS) were evaluated. RESULTS The results showed a significant increase in the average AOFAS score from 72 (range 63-79) preoperatively to 92 (84-96) points 12 months postoperatively. The pedobarography revealed significantly increased values in the force-time integral and the maximum force for the second and third toes 12 months postoperatively. Compared with preoperative measurement values a significantly increased peak pressure could be assessed for the third toe only. It is assumed that the combination of functional arthrodesis of the proximal interphalangeal (PIP) joint and the strain shift by tendon transfer causes this increase in peak pressure. CONCLUSION Atter Girdlestone-Taylor tendon transfer reestablishment of floor contact of flexible claw toes could be demonstrated by dynamic pedobarography.
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Marín-Peña OR, Viloria Recio F, Sanz Gómez T, Larrainzar Garijo R. Fourteen years follow up after Lisfranc fracture-dislocation: functional and radiological results. Injury 2012; 43 Suppl 2:S79-82. [PMID: 23622999 DOI: 10.1016/s0020-1383(13)70185-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Injuries to the Lisfranc joint have a high potential for chronic disability. Posttraumatic arthritis remains the most common complication but not all patients who develop degenerative radiographic changes are symptomatic. A cohort of 32 patients with a Lisfranc fracture dislocation was reviewed. Initial reduction and secondary displacement were measured by the Myerson scale. Radiographic evidence of osteoarthritis (OA) was also investigated. Long-term radiographical data were classified as good, fair or poor results. Functional outcome was measured using several different scales. Mean follow up was 14 years. Seventeen patients with anatomic close reduction but instability were treated with closed reduction and K-wire fixation followed by cast immobilisation. Eight patients with stable anatomic close reduction were treated with closed reduction and cast. Seven patients with unacceptable closed reduction were treated with open reduction and K-wire stabilisation. The analysis of radiological long-term data showed 15 patients with good results, 8 with fair results and 9 with poor results. Final mean AOFAS score was 91.7/100. There was no statistically significant difference between overall PFS scores and different type of treatment, Hardcastle long-term radiological scores or Hardcastle type of fracture (p >0.05). Overall, there was a poor association between the extent of radiological arthritis and clinical scores. We advocate that for the evaluation of long-term outcome of these injuries functional parameters should be the focus of assessment, instead of radiological changes.
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Affiliation(s)
- Oliver R Marín-Peña
- Orthopaedic and Traumatology Department, Infanta Leonor University Hospital, Madrid, Spain.
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Chen CC, Lin CH, Lin YH. Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report. Microsurgery 2012; 32:485-8. [DOI: 10.1002/micr.22033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 04/27/2012] [Indexed: 11/11/2022]
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31824bc119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jupiter DC, Shibuya N, Clawson LD, Davis ML. Incidence and risk factors for amputation in foot and ankle trauma. J Foot Ankle Surg 2012; 51:317-22. [PMID: 22285499 DOI: 10.1053/j.jfas.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Indexed: 02/03/2023]
Abstract
Mobility, especially in elderly patients, is often a proxy for overall health. It is thus of interest to understand the rates of lower extremity amputation and the risk factors for these procedures in the trauma population. We compared the rates of lower extremity amputation in low- versus high-level trauma by analyzing the National Trauma Data Bank. We also attempted to identify the risk factors in the low-level trauma population with foot and ankle trauma that predispose to lower extremity amputation. The factors associated with lower extremity amputation in foot and ankle trauma differed slightly from those in other multi-trauma patients. The factors associated with lower extremity amputation in the low-level foot and ankle trauma population that were statistically and clinically significant in this study included male gender, confounding injury, other trauma type versus blunt trauma, penetrating versus blunt trauma, occurrence of fracture, and occurrence of crush injury or wound. Understanding these risk factors will assist in educating patients and their family about their prognosis. Also, understanding these risk factors will assist surgeons with patient selection when considering salvage procedures.
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Affiliation(s)
- Daniel C Jupiter
- Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
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