Talectomy for the Management of Resistant Talipes Equinovarus Deformity; Does Adding Ilizarov External Fixator Provide Extra Advantages?

BACKGROUND

The management of resistant talipes equinovarus (TEV) is challenging. Residual deformity and recurrence are among the most feared complications. This study was conducted to evaluate the effectiveness of talectomy in the management of arthrogrypotic TEV and to investigate the value of adding a simplified Ilizarov fixator (SIF).

PATIENTS AND METHODS

A total of 42 resistant TEV feet among 23 arthrogrypotic children were operated between January 2012 and 2016. The average age was 6.7 ± 1.67 years. The feet were divided into 2 groups; group A (Casting group) included 20 feet (11 children) that were managed by talectomy and casting, while group B (Fixator group) included 22 feet (12 children) that were treated using a SIF concomitant with talectomy. The results were evaluated morphologically by Dimeglio grading system and functionally by Legaspi system.

RESULTS

The average follow-up was 36.62 ± 3.88 months. With the numbers available in this study, there was significant improvement (p ≤ .05) in the Dimeglio scores in both groups, which was significantly more evident (p ≤ .05) among the fixator group. The majority of the good functional results were reported among the fixator group, while the poor feet were observed mainly in the casting group (p ≤ .05). The functional end results were significantly affected (p≤ .05) by the final Dimeglio scores. The age had also statistically significant effect (p≤ .05) on the functional end results in group A only.

CONCLUSION

Talectomy is an effective procedure for salvaging arthrogrypotic TEV. Supplementation of the procedure by SIF was associated with more satisfactory morphological and functional results particularly in older children.

Distally Based Medial Hemisoleus Muscle Flap for Wound Coverage in the Distal Third of the Leg

Wound healing and coverage of soft tissue defects of distal tibia are challenging. Free tissue transfer is treatment of choice for distal tibial defects. However, resources for free tissue transfer are not readily available and they increase morbidity to host. Local and regional flaps play a key role in management of these defects with less demanding or specialized requirements. The soleus muscle flap is the workhorse flap for midtibia soft tissue defects and is used in reverse fashion to reach the distal third of the tibia. Despite minor complications, distally based medial hemisoleus flap is reliable in limb salvage cases.

Fixator-assisted Percutaneous Plate Fixation of Complex Diaphyseal Tibial Fractures

Aim

The purpose of this study is to evaluate the results of indirect reduction and fixation of comminuted diaphyseal tibial fractures using temporary simplified external fixator and plate osteosynthesis through a limited incision approach with special consideration of the duration of surgery and rate of complications.

Materials and methods

In this prospective case series study, 41 cases of comminuted diaphyseal tibial fractures were included. Twenty-two were closed fractures, 15 grade I open fractures, and four were grade II open fractures. Patients were evaluated clinically according to the lower extremity functional scale (LEFS).

Results

Of the 41 cases, 38 were followed up for at least 1 year. Using the LEFS, final scores ranged from 67–80 (mean 75). Union was achieved in all cases except one which united after bone grafting. The mean time to radiological healing was 12 weeks. Operative time from skin incision to closure ranged between 65 minutes and 100 minutes (mean of 80 minutes). There were four cases of superficial infection.

Conclusion

Treatment of comminuted tibial fractures through use the of a simplified external fixator to aid and maintain the reduction of comminuted tibial fractures whilst limited incisions are then used for minimally-invasive plate osteosynthesis in an effective and time-saving method with a low complication rate.

How to cite this article

Nada AA, Romeih M, El-Rosasy M. Fixator-assisted Percutaneous Plate Fixation of Complex Diaphyseal Tibial Fractures. Strategies Trauma Limb Reconstr 2019;14(1):25–28.

Late onset tibia vara. Acute correction strategy: proper case selection and a simple external fixation technique

Following proximal tibial osteotomy for cases of late onset tibia vara, both acute and gradual correction strategies were described, where each has its pros and cons. The aim of this study was to verify the proper selection criteria of cases with late onset tibia vara amenable to successful acute correction strategy using a homogenous patient group with clear inclusion criteria; all the cases were fixed by a low profile semicircular fixator module. Thirty legs in 20 patients (11 boys, nine girls) with late onset tibia vara, treated in our department between January 2005 and February 2008, that complied well with the assigned inclusion criteria constituted the material of this prospective study. Their mean age was 10.4 years (range, 6-14 years). They were all managed using the same modality that was acute correction based on the osteotomy rule II concept and fixed by a low profile miniature Ilizarov fixator module. After a mean follow up period of 5.9 years (range, 5-7) only (13%) of the cases showed recurrence. Proper selection of cases with late onset tibia vara undergoing acute correction strategy is of utmost importance for the sake of a successful outcome. On the other hand, the low profile simplified fixator module used is a handy and a compliant osteotomy fixation tool.

Realignment-lengthening osteotomy for malunited distal fibular fracture

PURPOSE

Persistent displacement of ankle fractures increases the stresses on the articular cartilage and leads to degenerative arthritis. Correction of the ankle mortise restores the normal ankle biomechanics and should prevent the development of degenerative joint disease.

METHODS

Seventeen patients were treated for symptomatic ankle joint due to malunited distal fibular fracture. There were eleven male and six female patients. Their ages ranged from 23 to 54 years (median 34 years). The procedure included transverse fibular osteotomy for restoration of the lateral malleolar alignment, acute distraction of the osteotomy to restore the fibular length with interpositional graft and reduction of subluxation of the distal tibio-fibular articulation. Internal fixation of the osteotomy was performed with plate and screws and trans-syndesmotic screws.

RESULTS

Fibular lengthening was performed in all cases and ranged from six to 12 mm (median eight millimetres). The American Orthopaedic Foot and Ankle Society score preoperatively ranged from 40 to 74 (median 60) and at follow up ranged from 50 to 95 (median 79). Progression of ankles arthrosis occurred in one patient leading to ankle arthrodesis as a secondary procedure. Results were satisfactory in 12 cases (70.6%), and unsatisfactory in five cases (29.4%) due to stiffness and pain in the ankle joint. The follow-up ranged from 24 to 45 months (median 31 months).

CONCLUSION

Corrective osteotomy of fibular malunion produces considerable improvement provided that the patient does not have significant degenerative changes before surgery. The use of athrodiastasis of the ankle as a secondary procedure may be of value to improve the outcome.

Acute correction of proximal tibial deformities in adolescents using Ilizarov external fixator: focal-dome versus straight-cut osteotomy

Straight-cut osteotomy was compared with focal-dome osteotomy in two similar groups of patients with proximal tibial deformities. Acute correction of deformity was carried out for 27 patients with a total of 36 bone segments. Ilizarov external fixator was used in all cases. No significant difference was found between the two groups in terms of bone healing, external fixation time and stability of osteotomy. The follow-up ranged from 24 to 63 months. In this study, the focal-dome osteotomy was not found to be superior to straight-cut osteotomy, which is simpler to perform and more versatile for deformity correction.