Closure of central defects of the forefoot with external fixation: a case report (original) (raw)
Related papers
Clinics in podiatric medicine and surgery, 2008
Central ray resections often result in a biomechanically unsound forefoot often accompanied by a cleft wound that is difficult to heal. Narrowing the forefoot enables the surgeon to close the plantar defect primarily, foregoing prolonged wound care and lowering the risk for postoperative complications. The authors present a technique of narrowing the forefoot using a small light-weight external fixation device that allows for immediate wound closure without adjacent metatarsal osteotomies. Four patients were treated with this technique, and all four healed in a timely fashion and resumed their previous lifestyle without skin breakdown. The forefoot narrowing technique results in a stable plantigrade forefoot in individuals at high risk for diabetes-related lower extremity reulceration and amputation.
Treatment of Nonunion and Malunion of Trauma of the Foot and Ankle Using External Fixation
Foot and Ankle Clinics, 2009
External fixation is a valuable clinical tool, because it allows the surgeon to promote healing of bone and correct deformities by static and dynamic means. External fixators are often quick and easy to apply and frequently suitable for damage control procedures in trauma scenarios. They have significant biologic advantages over internal fixation with preservation of tissue envelopes and blood supply. Therefore external fixators can be used in areas and occasions where internal fixation would pose a threat to wound healing and bone union. External fixation has its advantages over internal fixation, particularly where there is active infection in the foot or ankle, where methods of internal fixation almost certainly would succumb to infection. Internal fixation can be problematic when utilized in areas with poor skin coverage, for example the distal tibia. This can predispose to either wound breakdown or symptoms secondary to prominence of the hardware through thin subcutaneous tissue. Incisions made for wide exposure for placement of internal fixation through poorly vascularized or edematous skin, often seen in diabetic patients, can predispose to wound breakdown and are therefore more amenable to percutaneous external fixation methods. Bone loss and paucity of bone quality are often problems in nonunion revision surgery, especially in the presence of infection or in patients who have Charcot joints. In these clinical scenarios, internal fixation becomes difficult, and the advantages of minimally invasive techniques in external fixation become apparent. The construction and versatility of fixators also afford the surgeon the ability to place the
Investıgatıon of Anatomıc and Orthopedıc Propertıes of Os Metatarsale I
Zenodo (CERN European Organization for Nuclear Research), 2022
Background: Structure most affected by the clinical deformities associated with lower extremity is the first metatarsal bone which may cause orthopedic problems and chronic pain on foot, because approximately 80% of the load from the talus and calcaneus is transmitted to the ground via medial arch. Materials and Methods: Our study was performed on lower extremities of 32 adult patients without any foot deformity, which were amputated due to circulation failure in the Department of Orthopaedics and Traumatology. Firstly, tibia length, foot length and foot width were measured. Subsequently, the dimensions and length of first metatarsus as well as proximal and distal articular surface dimensions of the first metatarsus were measured.Results: The average values were as follows: tibia length: 35.9 cm, foot length:22.7cm, foot width: 8 cm, length of first metatarsus: 5.8 cm. Statistical significance was found among the dimensions of proximal end, dimensions of distal head and the thinnest site of the bone (p≤0.01). Conclusions: Various external deforming forces cause variations in the medial longitudinal arch and lead foot pain. The length, shape of the head as well as the dimensions of the proximal and distal joint surfaces of the first metatarsal bone are important factors in the development of foot deformities. Since peroneus longus and tibialis anterior muscles insert onto the first metatarsal bone, the forces exerted by their tendons affect morphology of the bone. Therefore, dimensions of these muscles and their tendons in relation with the dimensions of first metatarsal bone are essential in the prevention and treatment of foot deformities.
Journal of Vascular Surgery, 1993
Purpose: It is generally accepted that when necrosis extends proximal to the transmetatarsal level a viable and fimctional foot can no longer be preserved and a major (above-or below-knee) amputation must be performed. However, with continuing advances in operations for limb salvage we felt the need to reexamine this concept. Methods: In 1983 we initiated a prospective study to evaluate the role of extended foot amputations. All ambulatory patients with necrosis extending proximal to the transmetatarsal level (but not invoh4ng the whole foot) were included in the study. Among the 21 patients studied amputations ranged from open guillotine transmetatarsal amputation to removal of the medial or lateral three fifths of the foot. Five of these patients had adequate pedal circulation by clinical and laboratory criteria. The remaining 16 required vascular reconstruction to improve pedal flow. Results: Eighteen (86%) of 21 patients had complete healing of the foot amputations and were ambulatory at the time of discharge from the hospital. Two patients required early above-or below-knee amputations. Three additional patients sustained limb loss in the follow-up period. The cumulative graft patency rate was 94% at 12 months. The cumulative limb salvage rate at 24 months was 84%. The operative mortality rate was 1 (5%) of 21. Conclusion: Our experience in a small number of patients suggests that fimctional foot salvage is possible even when necrosis or gangrene extends proximal to the transmetatarsal level. (J VAsc SURG 1993;18:1030-6.)
Problems, Obstacles, and Complications of External Fixation in the Foot and Ankle
2017
External fixation has many indications including trauma, reconstruction, lengthening, and limb salvage. The modularity of the system allows it to be tailored to a particular need. External fixation provides many advantages versus internal fixation, and in some instances, it can be utilized to augment internal fixation. Historically external fixation was employed for treatment of complex, high-risk conditions. However, with better understanding and knowledge of external fixation principles, it can be applied successfully for many foot and ankle deformities. Complications are considered prevalent with external fixation. However, problems and obstacles during treatment are more likely to occur than a true complication that adversely affects the patient’s surgical outcome. This chapter will discuss the types of complications related to the use of external fixation and provide a guideline for prevention and management.
Reconstruction of Hind Foot Defects; a Simplified Workable Solution
.BACKGROUND: Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. We share here a simple and practical protocol (working solution) to select the most suitable method for soft tissue coverage of hind foot defects, customizable for every patient. METHODS: We carried out this study, in our department on 75 cases from March 2009 to May 2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy, Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury (isolated or combined), if combined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimal wound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VAC therapy, Skin graft, local transposition flap, perforator based flapspedicled ...
Reconstruction of Hind Foot Defects
The Professional Medical Journal
BACKGROUND: Reconstruction of traumatic as well as non-traumatic hind foot defects is always a challenging task. Weshare here a simple and practical protocol (working solution) to select the most suitable method for soft tissue coverage of hind footdefects, customizable for every patient. METHODS: We carried out this study, in our department on 75 cases from March 2009 to May2012. All cases with wound/defect in hind foot area were included. Majority of cases were traumatic rest included cases of malignancy,Trophic ulcers, infection. Patient's data including age, sex, site of injury, mode of injury, extent of injury (isolated or combined), ifcombined structures involved, type of wound, management of wound, wound healing time and complications were noted. Once optimalwound conditions were achieved the best possible reconstructive option was selected. The various reconstructive options include VACtherapy, Skin graft, local transposition flap, perforator based flapspedicled faciocut...
Versatility of Ilizarov external fixator in management of foot and ankle deformity
Journal of Orthopaedics and Traumatology, 2005
Traditional methods of correcting foot deformities may be difficult to apply in some conditions, especially in presence of other lower limb problems. This study discusses the versatility of Ilizarov external fixator (IEF) in such cases. It was performed in 34 foot deformities in 33 patients, treated with IEF between 1997 and 1999. The average age of the patients was 15 years. The aetiology of foot deformity was recurrent congenital talipes equinovarus (n=10), neglected congenital talipes equinovarus (n=3), poliomyelitis (n=9), post-traumatic deformity (n=6), post-burn deformity (n=1), arthrogryposis multiplex congenita (n=2), and cerebral palsy, fibular hemimelia and tibial hemimelia (1 case each). Unconstrained IEF was applied for the foot in all cases. The leg construct was applied according to the target: foot deformity alone or associated with other leg problems. IEF construct was extended to the femur in cases with flexion knee deformity and hinges were added. Follow-up continued until overcorrection was maintained for the same period of correction followed by an appropriate cast for 8 weeks. The mean time for deformity correction and Ilizarov stabilisation was 16 weeks, and follow-up period was 23.1 months. The results were good in 31, fair in 2 and bad in 1. Additional procedures were performed, most often in the same operating time. Primary arthrodesis was done for 5 feet and for one revision of failed previous arthrodesis. Open corrective osteotomy for arthrodesis was performed in 2 cases. Two females were treated for flexion knee with bloodless technique. Wire-site infections, wire cut-through a calcaneum and metatarsals and fracture post-IEF removal were observed. Although it is technically difficult, IEF can be considered an effective and versatile way of treating foot and other associated lower limb problems through one-reconstruction attack.