Acute Management of Major Trauma Involving the Foot and Ankle with Hoffmann External Fixation

Foot & Ankle ◽  
1981 ◽  
Vol 1 (6) ◽  
pp. 348-361 ◽  
Author(s):  
John E. Kenzora ◽  
Charles C. Edwards ◽  
Bruce D. Browner ◽  
James G. Gamble ◽  
Jivaka B. DeSilva
Keyword(s):  
External Fixation ◽  
Open Fracture ◽  
Major Trauma ◽  
Ankle Arthrodesis ◽  
Easy Access ◽  
Acute Management ◽  
Foot And Ankle ◽  
Fracture Dislocations ◽  
Tract Infections

Massive trauma involving the foot was treated by external fixation in 33 cases and followed for 1 to 3 years. Amputations were performed in seven (21%) because of uncontrollable deep sepsis in two and massive injury in five. The other 26 (79%) had functionally acceptable feet at follow-up, but all had some stiffness and cosmetic deformity. Complications attributed to the Hoffman external fixation were limited to three pin tract infections. We recommend Hoffmann external fixation when it is necessary to: 1) stabilize major open fracture dislocations; 2) maintain length where bone is lost or extensively comminuted; 3) prevent soft tissue contractures; 4) control joint position for delayed ankle arthrodesis; and 5) provide easy access for soft and bone tissue reconstructions.

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

2021 ◽  
pp. 175319342110593
Author(s):  
Atsuhiko Murayama ◽  
Kentaro Watanabe ◽  
Hideyuki Ota ◽  
Shigeru Kurimoto ◽  
Hitoshi Hirata
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plating ◽  
Distal Interphalangeal Joint ◽  
Active Flexion ◽  
Plate Group ◽  
Fracture Dislocations ◽  
Distal Interphalangeal

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

scholarly journals Outcomes of Hindfoot and Ankle Arthrodesis in Neuropathic Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
David Macknet ◽  
Andrew Wohler ◽  
Carroll P. Jones ◽  
J. Kent Ellington ◽  
Bruce E. Cohen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Median Number ◽  
Ankle Arthrodesis ◽  
High Rate ◽  
Hardware Failure ◽  
Radiographic Outcomes ◽  
Fixation Group

Category: Ankle Arthritis, Diabetes, Hindfoot Introduction/Purpose: Charcot neuropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity which can end with amputation. The foot and ankle surgeon’s aim is to reconstruct the high risk foot with the creation of a stable plantigrade foot, while reducing the risk of ulceration and allowing the patient to mobilize in commercially available footwear. There are numerous techniques for the reconstruction of the neuropathic hindfoot, but the most utilized of these include multiplanar external fixation or internal fixation with a plate or intramedullary nail. It is our goal to further elucidate outcomes of Charcot patients undergoing corrective ankle and hindfoot fusion comparing internal versus external fixation. Methods: We retrospectively collected 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 56 of which met our inclusion and exclusion criteria. This included 47 who had internal fixation as their primary procedure and 9 patients who underwent external fixation with a multi-planar external fixator. Our median follow up time was 3.4 years (IQR .5 to 12.9). Preoperatively we collected basic demographic variables, reasons for neuropathy, and ulcer status. Postoperatively we collected complications including infection, hardware failure, ulceration, recurrent deformity, and radiographic outcomes including union and hardware backout. Reoperation numbers and indications were also collected. Our primary outcome was limb salvage at final follow up. Secondarily, we collected final ambulatory and footwear status. Results: The limb salvage rate was 82% with 10 patients undergoing amputation, which did not vary between groups (p=.99). The primary reasons for amputation were persistent infection (4 of 10) and nonunion (4 of 10). Thirteen (24%) patients developed an infection. The median number of reoperations per patient was 1 (IQR 0-2) with the patients who underwent amputation undergoing a median of 2 (IQR 2-4) reoperations. The rate of union was 54%, occurring at a median of 26.5 (IQR 12-47) months. 44% (4/9) of patients in the external fixation group had a preoperative ulceration versus 19% (9/47) of the patients in the internal fixation group (p=.19). Preoperative ulceration was not a risk factor for amputation. Forty-two (75%) patients were ambulatory at final follow up. Conclusion: We report on the single largest series of Charcot patients undergoing hindfoot and ankle arthrodesis. The surgical management of this population has a high rate of complications with infection and reoperation being common. Despite a high nonunion rate most patients are able to ambulate in a brace or orthotic. Limb salvage can be expected with either internal or external fixation techniques.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

scholarly journals Management of elderly traumatic ankle arthritis with Ilizarov External Fixation: A Retrospective Study

2021 ◽  
Author(s):  
Jun Li ◽  
Wenzhao Wang ◽  
Bohua Li ◽  
Mingxin Li ◽  
Lei Liu
Keyword(s):  
External Fixation ◽  
Line Segment ◽  
Ankle Arthrodesis ◽  
Healing Time ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
X Ray ◽  
Significant Difference ◽  
Post Operation

Abstract Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis, while large sample randomized controlled trials are still needed.

Management of Neurologic Deformity of the Ankle and Foot With Concurrent Osteomyelitis With the Ilizarov Method

2017 ◽  
Vol 39 (2) ◽  
pp. 226-235 ◽  
Author(s):  
Nikolay Mikhailovich Kliushin ◽  
Anatoliy Sergeyevich Sudnitsyn ◽  
Koushik Narayan Subramanyam ◽  
Jefferson George
Keyword(s):  
External Fixation ◽  
Case Series ◽  
Interquartile Range ◽  
Ilizarov Method ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Eradication Of Infection ◽  
Tract Infections ◽  
Ankle And Foot

Background: The combination of neurologic deformity of the ankle and foot with osteomyelitis is a therapeutic challenge. We investigated the role of Ilizarov with regard to eradication of infection, correction of deformities and improvement of patient function. Methods: We retrospectively reviewed 77 patients (77 feet) with neurologic deformity of the ankle and foot with osteomyelitis treated sequentially in 3 stages by Ilizarov method. The 3 stages were (1) active debridement and Ilizarov stabilization, (2) further strengthening of Ilizarov fixator and active osteosynthesis consisting of strategies like arthrodesis, osteotomy distraction, bone transport, or combination thereof, (3) consolidation of fusion/regeneration achieved in second stage. Patients with Charcot arthropathy were not included in the study. There were 43 males and 34 females with mean age of 34.4 (range, 18 to 70) years. All patients had a minimum of 1 year follow-up and 49 patients had 5 years follow-up. Results: Mean duration of external fixation was 179.9 (range, 128 to 413) days. The success of infection eradication was 90.9% and 91.9% at the end of 1 and 5 years, respectively. We achieved plantigrade feet in all cases with no recurrence of deformity. The American Orthopaedic Foot & Ankle Score (AOFAS) improved from a median preoperative value of 74 (interquartile range, 65 to 75.25) to 81 (interquartile range, 77 to 88) ( P < .0001). The improvement of the score was by 7 points only considering the painless nature of the pathology, and the fact that pain contributed to 40% of total score. A total of 39 complications occurred in 30 patients which were managed successfully by alteration of rehabilitation and carefully chosen interventions. Conclusion: Ilizarov external fixation was an effective technique to address problems associated with neurologic foot and ankle deformity with infection. It allowed eradication of infection and achievement of a stable plantigrade foot. It had some disadvantages like lengthy duration of treatment, pin-tract infections, need for operative expertise, and supervised rehabilitation, but we feel these were definitely outweighed by its benefits. Level of Evidence: Level IV, retrospective case series.

scholarly journals Complication Rates in Ankle and Hindfoot Charcot Arthropathy Treated with Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
David M. Macknet ◽  
Andrew Wohler ◽  
Bruce E. Cohen ◽  
J. Kent Ellington ◽  
Carroll P. Jones ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Ankle Arthrodesis ◽  
Limb Salvage Rate ◽  
Charcot Arthropathy ◽  
Non Union ◽  
Radiographic Union ◽  
Salvage Rate

Category: Diabetes; Ankle; Hindfoot; Other Introduction/Purpose: Charcot arthropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity. When indicated, the surgical goals are to restore a stable plantigrade foot, reduce the risk of ulceration, and improve function to independent ambulation. Techniques for reconstruction of the neuropathic ankle/hindfoot include external and/or internal fixation. Current literature involving small series of surgical patients has shown a high rate of limb salvage and low complication rate. Our experience has been less promising, although we believe it remains a viable option. It is our goal to report the outcomes of Charcot patients undergoing corrective ankle and hindfoot reconstruction. Methods: We retrospectively reviewed 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 51 of which met inclusion and exclusion criteria with a minimum one year follow up. 42 had internal fixation as their primary procedure (plate or nail) and 9 patients underwent external fixation with a multi-planar external fixator. Median follow up time was 4 years (IQR 2.97 years). Preoperatively, basic demographic variables, etiology of neuropathy, ulcer status, radiographic measurements, Brodsky classification, and presence of a viable talus were collected and analyzed. Postoperatively, we collected complications including infection, hardware failure, ulceration, recurrent deformity, and nonunion. Reoperation numbers and indications for reoperation were also collected. The primary outcome measure was limb salvage at final follow up. Secondary outcome measures were ambulatory and footwear/bracing status. Results: 11 patients (20%) underwent amputation at final follow up and 26 (47.3%) achieved radiographic union, both of which did not vary by fixation type (p=0.67 and p=0.88). The primary reasons for amputation were persistent infection and non-union. 74.5% of patients developed a post-operative complication and 58.2% had at least one reoperation. 25.5% of patients developed a post- operative infection. Patients with a pre-operative ulceration were more likely to undergo external fixation (p=0.02), but amputation rates did not differ between groups (p>0.99). There was a trend toward increased risk of post-operative infection in the ulceration group (p=0.07). A pre-operative Meary’s angle >25° was more likely to undergo amputation (p=0.04) and less likely to achieve radiographic union (p=0.05). 75.9% of patients were ambulatory at final follow up. Conclusion: Our rates of amputation (20%), post-operative infection (25%), complications (74.5%) and non-union (52%) are higher than previously described. Previous literature has described a near 100% limb salvage rate, but in our report on a large series of Charcot patients undergoing hindfoot/ankle arthrodesis we describe an 80% limb salvage rate. Pre-operative Meary’s angle >25° was predictive of treatment failure.

scholarly journals The Combined Lambrinudi and Ankle Arthrodesis with Ring External Fixation in the Long-term Severe Neuromuscular Equinocavovarus Deformity with Ankle and Hindfoot Osteoarthritis: The Cases Presentation and Modified Guideline of Treatment

2019 ◽  
Vol 13 (1) ◽  
pp. 183-188
Author(s):  
Prasit Rajbhandari ◽  
Chayanin Angthong ◽  
Jiancheng Zang ◽  
Sihe Qin ◽  
Andrea Veljkovic
Keyword(s):  
Present Report ◽  
Treatment Algorithm ◽  
Deformity Correction ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Improved Outcomes ◽  
Ankle Surgery

Background: Severe equinocavovarus deformity develops from various causes and generally results in major disability that affects patient’s mobility and quality of life. It can be divided into neuromuscular and non-neuromuscular deformities, including two major subtypes: i.e., paralytic and spastic. In addition, ankle osteoarthritis could be caused by prolonged or progressive foot deformity. Objective: The present report proposes a modification of the accepted treatment algorithm and Lambrinudi’s surgical technique with ankle and hindfoot arthrodesis to correct theses challenging deformities with the long-term condition. Results: Two equinocavovarus cases were included, one in a 54-year old male and the second in a 63-year old female with paralaytic and spastic etiologies respectively. Patient’s deformity correction was acceptable. Each patient demonstrated improved outcomes due to a postoperative plantigrade foot and ankle position. No significant complications were encountered during the course of care and last follow-up. The mean follow-up time was 26 months. Conclusion: Severe long term neuromuscular equinocavovarus deformities are a challenging disability in the foot and ankle surgery. The present article proposes a modified guideline of treatment illustrated in two representative case studies of long-term paralytic and spastic equinocavovarus deformities. These conditions can be treated surgically using the stepwise approach as demonstrated in this article with acceptable outcomes.

scholarly journals Management of elderly traumatic ankle arthritis with Ilizarov External Fixation: A Retrospective Study

2021 ◽  
Author(s):  
Jun Li ◽  
Wenzhao Wang ◽  
Hai Yang ◽  
Bohua li ◽  
Mingxin Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Line Segment ◽  
Ankle Arthrodesis ◽  
Healing Time ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
X Ray ◽  
Significant Difference ◽  
Post Operation

Abstract Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator

2018 ◽  
Vol 20 (6) ◽  
pp. 441-450
Author(s):  
Karol Mochocki ◽  
Radosław Górski ◽  
Sławomir Żarek ◽  
Łukasz Szelerski ◽  
Paweł Małdyk
Keyword(s):  
Lower Limb ◽  
Weight Bearing ◽  
Kirschner Wire ◽  
Ankle Arthrodesis ◽  
Ilizarov Method ◽  
Comprehensive Treatment ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Ilizarov Fixator ◽  
Tract Infections

Background. Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. Material and methods. Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsilateral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. Results. The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on average (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infections and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achieved a notable improvement in daily functioning and quality of life. Conclusions. The outcomes of a comprehensive treatment consisting of ankle arthrodesis and lower-leg lengthening using the Ilizarov method confirm its effectiveness. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treatment stages, creating an optimal biological environment for bone healing. The patient recovers functionally to allow satisfactory and pain-free functioning as well as resumption of daily responsibilities. The low incidence of complications adds to the attractiveness of the method.

Fractures and Dislocations of the Foot and Ankle in Diabetics Associated with Charcot Joint Changes

1994 ◽  
Vol 15 (4) ◽  
pp. 182-185 ◽  
Author(s):  
George B. Holmes ◽  
Nathan Hill
Keyword(s):  
Soft Tissue ◽  
Early Recognition ◽  
Diabetic Patients ◽  
Foot And Ankle ◽  
Delay In Diagnosis ◽  
Charcot Joint ◽  
Appropriate Treatment ◽  
Fracture Dislocations ◽  
Open Injuries

This study was undertaken to evaluate the occurrence of Charcot joint changes in diabetic patients after fractures and/or dislocations of the foot and ankle. There were 20 fracture/dislocations of the foot and ankle in 18 patients, with an average follow-up of 27 months (range 14–70 months). There were eight fractures of the midfoot, six fractures of the ankle, four fractures of the hindfoot, and two fractures of the forefoot. Eight fractures were followed by the development of Charcot changes: five in the midfoot and one each in the forefoot, hindfoot, and ankle. Of nine fractures recognized early and initially treated by early immobilization or ORIF, seven healed uneventfully. Two fractures, both open injuries, developed soft tissue infection and osteomyelitis, respectively. Of the 11 fractures in which there was a delay in diagnosis and treatment, eight developed Charcot changes. The early recognition and appropriate treatment of fractures in diabetic patients appears to be important in the prevention of Charcot joint changes.

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