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

Kenzora, John E.; Edwards, Charles C.; Browner, Bruce D.; Gamble, James G.; DeSilva, Jivaka B.

doi:10.1177/107110078100100611

Cited by 22 publications

(8 citation statements)

References 1 publication

(1 reference statement)

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“…Moreover, The high amputation rate after Gustilo–Anderson type IIIC injury, uncontrollable deep sepsis or massive injury by high energy trauma has been reported. [8] Even though the injury of one Gustilo–Anderson type IIIC patient in our series was very severe, the foot was preserved with an acceptable function, which may be mainly attributed to the well-designed management.…”

Section: Discussionmentioning

confidence: 84%

Staged management of open Lisfranc injury

Shi²

2017

Medicine

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There are still controversies on the management and outcome of open Lisfranc injury in available studies. This study evaluates the staged management of Lisfranc injury and its complications.Patients who received a staged strategy for open Lisfranc injury were reviewed.One patient with degloving injury suffered from partial skin and hallux necrosis which was treated by debridement, hallux amputation, definitive internal fixation, and local flap transfer on the 12th day after first stage management. A definitive internal fixation and simultaneous skin graft or flap coverage were performed in another 3 patients with soft tissue defects. Other patients without soft tissue problems underwent a second stage of definitive internal fixation. Bone union was observed on the 12.5th week after definitive surgery. The median AOFAS midfoot score at the last follow-up was 74.4 ± 8.7, while the average VAS score was 2.2 ± 1.8. The average return-to-work time was 8th months postoperatively in 9 patients. Flap necrosis, infection, implant failure, nonunion, and osteomyelitis were not observed during the follow-up. Two patients received Lisfranc arthrodesis for persistent pain due to posttraumatic arthritis.In the management of open Lisfranc injury, surgeons must consider soft tissue condition. Staged strategy is a rational protocol for this severe injury. Temporary K-wire fixation after early radical debridement and realignment will facilitate the definitive internal fixation until soft tissue condition improves, which also can decrease the soft tissue complication.

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Section: Discussionmentioning

confidence: 84%

Staged management of open Lisfranc injury

Shi²

2017

Medicine

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“…(8) This technique may be superior to other treatment methods in open ankle and foot fractures. (9) External fixation is a valuable tool in arthrodeses and in midfoot fracture dislocations. SUMMARY Although ideal indications for the use of this technique have not yet been determined, the reported applications of external fixation in the management of trauma to the foot and ankle have produced encouraging early results in terms of good extremity function with few complications.…”

Section: Discussionmentioning

confidence: 99%

External Fixation of the Foot and Ankle

1986

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The use of Hoffmann external fixation in the treatment of ankle and foot trauma in 26 patients is reviewed. There were 21 males and five females, ranging in age from 14 to 56 years. There were 22 fresh fractures and four arthrodeses. Fourteen of the 22 injuries were open fractures. Eight of 22 involved foot joint disruptions. This form of treatment required a complete set of external fixation equipment, sound knowledge of foot and ankle anatomy, and technical skill in frame construction and application. This fixateur allowed three plane stabilization of complex fractures, mobilization of unaffected joints, and access to wounds for soft tissue care. Follow-up evaluations from 24 to 48 months demonstrated good clinical results. The fractures healed and soft tissue and joint function were preserved. The arthrodeses fused. There were no neurovascular complications, pin tract infections, or equipment breakage. Foot trauma frequently combines soft tissue injury and complex skeletal instability, which makes external fixation particularly attractive. Although ideal indications for the use of this technique have not yet been determined, the theoretical advantages and initial results are encouraging. External fixation is a useful addition to the treatment armamentarium of the foot surgeon.

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“…Mulier et al [24] used the Baltimore painful foot score [14] for the evaluation of 16 patients (6.2%) reporting a mean value of 78 (range, 60-100). A further analysis of the literature revealed that the so-called 'Maryland foot score' and the 'Baltimore painful foot score' historically use the same evaluation form.…”

Section: Functional Assessmentmentioning

confidence: 99%

The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature

Stavlas

Roberts

Xypnitos

et al. 2010

International Orthopaedics (SICOT)

141

127

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A systematic review of the literature was performed in order to evaluate the role of reduction and internal fixation in the management of Lisfranc joint fracturedislocations. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Eleven articles were eligible for the final analysis, reporting data for the management of 257 patients. Injuries of the first three metatarsal rays were treated by closed reduction and internal fixation with screws in 16.3% of the patients, open reduction and internal fixation with screws in 66.5% and open reduction and internal fixation with Kirschner wires (K-wires) in 17.1% of the patients. The preferred method for the stabilisation of the fourth and fifth metatarsal rays was K-wires. Screw-related complications were common and were reported in 16.1% of the cases. The mean American Orthopaedic Foot and Ankle Society midfoot score was 78.1 points. Post-traumatic radiographic arthritis was reported in 49.6% of the patients, but only in 7.8% of them it was severe enough to warrant an arthrodesis. We conclude that open reduction and internal fixation of the first three metatarsal rays with screws is a reliable method for the management of Lisfranc injuries. This can be complemented by K-wires application in the fourth and fifth metatarsal rays if needed.

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

Cited by 22 publications

References 1 publication

Staged management of open Lisfranc injury

Staged management of open Lisfranc injury

External Fixation of the Foot and Ankle

The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature

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