External Fixation of the Foot and Ankle

Abstract

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.

Forefoot Narrowing with External Fixation for Problem Cleft Wounds

“…The use of external fixator techniques in the foot has been described previously. 1 –11 However, none of the techniques are used for the purposes described in this paper. The fixators stabilized and/or lengthened contracted or shortened tissues in patients who did not have problem wounds.…”

Technique Tip: Open Reduction Internal Fixation of Comminuted Fractures of the Navicular with Bridge Plating to the Medial and Middle Cuneiforms

“…2 Proposed methods of fixation for comminuted navicular fractures include: direct screw or Kirschner wire fixation, which may be problematic if fractures are mutifragmented, 3 bridging external fixation between the first metatarsal and the talus; however; this does not provide direct stability to the injured midfoot and may be complicated by pin tract infections requiring fixator removal and potential collapse about the fracture. 1,3 Temporary bridge plating of the medial column has also been proposed; however, this necessitates a second procedure and may contribute to loss of motion at the talonavicular joint which is temporarily immobilized. 6 This is important as impedance of the ability of the navicular to glide over the talus can greatly impair foot function.…”