Outcome After Complex Trauma of the Foot

Abstract

Early outcome after complex trauma of the foot was essentially determined by soft tissue injury, whereas long-term outcome was determined more by the trauma of the bones and joints. Objective measurements such as dynamic pedography helped to better understand patients' limitations. Orthotic supply could be improved in a reasonable number of the patients.

Level 3 guideline on the treatment of patients with severe/multiple injuries

“…In the LEAP study subgroup analysis of 174 severe open foot injuries, there were significantly worse SIP values after limb preservation versus lower leg amputation when flap coverage and/or ankle arthrodesis were necessary [21]. In an analysis of 50 complex foot injuries, Kinner et al (2011) reported a significant correlation between amputation and ISS [ 16 as well as the primary soft tissue damage [39]. In contrast to the vascular surgery principle of waiting for demarcation of hypoperfused limb areas, in acute trauma, an early decision regarding the need for eventual amputation is advisable to enable early definitive soft-tissue closure [101,102].…”

Foot compartment syndrome – a clinical review

“…Arthough extensive fasciotomy in a severely injured foot has the potential for complications like wound healing problems, infection, and extensive scarring, most clincal series on fasciotomy for FCS do not report any complications directly related to compartment syndrom release [8,17,27,31], in one series of 14 fasciotomies one skin necrosis occurred and one free flap coverage was needed [29]. On the other hand, multiple late complications have been described for untreated compartment syndrome, as outlined below.…”

“…Recent studies on complex trauma of the foot revealed residual toe deformities in about two thirds of cases with presumably overlooked FCS and even despite early fasciotomy [17].…”

“…A recent study showed a 2% incidence of FCS in isolated foot injuries [40]. With complex trauma of the footan entity defined as multilevel fractures with high degree soft tissue damage [2,43] -the incidence of FCS rises to more than 50% [17,39].…”

Komplexe Verletzungen der Fußwurzel

“…B. Avulsions verletzungen) primär durch das Weich teilmanagement und sekundär durch den Behandlungserfolg der knöchernen und ligamentären Verletzungen determiniert [4].…”