No abstract

Traumatic calcanectomy is a complicated rare condition that results in chronic pain and loss of limb function as the calcaneus is crucial for bearing weight. For an adult, possible treatment options are limited to below knee amputation, bone grafts, and 3D prosthesis; however, for the pediatric population, therapeutic data are scarce. In this case report, the authors describe a technique that provides the possibility for hindfoot reconstruction while maintaining growth potential without traumatizing other anatomic regions. A 5‐year‐old patient presented in the emergency department after he accidentally slipped under a lawnmower, which resulted in full calcaneal amputation with large bone and plantar soft tissue defects from the medial to lateral malleoli. Four days later, reconstructive surgery was performed using a composite vascularized pedicle growth plate flap. The flap was based on the retrograde anterior tibial artery and consisted of the peroneus longus muscle and fasciocutaneous perforator flap to maintain soft tissue coverage. The calcaneus was reconstructed by a double barrel fibular transplant localizing the growth plate in the distal part of the neocalcaneus. Full consolidation of the fibular barrels was achieved and the growth plate was still open at the 8‐year follow‐up. The fibular transplant has acquired a similar shape to a calcaneus with symmetric flattening and opposite side angulation. The patient's lower extremity functional score was 78/80 points. Reconstruction of an amputated calcaneal bone is rare and complicated, especially for pediatric patients. Authors demonstrate treatment with a complex vascularized flap for sustained growth and good functional outcome in the long term.

Background and objectives: Congenital thumb hypoplasia is a rare deformity of upper extremity. The incidence for thumb hypoplasia grade II–V is 1:10,000 newborns per year in Latvia. A technique for extensor indicis proprius (EIP) tendon transfer with subperiosteal fixation was developed and used for thumb hypoplasia grades II and IIIa. Pollicization or second-toe-to-hand transplantation with metatarsophalangeal (MTP) joint arthrodesis was used for the reconstruction of hypoplasia grade IIIb–V. The aim of this retrospective cohort study is to evaluate the outcomes for reconstruction techniques used in one surgical center during a ten-year period by one surgeon to evaluate functional and aesthetical outcomes for new techniques. Materials and Methods: In total, 21 patients were operated on during 2007–2017, and 18 of these patients were involved in this study. Long-term follow-up was completed to evaluate the functions and aesthetics of the hands. Results: disabilities of the arm, shoulder and hand (DASH) was 9.35 (8–10.7) for the second-toe-to-hand with MTP joint arthrodesis transplantation method for pollicization method 19.8 (6–26.7), and for the EIP tendon transposition, 14.54 (0.9–56.3). Conclusions: The postoperative functional parameters of congenital hand hypoplasia patients, regardless of the surgical method, are worse than the functional results of healthy patients. The use of the second-toe-to-hand with MTP joint arthrodesis transplantation method provides patients with congenital hand IIIb–V hypoplasia a stable and functional first finger formation. The functional results are comparable to the clinical results of the pollicization method while ensuring the creation of a five-digit hand.