Ilizarov External Frame Technique for Pirogoff Amputations With Ankle Disarticulation and Tibiocalcaneal Fusion

Geßmann, Jan; Citak, Mustafa; Fehmer, T.; Schildhauer, Thomas A.; Seybold, D.

doi:10.1177/1071100713475612

Cited by 14 publications

(4 citation statements)

References 20 publications

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“…Most reports on these amputation levels have focused on patients with diabetes, peripheral vascular disease, infections, or tumors. While there are several small series and case reports in the literature on hind-and midfoot amputations for trauma, the heterogeneous injury types, surgical techniques, and reported outcome measures, and the small patient numbers without comparison groups make it difficult to interpret prior reports [23][24][25][26][27][28][29] . Our study was an attempt to compare outcomes of patients undergoing hind-and midfoot versus transtibial amputations after traumatic injury.…”

Section: Discussionmentioning

confidence: 99%

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Fram,

Bosse,

Odum

et al. 2024

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to compare 18-month clinical and patient-reported outcomes between patients with severe lower-limb injuries treated with a transtibial amputation or a hind- or midfoot amputation. Despite the theoretical benefits of hind- and midfoot-level amputation, we hypothesized that patients with transtibial amputations would report better function and have fewer complications. Methods: The study included patients 18 to 60 years of age who were treated with a transtibial amputation (n = 77) or a distal amputation (n = 17) and who were enrolled in the prospective, multicenter Outcomes Following Severe Distal Tibial, Ankle, and/or Foot Trauma (OUTLET) study. The primary outcome was the difference in Short Musculoskeletal Function Assessment (SMFA) scores, and secondary outcomes included pain, complications, amputation revision, and amputation healing. Results: There were no significant differences between patients with distal versus transtibial amputation in any of the domains of the SMFA: dysfunction index [distal versus transtibial], 31.2 versus 22.3 (p = 0.13); daily activities, 37.3 versus 26.0 (p = 0.17); emotional status, 41.4 versus 29.3 (p = 0.07); mobility, 36.5 versus 27.8 (p = 0.20); and bother index, 34.4 versus 23.6 (p = 0.14). Rates of complications requiring revision were higher for distal amputations but not significantly so (23.5% versus 13.3%; p = 0.28). One distal and no transtibial amputees required revision to a higher level (p = 0.18). A higher proportion of patients with distal compared with transtibial amputation required local surgical revision (17.7% versus 13.3%; p = 0.69). There was no significant difference between the distal and transtibial groups in scores on the Brief Pain Index at 18 months post-injury. Conclusions: Surgical complication rates did not differ significantly between patients who underwent transtibial versus hind- or midfoot amputation for severe lower-extremity injury. The average SMFA scores were higher (worse), although not significantly different, for patients undergoing distal compared with transtibial amputation, and more patients with distal amputation had a complication requiring surgical revision. Of note, more patients with distal amputation required closure with an atypical flap, which likely contributed to less favorable outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Fram,

Bosse,

Odum

et al. 2024

Journal of Bone and Joint Surgery

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“…1516,2455,56,57,5859,6061,62 There are some studies that describe amputation techniques and correction with external fixation but as yet no direct comparision with reconstruction surgery exists and external fixation may be tailored to those patients where there is a suggestion of ongoing infection. 63,64,65,66,67 In studies where external fixation was the method of stabilisation, the mean time to weight bearing was 19 weeks. 14,15,19 This is longer than the time observed with internal fixation (16 weeks), although clinically it is unclear how much benefit the 3 weeks would confer.…”

Section: Methods Of Fixationmentioning

confidence: 99%

Charcot foot reconstruction outcomes: A systematic review

Hester

Foley

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications. Methods: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques. Results: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation. Conclusions: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.

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“…In case a distal partial foot amputation cannot be performed, a Pirogoff amputation might be considered among other procedures as an alternative option rather than directly proceeding to a major amputation, such as a trans-tibial amputation (TTA). Pirogoff amputation, first described in 1854, results in an end-bearing stump with approximately 2-5cm of leg-length shortening (Figure 1), allowing limited barefoot mobility [1][2][3][4][5][6][7][8][9]. Indications for Pirogoff amputation include foot lesions that are too extensive for reconstruction or non-operative treatment [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Pirogoff Amputation with a Disappointing Outcome: A Case Report

Vegt¹,

Geertzen²,

Paping³

2020

SCR

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Case Presentation: A 53-year-old motorcyclist suffered trauma with an extensive foot injury. A Pirogoff amputation was performed. A hindfoot amputation might be considered as an alternative option rather than directly proceeding to a trans-tibial amputation. Results: A Pirogoff amputation was performed with a disappointing course afterward. Subsequently, we performed a literature search on the Pirogoff amputation. Conclusion: Further research is needed concerning the optimal amputation level for patients who need a hindfoot amputation since good studies are lacking. In general, a major advantage of the Pirogoff amputation is the possibility of some barefoot mobility. The disadvantages are fitting problems due to a bulbous stump and limited installation height for the incorporation of a prosthesis. A trans-tibial amputation might be considered in young and healthy patients because of the extensive possibilities for prosthetic fitting. The final decision of the amputation level should be made by an experienced surgical and rehabilitation team discussing the advantages and disadvantages with the patient involved. Currently, evidence from the literature is too limited to guide this discussion and the decision-making process.

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Ilizarov External Frame Technique for Pirogoff Amputations With Ankle Disarticulation and Tibiocalcaneal Fusion

Abstract: Level IV, case series.

Cited by 14 publications

References 20 publications

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Charcot foot reconstruction outcomes: A systematic review

Pirogoff Amputation with a Disappointing Outcome: A Case Report

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