Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Abstract

ObjectivesThe surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function.MethodsFollow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.ResultsIn 12 years of conflict, 114 patients sustained 134 fractures. Follow-up consisted of 90 fractures (90/134, 67%), at a median of five years (interquartile range (IQR) 52 to 80 months).The median Short-Form 12 physical component score (PCS) of 62 individuals retaining their limb was 45 (IQR 36 to 53), significantly lower than the median of 51 (IQR 46 to 54) in patients who underwent delayed amputation after attempted reconstruction (p = 0.0351).Regression analysis identified three variables associated with a poor F&A score: negative Bohler’s angle on initial radiograph; coexisting talus and calcaneus fracture; and tibial plafond fracture in addition to a hindfoot fracture. The presence of two out of three variables was associated with a significantly lower PCS compared with amputees (medians 29, IQR 27 to 43 vs 51, IQR 46 to 54; p < 0.0001).ConclusionsAt five years, patients with reconstructed hindfoot fractures have inferior outcomes to those who have delayed amputation. It is possible to identify injuries which will go on to have particularly poor outcomes.Cite this article: P. M. Bennett, T. Stevenson, I. D. Sargeant, A. Mountain, J. G. Penn-Barwell. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res 2018;7:131–138. DOI: 10.1302/2046-3758.72.BJR-2017-0217.R2.

Passive-dynamic ankle-foot orthosis improves medium-term clinical outcomes after severe lower extremity trauma

“…Improvements (and importantly, no deterioration) in mobility and pain status were demonstrated alongside unchanged levels of ‘none to minimal’ depression and anxiety and stable body mass index (27±3 kg·m 2 ). In light of the historical evidence,1 2 5 6 the outcomes demonstrated here are highly significant. Blair et al 20 found that return-to-duty rates were increased in servicemen who received an integrated orthotic and rehabilitation programme (51%) compared with an IDEO brace alone (13%).…”

“…This is the first study to evaluate the medium-term (mean 34±11 months) effect of a PDAFO on functional and psychosocial outcomes in patients with foot and ankle trauma. The results suggest that the provision of a PDAFO to patients presenting with lower extremity injuries commonly considered to demonstrate poor long-term clinical outcomes1 6 7 has contributed to lasting favourable results in a range of patient-reported measures. Improvements (and importantly, no deterioration) in mobility and pain status were demonstrated alongside unchanged levels of ‘none to minimal’ depression and anxiety and stable body mass index (27±3 kg·m 2 ).…”

“…Limb salvage can result in decreased function, persistent pain and disability 1–7. The US and UK military have previously reported more favourable functional and psychosocial outcomes in traumatic lower limb amputee groups compared with patients who underwent lower limb reconstruction 3 8.…”

Surgical Experience of Togo Level 2 Hospital During Peacekeeping Mission in Northern Mali

“…It is recommended to locate the ends of the tendons or nerves sectioned and then fix them temporarily in the soft parts to avoid their retraction. Their repair will be secondarily performed once the wounded stabilized [34].…”

Total Talar and Navicular Extrusions

“…A lthough open extruded talus injuries are rare cases that have been described, a case of an open extruded talus and navicular has not yet been described to our knowledge [1][2][3][4][5] . We describe a case of this unique injury that was initially treated with debridement and primary closure without reimplanting the talus and navicular.…”