Salvage of Combat Hindfoot Fractures in 2003-2014 UK Military

Bennett, Philippa M.; Stevenson, Tom; Sargeant, I.D.; Mountain, Andrew; Penn-Barwell, Jowan G.

doi:10.1177/1071100717697913

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…A previously reported series identified all 114 British military casualties with 134 fractured hindfeet from the conflicts in Iraq and Afghanistan. 7 A total of 77 patients (77/114, 68%) were successfully contacted and consented to participate in this follow-up study. Patients undergoing amputation, those with retained limbs, and those lost to follow-up were similar with respect to age, mechanism of injury, and associated injuries ( Table I ).…”

Section: Resultsmentioning

confidence: 99%

“…The question of whether severe hindfoot fractures sustained in combat could be salvaged successfully has previously been reported by the authors. 7 The results of this study contribute to addressing whether these injuries should be salvaged where the focus is on subsequent quality of life, rather than technical feasibility of surgical reconstruction. 22…”

Section: Discussionmentioning

confidence: 96%

“…This was a retrospective telephone-based follow-up study of a previously identified case series. 7 The study was registered with, and approved by, the United Kingdom Joint Medical Command. All surviving British military casualties from the 12 years of conflict in Iraq and Afghanistan with a fracture of either the talus, calcaneus, or both, were identified.…”

Section: Methodsmentioning

confidence: 99%

“…All surviving British military casualties from the 12 years of conflict in Iraq and Afghanistan with a fracture of either the talus, calcaneus, or both, were identified. 7 Data were gathered on patients’ demographics, injury details and surgical management; patients managed with a primary amputation in the first three surgical episodes were excluded. The severity of the injury was recorded using the New Injury Severity Score (NISS).…”

Section: Methodsmentioning

confidence: 99%

“…For British and American military surgeons caring for casualties from the recent conflicts, high-energy hindfoot fractures have surpassed open tibial fractures as the greatest test in terms of the salvage and reconstruction of severe lower limb injuries. 7 , 8 However, for surgeons working in certain African, Asian and Middle Eastern countries, these injuries have been a challenge for decades, and will likely continue to be long into the future. 9…”

Section: Introductionmentioning

confidence: 99%

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

Bennett

Stevenson

Sargeant

et al. 2018

Bone & Joint Research

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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