Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus

Carow, Juliane; Gueorguiev, Boyko; Klos, Kajetan; Herren, Christian; Pishnamaz, Miguel; Weber, Christian David; Nebelung, Sven; Kim, Bong-Sung; Knobe, Matthias

doi:10.1007/s00264-018-4031-7

Cited by 18 publications

(9 citation statements)

References 49 publications

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“…Another limitation is that functional outcomes of those cases with peroneal tendon dislocation were not uniformly recorded, which precludes comparison to those with talus fractures with no concurrent peroneal tendon dislocation. However, morbidity associated with isolated peroneal tendon dislocation has been described in literature and touched upon earlier in this discussion [17][18][19].…”

Section: Discussionmentioning

confidence: 94%

“…Chronic dislocation is associated with tear of the peroneus brevis due to attrition against the posterolateral ridge of the fibula. This adds to the morbidity of talus fractures and may lead to inferior outcomes of surgical treatment (17)(18)(19). Another implication of the presence of peroneal tendon dislocation is that it may affect approach selection for open reduction and internal fixation to allow for examination and treatment of the peroneal dislocation while maintaining maximum exposure.…”

Section: Discussionmentioning

confidence: 99%

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Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

Attia

Mahmoud

Taha

et al. 2020

International Orthopaedics (SICOT)

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Introduction Talus fractures are not uncommon and one of the serious fractures in the foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. They have been reported to be associated with calcaneum as well as talus fractures. Aim To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. Methods We retrospectively reviewed 93 consecutive talus fractures in the period between 1/1/2011 to 1/11/2018. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and three view ankle plain radiographs. Two independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification, if any. Any dispute was resolved by the senior author.Patient records were reviewed for laterality, age, sex,mode of injury, associated injuries and operative interventions. 50 ankles met the inclusion criteria. 49 were males, mean age was 32.5 year and the predominant mode of injury was a fall from height. Results Peroneal tendon dislocation was found in ten patients out of 50 (20%). Risk of dislocation increased with severity of the fracture and neck fractures. Most of the dislocations were missed by surgeons and radiologist, and no additional procedures were done to address such an injury. The Fleck sign had a statistically significant correlation with peroneal tendons dislocations (p=.005) Conclusion Peroneal tendons dislocation is associated with as high as 20% of talus fractures. The authors recommend carefully reviewing CT scans by surgeons and radiologists alike to avoid missing such injury and allow for appropriate surgical approach utilization. The Fleck sign is a highly specific radiographic sign that has a statistically significant correlation with PT dislocation and hence we recommend intra-operative assessment of peroneal tendons in patients with the fleck sign.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

Attia

Mahmoud

Taha

et al. 2020

International Orthopaedics (SICOT)

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“…To the best of our knowledge, gender differences in microcirculation in relation to hip surgery have not been previously reported. In a study on microcirculation in the hindfoot with healthy subjects, higher values were registered for men than women (Carow et al, 2018). Reasons might include more subcutaneous fat tissue in women compared to men (Carow et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, differences in microcirculation were found between surgical approaches in spine surgery, i.e., less impairment of microcirculation in minimally invasive surgery of the spine compared to open surgery (Ganse et al, 2017). Distinctions in microcirculation between approaches in Achilles tendon surgery in healthy subjects (Klos et al, 2018), gender differences in skin microcirculation over the calcaneus (Carow et al, 2018) and effects of pulsed ultrasound therapy in the foot were published (Kösters et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

et al. 2019

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Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO 2 ), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO 2 , Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO 2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO 2 , Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO 2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

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“…Gentle handling of soft tissue during raising of the lateral skin flaps to ensure good circulation is the most important factor in our opinion [18] [19]. Blade size 15 was used to make a curvilinear incision straight down to bone.…”

Section: Discussionmentioning

confidence: 99%

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Chin¹,

Ying²,

Izani³

2019

OJO

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Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 -Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.

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Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus

Cited by 18 publications

References 49 publications

Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

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