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Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers
OBJECTIVE: To assess the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers. METHODS: A retrospective analysis was conducted. Between 2010 and 2019, a two‐stage managemen...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons Australia, Ltd
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528983/ https://www.ncbi.nlm.nih.gov/pubmed/34596962 http://dx.doi.org/10.1111/os.13148 |
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author | Li, Ya‐xing Liu, Xi Chen, Yu Gan, Ting‐jiang Qin, Bo‐quan Ren, Yi Zhang, Hui |
author_facet | Li, Ya‐xing Liu, Xi Chen, Yu Gan, Ting‐jiang Qin, Bo‐quan Ren, Yi Zhang, Hui |
author_sort | Li, Ya‐xing |
collection | PubMed |
description | OBJECTIVE: To assess the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers. METHODS: A retrospective analysis was conducted. Between 2010 and 2019, a two‐stage management of TCTD followed by OCIF was performed in 13 patients (13 feet). There were five males and eight females with a mean age of 33.8 ± 14.6 years. Ten patients had a right‐side lesion, and three patients had a left‐side lesion. The etiology of deformity included seven cases of congenital neurological disease, one case of Charcot–Marie–Tooth disease, one case of trauma sequelae, and three cases of myelomeningocele. Duration of disease, size of ulcers, surgical procedures, healing time, external fixation time, and complications of these patients were recorded. The Texas wound classification and National Pressure Ulcer Advisory Panel (NPUAP) classification were used for assessing the ulcers. The modified Dimeglio score of deformity and American Orthopeadic Foot and Ankle Society (AOFAS) ankle‐hindfoot score were applied to evaluate the status before treatment and the results at final follow‐up. RESULTS: The TCTD and wound debridement were performed in all patients, and an additional Ilizarov correction technique was added in two patients. All ulcers were healed in 3 months after first‐stage treatment. The median patient self‐report time of ulcer healing was 2.0 weeks (IQR, 1.8–3.3). The median external fixation time was 138.0 days (IQR, 134.5–141.5) days. After second‐stage operative correction, the patients were followed‐up for an average of 28.0 ± 2.9 months. At the final follow‐up, the modified Dimeglio score of deformity was decreased from 6.7 ± 2.1 to 1 (IQR, 0.0–1.0), and the mean AOFAS score was improved from 42.9 ± 19.1 to 82.6 ± 7.7. Before the treatment, there were eight patients with severe deformity, four patients with moderate deformity, and one patient with mild deformity. Postoperatively, seven patients were classified as mild deformity and six patients had a postural foot. The results of AOFAS ankle‐hindfoot score were defined as excellent in three patients, as good in five, and as fair in five. Complications include one case of mild displacement of the osteotomized cortex and one case of pin‐tract infection. No delayed union, nonunion, relapse of ulcers, or deformity were observed. CONCLUSIONS: The two‐stage management of TCTD followed by OCIF could be considered as an alternative treatment for foot and ankle deformities combined with chronic ulcers. |
format | Online Article Text |
id | pubmed-8528983 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley & Sons Australia, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-85289832021-10-27 Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers Li, Ya‐xing Liu, Xi Chen, Yu Gan, Ting‐jiang Qin, Bo‐quan Ren, Yi Zhang, Hui Orthop Surg Clinical Articles OBJECTIVE: To assess the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers. METHODS: A retrospective analysis was conducted. Between 2010 and 2019, a two‐stage management of TCTD followed by OCIF was performed in 13 patients (13 feet). There were five males and eight females with a mean age of 33.8 ± 14.6 years. Ten patients had a right‐side lesion, and three patients had a left‐side lesion. The etiology of deformity included seven cases of congenital neurological disease, one case of Charcot–Marie–Tooth disease, one case of trauma sequelae, and three cases of myelomeningocele. Duration of disease, size of ulcers, surgical procedures, healing time, external fixation time, and complications of these patients were recorded. The Texas wound classification and National Pressure Ulcer Advisory Panel (NPUAP) classification were used for assessing the ulcers. The modified Dimeglio score of deformity and American Orthopeadic Foot and Ankle Society (AOFAS) ankle‐hindfoot score were applied to evaluate the status before treatment and the results at final follow‐up. RESULTS: The TCTD and wound debridement were performed in all patients, and an additional Ilizarov correction technique was added in two patients. All ulcers were healed in 3 months after first‐stage treatment. The median patient self‐report time of ulcer healing was 2.0 weeks (IQR, 1.8–3.3). The median external fixation time was 138.0 days (IQR, 134.5–141.5) days. After second‐stage operative correction, the patients were followed‐up for an average of 28.0 ± 2.9 months. At the final follow‐up, the modified Dimeglio score of deformity was decreased from 6.7 ± 2.1 to 1 (IQR, 0.0–1.0), and the mean AOFAS score was improved from 42.9 ± 19.1 to 82.6 ± 7.7. Before the treatment, there were eight patients with severe deformity, four patients with moderate deformity, and one patient with mild deformity. Postoperatively, seven patients were classified as mild deformity and six patients had a postural foot. The results of AOFAS ankle‐hindfoot score were defined as excellent in three patients, as good in five, and as fair in five. Complications include one case of mild displacement of the osteotomized cortex and one case of pin‐tract infection. No delayed union, nonunion, relapse of ulcers, or deformity were observed. CONCLUSIONS: The two‐stage management of TCTD followed by OCIF could be considered as an alternative treatment for foot and ankle deformities combined with chronic ulcers. John Wiley & Sons Australia, Ltd 2021-10-01 /pmc/articles/PMC8528983/ /pubmed/34596962 http://dx.doi.org/10.1111/os.13148 Text en © 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Clinical Articles Li, Ya‐xing Liu, Xi Chen, Yu Gan, Ting‐jiang Qin, Bo‐quan Ren, Yi Zhang, Hui Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title | Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title_full | Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title_fullStr | Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title_full_unstemmed | Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title_short | Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers |
title_sort | tibial cortex transverse distraction followed by open correction with internal fixation for management of foot and ankle deformity with ulcers |
topic | Clinical Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528983/ https://www.ncbi.nlm.nih.gov/pubmed/34596962 http://dx.doi.org/10.1111/os.13148 |
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