The sequelae of an undiagnosed, an insufficiently treated or unpreventable (by crush injury) com- partment or postischemic syndrome, most often after lower leg fracture or popliteal artery rupture, are caused by necrosis and contracture of the extrinsic foot muscles. The more harmless hammer toes due to contracture of the intrinsic muscles follow most often an untreated isolated foot CS induced e. g. by a calcaneal fracture. In combined CS of the lower leg and the foot or in some iso- lated cases of mainly one involved muscle we see different types of deformity (Types 1–5). The dif- ferent types are also altered by involvement of nerve damages. Due to the involved and the amount of scarred muscles we observe flexible or contract hammer toes, claw toes, hallux flexus, hallux valgus, foot equinus or the severest form of a postcompartment or postischemic pes equinovarus. Less common (16 of 66 cases) in our seria of corrections were the deformities caused by an isolated CS, such as necrosis of the anterior tibialis, long extensor or the peroneal muscles. Most surprisingly have been few cases of a functional hallux flexus or a severe hallux valgus in a boy.
High energy trauma in car accidents, local crush trauma like overroll traumata and falls from avery hight with resulting foot fractures are prone to develop an acute compartment syndrome (CS) in adults, in adolescents and in children as well.Because the soft tissue reaction is independent from the age of the patient typical pathology, diagnostic and treatment principals are the same in children like in adults. But neglected compartment release of the foot and/or the lower leg seems to lead to worse sequelae in children and adolescents than in adults. This was observed in the underlying study of eight compartment syndromes in four children and two adolescents (two bothsided) of which four cases were neglected ending up with tremendous sequelae of the toes or grotesque foot deformities appearing worse than compared to neglected cases in adults. Four acute foot compartment syndromes in children are presented here as case reports showing not any sequelae if treated immediately by operative release.
In contrast to the frequency of malunited ankle fractures in 7.7 % up to 50 % [8] during childhood especially due to Salter-Harris fractures Type 3–5 [1, 2, 7, 8], malunions and nonunions after fracture of one of the 12 essential foot bones are seen seldomly [9–12]. Therefore exists only little knowl-edge in literature how to correct latter ones. Because techniques how to correct malunited ankle fractures are well known this paper focuses on secondary anatomic reconstructions of foot fractures in children up to an age of 15 years. In all ten presented cases the main operative goal is stressed out to restore normal biomechanical axes by different osteotomies, by lengthening or shortening, by anatomic Lisfranc`s ligament repair, but also, if anyhow possible, by anatomic restauration of the malunited joint related to talus or navicular in order to prevent posttraumatic arthritic pain without sacrifying joint function in a child or young adolescent.
Introduction: Less invasive restoration of joint congruity and calcaneal shape in displaced intra-articular calcaneal fractures via a sinus tarsi approach followed by percutaneous internal fixation with an interlocking nail results in a low rate of soft-tissue complications and good short-term outcomes1 (Video 1). Indications & Contraindications: Step 1 Patient Placement: Place the patient in the lateral decubitus position, supporting the involved extremity with a soft radiolucent pillow, flex the contralateral knee, check with fluoroscopy before draping, and obtain lateral radiographs. Step 2 Incision: Use a sinus tarsi approach for control of the articular reduction. Step 3 Percutaneous Manipulation of the Main Fragments: Percutaneously manipulate the main fragments to facilitate reduction of the main tuberosity fragment toward the sustentacular fragment and subsequent joint reduction. Step 4 Joint Reduction with Direct Manipulation of the Main Fragments through the Sinus Tarsi Approach: Reduce the joint with direct manipulation of the main fragments through the sinus tarsi approach. Step 5 Joint Fixation with Screws: Check the congruency of the posterior subtalar joint facet, stabilize the posterior facet with 2 screws, reduce the tuberosity against the joint block and anterior process, and temporarily fix with Kirschner wires. Step 6 Introduction of the Intramedullary Nail: Make a 10-mm vertical incision below the attachment of the Achilles tendon, direct the guidewire toward the center of the calcaneocuboid joint, place the guidewire centrally within the calcaneal body, ream over the guidewire, and introduce the intramedullary nail with the attached aiming device. Step 7 Locking of the Nail: Use the aiming device to position the proximal Kirschner wire into the sustentacular fragment, place the nail so that it hits the sustentaculum tali properly, insert a second Kirschner wire through the other hole of the guiding arm, exchange the wires after drilling for locking screws, apply an end cap to extend the length of nail, if needed, and then verify proper reduction and implant position fluoroscopically. Step 8 Postoperative Management: Manage the patient with continuous passive motion and active range-of-motion exercises of the ankle beginning on postoperative day 2 and allow partial weight-bearing of 20 kg for 6 to 10 weeks. Results: Recently, we reported on 103 patients with 106 intra-articular calcaneal fractures treated with the C-Nail by 4 senior surgeons from February 2011 to October 20131. Pitfalls & Challenges:
- Publikační typ
- časopisecké články MeSH
