Pablo Randolino Juan, Gaitán Laura, Slullitel Gastón, Gonzalez Emanuel, Lopez Valeria
Instituto de Ortopedia y Trauma Dr. Jaime Slullitel. Rosario, Santa Fe, Argentina.
Hospital Escuela Eva Perón, Granadero Baigorria, Santa Fe, Argentina.
Foot Ankle Orthop. 2024 Aug 2;9(3):24730114241265113. doi: 10.1177/24730114241265113. eCollection 2024 Jul.
Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made.
We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment.
Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment.
In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well.
Level III, prospective cohort study.
关于复杂足部创伤，尤其是其确切治疗方法的证据匮乏。软组织包膜后遗症是延迟或使内固定难以实施的主要因素。外固定器提供的稳定性使其成为合理的初始治疗选择。尽管AO或环形固定器可应用于足部周围，但这可能涉及学习曲线和高昂成本，尤其是环形固定器。对于无法进展至内固定的患者，外固定器作为确定性固定方法的效果如何，几乎没有证据。
我们前瞻性评估了10例在我院连续接受治疗的成年严重复杂足部创伤患者。初始复位和固定采用最初设计用于桡骨远端骨折的外固定器，在初始手术时应用并在整个治疗过程中维持。
所有10例患者均实现骨折愈合，内外侧柱长度均得以恢复。1例患者发生慢性骨髓炎。在1年随访时，这些患者在12项简短健康调查（SF - 12）的身体状况部分平均得分为45.6分，精神状况部分平均得分为44.8分。足部功能指数在疼痛、残疾和日常活动受限方面的结果分别为33.3、39和41.5分，提示存在中度残留功能障碍。
在这个相对较小的复杂足部创伤病例系列中，我们发现使用简单外固定作为确定性治疗效果较好。
III级，前瞻性队列研究。
