Analysis of the Deformities of the Foot after Tibial Fracture and Outcome of the Surgical Treatment

경골 골절후 발생한 족부 변형들의 분석 및 치료 결과에 대한 분석

  • Kim, Jung-Ryul (Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine) ;
  • Kim, Young-Sin (Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine) ;
  • Shin, Sung-Jin (Department of Orthopaedic Surgery, Jeju National University College of Medicine) ;
  • Kim, Sang-Rim (Department of Orthopaedic Surgery, Jeju National University College of Medicine) ;
  • Seo, Kyu-Bum (Department of Orthopaedic Surgery, Jeju National University College of Medicine)
  • 김정렬 (전북대학교 의학전문대학원 정형외과학교실, 임상의학연구소) ;
  • 김영신 (전북대학교 의학전문대학원 정형외과학교실, 임상의학연구소) ;
  • 신성진 (제주대학교 의과대학 정형외과학교실) ;
  • 김상림 (제주대학교 의과대학 정형외과학교실) ;
  • 서규범 (제주대학교 의과대학 정형외과학교실)
  • Published : 2009.12.15

Abstract

Purpose: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. Materials and Methods: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. Results: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). Conclusion: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

Keywords

References

  1. Clawson DK: Claw toes following tibial fracture. Clin Orthop, 103: 47-48, 1974. https://doi.org/10.1097/00003086-197409000-00029
  2. Coughlin MJ: Lesser toe abnormalities. Inst Course Lect, 52: 421-444, 2003.
  3. Coughlin MJ: Operative repair of the mallet toe deformity. Foot Ankle Int, 16: 109-116, 1995. https://doi.org/10.1177/107110079501600301
  4. Curry EE, O’Brien TS and Johnson JE: Fibular nonunion and equinovarus deformity secondary to posterior tibial tendon incarceration in the syndesmosis: a case report after a bimalleolar fracture-dislocation. Foot Ankle Int, 20: 527-531, 1999. https://doi.org/10.1177/107110079902000811
  5. David A, Tiemann A, Richter J and Muhr G: Corrective soft tissue interventions for equinovarus deformity. Foot deformities after tibial compartment syndrome. Unfallchirurg, 100: 371-374, 1997. https://doi.org/10.1007/s001130050132
  6. DeLee JC and Stiehl JB: Open tibia fracture with compartment syndrome. Clin Orthop Relat Res, 160: 175–184, 1981.
  7. Duchenne GB: Physiologie des mouvements. Baillaire, Paris, 1867.
  8. Hahn SB, Park HJ, Park HW, Kang HJ and Cho JH: Treatment of severe equines deformity associated with extensive scarring of the leg, Clin Orthop, 393: 250-257, 2001. https://doi.org/10.1097/00003086-200112000-00028
  9. Horne G: Pes cavovarus following ankle fracture. A case report. Clin Orthop Relat Res, 184: 249-250, 1984.
  10. Ibrahim K: Pes cavus. In: Evarts CM ed. Surgery of the Musculoskeletal System. New York, Churchill Livingstone: 4015-4034, 1990.
  11. Karlstrom G, Lonnerholm T and Olerud S: Cavus deformity of the foot after fracture of the tibial shaft. J Bone Joint Surg Am, 57: 893-900, 1975.
  12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS and Sanders M: Clinical rating systems for the anklehindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 15: 349–353, 1994.
  13. Lee HS, Kim JS, Park SS, Lee DH, Park JM and Wapner KL: Treatment of checkrein deformity of the hallux. J Bone Joint Surg Br, 90: 1055-1058, 2008.
  14. Leitschuh PH, Zimmerman JP, Uhorchak JM, Arciero RA and Bowser L: Hallux flexion deformity secondary to entrapment of the flexor hallucis longus tendon after fibular fracture. Foot Ankle Int, 16: 232-235, 1995. https://doi.org/10.1177/107110079501600413
  15. Manoli A 2nd, Smith DG and Hansen ST Jr: Scarred muscle excision for the treatment of established ischemic contracture of the lower extremity. Clin Orthop Relat Res, 292: 309-314, 1993.
  16. Paulos L, Coleman S and Samuelson K: Pes cavovarus: Review of a surgical approach using selective soft-tissue procedures. J Bone Joint Surg, 62-A: 942–953, 1980.
  17. Przybyszewski J and Rozwadowska-Wroblinska A: Foot deformity as a late consequence of tibial shaft fracture. Chir Narzadow Ruchu Ortop Pol, 60: 47-49, 1995.
  18. Rosenberg GA and Sferra JJ: Checkrein deformity: an unusual complication associated with a closed Salter-Harris Type II ankle fracture: a case report. Foot Ankle Int, 20: 591-594, 1999. https://doi.org/10.1177/107110079902000910
  19. Sanders R, Fortin P, DiPasquale T and Walling A: Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 290: 87–95, 1993.
  20. Sanhudo JA and Lompa PA: Checkrein deformity: flexor hallucis tethering: two case reports. Foot Ankle Int, 23: 799-800, 2002.
  21. Schnepp KH: Hammer toe and claw foot. Am J Surg, 36: 351-359, 1933. https://doi.org/10.1016/S0002-9610(37)90845-6
  22. Schwend R and Drennan JC: Cavus foot deformity in children. J Am Acad Orthop Surg, 11: 201–211, 2003.
  23. Sraj SA, Saghieh S, Abdulmassih S and Abdelnoor J: Medium to long-term follow-up following correction of pes cavus deformity. J Foot Ankle Surg, 47: 527-532, 2008. https://doi.org/10.1053/j.jfas.2008.06.007