Traumatic partial hindfoot amputation with injury to the posterior tibial artery

Abstract

Introduction Talus and calcaneus fractures account for about 2 % of skeletal injury and 70 % of the foot fractures. Open fractures of the hindfoot are diagnosed in 30 %. More than half of the injuries are graded as type III according to classification of R.B. Gustilo, J.T. Anderson (1976). Injury to the posterior tibial artery is observed in 6.4 % of patients. Amputations resulting from an osseous-vascular injury and gangrene and crushed soft tissues are observed in 3-60 %. The objective was to demonstrate a rare clinical case of traumatic partial hindfoot amputation on the right side associated with open calcaneus and talus fracture and injury to the posterior tibial artery and resulted in a good outcome. Material and methods A clinical case of a 36-year-old patient who suffered a traumatic partial hindfoot amputation and injury to the posterior tibial artery. Results Restoration of the anatomy and the function of the right foot was achieved in the patient. Discussion There are no clinical guidelines and a unified classification for bone and vascular injuries and no universal method for the treatment of a combined injury including an open fracture of bones and injury to blood vessels. The choice of treatment modality, diagnosis of osteovascular injuries are produced on an individual basis depending on the external and internal factors affecting the injuries. An angiotraumatological approach used to treat the patient with the hind foot injury on the right included early primary surgical treatment of the osteovascular injury, accurate reduction and stable fixation using a sparing technique for the calcaneus, repair of the posterior tibial artery, complex drug therapy to improve blood rheology, reduce coagulability, address tissue ischemia and provide adequate regional anesthesia. Conclusion The combination of factors and use of an angiotraumatological approach employing organ sparing strategy and a multidisciplinary team of orthopaedic and trauma surgeons, angiosurgeons, anesthesiologists-resuscitators facilitated foot salvage, improved function and supportability.

Keywords

• combined osteovascular injury
• open fracture of the calcaneus
• injury to the posterior tibial artery