Foot fractures and complex trauma of the foot: a case series.

Foot fractures are common injuries. This retrospective study evaluates their frequency, incidence, treatment and outcomes with emphasis on complex trauma of the foot (CTF), an injury that affects soft tissue as well as bone. From 2005 to 2015, 506 patients with foot fractures were treated at our institution; of these, 27 had CTF. The Zwipp score was applied to diagnose CTF, the Gustilo-Anderson classification to grade open fractures and the Tscherne classification to grade closed fractures. Twelve months after the trauma, 20 CTF patients underwent the final X-ray assessment and clinical evaluation with the Visual Analogue Scale Foot and Ankle (VASFA), the Foot Function Index (FFI) and the 12-Item Short Form Survey (SF-12). Data were analyzed with the Spearman rank correlation test. The forefoot was the most frequently involved compartment both in patients with foot fracture and in those with CTF. At 12-month follow-up, the CTF patients showed a VASFA score of 51.5, an FFI of 47.5 and SF-12 scores of 37.9 (physical component summary) and 45.2 (mental component summary). The VASFA score and the FFI showed a significant correlation (rs = 0.84; p = 0.001). CTF is the cause of considerable residual disability and deeply affects quality of life.

Reconstruction of a long defect of the median nerve with a free nerve conduit flap

Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.