Case Report: Staged treatment of ankle deformity and first metatarsal deficiency after motorcycle spoke injury with Taylor external frame combined with fibular head grafting

Abstract

The treatment of the sequelae of severe foot injuries caused by motorcycle spoke injury, especially in pediatric patients, allows for new options and surgical protocols. The tarsometatarsal joint and the first metatarsal were reconstructed by precise preoperative design using the TSF space external fixation technique in one stage to correct the foot deformity and restore the volume and length, and free grafting of the fibular head with epiphysis in the second stage. This method is the first of its kind reported. The patient's foot deformity was corrected, walking, walking up and down stairs, and running functions were achieved, and the bone quality could grow with age. The combination of TSF six-axis spatial external fixation technique and microscopic technique can maximize the patient's appearance and function and is worth promoting.

Keywords: TSF six-axis spatial fixation; free fibular head graft with epiphysis; medial column defects; multi-planar deformities; spoke injury.

Figure 1

(A,B) appearance at other hospitals after an injury. (C,D) One year after trauma healing the right foot showed deformity development, acquired flatfoot, and ankle fusion.

Figure 2

(A) The patient needed assistance to stand normally and was unable to touch the floor with his right heel, which needed to be elevated by 2 cm. (B) The patient's gait was lame and the right foot was in an externally rotated position.

Figure 3

(A–C) preoperative 3D printing demonstrates the appearance of bone alignment in the affected foot. (D,E) Preoperative marking of the body surface was done according to the 3D print.

Figure 4

(A,B) postoperative appearance after ankle release and six-axis external fixation of TSF, medial volume lengthening.

Figure 5

(A–C) orthopedic appearance at two months postoperatively, with the ankle close to 90° of flexion and adequate volume in the medial column of the foot.

Figure 6

(A) Removed epiphyseal fibula head and articular tissue. (B) The two supplying vessels of the fibular head are anastomosed to the distal and proximal ends of the medial plantar artery under the microscope.

Figure 7

(A–C) on review two months after surgery, the patient was able to stand on her own, with both shoulders and both iliacs isometric, and the appearance of the foot was corrected.

Figure 8

(A–C) Two months postoperative x-ray showed that the internal fixation was in place and the medial column reconstruction was in good position.

Figure 9

(A,B) comparison of grafted bone length in the second six months orthopantomogram (left) and eight months orthopantomogram (right): the first metatarsal train followed the patient's developmental growth by 5 mm.