Operative Orthopädie und Traumatologie

, Volume 8, Issue 4, pp 279–286 | Cite as

The augmented chopart amputation in children

  • Merv Letts
Article

Summary

Goal of Surgery

Provision of a functional weight-bearing stump. Improved stability of ankle and subtalor joints. Prevention of developing an equinus deformity.

Indication

Severely mangled or malformed foot.

Severe bilateral foot and lower limb deformities.

Contraindications

Limb length discrepancy.

Inadequate plantar skin coverage.

Significant loss of tendons.

Gross instability at ankle or subtalar joint.

Preoperative Work Up

Radiographs of foot and ankle.

Careful examination of ankle and subtalar joints.

Positioning and Anaesthesia

Supine.

Above knee tourniquet.

General anaesthesia.

Surgical Technique

Augmentation of the traditional Chopart amputation with transfer of the tibialis anterior, tibialis posterior, and long toe extensor tendons to the talus and lengthening of the heal cord.

Postoperative Management

Compressive dressing to be changed after 3 weeks.

Weight bearing is resumed after 6 weeks.

Fitting of a modified Syme's prosthesis after 3 months.

Possible Complications

Haematoma.

Pull out of transferred tendons.

Skin flap necrosis.

Infection.

Results

6 patients have undergone this amputation, 2 of whom were amputated bilaterally.

Follow-up: 5 years. All patients were able to bear full weight. In 1 child the foot drifted into a slight equinus not necessitating a repeat Achilles tendon lengthening.

Key Words

Chopart amputation Tendon tranfer Syme's prosthesis 

Schlüsselwörter

Chopart-Amputation Sehnenverpflanzung Syme-Prothese 

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References

  1. 1.
    Blanco, J. S., J. A. Herring: Congenital Chopart amputation: a functional assessment. Clin. Orthop. 256 (1990), 14–21.PubMedGoogle Scholar
  2. 2.
    Boyd, H. B.: Amputation of the foot with calcaneotibial arthrodesis. J. Bone Jt Surg. 21-A (1939), 997–1000.Google Scholar
  3. 3.
    Christie, J., C. B. Clowes, D. W. Lamb: Amputations through the middle part of the foot. J. Bone Jt Surg. 62-B (1980), 473–474.Google Scholar
  4. 4.
    Greene, W. B., J. M. Cary: Partial foot amputations in children. J. Bone Jt Surg. 64-A (1982), 438–443.Google Scholar
  5. 5.
    Harris, W. R., E. A. Silverstein: Partial amputations of the Foot—a follow up study. Canad. J. Surg. 7 (1964), 6–11.PubMedGoogle Scholar
  6. 6.
    Kofmann, V.: Exarticulatio inter-tibio-calcanea and its functional result. J. Bone Jt Surg. 21 (1939), 521.Google Scholar
  7. 7.
    Kritter, A. E.: A technique for salvage of the infected diabetic gangrenous foot. Orthop. Clin. N. Amer. 4 (1973), 21–30.Google Scholar
  8. 8.
    Lange, T. A., R. J. Nasca: Traumatic partial foot amputation. Clin. Orthop. 185 (1984), 137–141.PubMedGoogle Scholar
  9. 9.
    Letts, M., A. Pyper: The modified Chopart's amputation. Clin. Orthop. 256 (1990), 44–49.PubMedGoogle Scholar
  10. 10.
    Lindquist, C., E. B. Riska: Chopart, Pirogoff & Syme amputations. Acta orthop. scand. 37 (1966), 110–116.CrossRefGoogle Scholar
  11. 11.
    MacDonald, A.: Chopart's amputation. J. Bone Jt Surg. 37-B (1955), 468–470.Google Scholar
  12. 12.
    Parziale, J. R., K. A. K. Hahn: Functional considerations in partial foot amputations. Orthop. Rev. 27 (1988), 262.Google Scholar
  13. 13.
    Paterson, R.: Memorial of the life of James Syme. Edmonton and Douglas, Edinburgh 1874.Google Scholar
  14. 14.
    Ricard, A., P. Launey: Technique chirurgicale 2. Octabe Doin, Paris 1905, p. 251.Google Scholar
  15. 15.
    Rubin, G.: Prosthetic fitting problems of the quasi-Syme. Clin. Orthop. 160 (1981), 233–241.PubMedGoogle Scholar
  16. 16.
    Tooms, R. E.: Amputations. In: Edmonson, A. S., A. H. Crenshaw (eds.): Campbell's operative orthopaedics, 6th ed. C. V. Mosby, St. Louis 1986, p 821–872.Google Scholar
  17. 17.
    Vitali, M., K. P. Robinson, B. G. Andrews, E. C. Harris: Below-knee amputations and prosthesis. Bailliere Tindall, London 1978.Google Scholar
  18. 18.
    Wagner, F. W., Amputations of the foot and ankle—current status. Clin. Orthop. 122 (1977), 62–69.PubMedGoogle Scholar

Copyright information

© Urban & Vogel 1996

Authors and Affiliations

  • Merv Letts
    • 1
  1. 1.Department of Surgery, Children's Hospital of Eastern OntarioUniversity of OttawaOttawaCanada

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