Document Detail

Ischemic necrosis following clubfoot surgery: the purple hallux sign.
MedLine Citation:
PMID:  15552558     Owner:  NLM     Status:  MEDLINE    
Ischemic necrosis, which develops rarely after clubfoot surgery, may have a vascular etiology, since many idiopathic and neurogenic clubfeet have congenital deficiency of the anterior tibial and dorsalis pedis arteries. Dorsalis pedis deficiency is demonstrated more frequently in those clubfeet showing greater deformity. Substantial hypoplasia of the profunda femoris and posterior and anterior tibial arteries was evident in the affected limb of a patient in this series who underwent postoperative arteriography. Herein, we report massive necrosis in seven limbs of six patients after clubfoot surgery and have combined this series with seven previously published cases. Additional cases support our hypothesis that arterial deficiencies put some postoperative clubfeet at risk of perioperative ischemic necrosis. Necrosis occurs in those regions supplied by the congenitally diminished anterior tibial and dorsalis pedis arteries. Knowing that children with congenital vascular deficiency are at risk for ischemic necrosis, surgeons should be alert to the subtle, early signs of ischemia and be prepared to prevent or ameliorate the consequences of this condition. Since hypoperfusion in these postoperative feet is a surgical emergency, we propose clinical guidelines for treatment for this phenomenon, which we have named the purple hallux sign.
R Hootnick David; David S Packard; E Mark Levinsohn; Scott A Berkowitz; David D Aronsson; Russell J Crider
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics. Part B     Volume:  13     ISSN:  1060-152X     ISO Abbreviation:  J Pediatr Orthop B     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2004-12-09     Revised Date:  2012-09-17    
Medline Journal Info:
Nlm Unique ID:  9300904     Medline TA:  J Pediatr Orthop B     Country:  United States    
Other Details:
Languages:  eng     Pagination:  315-22     Citation Subset:  IM    
Department of Orthopedic Surgery State University of New York, Upstate Medical University, Syracuse, New York 13210, USA.
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MeSH Terms
Abnormalities, Multiple / surgery
Arterial Occlusive Diseases / etiology,  radiography
Child, Preschool
Clubfoot / diagnosis,  surgery*
Foot / blood supply
Hallux / blood supply*
Ischemia / diagnosis,  etiology*
Orthopedic Procedures / adverse effects*,  methods
Postoperative Complications / diagnosis
Risk Assessment
Sampling Studies
Severity of Illness Index
Tibial Arteries

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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