{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T02:34:50Z","timestamp":1763346890403,"version":"3.40.5"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted. Between 2010 and 2019, a two\u2010stage management of TCTD followed by OCIF was performed in 13 patients (13 feet). There were five males and eight females with a mean age of 33.8 \u00b1\u200914.6\u2009years. Ten patients had a right\u2010side lesion, and three patients had a left\u2010side lesion. The etiology of deformity included seven cases of congenital neurological disease, one case of Charcot\u2013Marie\u2013Tooth disease, one case of trauma sequelae, and three cases of myelomeningocele. Duration of disease, size of ulcers, surgical procedures, healing time, external fixation time, and complications of these patients were recorded. The Texas wound classification and National Pressure Ulcer Advisory Panel (NPUAP) classification were used for assessing the ulcers. The modified Dimeglio score of deformity and American Orthopeadic Foot and Ankle Society (AOFAS) ankle\u2010hindfoot score were applied to evaluate the status before treatment and the results at final follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The TCTD and wound debridement were performed in all patients, and an additional Ilizarov correction technique was added in two patients. All ulcers were healed in 3\u2009months after first\u2010stage treatment. The median patient self\u2010report time of ulcer healing was 2.0\u2009weeks (IQR, 1.8\u20133.3). The median external fixation time was 138.0\u2009days (IQR, 134.5\u2013141.5) days. After second\u2010stage operative correction, the patients were followed\u2010up for an average of 28.0 \u00b1\u20092.9\u2009months. At the final follow\u2010up, the modified Dimeglio score of deformity was decreased from 6.7 \u00b1\u20092.1 to 1 (IQR, 0.0\u20131.0), and the mean AOFAS score was improved from 42.9 \u00b1\u200919.1 to 82.6 \u00b1\u20097.7. Before the treatment, there were eight patients with severe deformity, four patients with moderate deformity, and one patient with mild deformity. Postoperatively, seven patients were classified as mild deformity and six patients had a postural foot. The results of AOFAS ankle\u2010hindfoot score were defined as excellent in three patients, as good in five, and as fair in five. Complications include one case of mild displacement of the osteotomized cortex and one case of pin\u2010tract infection. No delayed union, nonunion, relapse of ulcers, or deformity were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The two\u2010stage management of TCTD followed by OCIF could be considered as an alternative treatment for foot and ankle deformities combined with chronic ulcers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13148","type":"journal-article","created":{"date-parts":[[2021,10,2]],"date-time":"2021-10-02T00:50:43Z","timestamp":1633135843000},"page":"2081-2092","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers"],"prefix":"10.1111","volume":"13","author":[{"given":"Ya\u2010xing","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, West China Hospital Sichuan University  Chengdu 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