There have been several studies including retrospective studies to compares the end-stage function traumatic below-knee amputee with that of the patient with salvaged severe tibial and acute calcaneal fractures. In one study, Twenty-four patients, 12 below-knee amputees and 12 with salvaged tibiae, were interviewed and examined one year or more after the completion of treatment. Emphasis was on function of the limb, the patient, and the quality of life. I've been surprised to learn that the early amputees had higher scores, fewer operations, and only six-week hospitalization on average, and returned to work and sport within six months... However neither the amputees, nor the salvaged group ever functioned entirely normally.
According to what I've been able to determine, virtually all people with these severe injuries have had to make significant changes to both work and sports activities, and over a third believed there was deterioration in their quality of life. The results of what I've been able to find suggest that amputation should be strongly considered when confronted with a borderline salvageable tibial and/or calcaneal injury or prolonged salvage attempts.
At this point, we have not given up hope that Devin will regain the use of his feet without resorting to amputation and the use of prosthetic limbs, even though the odds are strongly against him.
The damage to Devin's right ankle region is very extensive. His foot was "partially amputated" at impact. 80% of the skin around his ankle was torn and his foot was detached from his leg. At first sight all I could see was that his foot was no longer at the end of his leg... What I could not see was that a large portion of the cartilage had been destroyed, that the talus and calcaneus bones had been fractured (Cracked) as well as compressed. There were also fractures to the navicular, third metatarsal and intermediate cuneiform bones and additionally the end of the tibia had also been compressed and the top of the calcaneus was jammed into the end of the tibia.
It is disheartening to know that once a bone compresses it does not spring back into shape, and compression fractures may not be considered serious enough to cause immediate concern they still often result in painful arthritis in the future...
Harborviews top foot surgeon has taken over this surgery from Devin's "foot team". The surgeries to both of his feet will be done by Dr Benirschke & Dr Novak.
Dr. Benirschke is a professor of orthopaedics and sports medicine at UW (since 1985) specializing in surgical treatment for foot and ankle disorders and considered one of the top experts in these types of surgeries. He co-authored several articles including "Acute Calcaneal Fractures: Treatment Options and Results" in 1994 and "Surgical Treatment of Talar Body Fractures" in 2003. He has also authored several articles in the Journal of Orthopaedic Trauma.
Prior to the surgery, the surgeons told us that they would do their best to make his foot usable again, but were not very reassuring of Devin's chances due to the extent of the damages. They also said that they would most likely need to perform at least 2 operations on his right foot due to the multiple incisions required to gain access to the different injuries.
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