Abstract

Summary: This study aims to critically evaluate the classifications used to describe wheel spoke injury and define the subtypes that these classifications did not cater for. Thus, proposing a new classification of wheel spoke injuries (Lahore Classification) along with management of all subtypes.
Patients and Methods: Retrospective study of a total 156 wheel spoke injuries of foot was undertaken to categorize/classify these injuries in terms of injured structures. Wheel spoke injury patients of all ages and both genders; evaluated and admitted in Jinnah Burn & reconstructive surgery Centre (JB&RSC), Jinnah hospital/AIMC, Lahore, Pakistan were included in this study from January 2019 to December 2023.
Results: A total of 156 “Wheel Spoke Injury” patients involving feet presented to our department. Injury mechanism and structures involved were noted. There were 42 patients who did not fit in specific grades of the existing classifications. A modification in the existing classification for the wheel spoke injury was devised and management of different subtypes was undertaken. The proposed algorithm for management ranges from conservative care to the need for free flap to cover the defect.
Conclusion: Wheel spoke injuries of the foot can be managed more effectively with the help of a practical grading system. We propose a revised classification that will guide the management plan and a treatment algorithm which will ultimately improve the patient’s outcome.

Key words: Wheel Spoke Injury; Lahore; Classification; Achilles Tendon; Calcaneal Fracture; Calcaneum; Tibial Nerve; Neurovascular Bundle; Flap coverage; Soft tissue; Skin graft; Sural Flap; Free flap; Foot; Heel; Ankle; Treatment Algorithm.