scholarly journals A Novel and Safe Fibular Osteotomy for Total Ankle Replacement through Lateral Transfibular Approach

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Federico G. Usuelli ◽  
Jonathan RM Kaplan ◽  
Camilla Maccario ◽  
Luigi Manzi ◽  
Cristian Indino

Category: Ankle Arthritis Introduction/Purpose: The lateral transfibular total ankle arthroplasty (TAA) has been reported on with good short term outcomes. One key downside to the lateral TAA is the rate of symptomatic hardware and wound issues requiring hardware removal seen with the short oblique fibular osteotomy. Therefore, we report on a comparative cohort study of lateral TAA using the traditional short oblique fibular osteotomy to a long oblique fibular osteotomy, termed Foot and Ankle Reconstruction Group Osteotomy (FARG). Methods: Retrospective identification of primary lateral transfibular TAA performed by a single surgeon from May 2013 to October 2016 with minimum 2 years follow-up. Clinical assessment included patient demographics, wound complications, need for hardware removal, visual analogue scale, American Orthopaedic Foot & Ankle Society score, Short Form-12 Mental Composite Score, and Short Form-12 Physical Composite Score. Radiographic assessment included weight bearing x-rays to assess tibiotalar alignment, implant alignment, and fibular osteotomy healing. Results: A total of 159 primary lateral TAA were identified. The short oblique fibular osteotomy was used in 50 cases and the FARG osteotomy in 109 cases. Implant survival was 100% and there were no fibular osteotomy nonunions in both groups. There was improvement in all clinical parameters in both groups with no significant difference between groups in any of these parameters. The radiographic measures showed excellent alignment at all time points in both groups with no significant difference between groups. There was a significant difference between groups in the rate of wound dehiscence and rate of hardware removal for any reason with the FARG osteotomy having a lower rate of both compared to the short oblique fibular osteotomy. Conclusion: Modification of the traditional fibular osteotomy to the long oblique Foot & Ankle Reconstruction Group fibular osteotomy has excellent 2-year survival with good clinical and radiographic outcomes yet provides decreased rates of wound complications and decreased rates of symptomatic fibular hardware compared to the traditional short oblique fibular osteotomy.

2004 ◽  
Vol 14 (5) ◽  
pp. 361-365
Author(s):  
Régis Levasseur ◽  
Jean Pierre Sabatier ◽  
Olivier Etard ◽  
Pierre Denise ◽  
Annie Reber

To determine whether the vestibular system could influence bone remodeling in rats, we measured bone mineral density with dual energy X-rays absorptiometry before and 30 days after bilateral labyrinthectomy. Comparatively to intact control rats, labyrinthectomized animals showed a reduced bone mineral density in distal femoral metaphysis (p = 0.007): the variations between D0 and D30 were +3.0% for controls and -13.9% for labyrinthectomized rats. No significant difference between the 2 groups was observed in the whole body mineral density. These results suggest that the peripheral vestibular apparatus is a modulator of bone mass and more specifically in weight bearing bone. We discuss possible mechanisms of this vestibular influence probably mediated by the sympathetic nervous system.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
William V. Probasco ◽  
Benjamin E. Stein ◽  
Cyrus Fassihi ◽  
Lea McDaniel

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus is a very common deformity of the foot, often resulting from adult acquired flatfoot disorder (AAFD). This deformity in its early stages is treated conservatively with non-operatively modalities such as bracing, however in its later stages often requires surgical correction of the deformity in order to improve the pain and function of the extremity. Two commonly performed procedures in the correction of this type of deformity are a triple arthrodesis or joint sparing flatfoot reconstruction. The objective of this study was to identify whether differences existed in the financial burden or complication rates of non-fusion flatfoot reconstruction versus triple arthrodesis. Methods: The PearlDiver Database was queried from 2006-2013 to identify all Medicare patients who were admitted for a triple arthrodesis or non-fusion flatfoot reconstruction. 2308 patients were identified in each cohort and statistically matched in a 1:1 manner to control for influence of demographics and/or comorbidities. Postoperative complication rates (within 30 days) were evaluated and broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) and minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Additionally, total cost of care including cost of readmissions, and readmission within 30 days were evaluated. Results: No significant differences were noted in the postoperative complication rates between the two procedures within the first 30 days post-operatively in the initial univariate regression. There was a significant difference in the rate of 30 day readmission with 2.3% of triple arthrodeses being readmitted vs. 1.08% in the non-fusion joint reconstruction group (p=.002). Adjusted multivariate regression yielded similar results, with no significant differences in postoperative complication rates. The difference in readmission rate remained significant in the multivariate regression (OR 2.13, 95% CI 1.33-3.51, p=.002). Significant differences were also noted for mean total cost of care, with a higher mean total cost identified for the fusion group (x=7,868.0) compared to the reconstruction group (x=4,064.49, p<.001, Adjusted 𝛽𝛽 3,836.71, 95% CI 3,525.23 to 4,148.19, p<.001). Conclusion: This study compared triple arthrodesis versus joint-sparing flatfoot reconstruction. Within this study group there was no difference in complications between the two procedures. There was a significantly higher incidence of 30-day readmission in the triple arthrodesis group by about 2-fold. When comparing the total cost of care, there was a significantly higher cost associated with the triple arthrodesis, which cost on average about $3800 more than joint sparing flatfoot reconstruction. While revealing with regard to the aforementioned variables within the first 30 days post-operatively, further research needs to be conducted on the long term outcomes of these procedures. [Table: see text][Table: see text][Table: see text]


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0041
Author(s):  
Chamnanni Rungprai ◽  
Yantarat Sripanich ◽  
Warongporn Pongpinyopap

Category: Other Introduction/Purpose: Both open and endoscopic gastrocnemius recession are commonly used for treatment of gastrosoleus contracture, however; there was a paucity of evidence in literatures to compare post-operative outcomes between the two techniques. The purpose of this study is to compare outcomes and complications between open and endoscopic techniques. Methods: A prospective, randomized collected data of 53 consecutive patients who were diagnosed with gastrosoleus contracture and underwent either open (26 patients) or endoscopic (27 patients) gastrocnemius recession between 2016 and 2018. The primary outcome was ankle dorsiflexion and secondary outcomes were visual analogue scale (VAS), Short Form-36 (SF- 36), FAAM, plantarflexion weakness, operative times, and complications. Results: There were 53 patients with mean age of 49.1 years, mean BMI of 26.5 kg/m2, and mean follow-up of 11.5 months. Both techniques demonstrated significant improvement of ankle dorsiflexion (12.1 vs 11.3 degrees, p<0.001) and all functional outcomes (FAAM, SF-36, and VAS (p<0.001 all)); however, there was no significant difference between the two groups, (p>0.05 all). In addition, there were significant shorter operative times in endoscopic technique (7.3 vs 18.7 minutes, p<0.01). Complications included wound complications (3.8 vs 0%), painful scar (7.7 vs 0%), sural nerve injury (3.8 vs 0%), and plantarflexion weakness (3.8 vs 3.8%) for open and endoscopic techniques respectively. Conclusion: Both open and endoscopic techniques were demonstrated significant improvement of post-operative outcomes as measured with ankle dorsiflexion, FAAM, SF-36, and VAS. Although the post-operative outcomes were not significantly different between the two groups, the endoscopic technique demonstrated lesser complications and shorter operative times.


2019 ◽  
Vol 12 (6) ◽  
pp. 518-521
Author(s):  
Kempland C. Walley ◽  
Tyler A. Gonzalez ◽  
Sreeharsha V. Nandyala ◽  
Alec Macauley ◽  
Youssef Elnabawi ◽  
...  

Background. While biomechanical characteristics of locking screw fixation versus traditional plating has been studied extensively in orthopaedic literature, clinical outcome studies are lacking. The goal of this study was to evaluate the efficacy and complications rate of locking versus traditional nonlocking screws in complex ankle fractures employing distal fibula internal fixation with 1/3 semitubular small fragment plates. Methods. A retrospective review was performed between January 2010 and June 2013 of all patients in whom internal fixation of the fibula in an ankle fracture (open or closed) was performed using only 1/3 semitubular small fragment fibular plates. Patient characteristics, fracture patterns, specific screw choice that were placed in the most distal 2 fibular plate holes (either locking or nonlocking), infectious wound complications, and concomitant syndesmotic injury and the need and corresponding purpose for hardware removal were recorded. Results. A total of 135 patients were found to meet inclusion criteria and were analyzed for this study. Of the patients with locking screws, 25 of 98 (25%) elected to have hardware removed, while 13 of 37 (35%) of those with nonlocking screws elected hardware removal. This did not reach statistical significance (P = .30). There was no statistically significant difference between the groups with regards to age, smoking status, body mass index, diabetes, or use of syndesmotic screw fixation. There was no significant difference in loss of fixation, infection, or other surgical complications in between the groups. Conclusions. There was no significant decrease in the rate of hardware removal with the use of 1/3 tubular locking versus nonlocking plates in the treatment of distal fibula fractures. Despite these screws locking flush to the plate, the hardware is equally symptomatic in both groups. There was no significant difference in the rate of complications between the 2 groups and our data suggest that the added expense of using locking screws routinely when fixing lateral malleolar fractures should be carefully considered, especially if the fracture pattern does not warrant locking technology. Levels of Evidence: Prognostic, Level III


Swiss Surgery ◽  
2002 ◽  
Vol 8 (3) ◽  
pp. 113-120 ◽  
Author(s):  
Ménétrey ◽  
Siegrist ◽  
Fritschy

Purpose: Meniscectomy in the older patient remains a controversial topic. The aim of our study is to assess the mid-term outcome of arthroscopic partial medial meniscectomy in patients over fifty years of age and attempt to retrospectively identify symptoms and/or findings on examination which can differentiate between non-degenerative medial meniscal tears versus degenerative meniscal changes. Materials and Methods: Thirty-two patients over the age of fifty who had undergone arthroscopic medial partial meniscectomy, were reviewed. The average age was 60 (51-74 yrs) and the average follow-up was six years (3-7 yrs). Based upon the intra-operative findings, patients were divided into two groups: (1) non-degenerative meniscal tears (NDM; n = 12) and (2) degenerative meniscal changes (DM; n = 20). Our outcome measurements were with the HSS knee score, a satisfaction score, and weight-bearing X-rays. Results: In the NDM group, eleven patients were rated excellent or good, and one was rated poor. In the DM group, three patients were rated as excellent or good, eight as fair, and nine as poor. The HSS score was 97 +/- 4.6 for the NDM group and 85 +/- 9.5 for the DM group. The average satisfaction score was 9.2 +/- 0.7 (very satisfied) for the NDM group and 5.8 +/- 2.6 (fairly satisfied) for the DM group. There was no significant difference between the NDM and the DM groups with regards to pre-operative symptoms and signs, except for the McMurray sign, which was found to be positive in 83% of NDM cases versus 25% of DM cases (sensitivity = 83%). Using only these data, the McMurray sign was 67% specific for NDM. Conclusions: Arthroscopic medial meniscectomy in older patients provides 90% good results six years after a non-degenerative meniscal tear, but only 20% of good results after a degenerative meniscal tear. However, based on this study, neither symptoms nor physical examination are able to differentiate between traumatic meniscal tears and degenerative meniscal changes in older patients. A positive McMurray's sign favors the diagnosis of a traumatic tear. However, a specificity of this test of only 67% as shown in our data questions its utility in clinical decision-making.


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Nicola Krähenbühl ◽  
Maxwell Weinberg ◽  
Travis Bailey ◽  
Nathan Davidson ◽  
Heath Henninger ◽  
...  

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. Recently, weight-bearing computed tomography (CT) scans gained popularity with foot and ankle surgeons. This method is advantageous in that the distal tibio-fibular syndesmosis can be assessed in greater detail and under weight-bearing conditions. However, there are no studies investigating weight-bearing CT scans for assessment of subtle syndesmotic injury. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb) including external rotational torque (10 Nm). The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Using coronal CT images, the width between the anterior tibia and fibula (A), distance between the anterior tibial incisura and anterior fibula (F), the tibio-fibular overlap (TFO), and the angle between the medial malleolus and the longitudinal axis of the fibula were assessed (a). Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding measurement A, a significant difference (p=0.046) was observed between Condition 2 and 3 vs. Native, independent of which ligament was dissected first. Measurement F was significantly different between Condition 2 and 3 vs. Native (p=0.011) if the AITFL was dissected first, but only reached significance for Condition 3 vs. Native if the deltoid ligament was dissected first (p=0.007). The TFO and a were significant in Conditions 1, 2, and 3 vs. Native if the deltoid ligament was dissected first (p=0.050). When the AITFL was dissected first, significance was reached for the same conditions (p=0.046) with the exception of the TFO for Condition 2 vs. Native. No differences were found when comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: With weight-bearing CT scans and applied external rotation torque, the TFO and angle between the tibia and fibula (a) may be used to assess subtle syndesmotic injury to either the AITFL or the deltoid ligament. When both ligaments (AITFL and deltoid) were injured, the tibio-fibular width (A) and distance between the anterior part of the tibia and fibula (F) could also be used for assessment. Weight-bearing CT scans cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Further studies are needed to assess weight-bearing CT scans in the clinical setting.


2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Ssu-Yu Chang ◽  
Yi-Jia Lin ◽  
Wei-Chun Hsu ◽  
Lin-Fen Hsieh ◽  
Yuan-Hsiang Lin ◽  
...  

Six female patients with bilateral medial knee OA and 6 healthy controls were recruited. Patients with knee OA received a 6-week physiotherapist-supervised and home-based exercise program. Outcome measures, including the Western Ontario and McMaster Universities Arthritis Index and Short Form-36 Health Survey as well as objective biomechanical indices were obtained at baseline and follow-up. After treatment, no significant difference was observed in the knee abductor moment (KAM), lever arm, and ground reaction force. We, however, observed significantly improved pain and physical function as well as altered gait patterns, including a higher hip flexor moment and hip extension angle with a faster walking speed. Although KAM was unchanged, patients with bilateral knee OA showed an improved walking speed and altered the gait pattern after 6 weeks of supervised exercise. This finding suggests that the exercise intervention improves proximal joint mechanics during walking and can be considered for patients with bilateral knee OA. Non-weight-bearing strengthening without external resistance combined with stretching exercise may be an option to improve pain and function in individuals with OA who cannot perform high resistance exercises owing to pain or other reasons.


2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Beck ◽  
Steven Raikin ◽  
Tony Bryant ◽  
David Pedowitz

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Despite large numbers of traumatic 1st,2nd,3 rd, and 4th (1-4 MT) metatarsal shaft and neck fractures, there have be very few outcome studies related to their treatment. K- wire fixation of metatarsal fractures has been shown to lead to poor outcomes when residual displacement and angulation occurs. In order to maintain anatomic alignment, some surgeons use plates for fixation of metatarsal fractures. To the best of our knowledge, this is the first study to report the healing rates, fracture angulation and need for hardware removal of operatively treated 1-4 MT shaft and neck fractures with plate fixation. Methods: In this retrospective cohort study, we reviewed the medical records of all metatarsal fractures at our institution from October 1, 2006 – December 31, 2014 to identify all 1-4 MT shaft and neck fractures. All tarsometatarsal joint factures, isolated 5th metatarsal fractures, fractures treated at outside facilities, skeletally immature patients and fractures treated non operatively were excluded. Final available x-rays with a minimum of one year follow-up from the date of surgery were reviewed. Medical records and x-rays were reviewed for evidence of union, sagittal and coronal fracture angulation (degrees), time to full weight bearing, plate size, fracture location (neck vs shaft) and number of screws on each side of the fracture. Patients were also called to see if the plates were bothersome, if the plates had been removed, or if they desired to have the plate removed. Multiple linear regression analysis was used to make calculations of statistical significance. Results: 45 patients with 75 metatarsal fractures treated with plate fixation were included. All fractures went to union and full weight bearing. Average time to union and full weight bearing was 10.9 and 7.5 weeks respectively. The average coronal and sagittal plane angulation was 3.9 degrees and 2.2 degrees. No demographic variable showed statistical significance with regards to sagittal and coronal angulation. Fractures located in the neck were found to have higher coronal plane angulation malunion compared to fractures in the shaft (P=0.019). No variable was related to final sagittal plane angulation. 28/45 patients responded to our telephone interview with an average follow-up of 4.4 years. 10 stated the plate bothered them. No plates had been removed and 27/28 patients did not want the plate removed. Conclusion: Metatarsal fractures fixed with plates show high rates of union and low final fracture angulation. Patients did not report symptomatic hardware and did not desire to have plates removed. No patient included in this study underwent hardware removal.


2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Garras

Category: Ankle, Trauma Introduction/Purpose: Plating the lateral malleolus yields predictable patient outcomes and anatomic reductions with an efficient surgical procedure. However, large incisions and prominence result in wound complications in 5% to 16% of patients. Although rudimentary intramedullary fixation has been applied for these fractures for decades, new intramedullary devices have become available with broader indications. These nails have the promise of holding accurate reductions and faster patient rehabilitation with virtually non-existent wound issues due to the minimal incisions required for implantation. The aim of this study was to determine if a new intramedullary nail could provide radiographically sound reductions while reducing wound complications and providing faster rehabilitation in a variety of ankle fracture classifications. Methods: We retrospectively reviewed the x-rays of 40 ankle fracture patients repaired by two surgeons at different institutions from March 2015 through October 2016. Patients were followed for a minimum of six weeks. Radiographs were reviewed for fracture healing, mortise alignment and fibular length (figure 1). The group was comprised of usual fracture patterns SER 2, 3,4, PER, uni bimalleolar and trimalleolar. Most reductions were performed percutaneously, however a small-incision was used to reduce older fractures or those that could not be reduced without direct visualization. Results: All fractures appeared to have complete union and radiographically anatomic reductions. No wound infections presented, and patients experienced reduced pain with early weight-bearing. Conclusion: Modern intramedullary nails can deliver excellent results and provide an important part of a surgeon’s treatment armamentarium for lateral malleolus fractures. The nails are especially valuable for non-compliant patients or those with comorbidities that negatively affect skin healing.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 923.3-923
Author(s):  
S. Boussaid ◽  
M. Mrabet ◽  
S. Jemmali ◽  
H. Sahli ◽  
H. Ajlani ◽  
...  

Background:Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. It can affect the different parts of the spine.Objectives:The aim of this study was to determine the preferred spinal location of TB.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with tuberculous spondylodiscitis (TS).Results:Fifty-two patients were included (37F/15M). Their mean age was 55.21 years ± 17.79 [19-91]. TS was more frequently unifocal (75%) than multifocal (25%). Lumbar spine involvement was the most common (57.7%) and more frequent in women (63.3%) but with no statistically significant difference (p = 0.2). Other localizations were described such as: dorso-lumbar (21.2%), dorsal (15.4%), lumbosacral (3.8%) and cervical (1.9%). Lumbar pain was present in 34 patients (65.4%) and 29 patients (55.8%) suffered from segmental lumbar stiffness. Imaging was contributive by showing the vertebral location using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively).Conclusion:TS is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Spinal involvement is often unifocal and mostly diagnosed with lumbar pain or stiffness. Multifocal forms, touching several parts of the spine, however remain rare. Our findings remain consistent with those of the literature.Disclosure of Interests:None declared


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