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McHenry BD, Kruger KM, Exten EL, Tarima S, Harris GF. Sagittal subtalar and talocrural joint assessment between barefoot and shod walking: A fluoroscopic study. Gait Posture 2019; 72:57-61. [PMID: 31151088 DOI: 10.1016/j.gaitpost.2019.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND While wearing shoes is common in daily activities, most foot kinematic models report results on barefoot conditions. It is difficult to describe foot position inside shoes. This study used fluoroscopic images to determine talocrural and subtalar motion. RESEARCH QUESTION What are the differences in sagittal talocrual and subtalar kinematics between walking barefoot and while wearing athletic walking shoes? METHODS Thirteen male subjects (mean age 22.9 ± 2.9 years, mean weight 77.2 ± 6.9 kg, mean height 178.2 ± 3.7 cm) screened for normal gait were tested. A fluoroscopy unit was used to collect images during stance. Sagittal motion of the talocrural and subtalar joints of the right foot were analyzed barefoot and in an athletic walking shoe. RESULTS Shod talocrural position at heel strike was 6.0° of dorsiflexion and shod peak talocrural plantarflexion was 4.2°. Barefoot talocrural plantarflexion at heel strike was 4.2° and barefoot peak talocrural plantarflexion was 10.9°. Shod subtalar position at heel strike was 2.6° of plantarflexion and peak subtalar dorsiflexion was 1.5°. The barefoot subtalar joint at heel strike was in 0.4° dorsiflexion and barefoot peak subtalar dorsiflexion was 3.5°. As the result of wearing shoes, average walking speed and stride length increased and average cadence decreased. Comparing barefoot to shod walking there was a statistical significance in talocrural dorsiflexion and at heel strike and peak talocrural dorsiflexion, subtalar plantarflexion at heel strike and peak subtalar dorsiflexion, walking speed, stride length, and cadence. SIGNIFICANCE This work demonstrates the ability to directly measure talocrural and subtalar kinematics of shod walking using fluoroscopy. Future work using this methodology can be used to increase understanding of hindfoot kinematics during a variety of non-barefoot activities.
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Affiliation(s)
- Benjamin D McHenry
- Marquette University/The Medical College of Wisconsin, Department of Biomedical Engineering, 1515 W. Wisconsin Ave, Milwaukee, WI 53233, United States
| | - Karen M Kruger
- Marquette University/The Medical College of Wisconsin, Department of Biomedical Engineering, 1515 W. Wisconsin Ave, Milwaukee, WI 53233, United States; Shriners Hospitals for Children-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States.
| | - Emily L Exten
- OhioHealth Mansfield Campus, Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, 335 Glessner Ave, Mansfield, OH 44903, United States
| | - Sergey Tarima
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States
| | - Gerald F Harris
- Marquette University/The Medical College of Wisconsin, Department of Biomedical Engineering, 1515 W. Wisconsin Ave, Milwaukee, WI 53233, United States; Shriners Hospitals for Children-Chicago, 2211 North Oak Park Ave., Chicago, IL, United States
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Rosskopf AB, Sutter R, Pfirrmann CWA, Buck FM. 3D hindfoot alignment measurements based on low-dose biplanar radiographs: a clinical feasibility study. Skeletal Radiol 2019; 48:707-12. [PMID: 30353278 DOI: 10.1007/s00256-018-3089-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test a 3D-hindfoot alignment (HA) measurement technique based on low-dose biplanar radiographs (BPRs) in a clinical setting and compare the results with 2D-HA measurements on long axial view radiographs (LARs). MATERIALS AND METHODS This prospective study was approved by the local institutional review board. HA measurements on 3D-BPR and 2D-LAR of 50 patients (29 female; mean age 47 ± 16.6 years) were compared (positive values = valgus; negative values = varus). Two independent musculoskeletal radiologists (readers 1 and 2) performed 3D-HA measurements on BPR using a custom-made MATLAB code and measured HA on LAR during two separate readout sessions. Descriptive statistics and intraclass correlation coefficients (ICC) were calculated, and Bland-Altman plots were used for intermethod comparison. RESULTS Using BPRs, HA was 0.8° ± 9.°1 (range, -20.2 to 20.0) for reader 1, and 0.7° ± 9.5° (range, -21.2 to 18.3) for reader 2. HA on LARs was -2.0 ° ± 7.0° (range, -27.0° to 11.1°) for reader 1 and - 1.7° ± 7.0° (range, -24.1° to 14.3°) for reader 2. Interreader agreement for measurements was excellent, both for BPRs (ICC = 0.992; 95% CI:0.986-0.995) and LAR measurements (ICC = 0.962; 95% CI:0.932-0.978). Mean difference between the two methods was -2.43° (range, -29.4° to 25.6°) for reader 1 and -2.6° (range,-28.7° to 30.2°) for reader 2. On Bland-Altman plots, three measurements of reader 1 and six measurements of reader 2 were outside of the ±1.96 SD interval. CONCLUSION Hindfoot alignment measurements on 3D-BPR have an excellent interreader agreement in a clinical setting. Large measurement errors can occur in individual patients using 2D-LAR alone. Therefore, we suggest using 3D-BPR measurements in daily routine for the assessment of HA, which are independent of rotational foot malpositioning.
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Klerken T, Kosse NM, Aarts CAM, Louwerens JWK. Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome. Foot Ankle Surg 2019; 25:247-250. [PMID: 29409183 DOI: 10.1016/j.fas.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/15/2017] [Accepted: 11/19/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up. METHODS Between 1991 and 2002, 81 patients underwent a triple arthrodesis. Preoperatively, postoperatively, 3, 7.5 and 15 years after surgery, dorsoplantar (DP) and lateral X-rays were taken and used to evaluate the degree of OA and the geometry of the foot. The degree of OA was estimated using the Kellgren and Lawrence score. The geometry of the foot was assessed using Meary's angle; a Meary's angle exceeding 15° in DP and/or greater than -5 to 5° from the lateral view was defined as malalignment. In addition to the radiological evaluation, clinical scores (FFI and AOFAS) were recorded. RESULTS Thirty-five patients (40 feet) were available for analysis 15 years after surgery. In 19 cases there was an increase in ankle OA following the operation. Eight feet showed malalignment on the lateral view and 28 on the DP view. There was no difference in both an increase of ankle OA or clinical outcome between correct aligned feet and feet classified as malaligned. Thirty-three patients with 38 treated feet stated that they would decide to undergo the treatment again. Two patients would not want to undergo the same surgery again. The patients were satisfied with the result of surgery, clinical scores improved after surgery and remained stable in the long-term. CONCLUSIONS Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.
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Affiliation(s)
- Tina Klerken
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Nienke M Kosse
- Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Chris A M Aarts
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Dagneaux L, Moroney P, Maestro M. Reliability of hindfoot alignment measurements from standard radiographs using the methods of Meary and Saltzman. Foot Ankle Surg 2019; 25:237-241. [PMID: 29409188 DOI: 10.1016/j.fas.2017.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few methods have been described for measuring hindfoot alignment from an anteroposterior view. The objective of this study was to compare two methods of angular measurement based on the views of Meary and Saltzman. METHODS Thirty asymptomatic volunteers were included. Four radiographs were performed: the views of Meary and Saltzman with parallel feet and with the Fick correction. The reproducibility was determined by the inter- and intraobserver variability (ICC). RESULTS Meary's method revealed a mean valgus angulation of 3.9° (SD 3.47°). The reliability was extremely variable with a mean ICC of 0.59. The best reproducibility was obtained with Meary's method with and without Fick correction. CONCLUSION The results of this study show that the reliability of the angular measurements depends on the radiographic view and measurement method chosen. The lateral Fick correction did not counteract the influence of tibial rotation. The same method should be used consistently.
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Affiliation(s)
- Louis Dagneaux
- Department of Orthopaedic Surgery, Lower limb Surgery Unit, Lapeyronie University Hospital, 351 av. Gaston Giraud, 34295 Montpellier Cedex 05, France.
| | - Paul Moroney
- Institut Monégasque de Médecine et Chirurgie Sportive (IM2S), 11, Avenue d'Ostende, 98000, Monaco
| | - Michel Maestro
- Institut Monégasque de Médecine et Chirurgie Sportive (IM2S), 11, Avenue d'Ostende, 98000, Monaco
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Papachristos IV, Dalal RB. A novel technique to remove a broken tibiotalocalcaneal intramedullary nail using Moreland hip revision instrumentation. Ann R Coll Surg Engl 2019; 101:374-375. [PMID: 30854872 DOI: 10.1308/rcsann.2019.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hindfoot intramedullary devices are increasingly used in tibiotalocalcaneal arthrodesis after failed total ankle arthroplasty or as a salvage procedure after complex trauma. Nail breakage is a well-described complication and numerous techniques for removal of broken parts can be found in the literature, especially for femoral and tibial nails. There is a relative paucity regarding techniques solving the challenge of removing a broken hindfoot intramedullary nail. We describe a novel technique using a curved thin hook from the Moreland hip revision set to remove the distal part of a broken tibiotalocalcaneal intramedullary nail.
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Affiliation(s)
- I V Papachristos
- Stepping Hill Hospital, Stockport NHS Foundation Trust , Stockport , UK
| | - R B Dalal
- Stepping Hill Hospital, Stockport NHS Foundation Trust , Stockport , UK.,University of Manchester , Manchester , UK
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SahraNavard B, Hudson PW, de Cesar Netto C, Wills BW, Araoye IB, Bergstresser S, Cone BM, Shah A. A comparison of union rates and complications between single screw and double screw fixation of sliding calcaneal osteotomy. Foot Ankle Surg 2019; 25:84-89. [PMID: 29409301 DOI: 10.1016/j.fas.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/03/2017] [Accepted: 08/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The number of screws used for sliding calcaneal osteotomy fixation has not been examined in the literature. The purpose of this paper is to examine this topic. METHODS Retrospective chart review was performed on 190 patients who met selection criteria. We compared complication risk for single versus double screw, headed versus headless screw, and short versus longitudinal incision cases. RESULTS The mean age was 48.4 (18-83) years and average follow up was 28 (12-150) weeks. All cases achieved radiographic union. Overall complication rate was 19.5% (37/190). Risk of complication did not differ significantly between single and double screw (RR: 1.170; 95% CI: 0.66-2.09; p=0.594) or short and extended incision groups (RR: 0.868; 95% CI: 0.42-1.80; p=0.704). Risk of complication differed significantly between headed and headless screw fixation (RR: 5.558; 95% CI: 2.69-11.50; p<0.0001). CONCLUSIONS Single screw fixation of sliding calcaneal osteotomy achieves similar outcomes as double screw fixation. Headless screws are advantageous for minimizing hardware pain and subsequent hardware removal.
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Affiliation(s)
- Bahman SahraNavard
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Parke W Hudson
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Cesar de Cesar Netto
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Bradley W Wills
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Ibukunoluwa B Araoye
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Shelby Bergstresser
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Brent M Cone
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Ashish Shah
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
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Diacon AL, Kimmel LA, Hau RC, Gabbe BJ, Edwards ER. Outcomes of midfoot and hindfoot fractures in multitrauma patients. Injury 2019; 50:558-63. [PMID: 30448328 DOI: 10.1016/j.injury.2018.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Multitrauma patients suffering hindfoot fractures, including calcaneal and talar fractures, often result in poor outcomes. However, less is known about the outcomes following midfoot fracture in the mutitrauma population. This study aims to describe the epidemiology of midfoot fractures in multitrauma patients and to compare the outcomes of midfoot and hindfoot fractures in this population. METHODS Data about multitrauma patients (Injury Severity Score >12) sustaining a unilateral midfoot or hindfoot fracture were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and from retrospective review of medical records at a major trauma centre. Further outcome data were obtained via a survey using the American Academy of Orthopedic Surgeons Foot and Ankle Score (AAOS FAS) and the 12-item Short Form Health Survey (SF-12). RESULTS 122 multitrauma patients were included; 81 with hindfoot fractures and 41 with midfoot fractures. The median ISS (IQR) was 22 (17-29) and 27 (17-24) for the hindfoot and midfoot groups, respectively (p = 0.23). Hindfoot and midfoot fractures were commonly associated with intracranial injuries (80.3%), spine injuries (60.7%), ipsilateral lower extremity injuries (24.6%) and pelvic injuries (16.4%). The mean (SD) time to follow up was 4.5 (±2.7) years. There were no differences in mean SF-12 physical (37.97 vs 35.22, p = 0.33) or mental (46.90 vs 46.67, p = 0.94) component summary scores between the groups. There were no differences in mean AAOS FAS standard scores (69.3 vs 69.1, p = 0.97) or shoe comfort scores (median 40 vs 40 p = 0.18) between the groups. CONCLUSION Functional outcomes in multitrauma patients with midfoot or hindfoot fractures were comparable. These findings suggest that midfoot fractures should be treated with the same degree of due diligence as hindfoot fractures in the multitrauma patient.
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Lee HS, Kim WJ, Park ES, Kim JY, Kim YH, Lee YK. Mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. BMC Musculoskelet Disord 2019; 20:43. [PMID: 30696419 PMCID: PMC6352372 DOI: 10.1186/s12891-019-2419-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/14/2019] [Indexed: 11/28/2022] Open
Abstract
Background We hypothesized that calcaneal reconstruction can relieve chronic pain due to calcaneal malunion. We report the mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. Methods We reviewed the records of 10 male patients (10 ft) who underwent calcaneal reconstruction for calcaneal malunion between January 2009 and July 2014 at the mid-term follow-up. Talocalcaneal height and angle, calcaneal pitch, calcaneal width, Böhler angle, Stephens classification, and Zwipp classification were evaluated by three orthopedic doctors at each visit (pre-reconstruction, post-reconstruction, and at the last follow-up). Results The mean follow-up period was 67.1 months (range, 48–101 months). The sites of pain before reconstruction were lateral aspect (4 patients), plantar aspect (3 patients), diffuse pain (2 patients), and anterior aspect (1 patient). There was a significant difference in talocalcaneal height, talocalcaneal angle, calcaneal pitch, calcaneal width, and Böhler angle before and after reconstruction (p < 0.05). There was no significant difference between reconstruction and the last follow-up. Radiological measurement agreement was calculated to be moderate to strong (intraclass correlation coefficient: 0.659–0.988). Mean American Orthopedic Foot & Ankle Society Ankle and Hindfoot score improved from 66.50 ± 9.37 pre-reconstruction to 80.30 ± 8.52 at the last follow-up (p < 0.05). The mean visual analog scale score improved from 8.60 ± 1.43 before reconstruction to 3.40 ± 0.84 at the last follow-up (p < 0.05). Most patients were satisfied with the outcome postoperatively. Conclusions Our results showed substantial improvement in the clinical and radiological outcomes after calcaneal reconstruction of calcaneal malunion. This outcome was maintained until the mid-term follow-up. Therefore, calcaneal reconstruction may be a good option for the treatment of chronic pain caused by the malunion of a calcaneal fracture without severe subtalar arthritis. Further prospective studies are needed to test this theory. Level of Evidence: Level IV, Retrospective Case Series.
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Affiliation(s)
- Hong Seop Lee
- Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, 68, Hangeulbiseok-ro, Nowoungu, Seoul, 01830, Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea
| | - Eun Seok Park
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Jun Young Kim
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Young Hwan Kim
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do, 420-767, Republic of Korea.
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Masquijo JJ, Tourn D, Torres-Gomez A. Reliability of the talocalcaneal angle for the evaluation of hindfoot alignment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:20-23. [PMID: 30522960 DOI: 10.1016/j.recot.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/26/2018] [Accepted: 08/19/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Recent studies suggest that hindfoot deformity should be considered in the surgical treatment of tarsal coalitions. Many authors have used the angle between the talus and the calcaneus (TCA) for decision-making. However, its reliability has not been demonstrated and the measurement technique has not been standardized. The objective of this study was to standardize the TCA measurement technique, and to evaluate the inter and intra-observer reproducibility of the proposed technique. METHODS The foot CT scans of a group of 30 patients between 10 and 17 years of age were analysed. Ten patients had talocalcaneal coalitions, ten calcaneonavicular coalitions and ten had no coalitions. The inter and intra-observer reproducibility of the TCA was evaluated by the intraclass correlation coefficient (ICCs). A mixed-effects ANOVA model was used to calculate the ICCs for ICC2 agreement (A, 1). This procedure was applied to the three observers (inter-observer variability), and to the test-retest of observer 1 (intra-observer variability). A two-tailed p value of ≤.05 was considered significant. RESULTS The inter-observer and intra-observer agreements were excellent for the TCA. Inter-observer agreement: ICC2 (A, 1)=.95 (p<.001, CI 95%: .77-.93). Intra-observer agreement: ICC2 (A, 1)=.99 (p<.001, CI 95%: .97-.99). CONCLUSION The TCA is a reliable way to evaluate hindfoot alignment. This method of measurement, as described in this study, can be safely used for surgical planning in patients with tarsal coalitions.
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Affiliation(s)
- J J Masquijo
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina.
| | - D Tourn
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina
| | - A Torres-Gomez
- Departamento de Ortopedia y Traumatología Infantil, Sanatorio Allende, Córdoba, Argentina
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Barg A, Wiewiorski M, Paul J, Wurm M, Jacxsens M, Nykytina K, Valderrabano V. [Supramalleolar osteotomy in asymmetric ankle osteoarthritis : Short-term clinical and radiographic results]. Orthopade 2017; 46:761-75. [PMID: 28405708 DOI: 10.1007/s00132-017-3416-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. The aim of this prospective study was to analyze short-term clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis. METHODS A total of 16 patients with asymmetric ankle osteoarthritis and concomitant supramalleolar deformity - 7 patients with valgus deformity, 9 patients with varus deformity - were treated. Intraoperative and postoperative complications were recorded and analyzed. The clinical and radiographic outcomes were assessed after a mean follow-up of 3.6 ± 1.1 years. RESULTS In 10 of 16 patients, removal of hardware was performed. The AOFAS hindfoot score increased significantly after surgery. All categories of the SF-36 score showed significant improvement. The average range of motion also increased significantly. Radiographic assessment showed neutral hindfoot alignment at the latest follow-up. The postoperative clinical outcomes were comparable in both patient groups. The time until complete osseous union was significantly longer in patients with opening wedge osteotomy. CONCLUSION This prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. In progressive ankle osteoarthritis, joint-nonpreserving treatment options including total ankle replacement or ankle arthrodesis should be discussed.
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Abstract
The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and pathologic biomechanical changes. Once conservative treatment has failed, subtalar fusion should be considered. The indication for surgery is based on thorough clinical and radiographic evaluation. Several techniques for subtalar fusion are published in literature. This article aims to describe a technique for in situ arthrodesis of the subtalar joint, paying special attention to biomechanical aspects as well as preoperative clinical and radiological work-up.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland.
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, Zürich 8008, Switzerland
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Carow JB, Carow J, Gueorguiev B, Klos K, Herren C, Pishnamaz M, Weber CD, Nebelung S, Kim BS, Knobe M. Soft tissue micro-circulation in the healthy hindfoot: a cross-sectional study with focus on lateral surgical approaches to the calcaneus. Int Orthop 2018; 42:2705-13. [PMID: 29931550 DOI: 10.1007/s00264-018-4031-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 06/12/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Open reduction and internal fixation (ORIF) using an extended lateral approach combined with plate osteosynthesis represents the current gold standard in calcaneal fracture treatment, but it is associated with a wound complication rate of up to 30%. Literature suggests that micro-circulation is one of the key factors for sufficient wound healing. The aim of this study was to evaluate soft tissue micro-circulation of the hindfoot in healthy volunteers to determine influencing factors and to identify hypoxic or hypoperfused areas in non-trauma situations, with special attention to surgical approaches. METHODS Micro-circulation of the lateral hindfoot of 125 participants was non-invasively measured at 2 and 8 mm depths, utilizing a Micro-Lightguide O2C® spectrophotometer. Blood flow (BF [AU]) and oxygen saturation (SO2 [%]) of ten measurement points (MPs) were documented. Demographic factors (age, gender, body mass index [BMI], systolic/diastolic blood pressure, smoking, and pack-years) and regional differences with special regard to surgical approaches (extended lateral approach, Palmer approach, Ollier approach, and a self-modified extended lateral approach) were analyzed. RESULTS The SO2 assessments at 2- and 8-mm depths revealed higher values in males (p = 0.043; p = 0.025). There was a correlation between higher age and lower 2 mm BF (p = 0.044). Smoking history and number of pack-years did not predict micro-circulation. BF at the 2 mm depth was highest in the regions of Palmer and Ollier approach (p < 0.001). The MP at the distal calcaneal tuberosity showed significantly higher values regarding all parameters (SO2 (2 mm), p < 0.001; SO2 (8 mm), p = 0.001; BF (2 mm), p < 0.001; BF (8 mm), p < 0.001), compared to the surrounding area. CONCLUSIONS In non-trauma situations, young males were associated with better micro-circulatory supply of the lateral hindfoot. There was a trend for higher blood flow in regions of the Palmer and Ollier approach. The distal calcaneal tuberosity was clearly superior in all micro-circulatory parameters when compared to the surrounding area.
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Abstract
Objectives The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. Methods Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery. Results In 12 years of conflict, 114 patients sustained 134 fractures. Follow-up consisted of 90 fractures (90/134, 67%), at a median of five years (interquartile range (IQR) 52 to 80 months). The median Short-Form 12 physical component score (PCS) of 62 individuals retaining their limb was 45 (IQR 36 to 53), significantly lower than the median of 51 (IQR 46 to 54) in patients who underwent delayed amputation after attempted reconstruction (p = 0.0351). Regression analysis identified three variables associated with a poor F&A score: negative Bohler’s angle on initial radiograph; coexisting talus and calcaneus fracture; and tibial plafond fracture in addition to a hindfoot fracture. The presence of two out of three variables was associated with a significantly lower PCS compared with amputees (medians 29, IQR 27 to 43 vs 51, IQR 46 to 54; p < 0.0001). Conclusions At five years, patients with reconstructed hindfoot fractures have inferior outcomes to those who have delayed amputation. It is possible to identify injuries which will go on to have particularly poor outcomes. Cite this article: P. M. Bennett, T. Stevenson, I. D. Sargeant, A. Mountain, J. G. Penn-Barwell. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res 2018;7:131–138. DOI: 10.1302/2046-3758.72.BJR-2017-0217.R2.
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Affiliation(s)
- P M Bennett
- Royal Navy, Institute of Naval Medicine, Crescent Road, Alverstoke, Hampshire, PO12 2DL, UK
| | - T Stevenson
- Royal Navy, Institute of Naval Medicine, Crescent Road, Alverstoke, Hampshire, PO12 2DL, UK
| | - I D Sargeant
- Royal Air Force, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK
| | - A Mountain
- Royal Army Medical Corps, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - J G Penn-Barwell
- Royal Navy, Institute of Naval Medicine, Crescent Road, Alverstoke, Hampshire, PO12 2DL, UK
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De Boer AS, Van Lieshout EMM, Van 't Land F, Misselyn D, Schepers T, Den Hartog D, Verhofstad MHJ. Soft tissue complications and timing of surgery in patients with a tongue-type displaced intra-articular calcaneal fracture: An international retrospective cohort study. Injury 2018; 49:425-429. [PMID: 29248185 DOI: 10.1016/j.injury.2017.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/06/2017] [Accepted: 12/09/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tongue-type displaced intra-articular calcaneal fractures (DIACF) are associated with a specific pattern of fracture displacement in contrast to joint depression fractures. This may result in tension of soft tissue in the posterior part of the heel. Tension-induced ischemia can result in skin necrosis. The objectives of this study were to investigate whether patients with tongue-type calcaneal fractures exert a higher risk of complications, especially of the posterior soft tissues, than joint depression type fractures. Also, late interventions (e.g., antibiotics, debridements, and amputations) and the effect of timing of surgery on the complication rate was assessed. METHODS In this international retrospective cohort study, data of adult patients with a DIACF in the period January 1, 2005-December 31, 2015 were extracted from patients' medical files. Descriptive, univariate, and multivariable analyses were performed in SPSS. RESULTS A total of 560 patients with 632 DIACF were included (295 tongue-type and 337 non-tongue-type fractures). At hospital presentation, 20.3% of the patients with a tongue-type fracture had compromised posterior soft tissue versus 12.8% with non-tongue-type fractures (p = 0.032). However, corrected for potential confounders the risk was no longer statistically significant (OR 1.497; 95% CI 0.831-2.696). Patients with a TT-DIACF had a 1.2-3.4-fold higher rate of any local wound complication (deep infections, and full thickness lesions, p < 0.03). In addition they had 2.0-8.0-fold more intravenous antibiotics, debridements, soft tissue coverage procedures and amputations (p < 0.03). Patients who underwent surgery within two days after trauma had a higher risk to develop any complication, in particular superficial infections, when compared to surgery between 3-7 days, but no significant difference between 3 and 7 and ≥8 days could be demonstrated. CONCLUSION Despite the fact that patients with a tongue-type fracture developed posterior skin and soft tissue compromise nearly twice as often, this difference disappeared after correction for confounders. The overall complication risk was increased in patients with tongue-type calcaneal fractures as compared to patients with a non-tongue-type fracture. Whether or not patients with tongue-type fractures require immediate surgery cannot be concluded from the data.
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Affiliation(s)
- A Siebe De Boer
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Freek Van 't Land
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Dominique Misselyn
- Department of Traumatology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Tim Schepers
- Department of Trauma Surgery, Academic Medical Center Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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65
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Abstract
Arthrodesis of the ankle or foot is a common procedure for chronic pain and disability. Nonunion remains a prevalent complication among arthrodesis procedures. Some patients present with an inherent risk of developing a nonunion. Allograft biologics have gained popularity in an effort to reduce complications such as nonunion. Various biologics bring unique properties while maintaining a singular purpose. Platelet-derived growth factor (PDGF) may be introduced into a fusion site to facilitate healthy bony consolidation. The purpose of this article is to review the benefits and modalities of PDGF and how it can improve patient outcomes in ankle and hindfoot fusions.
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Affiliation(s)
- Ryan T Scott
- The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023, USA.
| | - Jeffrey E McAlister
- The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023, USA
| | - Ryan B Rigby
- Logan Regional Orthopedics, 1350 North 500 East, Logan, UT 84341, USA
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66
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Neri T, Barthelemy R, Tourné Y. Radiologic analysis of hindfoot alignment: Comparison of Méary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res 2017; 103:1211-1216. [PMID: 28965994 DOI: 10.1016/j.otsr.2017.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 05/31/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Among radiographic views available for assessing hindfoot alignment, the antero-posterior weight-bearing view with metal cerclage of the hindfoot (Méary view) is the most widely used in France. Internationally, the long axial view (LAV) and hindfoot alignment view (HAV) are used also. The objective of this study was to compare the reliability of these three views. HYPOTHESIS The Méary view with cerclage of the hindfoot is as reliable as the LAV and HAV for assessing hindfoot alignment. MATERIAL AND METHODS All three views were obtained in each of 22 prospectively included patients. Intra-observer and inter-observer reliabilities were assessed by having two observers collect the radiographic measurements then computing the intra-class correlation coefficients (ICCs). RESULTS The intra-observer and inter-observer ICCs were 0.956 and 0.988 with the Méary view, 0.990 and 0.765 with the HAV, and 0.997 and 0.991 with the LAV, respectively. Correlations were far stronger between the LAV and HAV than between each of these and the Méary view. Compared to the LAV and HAV, the Méary view indicated a greater degree of hindfoot valgus. DISCUSSION Intra-observer reliability was excellent with both the LAV and HAV, whereas inter-observer reliability was better with the LAV. Excellent reliability was also obtained with the Méary view. Combining the Méary view to obtain a radiographic image of the clinical deformity with the LAV to measure the angular deviation of the hindfoot axis may be useful when assessing hindfoot malalignment. A comparison of the three views in a larger population is needed before clinical recommendations can be made. LEVEL OF EVIDENCE II, prospective study.
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Affiliation(s)
- T Neri
- Department of orthopaedic surgery, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne, France; Inter-university laboratory of human movement science, EA 7424, université de Lyon, UJM-Saint-Étienne, 42023 Saint-Étienne, France.
| | | | - Y Tourné
- Clinique des Cèdres, 38432 Echirolles, France
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67
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Stegeman M, van Ginneken BTJ, Romijn MG, Castelein RM, Louwerens JWK. Diagnostics in tarsal fusion: The theory and practise in The Netherlands. Foot Ankle Surg 2017; 23:201-206. [PMID: 28865591 DOI: 10.1016/j.fas.2016.05.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 03/13/2016] [Accepted: 05/19/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compares the preferences of Dutch orthopaedic surgeons for different diagnostic modalities in performing tarsal fusions versus consensus, evidence or expert opinion reported in the literature. METHODS A literature search of Medline was performed to obtain evidence-based information on various diagnostic tools. In addition, 89 registered Dutch foot and ankle surgeons were sent a questionnaire concerning the diagnostic modalities use in tarsal fusion. RESULTS Fifty-eight (65%) questionnaires were returned. The experienced surgeons measured outcomes significantly more often than other surgeons. Diagnostic injections were often used, although scant evidence exists in the literature. Postoperative diagnostics mainly consist of X-ray examination, although there is consensus in the literature that computed tomography is more accurate. CONCLUSIONS The study revealed some surprising discrepancies concerning the use of diagnostic imaging in tarsal fusion. More clinical research is needed to identify the most effective diagnostic imaging modalities so as to encourage their wider adoption.
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68
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Jeong HJ, Sohn IW, Kim D, Cho SK, Park SB, Sung IH, Sung YK. Impact of midfoot and Hindfoot involvement on functional disability in Korean patients with rheumatoid arthritis. BMC Musculoskelet Disord 2017; 18:365. [PMID: 28836966 PMCID: PMC5571626 DOI: 10.1186/s12891-017-1726-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Foot involvement in rheumatoid arthritis (RA) patients has been reported to severely affect functional capacity and quality of life. We aimed to determine the impact of midfoot and hindfoot involvement on functional disability in Korean patients with RA. Methods We evaluated the RA involvement and deformity of three regions of the foot (forefoot, midfoot and hindfoot) and ankle using conventional radiography in Korean patients with RA. We compared the clinical features between RA patients with and without foot or ankle involvement. Using multivariable logistic regression analyses, the impact of midfoot or hindfoot involvement on functional disability in RA patients was evaluated. Results Overall, 120 patients with a median age of 48.0 [interquartile range (IQR), 37–56] years and median disease duration of 58.0 (IQR, 10–89) months were included. The prevalence of foot or ankle RA involvement was 74 (61.7%). The number of patients with forefoot, midfoot, hindfoot and ankle involvement was 32 (43.2%), 24 (32.4%), 46 (62.2%) and 4 (5.4%), respectively. Compared to patients without foot or ankle involvement those with such involvement had greater disease activity and functional disability, more of them were treated with biologic agents, and they had a lower health-related quality of life. After adjusting for potential confounders, hindfoot involvement was associated with a higher degree of functional disability. However, walking difficulty was more associated with midfoot involvement rather than with involvement in other regions. Conclusions In Korean patients with RA, hindfoot involvement is associated with functional disability and midfoot involvement affects walking. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1726-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hye-Jin Jeong
- Department of Rheumatology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Il Woong Sohn
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Dam Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Si-Bog Park
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.
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69
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Abstract
Triple (talonavicular, subtalar, and calcaneocuboid) joint arthrodesis and most recently double (talonavicular and subtalar) joint arthrodesis have been well proposed in the literature for surgical repair of the elective, posttraumatic, and/or neuropathic hindfoot deformities. The articulation of the hindfoot with the ankle and midfoot is multiaxial, and arthrodesis of these joints can significantly alter the lower extremity biomechanical manifestations by providing anatomic correction and alignment. This article reviews the indications and preoperative planning for some of the most common procedures to address the hindfoot deformity.
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Affiliation(s)
- John J Stapleton
- Foot and Ankle Surgery, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite 110, Allentown, PA 18103, USA; Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC 7776, San Antonio, TX 78229, USA
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70
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Yang C, Xu X, Hu M, Wang B, Zhu Y, Liu J. Optimization of hindfoot alignment radiography. Acta Radiol 2017; 58:719-725. [PMID: 27856802 DOI: 10.1177/0284185116668214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Cobey and Buck described methods to evaluate hindfoot alignment, but it is still unclear which method is better and easier to perform in clinical practice. Purpose To evaluate the optimal method for radiography of hindfoot alignment. Material and Methods We randomly selected 50 patients visiting the foot and ankle surgery outpatient department who underwent hindfoot alignment radiography between 1 July and 31 August 2015. Radiographs were taken using both Cobey's and Buck's methods. The patients were divided into three groups by calcaneal inclination angle. We assessed the calcaneotibial angle, calcaneovertical angle, and the distance from the bottom of the calcaneus to the mid-tibial axis. A comparative analysis was performed separately using the t-test. Results One hundred pairs of data for Cobey's and Buck's methods were obtained. The angles were analyzed separately in valgus, normal, and varus situations. The results showed no significant difference between Cobey's method and Buck's method regardless of any situation ( P > 0.05). Regarding the distance between the bottom of the calcaneus and the mid-tibial axis, the average result of Buck's method was about 1 mm larger than that of Cobey's method in the valgus and normal cases ( P < 0.05), except for varus cases ( P > 0.05). Conclusion Cobey's and Buck's techniques are the classic and popular hindfoot alignment assessment methods. The use of Buck's technique resulted in a better image with a less technical procedure and less time requirement. It is worthy of being popularized and used routinely for hindfoot radiography.
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Affiliation(s)
- Chonglin Yang
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xiangyang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Institute of Orthopedics and Traumatology, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Mu Hu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Bibo Wang
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Institute of Orthopedics and Traumatology, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Yuan Zhu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Institute of Orthopedics and Traumatology, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Jinhao Liu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Institute of Orthopedics and Traumatology, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
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71
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Smolen C, Quenneville CE. A Finite Element Model of the Foot/Ankle to Evaluate Injury Risk in Various Postures. Ann Biomed Eng 2017; 45:1993-2008. [PMID: 28470459 DOI: 10.1007/s10439-017-1844-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/25/2017] [Indexed: 11/25/2022]
Abstract
The foot/ankle complex is frequently injured in many types of debilitating events, such as car crashes. Numerical models used to assess injury risk are typically minimally validated and do not account for ankle posture variations that frequently occur during these events. The purpose of this study was to evaluate a finite element model of the foot and ankle accounting for these positional changes. A model was constructed from computed tomography scans of a male cadaveric lower leg and was evaluated by comparing simulated bone positions and strain responses to experimental results at five postures in which fractures are commonly reported. The bone positions showed agreement typically within 6° or less in all anatomical directions, and strain matching was consistent with the range of errors observed in similar studies (typically within 50% of the average strains). Fracture thresholds and locations in each posture were also estimated to be similar to those reported in the literature (ranging from 6.3 kN in the neutral posture to 3.9 kN in combined eversion and external rotation). The least vulnerable posture was neutral, and all other postures had lower fracture thresholds, indicating that examination of the fracture threshold of the lower limb in the neutral posture alone may be an underestimation. This work presents an important step forward in the modeling of lower limb injury risk in altered ankle postures. Potential clinical applications of the model include the development of postural guidelines to minimize injury, as well as the evaluation of new protective systems.
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Affiliation(s)
- Chris Smolen
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada. .,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
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72
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Baverel L, Brilhault J, Odri G, Boissard M, Lintz F. Influence of lower limb rotation on hindfoot alignment using a conventional two-dimensional radiographic technique. Foot Ankle Surg 2017; 23:44-49. [PMID: 28159042 DOI: 10.1016/j.fas.2016.02.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/17/2016] [Accepted: 02/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rotation is one of the variables explaining lack of reproducibility in assessing hindfoot alignment. The hypothesis for this study was that a mathematical model predicts how this modifies radiographic hindfoot alignment measurements. METHODS A cadaveric lower limb, disjointed at knee level, was used. Sagittal and coronal planes were fixed using a custom clamp. Standard AP views were shot every five degrees and measured hindfoot alignments were compared to theoretical values obtained from a mathematical simulation. RESULTS Hindfoot angle was 7.04° at 0° rotation and 2.11° at -90°. Intra-class and inter-investigator correlation was 0.863. The t-test showed no significant difference (p=0.73). Intra-investigator correlation was 0.957. The R2 correlation index was 0.852. CONCLUSIONS The mathematical model accurately predicted the variations of the hindfoot angle which was maximum when the foot was aligned with the X-rays source. It then decreased when the foot rotated away, following a parabolic curve.
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Affiliation(s)
- L Baverel
- CHU de Nantes, 1 place Alexis Ricordeau, Nantes, France
| | | | - G Odri
- Avicenne University Hospital, 125 rue de Stalingrad, 93000 Bobigny, France
| | - M Boissard
- CHU de Nantes, 1 place Alexis Ricordeau, Nantes, France
| | - François Lintz
- Ankle and Foot Surgery Centre, Clinique de l'Union, 31240 Saint Jean, France.
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73
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Abstract
Charcot neuroarthropathy is associated with progressive, noninfectious, osteolysis-induced bone and joint destruction. When the ankle and/or hindfoot is affected by the destruction process, management is further complicated with collapse and destruction of the talar body, which increases instability around the ankle. In this patient population, arthrodesis is the most commonly used surgical procedure. Internal fixation, external fixation, or a combination of both can be used for the treatment. Decision making between them should be individualized according to the patient characteristics.
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Affiliation(s)
- Tahir Ögüt
- Department of Orthopaedics and Traumatology, Cerrahpasa Medical School, Istanbul University, Fatih, Istanbul 34098, Turkey.
| | - Necip Selcuk Yontar
- Department of Orthopaedics and Traumatology, Istanbul Cerrahi Hospital, Hakkı Yeten Cad., Ferah Sok. No: 22, Fulya, Istanbul 34365, Turkey
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74
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Abstract
Despite advances in understanding bone healing physiology and surgical techniques, delayed union and nonunion still occur after the treatment of hindfoot arthrodesis. There is increasing appeal of bone morphogenetic proteins (BMPs) owing to the innate osteoinductive abilities of BMPs. Effective treatment with BMPs has been shown in animal studies. Human clinical studies have also shown success. The only study investigating the use of recombinant human BMP (rhBMP)-2 in hindfoot arthrodesis found a significant increase in fusion rate. Treatment cost effective. Complications from their use remain low. rhBMP-2 is a safe and effective bone-healing adjunct in hindfoot arthrodesis surgery.
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Affiliation(s)
- Jeremy Hreha
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
| | - Ethan S Krell
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
| | - Christopher Bibbo
- Department of Orthopaedics, The Rubin Institute for Advanced Orthopaedics at Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
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75
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Abstract
Nonunion after tibial shaft fracture and hindfoot arthrodesis remains a major problem. Known risk factors include advanced age, immunosuppression, smoking, and diabetes. Several factors must be considered in the fracture healing process. This review evaluates the efficacy of orthobiologics in improving union rates after fracture or arthrodesis. Use of compounds have shown increased cellular proliferation experimentally. Percutaneous autologous bone marrow has shown increased cellular proliferation. Matrix supplementation has shown significant improvements in bone healing. Several studies have highlighted the importance of adequate graft fill over graft type. Patients at increased risk for nonunion would benefit most from these adjuvant therapies.
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Affiliation(s)
- Sheldon S Lin
- Department of Orthopaedics, Rutgers New Jersey Medical School, 90 Bergen Street, Room 7300, Newark, NJ 07101, USA.
| | - Michael G Yeranosian
- Department of Orthopaedics, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103, USA
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76
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Abstract
BACKGROUND The list of indications of posterior ankle endoscopy is expanding and includes various soft tissue and bony pathologies of the posterior ankle. Some of the indications, e.g. release of frozen ankle, debridement of posteromedial soft tissue impingement of the ankle and debridement or fixation of the posteromedial osteochondral lesion of the talus, require approach to the posterior ankle medial to the flexor hallucis longus tendon. The purpose of this study was to assess the risk of injury to the posterior tibial neurovascular bundle during posterior ankle endoscopy. METHODS Fourteen fresh frozen foot and ankle specimens were used. A metal rod was inserted into the posteromedial, posterolateral and modified posteromedial portals and touched the medial border of the posterolateral talar tubercle and the posteromedial corner of the ankle mortise in turn. The neurovascular bundle and FHL tendon were examined for any kink. RESULTS The neurovascular bundle was kinked in all specimens (100%) with the rod at the posteromedial corner of the ankle mortise through the posteromedial portal and was kinked in 11 specimens (79%) with the rod through the modified posteromedial portal. The neurovascular bundle was kinked in 1 specimen (7%) with the rod through the posterolateral portal. CONCLUSIONS The neurovascular bundle was at risk during instrumentation of the posteromedial ankle through the posteromedial portal but was safe through the posterolateral portal.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
| | - L K Chan
- Institute of Medical and Health Sciences Education and Department of Anatomy, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China.
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77
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Nichols JA, Roach KE, Fiorentino NM, Anderson AE. Predicting tibiotalar and subtalar joint angles from skin-marker data with dual-fluoroscopy as a reference standard. Gait Posture 2016; 49:136-143. [PMID: 27414041 PMCID: PMC5810542 DOI: 10.1016/j.gaitpost.2016.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 02/02/2023]
Abstract
Evidence suggests that the tibiotalar and subtalar joints provide near six degree-of-freedom (DOF) motion. Yet, kinematic models frequently assume one DOF at each of these joints. In this study, we quantified the accuracy of kinematic models to predict joint angles at the tibiotalar and subtalar joints from skin-marker data. Models included 1 or 3 DOF at each joint. Ten asymptomatic subjects, screened for deformities, performed 1.0m/s treadmill walking and a balanced, single-leg heel-rise. Tibiotalar and subtalar joint angles calculated by inverse kinematics for the 1 and 3 DOF models were compared to those measured directly in vivo using dual-fluoroscopy. Results demonstrated that, for each activity, the average error in tibiotalar joint angles predicted by the 1 DOF model were significantly smaller than those predicted by the 3 DOF model for inversion/eversion and internal/external rotation. In contrast, neither model consistently demonstrated smaller errors when predicting subtalar joint angles. Additionally, neither model could accurately predict discrete angles for the tibiotalar and subtalar joints on a per-subject basis. Differences between model predictions and dual-fluoroscopy measurements were highly variable across subjects, with joint angle errors in at least one rotation direction surpassing 10° for 9 out of 10 subjects. Our results suggest that both the 1 and 3 DOF models can predict trends in tibiotalar joint angles on a limited basis. However, as currently implemented, neither model can predict discrete tibiotalar or subtalar joint angles for individual subjects. Inclusion of subject-specific attributes may improve the accuracy of these models.
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Affiliation(s)
- Jennifer A. Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Koren E. Roach
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240 Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Correspondence address: Andrew E. Anderson, PhD, University of Utah, Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, 590 Wakara Way, Salt Lake City, UT 84108, +1 801 587-5208
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Evers J, Schulze M, Gehweiler D, Lakemeier M, Raschke MJ, Wähnert D, Ochman S. A modified and enhanced test setup for biomechanical investigations of the hindfoot, for example in tibiotalocalcaneal arthrodesis. BMC Musculoskelet Disord 2016; 17:318. [PMID: 27472925 PMCID: PMC4966560 DOI: 10.1186/s12891-016-1177-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Abstract
Background Tibiotalocalcaneal arthrodesis (TTCA) using intramedullary nails is a salvage procedure for many diseases in the ankle and subtalar joint. Despite “newly described intramedullary nails” with specific anatomical shapes there still remain major complications regarding this procedure. The following study presents a modified biomechanical test setup for investigations of the hindfoot. Methods Nine fresh-frozen specimens from below the human knee were anaysed using the Hindfoot Arthrodesis Nail (Synthes) instrument. Quasi-static biomechanical testing was performed for internal/external rotation, varus/valgus and dorsal/plantar flexion using a modified established setup (physiological load entrance point, sledge at lever arm to apply pure moments). Additionally, a 3D optical measurement system was added to allow determination of interbony movements. Results The mean torsional range of motion (ROM) calculated from the actuator data of a material testing machine was 10.12° (SD 0.6) compared to 10° (SD 2.83) as measured with the Optotrak® system (between tibia and calcaneus). The Optotrak showed 40 % more rotation in the talocrural joint. Mean varus/valgus ROM from the material testing flexion machine was seen to be 5.65° (SD 1.84) in comparison to 2.82° (SD 0.46) measured with the Optotrak. The subtalar joint showed a 70 % higher movement when compared to the talocrural joint. Mean ROM in the flexion test was 5.3° (SD 1.45) for the material testing machine and 2.1° (SD 0.39) for the Optotrak. The movement in the talocrural joint was 3 times higher compared to the subtalar joint. Conclusion The modified test setup presented here for the hindfoot allows a physiological biomechanical loading. Moreover, a detailed characterisation of the bone-implant constructs is possible.
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Affiliation(s)
- Julia Evers
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Martin Schulze
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Dominic Gehweiler
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Martin Lakemeier
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Dirk Wähnert
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany
| | - Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Muenster, Germany.
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Kinner B, Roll C. [Modified Pirogoff's amputation]. Oper Orthop Traumatol 2016; 28:335-44. [PMID: 27339219 DOI: 10.1007/s00064-016-0452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel. INDICATIONS Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities. CONTRAINDICATIONS Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel. SURGICAL TECHNIQUE The incision runs from dorsal, 1-2 cm distal of the Chopart joint, to plantar, 5-6 cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws. POSTOPERATIVE MANAGEMENT No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2-4 weeks and definitive prosthesis after 2-3 months. RESULTS From January 2010 to December 2014 six patients were treated with a modified Pirogoff's amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.
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Affiliation(s)
- B Kinner
- Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
| | - C Roll
- Zentrum für Ambulante Rehabilitation, Regensburg, Deutschland
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de Muinck Keizer RJ, Backes M, Dingemans SA, Goslings JC, Schepers T. Post-traumatic subtalar osteoarthritis: which grading system should we use? Int Orthop 2016; 40:1981-5. [PMID: 27342703 DOI: 10.1007/s00264-016-3236-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess and compare post-traumatic osteoarthritis following intra-articular calcaneal fractures, one must have a reliable grading system that consistently grades the post-traumatic changes of the joint. A reliable grading system aids in the communication between treating physicians and improves the interpretation of research. To date, there is no consensus on what grading system to use in the evaluation of post-traumatic subtalar osteoarthritis. The objective of this study was to determine and compare the inter- and intra-rater reliability of two grading systems for post-traumatic subtalar osteoarthritis. METHODS Four observers evaluated 50 calcaneal fractures at least one year after trauma on conventional oblique lateral, internally and externally rotated views, and graded post-traumatic subtalar osteoarthritis using the Kellgren and Lawrence Grading Scale (KLGS) and the Paley Grading System (PGS). Inter- and intra-rater reliability were calculated and compared. RESULTS The inter-rater reliability showed an intra-class correlation (ICC) of 0.54 (95 % CI 0.40-0.67) for the KLGS and an ICC of 0.41 (95 % CI 0.26 - 0.57) for the PGS. This difference was not statistically significant. The intra-rater reliability showed a mean weighted kappa of 0.62 for both the KLGS and the PGS. CONCLUSION There is no statistically significant difference in reliability between the Kellgren and Lawrence Grading System (KLGS) and the Paley Grading System (PGS). The PGS allows for an easy two-step approach making it easy for everyday clinical purposes. For research purposes however, the more detailed and widely used KLGS seems preferable.
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Blázquez Martín T, Iglesias Durán E, San Miguel Campos M. Complications after ankle and hindfoot arthroscopy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:387-393. [PMID: 27311555 DOI: 10.1016/j.recot.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the percentage of complications associated with ankle and hindfoot arthroscopy in our hospital and to compare the results with those reported in the literature. MATERIAL AND METHOD A retrospective descriptive review was conducted on the complications associated with ankle and hindfoot arthroscopy performed between May 2008 and April 2013. A total of 257 arthroscopy were performed, 23% on subtalar joint, and 77% of ankle joint. An anterior approach was used in 69%, with 26% by a posterior approach, and the remaining 5% by combined access. RESULTS A total of 31 complications (12.06%) were found. The most common complication was neurological damage (14 cases), with the most affected nerve being the superficial peroneal nerve (8 cases). Persistent drainage through the portals was found in 10 cases, with 4 cases of infection, and 3 cases of complex regional pain syndrome type 1. DISCUSSION There have been substantial advances in arthroscopy of ankle and hindfoot in recent years, expanding its indications, and also the potential risk of complications. The complication rate (12.06%) found in this study is consistent with that described in the literature (0-17%), with neurological injury being the most common complication. CONCLUSIONS Ankle and hindfoot arthroscopy is a safe procedure. It is important to make a careful preoperative planning, to use a meticulous technique, and to perform an appropriate post-operative care, in order to decrease the complication rates.
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Affiliation(s)
- T Blázquez Martín
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España.
| | - E Iglesias Durán
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España
| | - M San Miguel Campos
- Unidad de Tobillo y Pie, Hospital Monográfico Asepeyo Coslada de Traumatología, Cirugía Ortopédica y Rehabilitación, Madrid, España
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Chatellard R, Berhouet J, Brilhault J. Efficiency of locking-plate fixation in isolated talonavicular fusion. Orthop Traumatol Surg Res 2016; 102:S235-9. [PMID: 27033837 DOI: 10.1016/j.otsr.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Talonavicular (TN) fusion is an effective means of treating hindfoot deformity and pain. At the cost of a certain limited morbidity, it allows lasting stabilization of all of the torque joints. Non-union rates, however, are high, due to insufficient mechanical stability of the fixation. The present study assessed radiological and clinical results in TN fusion fixed by two retrograde compression screws and a dorsal locking plate. MATERIAL AND METHOD A retrospective single-surgeon study recruited 26 TN fusions performed in 25 patients (13 male, 12 female; mean age, 54.6±15.4years) between March 1st, 2010 and February 28th, 2014. Mean follow-up was 14.9±8.7months. Bone fusion and anatomic results were assessed on dorsoplantar, lateral and Méary weight-bearing radiographs. RESULTS Radiologic fusion was achieved in all cases, at a mean 2.7±0.7months. Mean TN coverage angle was 21.7±10.5° preoperatively and 3.8±1.8° at follow-up. Mean AOFAS score improved significantly, from 37.2±11.8 (range, 20-53) preoperatively to 79.4±11.4 (range, 45-98) at follow-up. CONCLUSION TN fusion fixed by two retrograde compression screws and a dorsal locking plate provided a high rate of consolidation without loss of angular correction and with satisfactory clinical results. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective.
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Ohly NE, Cowie JG, Breusch SJ. Triple arthrodesis of the foot with allograft through a lateral incision in planovalgus deformity. Foot Ankle Surg 2016; 22:114-9. [PMID: 27301731 DOI: 10.1016/j.fas.2015.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/30/2015] [Accepted: 05/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Triple arthrodesis may be performed using various surgical approaches, most typically through two incisions and without structural bone graft. We have found that a single lateral incision allows adequate surgical exposure and structural bone graft facilitates lateral column reconstruction. METHODS A consecutive series of 30 triple arthrodeses with additive bone graft using a single lateral incision. Outcome measures were SF12 score, Manchester-Oxford Foot Questionnaire index score, visual analogue pain score and satisfaction scores, and radiographic assessment at 3, 6 and 12 months post-operatively. RESULTS Statistically significant improvements were seen in all measured outcomes, except the SF12 mental component score. The union rate was 100% with no loss of correction at 12 months. Twenty-nine out of 30 patients were satisfied. CONCLUSIONS In this series, triple arthrodesis using structural allograft through a single lateral incision was safe and effective, with restoration and maintenance of surgical deformity correction and foot length.
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Affiliation(s)
- Nicholas E Ohly
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Jonathan G Cowie
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
| | - Steffen J Breusch
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
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Fuhrmann RA, Pillukat T. [Subtalar arthrodesis]. Oper Orthop Traumatol 2016; 28:177-92. [PMID: 26895251 DOI: 10.1007/s00064-016-0438-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. INDICATIONS Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction. CONTRAINDICATIONS Inflammation, vascular disturbances, nicotine abuse. SURGICAL TECHNIQUE Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws. POSTOPERATIVE MANAGEMENT Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle. RESULTS Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.
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Kraus VB, Kilfoil TM, Hash TW, McDaniel G, Renner JB, Carrino JA, Adams S. Atlas of radiographic features of osteoarthritis of the ankle and hindfoot. Osteoarthritis Cartilage 2015; 23:2059-2085. [PMID: 26318654 PMCID: PMC4663119 DOI: 10.1016/j.joca.2015.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/28/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a radiographic atlas of osteoarthritis (OA) for use as a template and guide for standardized scoring of radiographic features of OA of the ankle and hindfoot joints. METHOD Under Institutional Review Board approval, ankle and hindfoot images were selected from a cohort study and from among cases that underwent ankle radiography during a 6-month period at Duke University Medical Center. Missing OA pathology was obtained through supplementation of cases with the assistance of a foot and ankle specialist in Orthopaedic surgery and a musculoskeletal radiologist. Images were obtained and reviewed without patient identifying information. Images went through multiple rounds of review and final images were selected by consensus of the study team. For intra-rater and inter-rater reliability, the kappa statistic was calculated for two readings by three musculoskeletal radiologists, a minimum of two weeks apart, of ankle and hindfoot radiographs from 30 anonymized subjects. RESULTS The atlas demonstrates individual radiographic features (osteophyte and joint space narrowing (JSN)) and Kellgren-Lawrence grade for all aspects of the talocrural (ankle joint proper) and talocalcaneal (subtalar) joints. Reliability of scoring based on the atlas was quite good to excellent for most features indicated. Additional examples of ankle joint findings are illustrated including sclerosis, os trigonum, subchondral cysts and talar tilt. CONCLUSIONS It is anticipated that this atlas will assist with standardization of scoring of ankle and hindfoot OA by basic and clinical OA researchers.
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Affiliation(s)
- Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Terrence M Kilfoil
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Thomas W. Hash
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Gary McDaniel
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jordan B Renner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John A. Carrino
- Department of Radiology, Department of Radiology, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY
| | - Samuel Adams
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
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Eichinger M, Schmölz W, Brunner A, Mayr R, Bölderl A. Subtalar arthrodesis stabilisation with screws in an angulated configuration is superior to the parallel disposition: a biomechanical study. Int Orthop 2015; 39:2275-80. [PMID: 26253359 DOI: 10.1007/s00264-015-2944-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the stability of two established screw configurations (SC) for subtalar arthrodesis using a cyclic loading model. METHODS Eight paired human cadaver hindfoot specimens underwent subtalar arthrodesis with either parallel or angulated SC. The instrumented specimens were subjected to a cyclic loading protocol (1000 cycles: ±5 Nm rotation moment, 50 N axial force). The joint range of motion (ROM) was quantified before and after cyclic loading, in the three principal motion planes of the subtalar joint using pure bending moments of ±3 Nm. RESULTS After instrumentation, the angulated SC showed significantly less mean ROM compared to the parallel SC in internal/external rotation (1.4° ± 2.2° vs. 3.3° ± 2.8°, P = 0.006) and in inversion/eversion (0.9° ± 1.4° vs. 1.5° ± 1.1°, P = 0.049). After cyclic loading, the angulated SC resulted in significantly less mean ROM compared to the parallel SC in internal/external rotation (3.3° ± 4.6° vs. 8.8° ± 8.0°, P = 0.006) and in inversion/eversion (1.9° ± 2.3° vs. 3.9° ± 3.9°, P = 0.017). No significant differences in the mean ROM were found between the angulated and parallel SC in dorsal extension/plantar flexion. CONCLUSION The angulated SC resulted in decreased ROM in the subtalar arthrodesis construct after instrumentation and after cyclic loading compared to the parallel SC. The data from our study suggest that the clinical use of the angulated SC for subtalar arthrodesis might be superior to the parallel SC.
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Abstract
Imaging of the subtalar joint can be challenging because of its complex planar anatomy. This article reviews the anatomy and common anatomic variants as seen with different imaging techniques. Although radiography remains the initial mode of imaging, computed tomography and MRI are frequently needed to better delineate the joint anatomy and improve the sensitivity and the specificity of detection of joint pathology. A short review of arthrographic techniques and various examples of imaging of common pathology involving this joint are also included.
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Affiliation(s)
- Robert Lopez-Ben
- Department of Radiology, University of North Carolina School of Medicine at Charlotte, NC 27516, USA; Charlotte Radiology, 1701 East Boulevard, Charlotte, NC 28203, USA.
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Abstract
Tarsal coalitions, while relatively uncommon, are typically identified in adult patients during an evaluation for ankle instability, sinus tarsus pain, and/or pes planovalgus. The true incidence of tarsal coalition is unknown with estimates ranging from 1% to 12% of the overall population. The most common area of involvement of the subtalar joint is the middle facet, and heightened awareness should be present in adult patients with limited motion of the subtalar joint. Standard radiographic imaging, to include a Harris heel view, is recommended initially, although computerized tomography scan and MRI are often necessary to confirm the diagnosis.
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Abstract
Arthrodesis of the subtalar joint can be performed via both open and arthroscopic techniques. Both groups of procedures have their own relative indications and contraindications, as well as complications. Good results have been reported for both general procedures, although some studies suggest superiority with arthroscopic subtalar arthrodesis.
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Affiliation(s)
- Brent Roster
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
| | - Christopher Kreulen
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Eric Giza
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
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Matsumoto T, Nakamura I, Juji T, Ito K. Severe pes planovalgus successfully treated in a patient with mutilating rheumatoid arthritis using a new surgical approach involving medial malleolar resection and medial displacement of the talus: A case report. Mod Rheumatol 2015; 27:1083-1088. [PMID: 25867229 DOI: 10.3109/14397595.2015.1040613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report the case of a 56-year-old female with mutilating rheumatoid arthritis, who developed severe pes planovalgus. The foot was successfully reconstructed through a combination of osteotomies, including medial displacement of the talus accompanied by resection of the medial malleolus. This maneuver enabled a ∼1-cm medial displacement of the hindfoot while minimizing the adverse effect on forefoot rotation.
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Affiliation(s)
- Takumi Matsumoto
- a Department of Rheumatology , Yugawara Hospital, Ashigara-shimo , Kanagawa , Japan
| | - Ichiro Nakamura
- a Department of Rheumatology , Yugawara Hospital, Ashigara-shimo , Kanagawa , Japan.,b Faculty of Medical Science for Health, Teikyo Heisei University , Toshima, Tokyo , Japan
| | - Takuo Juji
- a Department of Rheumatology , Yugawara Hospital, Ashigara-shimo , Kanagawa , Japan
| | - Katsumi Ito
- a Department of Rheumatology , Yugawara Hospital, Ashigara-shimo , Kanagawa , Japan
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Wang SJ, Kim YD, Huang HH, Wu ZY, Lu L, Chen HF, Guo XR, Wei XH. Lateral calcaneal artery perforator-based skin flaps for coverage of lower-posterior heel defects. J Plast Reconstr Aesthet Surg 2015; 68:571-9. [PMID: 25752717 DOI: 10.1016/j.bjps.2014.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/25/2014] [Accepted: 12/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perforator-based flaps have been explored across almost all of the lower leg except in the Achilles tendon area. This paper introduced a perforator flap sourced from this area with regard to its anatomic basis and clinical applications. METHODS Twenty-four adult cadaver legs were dissected to investigate the perforators emerging along the lateral edge of the Achilles tendon in terms of number and location relative to the tip of the lateral malleolus, and distribution. Based on the anatomic findings, perforator flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) alone or in concert with the perforator of the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in eight cases. Postoperatively, subjective assessment and Semmes-Weinstein filament test were performed to evaluate the sensibility of the sural nerve-innerved area. RESULTS The PA ended into the anterior perforating branch and LCA at the level of 6.0 ± 1.4 cm (range 3.3-9.4 cm) above the tip of the lateral malleolus. Both PA and LCA, especially the LCA, gave rise to perforators to contribute to the integument overlying the Achilles tendon. Of eight flaps, six were based on perforator(s) of the LCA and two were on perforators of the PA and LCA. Follow-up lasted for 6-28 months (mean 13.8 months), during which total flap loss and nerve injury were not found. Functional and esthetic outcomes were good in all patients. CONCLUSION The integument overlying the Achilles tendon gets its blood supply through the perforators of the LCA primarily and that of through the PA secondarily. The LCA perforator(s)-based and the LCA plus PA perforators-based stepladder flap is a reliable, sensate flap, and should be thought of as a valuable procedure of choice for coverage of lower-posterior heel defects in selected patients.
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Affiliation(s)
- Sui-Jiang Wang
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Yu-Dan Kim
- Second People(')s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Hai-hua Huang
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Ze-Yong Wu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Ling Lu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Hai-Fang Chen
- Department of Human Anatomy, Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Xiao-Rui Guo
- Second People(')s Hospital of Zhongshan, Zhongshan, Guangdong, China
| | - Xiao-Hua Wei
- Shilong BoAi Hospital of Dongguan, Dongguan, Guangdong, China
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Abstract
The emergence of subtalar arthroscopy has improved the understanding and accuracy of diagnosing several hindfoot pathologic conditions, in particular, sinus tarsi syndrome. Subtalar arthroscopy has evolved into a useful diagnostic and therapeutic tool. The surgeon's experience is still essential to achieve good results. This article reviews the clinical indications, surgical techniques, and outcomes of subtalar arthroscopy.
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Affiliation(s)
- Gerardo Muñoz
- Departamento de Ortopedia y Traumatologia, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago 7591046, Chile.
| | - Sergio Eckholt
- Departamento de Ortopedia y Traumatologia, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago 7591046, Chile
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93
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Abstract
Posterior ankle and hind foot arthroscopy has become an important diagnostic and therapeutic tool when dealing with ankle pathology. Although not yet widely adopted it is gaining popularity and there have been various descriptions of the technique [1] and its outcomes [2,3]. With posterior arthroscopy there are well-documented risks of injury to the sural nerve and medial neurovascular bundle in particular [7-9]. These risks need to be carefully considered, particularly by surgeons early in the learning curve of what is undoubtedly a challenging technique. In an ideal world there should be scope for regular simulation to be integrated into a consultant's working week and this would allow them to be prepared for untoward incidences and also learn new techniques such as hind-foot arthroscopy in a safe environment prior to introduction into clinical practice.
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94
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Abstract
The talus is the most proximal bone of the hindfoot that couples the foot to the leg. It is the second most common fracture of the tarsal bones, second in frequency to the calcaneous. However, overall injuries to the talus are relatively rare, and most surgeons have little experience in managing them. This article discusses fractures of the talus, including injuries to the talar neck, body, head, and processes. Although subtalar dislocations and osteochondral injuries are important topics, they are not addressed in this article.
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Affiliation(s)
- Yury Bykov
- Orthopaedic Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite 110, Allentown, PA 18103, USA.
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95
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Dominic Marley W, Tucker A, McKenna S, Wong-Chung J. Pre-requisites for optimum centering of a tibiotalocalcaneal arthrodesis nail. Foot Ankle Surg 2014; 20:215-20. [PMID: 25103711 DOI: 10.1016/j.fas.2014.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/08/2014] [Accepted: 05/20/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Purpose of study was to compare nail alignment, incidence of stress riser and fracture with straight and curved nails of different lengths. METHODS We conducted a retrospective review of consecutive, initially 13 straight and subsequently 15 curved nails implanted in 17 men and 11 women. Angles of incidence and reflection subtended by nail tip with inner tibial cortex were measured. Cortical hypertrophy was assessed on follow-up radiographs. RESULTS Angles of incidence and reflection were greater with short straight nails, less with long straight nails and stayed close to zero with long curved nails. Stress fractures occurred in 2 patients with straight nails at the level of the proximalmost tibial screw. Cortical hypertrophy was present in 7 patients with straight nails and in only 1 patient with a curved nail (p=0.01). CONCLUSIONS Both nail length and inbuilt valgus contribute to better central positioning within the tibia. However, cortical stress reactions occur less frequently with curved nails.
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Affiliation(s)
- William Dominic Marley
- Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK
| | - Adam Tucker
- Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK
| | - Sean McKenna
- Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK
| | - John Wong-Chung
- Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, UK.
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96
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Sié EJ, Traoré A, Sy AK, Soumaro K, Lambin Y. Delayed debridement of an open total talar dislocation reimplanted in the emergency room. J Clin Orthop Trauma 2014; 5:176-80. [PMID: 25983494 DOI: 10.1016/j.jcot.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/18/2014] [Indexed: 11/21/2022] Open
Abstract
Open total talar dislocation is a rare but well known injury. Its management is controversial and fraught with complications such as infection, avascular necrosis, and post-traumatic osteoarthritis. We report the case of a woman sustaining a pure open talar dislocation reduced in the emergency room. Debridement was done three days after the injury in the operating room. There was no infection. One year after surgery she complained of occasional pain. Ambulation was normal. She wore regular shoes. The overall alignment of the ankle, hindfoot, and midfoot was normal. Movements of the tibiotalar and subtalar joints were not impaired. She has resumed her regular activities. Radiographs showed no signs of avascular necrosis. All components of the treatment strategy of open total dislocation should be carried out in emergency. This results in environment close to the original biological state. Good results can be achieved if infection is avoided.
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97
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Yañez Arauz JM, del Vecchio JJ, Amor RT, Piazza DA. Non-irradiated frozen structural allograft in reconstructive surgeries of the hindfoot and midfoot. Foot Ankle Surg 2014; 20:120-4. [PMID: 24796831 DOI: 10.1016/j.fas.2014.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. METHODS We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications. RESULTS We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen. CONCLUSION This treatment is a good option to treat severe defects or fill sequelae deformities.
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Affiliation(s)
| | | | - Ricardo Tito Amor
- Department of Orthopaedic Surgery, Austral University Hospital, Buenos Aires, Argentina
| | - Diego Amadeo Piazza
- Department of Orthopaedic Surgery, Austral University Hospital, Buenos Aires, Argentina
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98
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Abstract
Foot pain is a common orthopedic condition that can have an impact on health-related quality of life. The evaluation of plantar hindfoot pain begins with history and physical examination. Imaging modalities, standard radiographs, sonography, MR, CT are often utilized to clarify the diagnosis. The article is a detailed description of the sonographic evaluation of the plantar fascia and its disorders as well as the common etiologies in the differential diagnosis of plantar fasciopathy.
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99
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Abstract
Most posterior hindfoot procedures have been described with the patient positioned prone. This affords excellent access to posterior hindfoot structures but has several disadvantages for the management of the airway, the requirement for an endotracheal tube in all patients, difficulty with ventilation and an increased risk of pressure injuries, especially with regard to reduced ocular perfusion. We describe use of the 'recovery position', which affords equivalent access to the posterior aspect of the ankle and hindfoot without the morbidity associated with the prone position. A laryngeal mask rather than endotracheal tube may be used in most patients. In this annotation we describe this technique, which offers a safe and simple alternative method of positioning patients for posterior hindfoot and ankle surgery.
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Affiliation(s)
- N Gougoulias
- Frimley Park Hospital, Portsmouth Road, Camberley, Surrey GU16 7UJ, UK
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100
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Upadhaya GK, Jain VK, Sinha S, Naik AK. Isolated calcaneocuboid joint tuberculosis: a rare case report. Foot (Edinb) 2013; 23:169-71. [PMID: 24239029 DOI: 10.1016/j.foot.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 09/29/2013] [Accepted: 10/03/2013] [Indexed: 02/04/2023]
Abstract
Tubercular arthritis affecting the foot is uncommon. Isolated calcaneocuboid joint tuberculosis has never been reported in the literature. Herein we report a case of 43-year-old male who presented with insidious onset pain in hindfoot of 4 months duration. Radiograph revealed destruction of calcaneocuboid joint along with cuboid. Computed Tomography scan further consolidated the findings. Diagnosis was confirmed from aspiration from joint with culture of mycobacterium tuberculosis. Anti-tubercular chemotherapy was started and good clinical response was noted. We reported this case because of its rarity to involve calcaneocuboid joint and the excellent outcome with medical treatment.
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Affiliation(s)
- Gaurav Kumar Upadhaya
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
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