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Sanhudo JAV, Ilha TADSH. Lateral Fixation for Talonavicular Arthrodesis Using the Medial Approach: Technique Tip. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241239329. [PMID: 38533426 PMCID: PMC10964467 DOI: 10.1177/24730114241239329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
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France J, Murray J, Chadwick C, Davies M. Talonavicular arthrodesis: Does the IOFiX system provide safe and reliable fixation? Foot (Edinb) 2023; 56:102002. [PMID: 36963314 DOI: 10.1016/j.foot.2023.102002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/26/2023]
Abstract
AIMS Talonavicular (TN) arthrodesis is a common procedure to treat arthritis of the TN joint.It can also form part of a wider triple fusion to restore the architecture of the foot.Traditional methods of arthrodesis are not universally successful. The aim of this study was to evaluate the clinical and radiological outcomes of those who had a TN fusion using the IOFiX system. Data was collected retrospectively from the hospital operation database. Inclusion criteria included patients who underwent a TN fusion between 2012 and 19 with the IOFiX system. All patients were over 16 years of age and at least one year post operation.Patient demographics were obtained, as well as rate of union and rate of re-operation for analysis. RESULTS 35 patients were identified. The mean age was 58 years (range 34-85). The most common indication was osteoarthritis of the TN joint (n = 19), followed by acquired adult flat foot (n = 8), rheumatoid arthritis (n = 3), avascular necrosis (n = 2) and a previous nonunion.(n = 1). 9 % (n = 3) of patients did not achieve union by one year and 14 % (n = 5) required another operation subsequent to their initial surgery: four to remove metalwork, and one to treat non-union of the arthrodesis. The use of bone graft did not affect complication rates. TN fusion, when performed as part of a triple fusion, showed a tendency for reducing the rate of non-union, however this did not achieve statical significance. CONCLUSION This study suggests that the IOFiX system offers a reliable and acceptable alternative technique for patients undergoing a TN fusion. Further work is required to assess if early signs of improved outcome when used in triple fusion, over isolated TN fusion,are significant.
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Affiliation(s)
- Jonathan France
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, United Kingdom
| | - James Murray
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, United Kingdom.
| | - Carolyn Chadwick
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, United Kingdom
| | - Mark Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, United Kingdom
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Talo-navicular and calcaneo-cuboid fusion with PEEK H-pode™ vs. Titanium Maxlock™ locking plates: Comparison of functional and radiographic outcomes. Orthop Traumatol Surg Res 2023; 109:103343. [PMID: 35660079 DOI: 10.1016/j.otsr.2022.103343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Locking plates are increasingly used to achieve hindfoot fusion. The objective of this study was to compare hindfoot fusion outcomes with the PEEK H-pode™ (Biotech™) locking plate and the titanium Maxlock™ (Tornier-Wright™) locking plate. HYPOTHESIS A polyetheretherketone (PEEK) H-pode™ locking plate provides similar fusion rates to a titanium Maxlock™ locking plate for talo-navicular and calcaneo-cuboid arthrodesis. METHODS We conducted a retrospective comparative study in 39 patients (including 21 [54%] with pes planovalgus and 11 [28%] with neurological equinovarus deformities) who underwent talo-navicular and/or calcaneo-cuboid fusion, usually combined with subtalar fusion. The first 17 patients (January 2014-February 2016) were managed with Maxlock™ locking plates and the next 22 patients (March 2016-August 2018) with H-pode™ locking plates. These two cohorts of consecutive patients were comparable regarding age, sex distribution, body mass index, and comorbidities. At last follow-up more than 1year after surgery, we compared functional scores, pain intensity, and fusion assessed by radiographs and computed tomography (CT) (threshold set at 33%). RESULTS Mean follow-up was 42months (range: 34-63months) in the Maxlock™ group and 25months (range: 12-36months) in the H-pode™ group. At last follow-up, the two groups were not significantly different for the mean values of the American Orthopedic Foot & Ankle Society score, European Foot & Ankle Society score, and visual analogue scale pain score. Neither were the two groups significantly different for talo-navicular and calcaneo-cuboid fusion by CT. In the Maxlock™ group, we found non-significant trends towards a higher proportion of patients with talo-navicular nonunion (18% vs. 5% in the H-pode™ group) and weaker talo-navicular fusion in patients with pes planovalgus (60.8% vs. 82.0%, respectively). Radiographic results overestimated the fusion rates. DISCUSSION Talo-navicular and calcaneo-cuboid fusion was not significantly different with H-pode™ and Maxlock™ locking plates. CT was more accurate than standard radiography to assess fusion. These results underline the usefulness of PEEK locking plates for talo-navicular and calcaneo-cuboid fusion; moreover, the radiolucency of PEEK facilitates the interpretation of radiographs. LEVEL OF EVIDENCE IV.
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Goh TS, Han JB, Lee SM, Kang SW, Shin WC, Woo SH. Screw only versus screw plus plate in isolated talonavicular arthrodesis. Foot Ankle Surg 2022; 28:1045-1049. [PMID: 35300936 DOI: 10.1016/j.fas.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to compare outcomes of treatment of isolated talonavicular arthrodesis (ITNA) with screw only or screw plus plate, respectively. METHODS We retrospectively evaluated 40 consecutive cases of ITNA [two-screw fixation patients: Group 1 (23 cases); screw-plus-plate fixation patients: Group 2 (17 cases)]. Outcome measures included radiographic findings, Foot and Ankle Outcome Scores (FAOS), and visual analogue scale (VAS) scores. RESULTS Nonunion occurred more frequently in group 1 (21.7%) than in group 2 (5.9%), but there was no statistical significance (p = 0.216). Although the preoperative FAOS and VAS score showed similar results between both groups, there were significantly better clinical outcomes in two of five FAOS domains and VAS scores at 3 months postoperative and final follow-up (p < 0.05). CONCLUSION Although union rates were not significantly different, nonunion occurred more frequently in screw only group and we obtained more favorable clinical outcomes in screw plus plate group.
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Affiliation(s)
- Tae Sik Goh
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea
| | - Jung Bum Han
- Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Sang Min Lee
- Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Won Chul Shin
- Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Seung Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea; Department of Orthopedic Surgery, Pusan National University Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea.
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Vacketta VG, Jones JM, Philp FH, Saltrick KR, McMillen RL, Hentges MJ, Catanzariti AR. Radiographic Outcomes of Talonavicular Joint Arthrodesis With Varying Fixation Techniques in Stage III Adult Acquired Flatfoot Reconstruction. J Foot Ankle Surg 2022; 61:969-974. [PMID: 35027310 DOI: 10.1053/j.jfas.2021.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/09/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
Utilization of the talonavicular joint (TN) arthrodesis as an isolated procedure or in combination with hindfoot arthrodesis has been described in the literature for treatment of numerous hindfoot conditions. When used in isolation or with concomitant hindfoot arthrodesis, the TN joint has demonstrated nonunion rates reported as high as 37% in the literature. Despite previous research, there remains a lack of agreement upon the ideal fixation technique for TN joint arthrodesis with and without concomitant subtalar joint arthrodesis. The purpose of this study was to retrospectively compare the radiographic and clinical results of TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs in the treatment of advanced hindfoot malalignment in stage III adult-acquired flatfoot deformity. We retrospectively reviewed 105 patients who underwent TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs. Our results demonstrated a nonunion rate of 16.2%, with 17 nonunions identified within our patient population. One (2.4%) nonunion was observed in the 3-screw cohort, 7 (33.3%) nonunions were observed in the 2-screw cohort, 4 (16.0%) nonunions were observed in the 2-screw plus plate cohort, and 5 (29.4%) nonunions were observed in the 1-screw plus plate cohort. The difference in nonunion rate between the 4 cohorts was statistically significant. Based on these results, we conclude that the use of a 3-screw construct for TN joint arthrodesis as part of double arthrodesis procedure demonstrates a statistically significant reduction in nonunion rate and should be considered a superior fixation construct for this procedure.
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Affiliation(s)
- Vincent G Vacketta
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Jacob M Jones
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Frances Hite Philp
- Health Outcomes Researcher, Orthopaedic and Research Institutes, Allegheny Health Network, Pittsburgh, PA
| | - Karl R Saltrick
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Ryan L McMillen
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Matthew J Hentges
- Attending Faculty of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Director of Residency Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
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Andrews NA, Patch DA, Torrez TW, Sutherland CR, Harrelson WM, Pitts C, Agarwal A, Shah A. Which surgical approach is optimal for joint preparation in talonavicular fusion - A cadaver study. Foot Ankle Surg 2022; 28:657-662. [PMID: 34420873 DOI: 10.1016/j.fas.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/12/2021] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fusion of the talonavicular joint has proven challenging in literature. The optimal surgical approach for talonavicular arthrodesis is still uncertain. This study compares the amount of physical joint preparation between dorsal and medial approaches to the talonavicular joint. METHODS Twenty fresh frozen cadaver specimens were randomly assigned to receive either a dorsal or medial operative approach to the talonavicular joint. The joint surface was prepared, and the joint was disarticulated. Image analysis, using ImageJ, was performed by two blinded reviewers to assess the joint surface preparation and this was compared by surgical approach. RESULTS The dorsal approach had a higher median percentage of talar and total talonavicular joint surface area prepared (75% vs. 59% (p = .007) and 82% vs. 70% (p = .005)). Irrespective of approach, the talus was significantly more difficult to prepare than the navicular (62% vs 88% (p = .001)). CONCLUSION The dorsal approach provides superior talonavicular joint preparation. The lateral ¼th of the talar head was the most difficult surface to prepare, and surgeons performing double or triple arthrodesis may prepare the lateral talar head from the lateral approach. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Timothy W Torrez
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Charles R Sutherland
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Charles Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
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Greer N, Yoon P, Majeski B, Wilt TJ. Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review. J Foot Ankle Surg 2021; 60:1029-1037. [PMID: 34039511 DOI: 10.1053/j.jfas.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
Orthobiologics are biologically-derived materials intended to promote bone formation and union. We review evidence on effectiveness and harms of orthobiologics compared to no orthobiologics for foot and ankle arthrodesis. We searched multiple databases (1995-2019) and included clinical trials and other studies with concurrent controls, English language, and reporting patient-centered outcomes, union/time to union, costs/resource utilization, or harms. Studies were organized by orthobiologic used. We describe quality and limitations of available evidence but did not formally rate risk of bias or certainty of evidence. Most of the 21 studies included were retrospective chart reviews with orthobiologics used at surgeon's discretion for patients considered at higher risk for nonunion. Ten studies compared autologous bone graft versus no graft and 2 compared remote versus local graft with few studies of other orthobiologics. All studies reported a measure of fusion and about half reported on function/quality of life. Few studies reported harms. Due to limited reporting, we were unable to assess whether effectiveness varies by risk factors for nonunion (eg, age, gender, smoking status, obesity, diabetes) or whether orthobiologics were cost-effective. Available evidence is of poor quality with small sample sizes, inadequate reporting of risk factors for nonunion, variations in orthobiologics, surgical techniques used, and outcome assessment, and potential selection bias. Research is needed to adequately inform surgeons about benefits and harms and guide patient selection for use, or type, of orthobiologics. Careful assessment of individual patient risk for nonunion is critical prior to orthobiologic use.
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Affiliation(s)
- Nancy Greer
- Program Manager, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN.
| | - Patrick Yoon
- Orthopedic Surgeon, Minneapolis VA Medical Center, Minneapolis, MN
| | - Brittany Majeski
- Research Coordinator, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN
| | - Timothy J Wilt
- Director Evidence Synthesis Program and Core Investigator, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN; Staff Physician, Minneapolis VA Medical Center, Minneapolis, MN; Professor of Medicine, University of Minnesota School of Medicine, Minneapolis, MN
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Cristino DM, Schmidt EC, Metikala S, Mahmoud K, Hast MW, Farber DC. A cadaveric comparison of two methods for isolated talonavicular arthrodesis: Two-screws versus plate with integrated compression screw. Foot Ankle Surg 2021; 27:405-411. [PMID: 32553424 DOI: 10.1016/j.fas.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compared stiffness between two constructs for talonavicular arthrodesis: a dorsomedial plating system and two partially threaded cannulated cancellous screws. We hypothesized that the plate would exhibit greater stiffness and resistance to deformation during cyclic loading. METHODS The constructs were implanted in eight matched pairs of cadaveric feet and subjected to axial torsion, cantilever bending in two directions, and cyclic loading to failure. RESULTS The two-screw constructs were significantly stiffer in plantar-dorsal bending (p = .025) and trended towards a higher number of cycles before failure than the plate group (p = .087). No significant differences were observed in internal torsion (p = .620), external torsion (p = .165), or medial-lateral bending (p = .686). CONCLUSIONS This study provided the first biomechanical assessment of a plating system with an integrated compression screw, which was significantly less stiff than a two-screw construct when loaded from plantar to dorsal.
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Affiliation(s)
- Danielle M Cristino
- Biedermann Lab for Orthopaedic Research, University of Pennsylvania, 3737 Market Street, 10th Floor Suite 1050, Philadelphia, PA 19104, United States.
| | - Elaine C Schmidt
- Biedermann Lab for Orthopaedic Research, University of Pennsylvania, 3737 Market Street, 10th Floor Suite 1050, Philadelphia, PA 19104, United States.
| | - Sreenivasulu Metikala
- Department of Orthopaedic Surgery, Pennsylvania Hospital, Farm Journal Building, 5th Floor 230 West Washington Square, Philadelphia, PA 19106, United States.
| | - Karim Mahmoud
- Department of Orthopaedic Surgery, Pennsylvania Hospital, Farm Journal Building, 5th Floor 230 West Washington Square, Philadelphia, PA 19106, United States.
| | - Michael W Hast
- Biedermann Lab for Orthopaedic Research, University of Pennsylvania, 3737 Market Street, 10th Floor Suite 1050, Philadelphia, PA 19104, United States.
| | - Daniel C Farber
- Department of Orthopaedic Surgery, Pennsylvania Hospital, Farm Journal Building, 5th Floor 230 West Washington Square, Philadelphia, PA 19106, United States.
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Lee SR, Stibolt D, Patel H, Abyar E, Moon A, Naranje S, Shah A. Structures at Risk During Percutaneous Screw Fixation for Talonavicular Fusion. Foot Ankle Int 2018; 39:1502-1508. [PMID: 30132696 DOI: 10.1177/1071100718790489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Talonavicular (TN) fusion using screws dorsomedially and dorsolaterally can cause neurovascular injury. The purpose of our cadaveric study was to evaluate the safety of percutaneous screw insertion in relation to dorsal neurovascular structures. METHODS: Ten fresh-frozen cadaver legs were used for this study. Percutaneous cannulated screws were inserted to perform isolated TN arthrodesis. The screws were inserted at 3 consistent sites: a "medial screw" at the dorsomedial navicular where it intersected at the medial plane of the first cuneiform, a "central screw" at the edge of the dorsal navicular between the medial and intermediate cuneiforms, and a "lateral screw" at the edge of the dorsal navicular between the intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and/or tendons. RESULTS: The medial screw injured the anterior tibialis tendon in 2 cases (20%), the central screw injured the extensor hallucis longus tendon in 3 cases (30%), and the lateral screw injured the anterior branch of the superior peroneal nerve (SPN), the lateral branch of the SPN, and the medial branch of the distal peroneal nerve (DPN) once each in a total of 3 cases (30%). Despite no direct injury, the central screw indicated a potential risk of neurovascular injury: closest distance to the anterior SPN was 2 mm and to the medial DPN 2 mm. CONCLUSION: Although neurovascular injury risk exists for all of these screw placements, TN fusion with a central screw introduced a potentially decreased risk of neurovascular injury at the expense of increased risk of tendon injury compared to the lateral screw. CLINICAL RELEVANCE: Based on these results, we recommend a careful dissection be performed prior to percutaneous screw insertion.
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Affiliation(s)
- Sung Ro Lee
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Davis Stibolt
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Eldar Abyar
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew Moon
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sameer Naranje
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashish Shah
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Xie MM, Xia K, Zhang HX, Cao HH, Yang ZJ, Cui HF, Gao S, Tang KL. Individual headless compression screws fixed with three-dimensional image processing technology improves fusion rates of isolated talonavicular arthrodesis. J Orthop Surg Res 2017; 12:17. [PMID: 28114949 PMCID: PMC5259994 DOI: 10.1186/s13018-017-0516-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screw fixation is a typical technique for isolated talonavicular arthrodesis (TNA), however, no consensus has been reached on how to select most suitable inserted position and direction. The study aimed to present a new fixation technique and to evaluate the clinical outcome of individual headless compression screws (HCSs) applied with three-dimensional (3D) image processing technology to isolated TNA. METHODS From 2007 to 2014, 69 patients underwent isolated TNA by using double Acutrak HCSs. The preoperative three-dimensional (3D) insertion model of double HCSs was applied by Mimics, Catia, and SolidWorks reconstruction software. One HCS oriented antegradely from the edge of dorsal navicular tail where intersected interspace between the first and the second cuneiform into the talus body along the talus axis, and the other one paralleled the first screw oriented from the dorsal-medial navicular where intersected at the medial plane of the first cuneiform. The anteroposterior and lateral X-ray examinations certified that the double HCSs were placed along the longitudinal axis of the talus. Postoperative assessment included the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS), the visual analogue scale (VAS) score, satisfaction score, imaging assessments, and complications. RESULTS At the mean 44-months follow-up, all patients exhibited good articular congruity and solid bone fusion at an average of 11.26 ± 0.85 weeks (range, 10 ~ 13 weeks) without screw loosening, shifting, or breakage. The overall fusion rates were 100%. The average AOFAS score increased from 46.62 ± 4.6 (range, 37 ~ 56) preoperatively to 74.77 ± 5.4 (range, 64-88) at the final follow-up (95% CI: -30.86 ~ -27.34; p < 0.001). The mean VAS score decreased from 7.01 ± 1.2 (range, 4 ~ 9) to 1.93 ± 1.3 (range, 0 ~ 4) (95% CI: 4.69 ~ 5.48; p < 0.001). One cases (1.45%) and three cases (4.35%) experienced wound infection and adjacent arthritis respectively. The postoperative satisfaction score including pain relief, activities of daily living, and return to recreational activities were good to excellent in 62 (89.9%) cases. CONCLUSIONS Individual 3D reconstruction of HCSs insertion model can be designed with three-dimensional image processing technology in TNA. The technology is safe, effective, and reliable to isolated TNA method with high bone fusion rates, low incidences of complications.
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Affiliation(s)
- Mei-Ming Xie
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Kang Xia
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hong-Xin Zhang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hong-Hui Cao
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Zhi-Jin Yang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hai-Feng Cui
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Shang Gao
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Kang-Lai Tang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China.
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van den Broek M, Vandeputte G, Somville J. Dual Window Approach With Two-Side Screw Fixation for Isolated Talonavicular Arthrodesis. J Foot Ankle Surg 2016; 56:171-175. [PMID: 27291683 DOI: 10.1053/j.jfas.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 02/03/2023]
Abstract
Isolated talonavicular arthrodesis is a commonly performed surgical intervention. Nonunion is a dreaded complication. The aim of the present study was to analyze the clinical and radiologic outcome of talonavicular arthrodesis using a dual approach with 2-side screw fixation. From February 2012 to September 2014, isolated talonavicular arthrodesis was performed on 17 joints of 16 patients (mean age 59.12 years). All procedures were performed by a single surgeon. The incidence of union, visual analog scale scores, and complications were analyzed. Radiographic union was achieved in all 17 cases (100%) at a mean period of 13.12 weeks. The visual analog scale scores had improved significantly (p < .001) at a mean follow-up of 48.53 weeks. One patient (6%) had minimal wound problems, and one (6%) showed prolonged swelling postoperatively. We have concluded that the dual window approach with 2-side screw fixation for isolated talonavicular arthrodesis results in excellent clinical and radiographic results and high fusion rates.
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Affiliation(s)
| | | | - Johan Somville
- Orthopaedic Department, University Hospital, Antwerp, Belgium
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12
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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] [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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Shymon SJ, Moss L, Harris TG. Case Series Using a Novel Implant and Accelerated Rehabilitation for Patients Undergoing an Isolated Talonavicular Arthrodesis. Foot Ankle Spec 2016; 9:227-31. [PMID: 26644033 DOI: 10.1177/1938640015620638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Talonavicular (TN) arthrodeses for TN arthritis have a high rate of nonunions for an essential hindfoot joint. In this case series, 12 patients underwent an isolated TN arthrodesis using a novel implant (IO FiX) by a single surgeon with a minimum 1-year follow-up (30.1 ± 14.7 months; mean ± SD). All patients (62 ± 12 years) underwent an aggressive rehabilitation protocol given the strength and compression of the implant. There were no nonunions, nor were there any patients lost to follow-up. Time to radiographic union was 9.6 ± 1.4 weeks. The Visual Analog Scale pain level decreased from 7.3 ± 0.9 preoperatively to 2.1 ± 0.7 postoperatively (P < .001). The Short-Form-12 physical component improved from 27.9 ± 4.2 preoperatively to 42.2 ± 3.5 postoperatively (P < 0.001), while the Short-Form-12 mental component did not change from 50.8 ± 6.9 preoperatively to 54.4 ± 3.8 postoperatively (P > .05). Use of the novel fixation device for TN arthrodesis by a single surgeon with an accelerated rehabilitation protocol significantly decreased patients' pain and improved their physical functional outcomes (P < .001). The IO FiX implant can potentially improve TN arthrodesis fusion rates and surgical outcomes. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Stephen Joseph Shymon
- Harbor-UCLA Medical Center, Department of Orthopaedic Surgery, Torrance, California (SJS, LM, TGH)Congress Medical Associates, Pasadena, California (TGH)
| | - Lewis Moss
- Harbor-UCLA Medical Center, Department of Orthopaedic Surgery, Torrance, California (SJS, LM, TGH)Congress Medical Associates, Pasadena, California (TGH)
| | - Thomas Gregory Harris
- Harbor-UCLA Medical Center, Department of Orthopaedic Surgery, Torrance, California (SJS, LM, TGH)Congress Medical Associates, Pasadena, California (TGH)
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Carranza-Bencano A, Tejero S, Fernández Torres JJ, Del Castillo-Blanco G, Alegrete-Parra A. Isolated talonavicular joint arthrodesis through minimal incision surgery. Foot Ankle Surg 2015; 21:171-7. [PMID: 26235855 DOI: 10.1016/j.fas.2014.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/13/2014] [Accepted: 11/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to analyze bony fusion and functional outcomes after talonavicular arthrodesis (TNA) using an original minimally invasive surgery (MIS). METHODS There was a total of 11 feet in 11 patients who underwent TNA and were followed up for 47 months (range 40.8-53.1). Functional outcomes were measured by AOFAS and quality of life by eight sections of SF-36. RESULTS Radiographic and clinical consolidation was achieved in 10 of 11 cases. In the AOFAS score, physical function improved a mean of 34.4 points (95% CI: 23.2-45.6; p<.0001) and pain improved a mean of 23.6 points (95% CI: 17.4-29.8; p<.0001). One osteoporotic and rheumatic patient had a non-union. No cases of early complications, such as wound infections, neurovascular damage or delayed wound healing, occurred. CONCLUSION Isolated TNA by MIS could be an option for the treatment of TN arthritis, especially for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- A Carranza-Bencano
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain.
| | - Sergio Tejero
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | - J J Fernández Torres
- University of Sevilla, Spain; Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
| | | | - A Alegrete-Parra
- Foot Ankle Unit, Universitary Hospital "Virgen del Rocío", Sevilla, Spain
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[Osteosynthesis of talonavicular fusion with a claw plate and compression screw]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 27:252-61. [PMID: 25519036 DOI: 10.1007/s00064-014-0301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/21/2013] [Accepted: 02/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE A new method of osteosynthetic stabilization of talonavicular fusion is presented. INDICATIONS Idiopathic and posttraumatic talonavicular arthritis, talonavicular destruction in rheumatoid arthritis, adult acquired flatfoot deformity, cavovarus deformity, talonavicular degenerative disease in tarsal coalition. CONTRAINDICATION Major hindfoot deformity or instability, severe osteopenic conditions of tarsal bones. SURGICAL TECHNIQUE Talonavicular fusion is stabilized with a medioplantar 6.5-mm lag screw in combination with a dorsolateral 3.5-mm claw plate (Charlotte Claw compression plate; Fa. Wright Medical Technology, Memphis, USA) by a dorsal surgical access. POSTOPERATIVE MANAGEMENT Nonweight-bearing in a cast or walker for 6 weeks; after radiologic control increasing weight-bearing is allowed. RESULTS The technique was used in 44 patients, among them 31 cases of isolated talonavicular fusion. Complete bony healing was observed in 42 cases after medium follow-up time of 13.3 months. All 19 cases of isolated talonavicular fusion without posterior tibial tendon dysfunction healed uneventfully; two cases of non-union were observed in 12 patients with posterior tibial tendon dysfunction.
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Baier C, Springorum HR, Maderbacher G, Pickl C, Grifka J, Götz J. [Arthrodesis for patients with rheumatic arthritis of the ankle and hindfoot. A reasonable option?]. Z Rheumatol 2014; 73:796-805. [PMID: 25373549 DOI: 10.1007/s00393-014-1405-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ankle and hindfoot deformities as well as degenerative changes are often found in patients with rheumatological diseases. They often suffer from severe pain and complain of increasing immobility. Corrective procedures with ankle or hindfoot arthrodesis are promising options. OBJECTIVES This article presents epidemiological data and describes the clinical aspects, diagnostics and treatment options for patients with ankle and hindfoot osteoarthritis. MATERIALS AND METHODS The retrospective results of 56 patients after ankle or hindfoot arthrodesis are presented. RESULTS After an average follow-up of 52 months the majority of results were good or excellent with relief of pain and reconstruction of the function of the foot. CONCLUSION Ankle or hindfoot arthrodesis represents a promising option for patients with severe osteoarthritis and can safeguard patients from increasing immobility.
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Affiliation(s)
- C Baier
- Orthopädische Klinik, Universität Regensburg im Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland,
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Higgs Z, Jamal B, Fogg QA, Kumar CS. An anatomical study comparing two surgical approaches for isolated talonavicular arthrodesis. Foot Ankle Int 2014; 35:1063-7. [PMID: 25037709 DOI: 10.1177/1071100714540886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Two operative approaches are commonly used for isolated talonavicular arthrodesis: the medial and the dorsal approach. It is recognized that access to the lateral aspect of the talonavicular joint can be limited when using the medial approach, and it is our experience that using the dorsal approach addresses this issue. We performed an anatomical study using cadaver specimens, to compare the amount of articular surface that can be accessed by each operative approach. METHODS Medial and dorsal approaches to the talonavicular joint were performed on each of 11 cadaveric specimens (10 fresh frozen, 1 embalmed). Distraction of the joint was performed as used intraoperatively and the accessible area of articular surfaces was marked for each of the 2 approaches using a previously reported technique. Disarticulation was performed and the marked surface area was quantified using an immersion digital microscribe, allowing a 3-dimensional virtual model of the articular surfaces to be assessed. RESULTS The median percentage of total accessible talonavicular articular surface area for the medial and dorsal approaches was 71% and 92%, respectively (Wilcoxon signed-rank test, P < .001). CONCLUSION This study provides quantifiable measurements of the articular surface accessible by the medial and dorsal approaches to the talonavicular joint. CLINICAL RELEVANCE These data support for the use of the dorsal approach for talonavicular arthrodesis, particularly in cases where access to the lateral half of the joint is necessary.
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Affiliation(s)
- Zoe Higgs
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Bilal Jamal
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Quentin A Fogg
- Laboratory of Human Anatomy, Faculty of Biomedical and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - C Senthil Kumar
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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Stegeman M, Louwerens JWK, van der Woude JT, Jacobs WCH, van Ginneken BTJ. Outcome After Operative Fusion of the Tarsal Joints: A Systematic Review. J Foot Ankle Surg 2014; 54:636-45. [PMID: 25022614 DOI: 10.1053/j.jfas.2014.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Indexed: 02/03/2023]
Abstract
Arthrodesis of 1 or more joints of the hindfoot is performed to treat severe functional impairment due to pain, deformity, and/or instability. Evaluation of the results of hindfoot arthrodesis from the published data has been difficult owing to the great variety of pathologic entities and surgical techniques reported in the studies. A comprehensive search for relevant reports, reference lists, and citation tracking of the included studies was conducted using the PubMed(®), Embase(®), and CINAHL(®) databases. The studies had to have been prospective, included patients with hindfoot problems, evaluated arthrodesis of 1 or more tarsal joints, and had at least 1 of the following primary clinical outcome parameters: pain, function, or complications. Two of us independently selected the relevant studies using predefined criteria and graded the quality of evidence using a 0 to 9 star scale according to the Newcastle-Ottawa Scale. A total of 16 prospective case series were included; 5 studies scored 6 stars, 8 scored 5 stars, 2 scored 4 stars, and 1 scored 3 stars. A best evidence synthesis was performed, and improvement in function and pain was found for 3 combinations: talonavicular arthrodesis for rheumatoid arthritis, triple arthrodesis for rheumatoid arthritis, and subtalar arthrodesis for post-traumatic arthritis showed good results for pain and function, the last especially when performed arthroscopically. The best evidence syntheses revealed good results for pain and function for these disease-operative technique combinations.
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Affiliation(s)
- Mark Stegeman
- Department of Orthopaedics, Maartenskliniek Woerden, Woerden, The Netherlands.
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Cianforlini M, Marinelli M, Ponzio I, de Palma L. Chopart arthrodesis with graft bone from the iliac crest after a traumatic subamputation of the forefoot: surgical technique. J Surg Case Rep 2014; 2014:rju007. [PMID: 24876372 PMCID: PMC4164187 DOI: 10.1093/jscr/rju007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We present a 49-year-old man with a traumatic subamputation of the forefoot, associated with lacerated wound in correspondence of the dorsal surface of the right foot, with injuries of tendinous, ligamentous and vascular structures and with the loss of talus head. The patient underwent salvage arthrodesis of the talonavicular and calcanealcuboid joints with graft bone harvested from the iliac crest. The patient was re-evaluated during a clinical and radiographic follow-up. The arthrodesis was consolidated in ∼3 months. There were no infectious problems and the patient has resumed normal work activities. At a sixth month follow-up, the patient had returned to work and remained pain free while walking. Early anatomic reduction, stable fixation and ligament reconstruction are essential for a good outcome. Primary arthrodesis is a viable option for severe midfoot fracture dislocations, because it facilitates rehabilitation and functional recovery and obviates the need for a secondary arthrodesis should arthritis arise.
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Affiliation(s)
- Marco Cianforlini
- Clinical Orthopaedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Marinelli
- Clinical Orthopaedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Isabella Ponzio
- Clinical Orthopaedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi de Palma
- Clinical Orthopaedics, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Schuh R, Gruber F, Wanivenhaus A, Hartig N, Windhager R, Trnka HJ. Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet. INTERNATIONAL ORTHOPAEDICS 2013; 37:1815-20. [PMID: 23974840 DOI: 10.1007/s00264-013-2071-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Stage II posterior tibial tendon dysfunction (PTTD) can be treated by flexor digitorum longus (FDL) tendon transfer and medial displacement calcaneal osteotomy (MDCO). Numerous authors have studied the clinical and radiographic results of this procedure. However, little is known about the kinematic changes. Therefore, the purpose of this study was to assess plantar-pressure distribution in these patients. METHODS Seventy-three patients with PTTD stage II underwent FDL tendon transfer and MDCO. Plantar pressure distribution and American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed 48 months after surgery. Pedobarographic parameters included lateral and medial force index of the gait line, peak pressure (PP), maximum force (MF), contact area (CA), contact time (CT) and force-time integral (FTI). RESULTS In the lesser-toe region, PP, MF, CT, FTI and CA were reduced and MF in the forefoot region was increased. These changes were statistically significant. We found statistically significant correlations between AOFAS score and loading parameters of the medial midfoot. CONCLUSIONS Study results reveal that FDL tendon transfer and MDCO leads to impaired function of the lesser toes during the stance phase. However, there seems to be a compensating increased load in the forefoot region.
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Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedics, Medical University of Vienna, Austria.
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