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Bernasconi A, Izzo A, D'Agostino M, Mariconda M, Coviello A. Role of fibular autograft in ankle arthrodesis fixed using cannulated screws: a proportional meta-analysis and systematic review. Sci Rep 2023; 13:18614. [PMID: 37903965 PMCID: PMC10616077 DOI: 10.1038/s41598-023-46034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/26/2023] [Indexed: 11/01/2023] Open
Abstract
Ankle arthrodesis is commonly performed to treat end-stage ankle osteoarthritis. The aim of this study was to determine whether the use of fibular autograft might increase the fusion rate and decrease the complication rate in ankle arthrodesis (AA) fixed using cannulated screws. To perform this PRISMA-compliant proportional meta-analysis, multiple databases were searched for studies in which patients undergone AA (using exclusively cannulated screws and augmented with fibular bone graft) were followed. The characteristics of the cohort, the study design, surgical details, the nonunion and complication rate at the longest follow-up were extracted and recorded. The modified Coleman Methodology Score (mCMS) was applied to appraise the quality of studies. Two groups were built: arthrodeses fixed with screws combined with cancellous autograft (G1) and arthrodeses fixed with screws combined with cancellous autograft and augmented with a lateral fibular onlay (G2). A third group (arthrodeses fixed with screws and no graft, G3) was extracted from previous literature for a further comparison. Overall, we included 306 ankles (296 patients) from ten series (ten studies). In G1 and G2 there were 118 ankles (111 patients) and 188 ankles (185 patients), respectively. In patients where cancellous autograft was used, a further augmentation with a fibular lateral strut autograft did not change significantly the nonunion (4% [95% CI 1-9] in G1 vs. 2% [95% CI 0-5) in G2, p = 0.99) nor the complication rate (18% [95% CI 0-36] in G1 vs. 13% [95% CI 6-21) in G2, p = 0.71). Upon comparison with 667 ankles (659 patients, G3) in which arthrodeses had been performed without grafting, the nonunion and complication rates did not differ significantly either (pooled estimates: 3% [95% CI 1-3) in G1 + G2 vs. 3% [95% CI 2-4] in G3, p = 0.73 for nonunion; 15% [8-23] in G1 + G2 vs. 13% [95% CI 9-17] in G3, p = 0.93 for complications). In ankle arthrodesis fixed with cannulated screws combined with cancellous autograft at the fusion site, a construct augmentation with a distal fibular onlay strut graft positioned laterally at the ankle joint does not reduce the risk of nonunion or complication. In general, the use of bone graft does not influence significantly the nonunion nor the complication rate as compared to non-grafted screw-fixed ankle arthrodeses.Kindly check and confirm the corresponding author mail id is correctly identified.It's all correct.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Antonio Izzo
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Martina D'Agostino
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
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deMeireles AJ, Guzman JZ, Nordio A, Chan J, Okewunmi J, Vulcano E. Complications After Percutaneous Osteotomies of the Calcaneus. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221119731. [PMID: 36046552 PMCID: PMC9421033 DOI: 10.1177/24730114221119731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Open hindfoot surgery is associated with a relatively high rate of complications, including neurovascular injuries and wound healing problems compared with percutaneous techniques. However, there is a scarcity of literature describing the outcomes of these percutaneous techniques given their relatively recent adoption. The present study aims to assess the rate of postoperative complications for 3 commonly performed percutaneous calcaneal osteotomies. Methods: One hundred eighteen patients (unilateral feet) were treated with one of 3 common percutaneous calcaneal osteotomies. Sixty-five patients (55.1%) were treated with a medializing calcaneal osteotomy for hindfoot valgus, 32 patients with a Zadek osteotomy (27.1%) for insertional Achilles tendinopathy, and 21 patients (17.8%) with a modified Dwyer osteotomy for hindfoot varus. Fisher exact test was used to assess for associations between categorical variables. Results: The mean age was 46.2 years and there was a mean follow-up of 16.1 months. The overall rate of postoperative complications was 3.4% (n = 4), and no significant differences were found between the different osteotomy types. Complications included 2 cases (1.7%) of transient neuritis, 1 case of prolonged wound drainage (0.8%), and 1 nonunion (0.8%). None of the complications were associated with any recorded preoperative comorbidity. Discussion: In this series, we found that percutaneous calcaneal osteotomies are a safe alternative method for the treatment of conditions involving the hindfoot. The rate of postoperative complications may be less when compared to the reported rates of open hindfoot correction and should be considered in patients with a traditionally high risk of developing a postoperative complication. Level of Evidence: Level IV, retrospective analysis.
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Affiliation(s)
- Alirio J. deMeireles
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Javier Z. Guzman
- Leni & Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Nordio
- Leni & Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jimmy Chan
- Leni & Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Okewunmi
- Leni & Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ettore Vulcano
- Columbia University Orthopaedics at Mount Sinai Medical Center, Miami Beach, FL, USA
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Bouchard M, Ross TD. Bony Procedures for Correction of the Flexible Pediatric Flatfoot Deformity. Foot Ankle Clin 2021; 26:915-939. [PMID: 34752244 DOI: 10.1016/j.fcl.2021.09.001] [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] [Indexed: 02/02/2023]
Abstract
The pediatric flexible flatfoot is a common foot shape that is most often asymptomatic and may be a physiologic variant of normal. Surgery is only indicated when nonoperative interventions have failed to resolve symptoms. The goal of surgery is to alleviate symptoms by improving hindfoot alignment and restoring the medial arch while preserving joint mobility. This article focuses on the common bony techniques for surgical correction of the pediatric flexible flatfoot that has failed nonoperative management, including calcaneal, midfoot, and supramalleolar osteotomies and distal tibial hemiepiphyseodesis.
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Affiliation(s)
- Maryse Bouchard
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedic Surgery, The University of Toronto, Toronto, Canada.
| | - Tayler Declan Ross
- Division of Orthopaedic Surgery, The University of Toronto, 500 University Avenue #602, Toronto, Ontario M5G 1V7, Canada
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Walther M, Hörterer H, Harrasser N, Röser A, Gottschalk O. Minimal-invasive Komponenten der Therapie der Tibialis-posterior-Insuffizienz des Erwachsenen. DER ORTHOPADE 2020; 49:962-967. [DOI: 10.1007/s00132-020-03990-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saxena A, Patel R. Medial Displacement Calcaneal Osteotomy: A Comparison of Screw Versus Locking Plate Fixation. J Foot Ankle Surg 2016; 55:1164-1168. [PMID: 27640930 DOI: 10.1053/j.jfas.2016.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Indexed: 02/03/2023]
Abstract
Locking plate fixation is becoming more popular for fixation of lower extremity osteotomies. The present study evaluated locking plate fixation compared with screw fixation in the medial displacement calcaneal osteotomy procedure, measuring the outcomes and rate of hardware removal. The procedure was performed on 30 patients, 31 times, with 17 undergoing single screw fixation and 14 undergoing locking plate fixation. The return to activity was 6.87 ± 1.43 months, including some patients for whom running was their main activity. No malunions, nonunions, displacements, or infections developed. In 3 patients (21.4%), the locking plate was removed compared with 1 patient (5.9%) who required screw removal. The difference was not significant (p = .30). No differences were found in their postoperative American Orthopaedic Foot and Ankle Scale scores (91.9 ± 7.7 with plates versus 94.4 ± 5.8 with screws; p = .36). The Roles and Maudsley scores were the same in the 2 groups preoperatively at 4.0 ± 0.0, with the postoperative scores improving to 1.50 ± 0.5 and 1.41 ± 0.5 for the plate and screw group, respectively (p = .62). No significant increase was seen for patients undergoing hardware removal, regardless of the adjunctive procedure used (i.e., flexor digitorum longus/Kidner, Lapidus or midfoot fusion, subtalar arthroereisis, and endoscopic gastrocnemius recession). The stage of posterior tibialis dysfunction had no significant difference in the postoperative scores. From the results of the present study, we have concluded that using a locking plate or a single screw for fixation of the medial displacement calcaneal osteotomy provides acceptable patient outcomes and that the differences in the rate of hardware removal were not statistically significant between the 2 groups.
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Affiliation(s)
- Amol Saxena
- Podiatrist, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.
| | - Rajan Patel
- Former Fellow, Palo Alto Medical Foundation, Palo Alto, CA
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Lee M, Guyton GP, Zahoor T, Schon LC. Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip. J Foot Ankle Surg 2016; 55:1121-6. [PMID: 27286926 DOI: 10.1053/j.jfas.2016.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 02/03/2023]
Abstract
As a standard open approach, the lateral oblique incision has been widely used for calcaneal displacement osteotomy. However, just as with other orthopedic procedures that use an open approach, complications, including wound healing problems and neurovascular injury in the heel, have been reported. To help avoid these limitations, a percutaneous technique using a Shannon burr for calcaneal displacement osteotomy was introduced. However, relying on a free-hand technique without direct visualization at the osteotomy site has been a major obstacle for this technique. To address this problem, we developed a technical tip using a reference Kirschner wire. A reference Kirschner wire technique provides a reliable and accurate guide for minimally invasive calcaneal displacement osteotomy. Also, the technique should be easy to learn for surgeons new to the procedure.
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Affiliation(s)
- Moses Lee
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD; Orthopaedic Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Gregory P Guyton
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Talal Zahoor
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Lew C Schon
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
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Abstract
Different types of posterior calcaneal osteotomy are used for calcaneal realignment in the management of hindfoot deformity. We describe a percutaneous technique of posterior calcaneal osteotomy that can be either a Dwyer-type closing wedge osteotomy or displacement osteotomy.
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Affiliation(s)
- Tun Hing Lui
- Consultant, Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territory, Hong Kong Special Administrative Region, People's Republic of China.
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Didomenico LA, Anain J, Wargo-Dorsey M. Assessment of medial and lateral neurovascular structures after percutaneous posterior calcaneal displacement osteotomy: a cadaver study. J Foot Ankle Surg 2011; 50:668-71. [PMID: 21907595 DOI: 10.1053/j.jfas.2011.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Indexed: 02/03/2023]
Abstract
A prospective investigation of the effects on the medial and lateral neurovascular structures of the rearfoot after percutaneous posterior calcaneal displacement osteotomy was performed using 20 below the knee fresh frozen cadaver specimens. This anatomic study aimed to examine the medial and lateral neurovascular structures to determine whether they were jeopardized during execution of the osteotomy. After completion of the osteotomy, the medial plantar, lateral plantar, medial calcaneal, sural, and posterior tibial neurovascular structures, along with their respective branches, were inspected for iatrogenic injury. Our findings demonstrated that the percutaneous, subperiosteal osteotomy minimized trauma to the local soft tissue envelope and protected the adjacent neurovascular structures. Because no iatrogenic injury was observed in the cadaveric specimens, we postulated that percutaneous calcaneal displacement osteotomy is a safe, predictable, and advantageous alternative compared with open techniques for osteotomy and could result in reduced postoperative complications. The results of this investigation remain to be confirmed in the clinical setting.
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Affiliation(s)
- Lawrence A Didomenico
- Department of Podiatry, Department of Surgery, St. Elizabeth Health Center, Youngstown, OH, USA.
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