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Tahmasbi A, Shadmehr A, Attarbashi Moghadam B, Fereydounnia S. Does Kinesio taping of tibialis posterior or peroneus longus have an immediate effect on improving foot posture, dynamic balance, and biomechanical variables in young women with flexible flatfoot? Foot (Edinb) 2023; 56:102032. [PMID: 37019042 DOI: 10.1016/j.foot.2023.102032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Flexible flatfoot is common in young adults. One of its causes is the failure of dynamic stabilizers, which play an important role in the medial longitudinal arch support, and their appropriate function is necessary for the integrity of the lower extremity and the spine. OBJECTIVE The study aimed to determine Kinesio taping on which extrinsic foot muscle provides greater benefit regarding enhancement of foot posture, dynamic balance, and biomechanical parameters in functional tasks immediately. METHODS Thirty women were recruited for the study. They were randomly divided into groups (A = 15, B = 15). In group A, Kinesio taping was applied on the tibialis posterior (TP), and in group B, Kinesio taping was applied on the peroneus longus (PL) and remained for 30 min. Outcome measures were the navicular drop test (NDT), foot posture index (FPI), Y-balance test, and biomechanical parameters in functional tasks. Before/After within-group and between-group comparisons of outcome measures were performed. RESULTS NDT and FPI decreased in both groups (p < 0.05) with no significant difference between groups. In group A, maximum total force of the stance phase (MaxTFSP) during running increased, and some temporal parameters were changed. (p < 0.05). In group B, Y-balance test improved in all directions, and the width of the gait line during walking increased. There were no significant differences in the postural stability parameters in the within-group comparison, except for mean center of pressure displacement in group B (p = 0.04). CONCLUSION Kinesio taping of both muscles could improve foot posture. TP Kinesio taping can increase the MaxTFSP during running and alter some temporal parameters during walking and running tasks. PL Kinesio taping could lead to better dynamic stability and coordination during dynamic tasks. Each muscle can be considered a therapeutic target for a specific purpose.
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Affiliation(s)
- Alireza Tahmasbi
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadmehr
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Sara Fereydounnia
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Change in Center of Pressure Progression in the Foot Provides Clues for Functional Improvement of the More Affected Lower Limb During Post-stroke Gait Rehabilitation. Am J Phys Med Rehabil 2021; 100:229-234. [PMID: 32732748 DOI: 10.1097/phm.0000000000001548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (apCoP) in post-stroke gait rehabilitation. DESIGN This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The apCoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between apCoP changes and spatiotemporal parameter changes were investigated. RESULTS The apCoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the apCoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the apCoP on the more affected side. CONCLUSION The change in apCoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The apCoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation.
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Li Z, Wu X, Zhou H, Xu S, Xiao F, Huang H, Yang Y. Cost-utility analysis of extensile lateral approach versus sinus tarsi approach in Sanders type II/III calcaneus fractures. J Orthop Surg Res 2020; 15:430. [PMID: 32948240 PMCID: PMC7501640 DOI: 10.1186/s13018-020-01963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes, and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results One hundred nine patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory, and radiographic evaluation expense, surgery, anesthesia, and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P < .001, P = .008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P < .001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8 ± 2835.2/QALY and $7914.9 ± 1822.0/QALY respectively, and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials. Level of evidence 5
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Affiliation(s)
- Zihua Li
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Xinbo Wu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Shaochen Xu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Fajiao Xiao
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Hui Huang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
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Ortu S, Brusoni M, Pisanu F, Caggiari G, Ciurlia E, Bienati F, Manunta AF, Doria C, Manca M. Functional and radiological outcomes in displaced heel fractures: Open reduction and internal fixation versus external fixation. Orthop Rev (Pavia) 2020; 12:8506. [PMID: 32922697 PMCID: PMC7461638 DOI: 10.4081/or.2020.8506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
Management of intra-articular heel fractures is controversial. The main goals of surgical treatment are restoring subtalar articular congruence and width, height, form and alignment of the heel. The gold standard is considered Open Reduction and Internal Fixation (ORIF), a complex technique with a high rate of complications. External Fixation (EF) could be a good alternative. In this study were identified 37 fractures in 35 patients (24 patients underwent ORIF and EF was performed in 13 cases) and the outcomes of the two techniques were compared. The mean surgical time for ORIF was 107.8 minutes, while for EF was 88.61 minutes and the ORIF group presented a higher rate of complications, despite of similar results in the mean postoperative AOFAS Ankle and Hindfoot Scale scores (73.31/100 points in the ORIF group and 75.40/100 points in the EF group). Fast learning curve, short surgery time and low complications rate make EF an alternative to ORIF in treating intraarticular heel fractures.
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Affiliation(s)
| | | | | | | | | | | | | | - Carlo Doria
- Orthopaedic Department, University of Sassari
| | - Mario Manca
- Orthopaedic Department, Versilia Hospital, Italy
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Popkov D, Dolganova T, Mingazov E, Dolganov D, Kobyzev A. Combined technique of titanium telescopic rods and external fixation in osteogenesis imperfecta patients: First 12 consecutive cases. J Orthop 2020; 22:316-325. [PMID: 32675919 DOI: 10.1016/j.jor.2020.05.017] [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: 04/30/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction The major limitation of any intramedullary telescopic system is rotational and longitudinal instability. The combination of telescopic system with an external fixator in patients with osteogenesis imperfecta (OI) demonstrated advantages of stability, early weight-bearing and rehabilitation. This study aimed to examine the outcomes of deformity correction by combined technique uniting titanium telescopic rod and reduced Ilizarov frame in children with types III or IV of OI with a minimum 1-year follow-up. Material and methods The study included 12 children with OI who underwent femoral deformity correction (20 segments) or tibial deformity correction (4 segments) by combined technique. The children ranged in age between 2 years and 3 months and 12 years and 4 months (mean: 8.9 ± 2.02 years) at the time of the rodding. Parameters of surgery, clinical examination data, data of 3D gait analysis were assessed in the study. Results External fixation lasted 35.8 ± 13.2 days in average. Neither loss of threaded fixation in the distal femoral and tibial epiphyses and apophysis of the greater trochanter nor migration of the rod into the knee and ankle joints were observed in follow-up. No secondary rotational or longitudinal bone displacement was noted. Telescoping gain related to spontaneous growth assessed at one-year follow-up control was 13.7 mm in the tibia and 15.9 mm in the femur. There were no deep infection or neurologic complications. The alignment measured by radio anatomical reference angles was maintained throughout the follow-up period.Gait abnormalities in postoperative period were caused by bulk and weight of EF: external hip rotation, slight external angle of foot progression, increased stride width and increased hip abduction angle. The second feature was reduced ROM in sagittal plane at all levels associated with significantly reduced ankle plantarflexion, hip and knee joint moments in comparison to kinetics of limb without EF. These abnormalities resolved by the one-year assessment. Conclusion The combination of titanium telescopic rod with reduced external fixation is reliable advantage in reconstructive orthopaedic surgery for OI children. Reduced external fixation allows to overcome inconveniencies of longitudinal and rotational instability of telescopic systems. Children were able to walk with weight-bearing since early postoperative period because of external fixation. Gait temporary changes were influenced by external device size and by strategy to reduce pin site pain.
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Affiliation(s)
- Dmitry Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Tamara Dolganova
- Ilizarov National Medical Center for Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Eduard Mingazov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Dmitry Dolganov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Andrey Kobyzev
- Ilizarov National Medical Center for Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
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Sanders FRK, Peters JJ, Schallig W, Mittlmeier T, Schepers T. What is the added value of pedobarography for assessing functional outcome of displaced intra-articular calcaneal fractures? A systematic review of existing literature. Clin Biomech (Bristol, Avon) 2020; 72:8-15. [PMID: 31783218 DOI: 10.1016/j.clinbiomech.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Displaced intra-articular calcaneal fractures often result in permanent disability, reduced quality of life and high socio-economic costs. Since they often result in a change in geometry of the foot, pedobarography may be useful in predicting outcome at an early stage. The aim of this study was to examine whether a correlation exists between pedobarography and functional outcomes in patients with a displaced intra-articular fracture. METHODS In this systematic review, studies were included when they investigated the correlation between pedobarography and functional outcome in displaced intra-articular calcaneal fractures. Excluded were studies on <10 patients or on animals/cadavers. Collected were baseline patient/treatment characteristics, pedobarographic data (peak pressures, maximum force and centre of pressure) and functional outcome scores. FINDINGS Out of 153 abstracts, 40 remained for full text screening and 9 were included. Pedobarographic measurements (pressure plate or insoles) showed a lateralization of centre of pressure, decreased pressures underneath the hindfoot, first and second toe and increased pressure underneath the midfoot and forefoot. Correlations with functional outcome were found in some combined pedobarographic results (entire foot/multiple measurements), but hardly in pressures underneath specific foot areas. INTERPRETATION Even though increased or decreased pressures in specific areas of the foot may not be directly related to functional outcome, combined scores often did. For pedobarography to serve as a prediction tool, it should be more standardised. However, assessing centre of pressure and altered peak pressures underneath the foot, may be useful in developing customized aids such as insoles, aiming for a more individualized improvement.
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Affiliation(s)
- Fay R K Sanders
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jess J Peters
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam UMC, Univ. of Amsterdam, Department of Radiology and Nucleair Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Thomas Mittlmeier
- Rostock University Medical Center, Dept. of Trauma, Hand and Reconstructive Surgery, Schillingallee 35, 18057 Rostock, Germany
| | - Tim Schepers
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Jandova S, Pazour J, Janura M. Comparison of Plantar Pressure Distribution During Walking After Two Different Surgical Treatments for Calcaneal Fracture. J Foot Ankle Surg 2019; 58:260-265. [PMID: 30658959 DOI: 10.1053/j.jfas.2018.08.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 02/03/2023]
Abstract
The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.
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Affiliation(s)
- Sona Jandova
- Associate Professor, Technical University of Liberec, Liberec, Czech Republic.
| | - Jan Pazour
- Surgeon, Traumacenter, Liberec Regional Hospital, Liberec, Czech Republic
| | - Miroslav Janura
- Professor, Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
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Foot Function After Surgically Treated Intraarticular Calcaneal Fractures: Correlation of Clinical and Pedobarographic Results of 65 Patients Followed for 8 Years. J Orthop Trauma 2018; 32:593-600. [PMID: 30277980 DOI: 10.1097/bot.0000000000001325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To correlate functional deficits after surgical treatment of displaced intraarticular calcaneal fractures (DIACFs) as measured through dynamic pedobarography with clinical and radiographic long-term results. DESIGN Retrospective single-center study. SETTING Level 1 trauma center. PATIENTS Sixty-five patients with unilateral DIACFs, reexamined at an average of 8.1 years after surgery. INTERVENTION Internal fixation of DIACF with lateral plate or percutaneous screws. MAIN OUTCOME MEASUREMENTS Dynamic pedobarography, AOFAS, Zwipp, SF-36 scores, Foot Function Index, Böhler angle, and articular congruity. RESULTS When compared with the uninjured side, pedobarography of the operated foot revealed a significantly increased contact area of the hindfoot and midfoot, with a decreased contact area under first/second metatarsal (MT) and first/second toe after DIACF. Maximum pressure and pressure time integral were significantly increased at the midfoot and lateral MT with a decrease under the hindfoot and first to second MT/toe. Midfoot pressure time integral correlated with the range of plantarflexion. Fracture classification correlated with MT 1 contact time. Hindfoot and MT contact times were negatively correlated with Böhler angle. Patients with the smallest side-to-side differences in pedobarogaphy had overall highest scores and significantly greater ankle/hindfoot range of motion at follow-up. CONCLUSIONS Significant correlations were found between clinical and pedobarographic results. Increased contact areas and time at the midfoot indicating a lateral load shift correlated with inferior outcome and decreased subtalar motion. These results support the importance of reconstruction of the subtalar joint and overall bony morphology of the calcaneus with preservation of subtalar motion as necessary for global foot function. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Layton RB, Stewart TD, Harwood P, Messenger N. Biomechanical analysis of walking gait when simulating the use of an Ilizarov external fixator. Proc Inst Mech Eng H 2018; 232:628-636. [DOI: 10.1177/0954411918776694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Ilizarov frame is an external fixation device, primarily used for the treatment of complex fractures. The authors postulate that the size and weight of the frame may lead to biomechanical adaptations to gait, independent to any injury. Temporospatial characteristics, kinetics and kinematics were assessed when simulating the use of an Ilizarov frame. Fifteen healthy participants performed walking trials, with and without the simulated frame. Significant changes to temporospatial characteristics were identified, with a decreased mean walking speed (with: 1.24 m s–1; without: 1.29 m s–1) and increased mean step width (with: 0.14 m; without: 0.11 m). The push-off phase of gait differed significantly between test conditions with mean increases in ankle dorsiflexion angles (with: 90.4°; without: 89.0°) and extension moments (proportional to body weight or P BWT) at the knee and ankle (knee with: 0.8 P BWT·m; without: 0.7 P BWT·m; ankle with: 1.6 P BWT·m; without: 1.6 P BWT·m). Although changes were small and likely to be clinically insignificant, the size and weight of the frame led to adaptations which may be magnified for patient groups with associated injury and pain at the lower limb. Results provide an argument for the potential redesign of the frame.
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Affiliation(s)
- Robin B Layton
- School of Biomedical Sciences, University of Leeds, Leeds, UK
- Department of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Todd D Stewart
- Department of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Paul Harwood
- Leeds Major Trauma Centre, Leeds General Infirmary, Leeds, UK
| | - Neil Messenger
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Esparon T, Thomson CM, Rea PM, Jamal B. Circular frame fixation for calcaneal fractures risks injury to the medial neurovascular structures: A cadaveric description. Injury 2016; 47:2700-2705. [PMID: 27773371 DOI: 10.1016/j.injury.2016.10.005] [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: 07/18/2016] [Accepted: 10/13/2016] [Indexed: 02/02/2023]
Abstract
AIM There is a risk of iatrogenic injury to the soft tissues of the calcaneus and this study assesses the risk of injury to these structures in circular frame calcaneal fracture fixation. MATERIALS AND METHODS After olive tip wires were inserted, an L-shaped incision on the lateral and medial aspects of 5 formalin fixed cadaveric feet was performed to expose the underlying soft tissues. The calcaneus was divided into zones corresponding to high, medium and low risk using a grading system. RESULTS Structures at high risk included the posterior tibial artery, posterior tibial vein and posterior tibial nerve on the medial aspect. Soft tissue structures on the lateral side that were shown to be at lower risk of injury were the small saphenous vein and the sural nerve and the tendons of fibularis longus and fibularis brevis. CONCLUSION The lateral surface of the calcaneus provides a lower risk area for external fixation. The risk of injury to significant soft tissues using a circular frame fixation approach has been shown to be greater on the medial aspect. CLINICAL RELEVANCE This study highlights the relevant anatomical relations in circular frame fixation for calcaneal fractures to minimise damage to these structures.
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Affiliation(s)
- Tom Esparon
- Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK
| | - Callum M Thomson
- Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK
| | - Paul M Rea
- Laboratory of Human Anatomy, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, Univeristy of Glasgow, UK.
| | - Bilal Jamal
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, UK
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van Hoeve S, Poeze M. Outcome of Minimally Invasive Open and Percutaneous Techniques for Repair of Calcaneal Fractures: A Systematic Review. J Foot Ankle Surg 2016; 55:1256-1263. [PMID: 27555351 DOI: 10.1053/j.jfas.2016.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 02/03/2023]
Abstract
Percutaneous and minimally invasive open techniques for the treatment of calcaneal fractures are now frequently used with good results, although a comparison between these different techniques has not yet been performed. The aim of the present review was to search for studies evaluating the outcomes of patients after treatment with percutaneous and minimally invasive open techniques for calcaneal fractures. A search was performed using PubMed/MEDLINE, Embase, and the Cochrane Library. Studies from the previous 15 years in English were included. Data on the Sanders classification, operation technique, infection rate, American Orthopaedic Foot and Ankle Society ankle-hindfoot score, radiographic evaluation, and follow-up were extracted. The techniques were divided into 4 groups: minimally invasive open, percutaneous reduction and screw osteosynthesis, external fixation, and other. Forty-six studies were included, with 1776 patients and 2018 calcaneal fractures. Of the 2018 fractures, 924 (46%) were classified as Sanders II, 558 (28%) as Sanders III, and 245 (12%) as Sanders IV; the fractures of 291 patients(14%) were not classified or were classified as complete extra-articular. Of the 46 studies, 15 used a minimally invasive open technique, 19 evaluated the outcome of percutaneous reduction and screw osteosynthesis, 10 investigated the results of an external fixation system, and 2 studies used other operative techniques. The median infection rate was 3% (range 0% to 33%). The median American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 83 (range 67 to 94). The median angle of Böhler postoperatively was 24° (range 14° to 35°) and had increased after operative treatment, with a median of 16° (range 0° to 39°). The percutaneous reduction and screw osteosynthesis and minimal invasive open technique resulted in significantly better outcomes compared with external fixation and other techniques. In conclusion, percutaneous reduction and screw osteosynthesis and minimal invasive open techniques have the best outcomes for the minimal invasive open surgical treatment of calcaneal fractures.
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Affiliation(s)
- Sander van Hoeve
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Martijn Poeze
- Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Hetsroni I, Ben-Sira D, Nyska M, Ayalon M. Plantar Pressure Anomalies After Open Reduction With Internal Fixation of High-Grade Calcaneal Fractures. Foot Ankle Int 2014; 35:712-8. [PMID: 24713132 DOI: 10.1177/1071100714531226] [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 Plantar pressure abnormalities after open reduction with internal fixation (ORIF) of intra-articular calcaneal fractures have been observed previously, but high-grade fractures were not selectively investigated and follow-up times were shorter than 2 years. The purpose of this study was to characterize plantar pressure anomalies in patients with exclusively high-grade calcaneal fractures after ORIF with a minimum 2 years of follow-up, and to test the association between plantar pressure distribution and the clinical outcome. METHODS The orthopaedic registry was reviewed to identify patients with isolated high-grade calcaneal fractures (Sanders types III-IV) who were operated on and had a minimum 2 years of follow-up. Sixteen patients were evaluated. Mean age was 47 years and follow-up was between 2 and 6 years. The Pedar-Mobile system was used to measure 3 loading and 3 temporal variables and compare these between the operated and the uninjured limbs. RESULTS Mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 76 ± 7 at latest follow-up. Bohler's angle was 5 ± 8 degrees before surgery and 25 ± 7 degrees at latest follow-up. Stance was shorter in operated limbs (P = .001). Timing of the peak of pressure was delayed in operated limbs under the hallux and the second toe (P ≤ .03). Peak pressure, force time integral, and pressure time integral were increased under the lateral midfoot (P ≤ .03) and decreased under the second metatarsal (P ≤ .03). Force time integral was decreased under the first metatarsal (P = .02) and under the hallux and the lateral toes (P ≤ .05). Increased loading under the lateral midfoot and decreased loading under the lateral toes were correlated with poorer clinical outcome (r = -.53, P < .05, and r = .63, P < .01, respectively). CONCLUSIONS Side-to-side plantar pressure mismatch persisted at more than 2 years after ORIF of high-grade calcaneal fractures performed via lateral approach, despite improvement of Bohler's angle. This was characterized by shortened stance phase, delayed timing of peak of pressure under the hallux and second toe, lateral load shift at the midfoot, and decreased toe pressures in operated limbs. Since loading abnormalities were correlated with the clinical outcome, modifications in treatment strategy that can improve foot loading may be desirable in these cases. LEVEL OF EVIDENCE Level III, case control.
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Affiliation(s)
- Iftach Hetsroni
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ben-Sira
- Biomechanics Laboratory, Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
| | - Meir Nyska
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Ayalon
- Biomechanics Laboratory, Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
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Bégué T, Mebtouche N, Auregan JC, Saintyves G, Levante S, Cottin P, Masquelet AC. External fixation of the thalamic portion of a fractured calcaneus: a new surgical technique. Orthop Traumatol Surg Res 2014; 100:429-32. [PMID: 24736015 DOI: 10.1016/j.otsr.2014.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/13/2013] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
The optimal treatment for intra-articular calcaneus fractures remains controversial, despite internal fixation techniques providing good results. The major point of contention is the need to reconstruct the overall morphology versus to restore the anatomy of the subtalar joint perfectly. We will describe a two-stage technique for treating intra-articular calcaneus fractures in which the primary fracture line goes through the thalamic fragment. The first procedure focuses on the overall morphology by restoring the height and length with osteotaxis being accomplished with a medial external fixator. The second procedure consists of internal fixation through a minimally invasive lateral approach to restore the anatomy of the articular facets. Any defects are filled with injectable bone substitute. This novel technique is compared to the complication rates and radiology and anatomy outcomes in published studies. This two-stage surgical technique reduces the length of hospital stays and the number of complications.
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Affiliation(s)
- T Bégué
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - N Mebtouche
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - J-C Auregan
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - G Saintyves
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - S Levante
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - P Cottin
- Orthopaedic and Trauma Surgery Department, hôpital Antoine-Béclère, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - A-C Masquelet
- Service de chirurgie orthopedique et traumatologique, hôpital Avicenne, Bobigny, France
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Atallah L, Wiik A, Lo B, Cobb JP, Amis AA, Yang GZ. Gait asymmetry detection in older adults using a light ear-worn sensor. Physiol Meas 2014; 35:N29-40. [DOI: 10.1088/0967-3334/35/5/n29] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fu TH, Liu HC, Su YS, Wang CJ. Treatment of displaced intra-articular calcaneal fractures with combined transarticular external fixation and minimal internal fixation. Foot Ankle Int 2013; 34:91-8. [PMID: 23386767 DOI: 10.1177/1071100712460364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate clinical outcomes after surgery for displaced intra-articular fractures using an external fixator and minimal internal fixation. METHODS In this retrospective observational study, a total of 39 patients (32 [82%] men and 7 [18%] women) with 48 displaced intra-articular calcaneal fractures were included. An extended lateral approach was used to stabilize fractures using multiple sagittal plane screws, axial percutaneous threaded Kirschner wires for the frontal fracture plane, and an external fixator for reduction assistance and maintenance. The following variables were assessed: preoperative and postoperative Böhler's angle; calcaneal length, height, and width; postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores; and complications. Mean duration of follow-up was 74 ± 26 months. RESULTS The mean time from surgery to external fixator removal was 12 ± 1 weeks. The mean preoperative Böhler's angle (-3 ± 21 degrees), calcaneal length (7.9 ± 0.6 cm), and calcaneal height (3.6 ± 0.5 cm) were significantly increased (P < .05) at final follow-up (28.3 ± 6.5, 8.3 ± 0.6, and 4.5 ± 0.5, respectively), whereas the mean preoperative calcaneal width (4.2 ± 0.5) was significantly decreased from the final follow-up mean (3.8 ± 0.5). There were no significant differences between any of the normal and postoperative measures. The mean AOFAS score was 82 ± 12. Complications included superficial pin tract infection (n = 7, 15%), superficial wound edge necrosis (n = 4, 8%), and deep infection (n = 2, 4%). CONCLUSION Our findings suggest that use of an external fixator with minimal internal fixation is an effective option for treating displaced intra-articular calcaneal fractures. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Te-Hu Fu
- Division of Emergency and Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Besch L, Waldschmidt JS, Daniels-Wredenhagen M, Varoga D, Mueller M, Hilgert RE, Mathiak G, Oestern S, Lippross S, Seekamp A. The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results. J Foot Ankle Surg 2010; 49:8-15. [PMID: 20123280 DOI: 10.1053/j.jfas.2009.07.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Indexed: 02/03/2023]
Abstract
We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. Long-term follow-up was performed after an average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed according to Sanders classification. Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the final method of treatment (group I). A change to open reduction with internal fixation was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group II). There were no late amputations, osteomyelitis, or malunions. According to Sanders classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures. Pin loosening or pin infection was seen in 4 cases, but there was no redislocation. The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%, and any shortening or deviation of the axis was corrected in 82% of the cases. The AOFAS score for the group averaged 66.5. According to Sanders classification, group II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in 88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences in patient outcome scores between open reduction with internal fixation and hinged fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle joint, the risk of infection is minimized, and secondary plate fixation remains possible.
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Affiliation(s)
- Lutz Besch
- Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Tarkin IS, Sop A, Pape HC. High-energy foot and ankle trauma: principles for formulating an individualized care plan. Foot Ankle Clin 2008; 13:705-23. [PMID: 19013404 DOI: 10.1016/j.fcl.2008.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Care of the patient with high-energy foot and ankle trauma requires an individualized care plan. Staged treatment respecting the traumatized soft tissue envelope is often advisable. Wound care is a priority, and the vacuum-assisted closure dressing serves an integral role. Before definitive reconstruction, the surgeon needs to develop a treatment plan designed to match the unique personality of the patient and injury. Amputation is considered a rational treatment option for the patient with severe injury and poor host biology. Despite the most appropriate management, many severe foot and ankle injuries have a guarded prognosis.
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Affiliation(s)
- Ivan S Tarkin
- University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, 3471 Fifth Avenue, Pittsburgh, PA 15213 412-605-3252, USA.
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