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Shams A, Gamal O, Mesregah MK. Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study. Foot Ankle Spec 2023; 16:28-35. [PMID: 33511858 DOI: 10.1177/1938640020987750] [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: 11/16/2022]
Abstract
BACKGROUND Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Ahmed Shams
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Osama Gamal
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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Development of the center of pressure velocity in the healing process after intra-articular calcaneus fractures. Gait Posture 2022; 95:135-140. [PMID: 35489225 DOI: 10.1016/j.gaitpost.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/15/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcaneal fractures are among the most common foot injuries and sometimes develop manifold post-surgical complications. Restricted foot movement is one of the main functional limitations which often persists during long-term rehabilitation. Therefore, it is important to quantitatively monitor the biomechanical foot mobility after calcaneal fracture from an early stage in order to achieve an optimal therapeutic treatment. RESEARCH QUESTION Evaluation of the Center of Pressure velocity (vCOP) in patients after intrarticular calcaneal fractures during the healing progress from three to 24 months after surgery. METHODS A total of 20 patients with unilateral calcaneal fracture were investigated by means of pedobarography and marker-based gait analysis at three, six, 12 and 24 months after surgery. Data for vCOP [m/s], maximum external dorsal extension moments during stance (DEmomentstance) and tibiotalar range of motion during mid stance (MS) and terminal stance (TS) were obtained. Functional evaluation was performed using clinical examination (e.g. calf circumference measurements) and patient-reported outcome measures (SF-36). RESULTS When compared to the healthy side, vCOP of the injured side showed a significant reduction during MS (3 months: 48%, p < 0.001; 6 months: 13%; p = 0.040) and an significant increase during TS (3 months: 110%, p < 0.001; 6 months: 43%, p < 0.001; 12 months: 17%, p = 0.012). DEmomentstance of the fractured foot, showed a significant increase of 80% (p < 0.001) from three to 24 months after surgery, which correlated with vCOP at three and six months after surgery (p < 0.05; vCOP MS: 3 months: r = 0.876, 6 months: r = 0.685; vCOP TS: 3 months: r = -0.554, 6 months r = -0.626). SIGNIFICANCE vCOP might serve as an indicator for foot mobility and function during the early healing phase after calcaneal fractures. As vCOP can be obtained by pedobarography it is more readily accessible an less costly compared to foot function obtained by marker based gait analysis.
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Kasnakova P, Mihaylova A, Djurdjev B, Tornyova B. Randomized controlled trial of multidisciplinary rehabilitation therapy using mobile applications in cases of ankle fractures. Eur J Transl Myol 2022; 32. [PMID: 35638576 PMCID: PMC9295163 DOI: 10.4081/ejtm.2022.10471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
A multidisciplinary approach to rehabilitation in patients with ankle fractures is needed to return to their daily activities. Mobile health applications can improve or optimize the rehabilitation process. The purpose of this study is to monitor the efficiency of a modified and validated rehabilitation scheme for the functional rehabilitation of the lower limbs. The subjects of the study are patients in the post-immobilization and post-operative period. The algorithm of procedures administered to the patients were performed by physiotherapists and monitored via mobile apps. The results show a reduction of the swelling and the pain, overcoming the muscular imbalance, enhanced stabilization, correct way of walking, and an improved quality of life of the patients with ankle fractures. Despite a certain trend towards residual deficit, the implementation of kinesitherapeutic means creates the necessary background on the basis of which specialized methods can be applied - joint-mobilizing techniques and passive stretching, for the purpose of the full recovery of the functions of the lower extremity. The application of mobile apps optimizes the recovery process and increases access to rehabilitation.
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Affiliation(s)
| | | | - Boris Djurdjev
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv.
| | - Biyanka Tornyova
- Department of Health Care Management, Faculty of Public Health, Medical University of Plovdiv.
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Morsi IM, Khalifa AA, Hussien MA, Abdellatef A, Refae H. Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF). Foot (Edinb) 2020; 45:101740. [PMID: 33011495 DOI: 10.1016/j.foot.2020.101740] [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: 04/16/2020] [Revised: 07/06/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Optimum management of displaced intra-articular calcaneal fractures (DIACF) still controversial. Open surgery carries the risk of wound complications, while non-operative management has a high incidence of arthrosis. To avoid these complications, minimally invasive and percutaneous fixation was introduced. The purpose of this study was to prospectively evaluate the short term clinical and radiological outcomes after closed reduction and percutaneous fixation of DIACF using K-wires. PATIENTS AND METHODS Outcomes of twenty patients were evaluated at the final follow up. A functional assessment using the AOFAS scoring system. Radiological parameters recorded included three angles (Böhler's, Gissane and posterior facet inclination angles) and three distances (calcaneal length, height and width). Any complications were reported at any follow-up. RESULTS The mean patient's age was 33 ± 15.2 years, 8 (40%) patients with type II fractures, 10 (50%) patients with type III fractures, and 2 (10%) with type IV fracture according to Sanders classification. After a mean follow-up of 9 months, the mean AOFAS score was 84, excellent in 9 patients (45%), good in 9 (45%), and fair in 2 (10%). At the final follow-up the Böhler's angle, Gissane angle and PFIA was 25.1° ± (5.2), 119.9° ± (9.4) and 51.7° ± (5.9) respectively and the calcaneal height, length and width was 41.8 mm ± (2.1), 75.1 mm ± (3.01) and 40.9 mm ± (2.6) respectively. We had no cases of deep infection, 20% had significant subtalar arthritis. CONCLUSION The closed reduction and percutaneous fixation technique for DIACF management offered acceptable clinical and radiographic outcomes, with fewer complications when compared to other management options.
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Affiliation(s)
- Ibrahim Mahmoud Morsi
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | | | - Ahmed Abdellatef
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Hesham Refae
- Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
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Eceviz E, Çevik HB, Öztürk O, Özen T, Çolak TK, Çolak İ, Polat MG. Pedobarographic, Clinic, and Radiologic Evaluation after Surgically Treated Lisfranc Injury. J INVEST SURG 2020; 34:1191-1197. [PMID: 32654544 DOI: 10.1080/08941939.2020.1790700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lisfranc injuries are rare, often missed, and may cause permanent structural deterioration of tarsometatarsal joint, despite optimal management. Consequently, a Lisfranc injury may lead to disruption of the biomechanics of the normal foot during walking and may alter the plantar pressure distribution, which is essential for proper gait mechanics. Therefore, the main purpose of the study was to specify the dynamic plantar pressure, radiographic and clinical features, after surgically managed Lisfranc injuries. METHODS This study was carried out over a period of 10 years and included 62 patients who were surgically treated for Lisfranc injury, with mean 57-month follow-up. Radiological (intermetatarsal, Kite's, first metatarsophalangeal, Meary's, Hibbs' and calcaneal pitch angles, and medial cuneiform-fifth metatarsal distance), pedobarographical, and clinical results with the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score assessments for both feet were assessed. RESULTS In the radiological assessment, the mean first intermetatarsal (p = 0.006) and Meary's angle (p = 0.000) were decreased on the injured feet compared to the uninjured feet on the anteroposterior and lateral radiographs. In the pedobarographic assessment, the injured feet midfoot contact time increased (p = 0.03), and maximum force (p = 0.001), total peak pressure (p = 0.008), and contact area (p = 0.017) decreased, compared to the uninjured feet. The mean AOFAS score was 75/100 at the final follow-up visit. There was seen to be reduced both contact surface area and time of the midfoot. CONCLUSION Despite surgical management of Lisfranc injuries, the injured foot does not regain functional, radiological, or pedobarographical levels as compared to the uninjured foot for ≥ 57 months.
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Affiliation(s)
- Engin Eceviz
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Hüseyin Bilgehan Çevik
- Department of Orthopaedics and Traumatology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Orhan Öztürk
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Tuğçe Özen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Tuğba Kuru Çolak
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
| | - İlker Çolak
- Department of Orthopaedics and Traumatology, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Mine Gülden Polat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
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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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Peña Fernández M, Hoxha D, Chan O, Mordecai S, Blunn GW, Tozzi G, Goldberg A. Centre of Rotation of the Human Subtalar Joint Using Weight-Bearing Clinical Computed Tomography. Sci Rep 2020; 10:1035. [PMID: 31974489 PMCID: PMC6978465 DOI: 10.1038/s41598-020-57912-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/06/2020] [Indexed: 11/09/2022] Open
Abstract
Accurate in vivo quantification of subtalar joint kinematics can provide important information for the clinical evaluation of subtalar joint function; the analysis of outcome of surgical procedures of the hindfoot; and the design of a replacement subtalar joint prosthesis. The objective of the current study was to explore the potential of full weight-bearing clinical computed tomography (CT) to evaluate the helical axis and centre of rotation of the subtalar joint during inversion and eversion motion. A subject specific methodology was proposed for the definition of the subtalar joint motion combining three-dimensional (3D) weight-bearing imaging at different joint positions with digital volume correlation (DVC). The computed subtalar joint helical axis parameters showed consistency across all healthy subjects and in line with previous data under simulated loads. A sphere fitting approach was introduced for the computation of subtalar joint centre of rotation, which allows to demonstrate that this centre of rotation is located in the middle facet of the subtalar joint. Some translation along the helical axis was also observed, reflecting the elasticity of the soft-tissue restraints. This study showed a novel technique for non-invasive quantitative analysis of bone-to-bone motion under full weight-bearing of the hindfoot. Identifying different joint kinematics in patients with ligamentous laxity and instability, or in the presence of stiffness and arthritis, could help clinicians to define optimal patient-specific treatments.
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Affiliation(s)
- Marta Peña Fernández
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK.
| | - Dorela Hoxha
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK
| | - Oliver Chan
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Simon Mordecai
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Gordon W Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, PO1 2DT, UK
| | - Gianluca Tozzi
- Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK
| | - Andy Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
- MSK Lab, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UK
- The London Ankle & Arthritis Centre, The Wellington Hospital, Wellington Place, London, NW8 9LE, UK
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