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Yeager MT, Nihalani S, Rutz RW, Mohammed ZJ, Hargreaves M, McCrosson M, Scheinberg M, Singh S, Shah AB. Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion. Foot Ankle Int 2024; 45:412-418. [PMID: 38282285 DOI: 10.1177/10711007231224793] [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: 01/30/2024]
Abstract
BACKGROUND The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. METHODS In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. RESULTS The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. CONCLUSION This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr.Level of Evidence:Level V, mechanism-based reasoning..
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Affiliation(s)
- Matthew T Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shrey Nihalani
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert W Rutz
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zuhair J Mohammed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mathew Hargreaves
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew McCrosson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Swapnil Singh
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashish B Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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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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Fadle AA, El-Adly W, Attia AK, Mohamed MM, Mohamadean A, Osman AE. Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts. INTERNATIONAL ORTHOPAEDICS 2021; 45:2219-2229. [PMID: 33895880 PMCID: PMC8494666 DOI: 10.1007/s00264-021-05041-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.
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Affiliation(s)
- Amr A. Fadle
- Orthopedic Department, Assiut University, Assiut, Egypt
| | - Wael El-Adly
- Orthopedic Department, Assiut University, Assiut, Egypt
| | - Ahmed Khalil Attia
- Orthopedic Surgery Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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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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Hu D, Zhang Y, Liang X, Li Y, Zhao H. [Effectiveness of talonavicular arthrodesis for Müller-Weiss disease]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1434-1437. [PMID: 29806382 DOI: 10.7507/1002-1892.201703052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (-2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (-2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones ( P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.
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Affiliation(s)
- Dong Hu
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Yan Zhang
- Xi'an Medical University, Xi'an Shaanxi, 710068, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054,
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hongmou Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.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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