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Badell JS, Cottom JM. Operative Time, Cost, and Union Rate of Power Rasp Joint Preparation Versus Traditional Preparation in Arthrodesis of the Foot and Rearfoot. J Foot Ankle Surg 2024; 63:456-463. [PMID: 38494112 DOI: 10.1053/j.jfas.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon's practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.
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Affiliation(s)
- Jay S Badell
- Fellowship Trained Foot and Ankle Surgeon; Fellowship Surgery Faculty, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.
| | - James M Cottom
- Fellowship Trained Foot and Ankle Surgeon; Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
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Perkins JM, Vacketta VG, Prissel MA. Triple Arthrodesis: How to Manage Failures, Malunion, and Nonunion. Clin Podiatr Med Surg 2023; 40:649-668. [PMID: 37716743 DOI: 10.1016/j.cpm.2023.05.008] [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] [Indexed: 09/18/2023]
Abstract
Nonunions are managed by general principles that govern other bone healing sites; however, when confounding with malunion, additional attention must be given. Malunited triple arthrodesis requires a thorough understanding of biomechanical and surgical principles for adequate revision surgery. Due to the rigid nature of arthrodesis surgery on a weight-bearing surface, malunited fusions have very low patient tolerance. The lack of joints leads to a block of bone that can be corrected via derotational osteotomies with wedge supplementation. However, even if a rectus foot is achieved, compensatory motion via the ankle joint commonly causes arthritic long-term sequelae.
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Affiliation(s)
- Jacob M Perkins
- Orthopedic Foot and Ankle Center Advanced Foot and Ankle Reconstruction Fellowship, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA.
| | - Vincent G Vacketta
- Orthopedic Foot and Ankle Center Advanced Foot and Ankle Reconstruction Fellowship, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA
| | - Mark A Prissel
- Advanced Foot and Ankle Reconstruction, Orthopedic Foot and Ankle Center, 350 W. Wilson Bridge Road, Street. 200, Worthington, OH 43085, USA
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Casciato D, Wynes J. The Navicular Cuneiform Joint: Updates on Avoiding and Managing a Nonunion. Clin Podiatr Med Surg 2023; 40:613-621. [PMID: 37716740 DOI: 10.1016/j.cpm.2023.05.006] [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] [Indexed: 09/18/2023]
Abstract
Naviculocuneiform arthrodesis, while often used to support the medial column during management of primary/post-traumatic arthritis, deformity correction, or in the surgical treatment of progressive collapsing foot deformity, can develop nonunion. Addressing this condition hinges on the assessment of various parameters such as patient/host factors and recognition of the etiology of the nonunion. In this article, methods of optimizing this surgical intervention through anatomic and physiologic considerations are highlighted. Further, information is provided to assist foot and ankle surgeons in performing a comprehensive work-up to allow for successful reconstruction and optimal patient outcomes.
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Affiliation(s)
- Dominick Casciato
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob Wynes
- Department of Orthopaedics, Limb Preservation and Deformity Correction Fellowship, University of Maryland School of Medicine, Baltimore, MD, USA.
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Elhessy AH, Annasamudram A, Wu S, Conway JD. The Trans-Achilles Approach for Plate Supplementation of Ankle Arthrodesis With an Existing Hindfoot Fusion Nail: A Case Report. Cureus 2023; 15:e39569. [PMID: 37378212 PMCID: PMC10292673 DOI: 10.7759/cureus.39569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Tibiotalar arthrodesis revision surgeries are not uncommon. Several approaches have been described in the literature for ankle arthrodesis nonunions. In this article, we describe the posterior trans-Achilles approach, which ensures adequate surgical exposure while minimizing damage to the surrounding soft tissues. It provides a convenient method for utilizing bone grafts or substitutes and allows for the advantageous application of posterior plating. The possible complications of this approach are delayed wound healing, wound infection, injury to the sural nerve, and the potential need for a skin graft. Despite the advantages of this approach, infection, delayed union, and nonunion risks remain high in this patient population. Finally, the trans-Achilles approach is valid for complex ankle procedures, especially in revisions with compromised ankle soft tissue envelopes.
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Affiliation(s)
- Ahmed H Elhessy
- Medicine, University of Maryland School of Medicine, Baltimore, USA
- Orthopedics, The Rubin Institute for Advanced Orthopedics/Sinai Hospital, Baltimore, USA
| | - Abhijith Annasamudram
- Orthopedics, The Rubin Institute for Advanced Orthopedics/Sinai Hospital, Baltimore, USA
| | - Stephanie Wu
- Podiatry, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Baltimore, USA
| | - Janet D Conway
- Orthopedics, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Baltimore, USA
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Sagherian BH, Hoballah JJ, Tamim H. Comparing the 30-Day Complications Between Smokers and Nonsmokers Undergoing Surgical Fixation of Ankle Fractures. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221115677. [PMID: 35959141 PMCID: PMC9358578 DOI: 10.1177/24730114221115677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: There have been conflicting reports regarding the effect of smoking on complications after surgical treatment of ankle fractures. This study aimed at identifying the complications for which smokers and subgroups of smokers are at a higher risk compared to nonsmokers when undergoing surgery for fixation of rotational ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program data set from 2008 to 2019 was used to compare the 30-day wound, cardiac, renal, and infectious complications, related readmissions, and return to the operating room between the 2 cohorts. Results: Of 33 741 patients included, 25 642 (76.0%) were nonsmokers and 8099 (24.0%) were smokers. Multivariate analysis showed that smokers were at a higher risk for deep wound infection (OR 2.34, 95% CI 1.48-3.69, P < .001), wound dehiscence (OR 2.43, 95% CI 1.56-3.77, P < .001), related return to the operating room (OR 1.69, 95% CI 1.36-2.11, P < .001), and related readmissions (OR 1.67, 95% CI 1.32-2.09, P < .001). Smokers at an increased risk for deep infection included patients between 50 and 59 years (OR 5.75, 95% CI 1.78-18.5, P = .003), who were Black (OR 4.24, 95% CI 1.04-17.23, P = .044), who had body mass index (BMI) 35 to 39.9 (OR 3.73, 95% CI 1.46-9.50, P = .006), or operative times between 60 and 90 minutes (OR 3.64, 95% CI 1.79-7.39, P < .001). Smoker subgroups at a higher risk for wound dehiscence included patients between 50 and 59 years (OR 9.86, 95% CI 3.29-29.53, P < .001), with operative times between 90 and 120 minutes (OR 4.88, 95% CI 1.89-12.58, P < .001), with BMI 30 to 34.9 (OR 3.06, 95% CI 1.45-6.45, P = .003) and who underwent spinal/epidural anesthesia (OR 9.31, 95% CI 2.31-37.58, P = .002). Conclusion: Smokers were at an increased risk for deep wound infection, wound dehiscence, related reoperations, and related readmissions after ankle fracture surgery. Certain subgroups were at an even higher risk for these complications. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Bernard H. Sagherian
- Division of Orthopedic Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jawad J. Hoballah
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit in the Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hembree WC, Gallagher BW, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2022; 104:857-863. [PMID: 35316249 DOI: 10.2106/jbjs.21.01562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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