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Stone R, Dao T, Hill Z, Malay DS, Mendicino R. Defining the Structures at Risk and an Anatomical Safe Zone for Percutaneous Antegrade Subtalar Joint Fixation With a Single Screw: A Cadaveric Study. J Foot Ankle Surg 2024; 63:50-54. [PMID: 37666469 DOI: 10.1053/j.jfas.2023.08.012] [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: 03/30/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
Percutaneous antegrade (anterior to posterior) fixation for subtalar joint (STJ) arthrodesis offers various intraoperative and biomechanical advantages. Currently, the entry point for percutaneous antegrade STJ screw fixation is not clearly described and variable. To our knowledge, there are no publications that evaluate anatomic structures at risk or define an anatomically safe entry point for this fixation. The aim of this investigation was to define an anatomically safe and reproducible entry point for percutaneous antegrade STJ arthrodesis fixation, while also describing anatomic structures at risk when undertaking this method of fixation. We hypothesized that percutaneous single screw antegrade STJ fixation would encroach upon named anatomic structures in more than one cadaveric specimen. Ten cadaver limbs were used in this investigation. A percutaneous guidewire was inserted 5 mm lateral to the tibialis anterior tendon. The midpoint of the talar neck served as the sagittal plane starting point, as seen on the lateral fluoroscopic view. A cannulated 6.5-mm headed screw was inserted antegrade through the STJ into the calcaneus. Each specimen was dissected to assess the distance from the screw to nearby anatomic structures and distance from the tibialis anterior tendon to named structures. Our hypothesis was found to be incorrect, as 0/10 screws invaded neurovascular or tendinous structures. The dorsalis pedis artery and deep peroneal nerve were on average 12.1 ± 2.79 mm and 12.2 ± 2.82 mm lateral to the screw, respectively. These findings are clinically relevant and ultimately allow us to define an anatomic safe starting point for percutaneous antegrade STJ single screw fixation.
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Affiliation(s)
- Ryan Stone
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH.
| | - Tung Dao
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH
| | - Zachary Hill
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH
| | - D Scot Malay
- Staff Surgeon and Director of Podiatric Research, The Penn Presbyterian Medical Center, Philadelphia, PA
| | - Robert Mendicino
- Residency Program Director, OhioHealth Grant Medical Center, Columbus, OH
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Silvampatti SR, Dsouza TDL, Ramakanth R, Mehta M, Rajasekaran S. Inconclusive evidence that arthroscopic techniques yield better outcomes than open techniques for subtalar arthrodesis-A systematic review. J ISAKOS 2022; 8:114-121. [PMID: 36368634 DOI: 10.1016/j.jisako.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/26/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
IMPORTANCE Open in situ subtalar arthrodesis (ISTA) has been a standard procedure for treating subtalar arthritis for varied etiologies with good outcomes. There has been a paradigm shift from ISTA to arthroscopic subtalar arthrodesis (ASTA) over the past two decades due to increase in number of surgeons performing arthroscopy worldwide. However, there is only limited evidence in the existing literature to substantiate the benefit of this change with regards to patient benefit. To our knowledge, there are also no systematic reviews comparing the results of the two techniques for subtalar arthrodesis (STA). AIM Our systematic review aims to determine the superior technique for performing STA by comparing the outcomes, union rates, and complications between open and arthroscopic approach for in situ STA. We hypothesised that both procedures would have similar outcomes, union rates, time to union, and complication rate for in-situ STA. EVIDENCE REVIEW Three databases, MEDLINE/PubMed, the Cochrane Library, and Google Scholar, were searched using predefined inclusion and exclusion criteria to compare the two procedures. Risk of bias assessment was done using The Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool for assessing the risk of bias in the included studies. Weighted mean averages were computed for all parameters and tabulated separately for ASTA and ISTA. FINDINGS We included a total of 22 studies with a total of 978 (ASTA-310, ISTA-668) patients in the review. The most common indication for both techniques was post traumatic subtalar arthritis due to malunited calcaneal fracture in both groups (54.5%). The American Orthopaedic Foot & Ankle Society score was better in the ASTA group with a weighted average improvement of 43.4, while the weighted average improvement was 31.1 in the ISTA group, respectively. Patients undergoing ASTA had a weighted average union rate of 95.5% (standard deviation [SD]-3.6) with a weighted average time to union of 12.2 weeks (SD-2.4) while the ISTA group reported 90.7% (SD-6) union rate with a weighted average time to union of 15.5 weeks (SD-8.4). The weighted overall average complication rate was 13.1% (SD-8.9) in ASTA group and 20.3% (SD-16.2) in the ISTA group with hardware-related complications being the most common in both the groups. CONCLUSION From the existing literature, our review suggests that both ASTA and ISTA techniques are effective procedures for STA. However, there is no conclusive evidence to recommend one technique over another. High quality randomised studies may be further required to clearly define the superiority of one technique over another LEVEL OF EVIDENCE: level III.
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Affiliation(s)
| | - Terence Derryl L Dsouza
- Department of Arthroscopy and Foot & Ankle, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India.
| | - Rajagopalakrishnan Ramakanth
- Department of Arthroscopy and Foot & Ankle, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India.
| | - Meet Mehta
- Department of Arthroscopy and Foot & Ankle, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India.
| | - Shanmuganathan Rajasekaran
- Department of Arthroscopy and Foot & Ankle, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India.
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Rosli MA, Wan Ismail WF, Wan Sulaiman WA, Mat Zin NA, Abdul Halim S, Mat Johar F, Mat Saad AZ, Halim AS. Calcaneal Reconstruction With Free Deep Circumflex Iliac Artery Osseocutaneous Flap Following Aggressive Benign Bone Tumor Resection. Foot Ankle Int 2021; 42:1570-1578. [PMID: 34286617 DOI: 10.1177/10711007211025280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors. METHODS We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case. RESULTS The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either. CONCLUSION Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mohamad Aizat Rosli
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Faisham Wan Ismail
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Azman Wan Sulaiman
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nor Azman Mat Zin
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Syurahbil Abdul Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Fatimah Mat Johar
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Plastic & Reconstructive Unit, MSUMC, Management and Science University, University Drive, Off Persiaran Olahraga, Shah Alam, Selangor, Malaysia
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Morio H, Sugimoto K, Isomoto S, Nakamoto Y, Samoto N, Tanaka Y. Severe Talonavicular Osteoarthritis After a Neglected Navicular Stress Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00007. [PMID: 34237035 DOI: 10.2106/jbjs.cc.20.00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 17-year-old high school rugby player complained of right midfoot pain for 18 months. Radiographs showed severe osteoarthritic changes in the right talonavicular joint. A navicular fracture, talonavicular joint narrowing, a talar head cyst, and proximal navicular fragmentation were detected on computed tomography (CT). The patient underwent removal of the osteochondral fragments and fracture reduction and returned to rugby 8 months postoperatively. CT showed a remodeling of the talonavicular joint 2 years postoperatively. CONCLUSION In a young athlete, reconstruction of the talonavicular joint should be attempted before joint fusion, even if the joint shows signs of secondary osteoarthritis.
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Affiliation(s)
- Hidenori Morio
- Department of Orthopaedic Surgery, Nara Prefecture General Hospital, Nara, Japan
| | - Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Prefecture General Hospital, Nara, Japan
| | - Shinji Isomoto
- Department of Orthopaedic Surgery, Nara Prefecture General Hospital, Nara, Japan
| | - Yusuke Nakamoto
- Department of Orthopaedic Surgery, Nara Prefecture General Hospital, Nara, Japan
| | - Norihiro Samoto
- Department of Orthopaedic Surgery, Nara Prefecture General Hospital, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, School of Medicine, Nara, Japan
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Open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis for complex displaced intraarticular calcaneus fractures: An expected value decision analysis. OTA Int 2020; 1:e005. [PMID: 33937643 PMCID: PMC7953466 DOI: 10.1097/oi9.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
Objectives: To determine the optimal patient-oriented treatment between open reduction and internal fixation (ORIF) with or without primary subtalar arthrodesis (PSTA) for patients with displaced intraarticular calcaneus fractures (DIACFs, OTA 82-C3 and C4). Design: Expected value decision analysis. Setting: Academic military treatment facility Participants: One hundred randomly selected volunteers. Intervention: Hypothetical clinical scenario involving ORIF versus ORIF with PSTA. Main outcome measurements: Decision analysis was used to elucidate the superior treatment option based on expected patient values, composed of: the product of the average outcome probabilities established by previously published studies and the average ascribed patient utility values for each outcome probability. One-way sensitivity analysis was performed to quantify the amount of change required for the inferior treatment to equal or surpass the superior option. Results: Expected values for ORIF and ORIF with PSTA were 8.96 and 18.06, respectively, favoring ORIF with PSTA. One-way sensitivity analysis was performed by artificially decreasing the rate of secondary fusion following isolated ORIF thus increasing its overall expected value. Adjusting the rate of secondary fusion to 0%, the expected value of ORIF with PSTA nearly doubled that of ORIF (18.06 vs 9.45). Similarly, when adjusting the moderate and severe complication rates following ORIF with PSTA to 100%, the expected value of ORIF with PSTA still exceeded that of ORIF (15.45 vs 8.96, and 13.52 vs 8.96, respectively). Conclusion: Expected value decision analysis favors ORIF with PSTA as the optimal treatment for complex DIACF.
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Golec P, Golec J. Evaluation of Long-Term Quality of Life Using the Foot and Ankle Outcome Score (FAOS) Questionnaire in Patients Treated by Minimally Invasive Reduction and Percutaneous Stabilization of Intra-Articular Calcaneal Fractures. Med Sci Monit 2020; 26:e921602. [PMID: 32347218 PMCID: PMC7204125 DOI: 10.12659/msm.921602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Treatment of displaced intra-articular calcaneal fractures is controversial. Choosing the optimal surgical technique is very important for patient quality of life and activity. In this study, we asked the question: “What is the long-term quality of life of patients after intra-articular calcaneal fractures treated by minimally invasive reduction and percutaneous stabilization (MIRPS)?”. Material/Methods We included 51 patients – 45 males (88%) and 6 females (12%) – who underwent MIRPS of intra-articular calcaneal fractures. The males were ages 22–63 years, with a mean age of 46 years, while the females were aged 31–63, with a mean age of 47 years. The FAOS (Foot and Ankle Outcome Score) survey was used. Results Women’s FAOS scores were 72–95%, with a mean of 82%, and varied according to type of fracture, surgery method used, and comorbid fractures. Men’s FAOS scores were 50–95%, with a mean of 84%, and varied according to type of fracture, surgery method used, and comorbid fractures. Conclusions According to set criteria regarding the FAOS scale, mainly good and very good results were observed in patients treated surgically for intra-articular calcaneus fractures using MIRPS. Westhues’ method scored a significantly higher foot rating than W-R (Westhues’-Rąpała method). Patients with TTF (tongue-type fracture) scored higher in the FAOS than patients treated with JDTF (joint depression-type fracture). In other cases, no significant differences were observed.
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Affiliation(s)
- Piotr Golec
- Department of Traumatology and Orthopedics, University Children's Hospital of Cracow, Cracow, Poland.,Department of Traumatologic Surgery and Orthopedics, 5th Military Hospital with Policlinic Independent Public Health Care Centre in Cracow, Cracow, Poland
| | - Joanna Golec
- Department of Rehabilitation in Traumatology, Academy of Physical Education, Cracow, Poland
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7
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Ma ZJ, Bai LP, Zhang GM, Zhang LB, Chen Z. Natural Value of Böhler's Angle in Normal Chinese Population. Orthop Surg 2019; 11:1201-1208. [PMID: 31773895 PMCID: PMC6904593 DOI: 10.1111/os.12560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To determine the value of Böhler's angle (BA) in a group of Chinese people, analyze possible factors that influence it, and compare BA with that in previous literature. Methods A total of 143 cases, aged from 4 to 79 years, were enrolled in the study, including 64 males and 79 females (79 left feet and 64 right feet). Radiographs were independently measured by six observers. Age, sex, body side, subtalar joint congruity (STJC), and X‐beam obliquity (TT) were recorded. The database was assessed based on intraobserver agreement, data distribution, the randomness of case selection, and the ratio equality of binomial variables. Then, the normal value of BA was established, as well as the correlation between BA and other parameters. Results In the present study, the interobserver reliability of BA, STJC, and TT was excellent. The BA data revealed a normal distribution, and the randomness of case selection was verified for age, sex, and body side. The ratio of sex and body side was equal. Homogeneity of variance was observed when comparing the value of BA between different groups. The value of BA was 31.6° ± 5.19° (range, 20.08°–47.19°), which was not related to age, sex, body side, and minor X‐ray beam obliquity. BA application was not suitable for individuals younger than 10 years. The mean value of BA in this study was not identical with those in previous reports. This demonstrated that BA varies for different races. Conclusion For Chinese people, 30° to 33° is recommended as the target value of BA for calcaneal fracture reduction, except in children under 10 years of age.
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Affiliation(s)
- Zhi-Jian Ma
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China.,Trauma Center, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Li-Ping Bai
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Guang-Ming Zhang
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Lian-Bi Zhang
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhong Chen
- Trauma Center, The Second People's Hospital of Yunnan Province, Kunming, Yunnan, China
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Duan XJ, Fan HQ, Wang FY, He P, Yang L. Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis. Orthop Surg 2019; 11:405-413. [PMID: 31106975 PMCID: PMC6595118 DOI: 10.1111/os.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. METHODS We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. RESULTS All customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). CONCLUSION It is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.
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Affiliation(s)
- Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fu-You Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng He
- Chongqing Institute of Optics and Mechanics, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Comparison between subtalar joint quantitative kinematic 4-D CT parameters in healthy volunteers and patients with joint stiffness or chronic ankle instability: A preliminary study. Eur J Radiol 2019; 114:76-84. [DOI: 10.1016/j.ejrad.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/06/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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10
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Vilá-Rico J, Ojeda-Thies C, Mellado-Romero MÁ, Sánchez-Morata EJ, Ramos-Pascua LR. Arthroscopic posterior subtalar arthrodesis for salvage of posttraumatic arthritis following calcaneal fractures. Injury 2018; 49 Suppl 2:S65-S70. [PMID: 30219150 DOI: 10.1016/j.injury.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subtalar arthrodesis is a treatment option for pain due to posttraumatic arthritis following calcaneal fractures. The goal of this study is to examine the results of arthroscopic subtalar arthrodesis for posttraumatic arthritis following calcaneal fractures. PATIENTS AND METHODS We performed a retrospective case series reviewing 37 consecutive patients (36 male) treated for posttraumatic arthritis following calcaneal fractures by arthroscopic subtalar arthrodesis. The fractures were due to high-energy injuries in 81% of cases, and 12 fractures (32.4%) had been previously treated with internal fixation. Average follow-up was 57.5 months. RESULTS Average American Orthopedic Foot and Ankle Society (AOFAS) scores significantly improved from 49.0 ± 10.9 points preoperatively to 76.0 ± 8.0 points at final follow-up. Average time to union was 12.5 weeks. Six patients (16.2%) suffered complications: superficial wound infection (2.7%), symptomatic hardware that warranted removal (5.4%) and nonunion (8.1%) presented nonunion. All three cases had prior internal fixation through an extensile lateral approach, and fused after a repeat surgery. CONCLUSION Arthroscopic subtalar arthrodesis offers consistent improvement in cases of posttraumatic arthritis following calcaneal fractures, with a union rate similar to published series of open arthrodesis. We observed more nonunions in patients who had been treated previously with internal fixation. In spite of this, we continue to recommend arthroscopic subtalar arthrodesis, as it preserves the soft tissue envelope better than open techniques.
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Affiliation(s)
- Jesús Vilá-Rico
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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11
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Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2017.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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12
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Harb A, von Horn A, Gocalek K, Schäck LM, Clausen J, Krettek C, Noack S, Neunaber C. Lactated Ringer-based storage solutions are equally well suited for the storage of fresh osteochondral allografts as cell culture medium-based storage solutions. Injury 2017; 48:1302-1308. [PMID: 28571706 DOI: 10.1016/j.injury.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Due to the rising interest in Europe to treat large cartilage defects with osteochondrale allografts, research aims to find a suitable solution for long-term storage of osteochondral allografts. This is further encouraged by the fact that legal restrictions currently limit the use of the ingredients from animal or human sources that are being used in other regions of the world (e.g. in the USA). Therefore, the aim of this study was A) to analyze if a Lactated Ringer (LR) based solution is as efficient as a Dulbecco modified Eagle's minimal essential medium (DMEM) in maintaining chondrocyte viability and B) at which storage temperature (4°C vs. 37°C) chondrocyte survival of the osteochondral allograft is optimally sustained. METHODS 300 cartilage grafts were collected from knees of ten one year-old Black Head German Sheep. The grafts were stored in four different storage solutions (one of them DMEM-based, the other three based on Lactated Ringer Solution), at two different temperatures (4 and 37°C) for 14 and 56days. At both points in time, chondrocyte survival as well as death rate, Glycosaminoglycan (GAG) content, and Hydroxyproline (HP) concentration were measured and compared between the grafts stored in the different solutions and at the different temperatures. RESULTS Independent of the storage solutions tested, chondrocyte survival rates were higher when stored at 4°C compared to storage at 37°C both after short-term (14days) and long-term storage (56days). At no point in time did the DMEM-based solution show a superior chondrocyte survival compared to lactated Ringer based solution. GAG and HP content were comparable across all time points, temperatures and solutions. CONCLUSION LR based solutions that contain only substances that are approved in Germany may be just as efficient for storing grafts as the USA DMEM-based solution gold standard. Moreover, in the present experiment storage of osteochondral allografts at 4°C was superior to storage at 37°C.
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Affiliation(s)
- Afif Harb
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Alexander von Horn
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Kornelia Gocalek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Luisa Marilena Schäck
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Jan Clausen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Sandra Noack
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Claudia Neunaber
- Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Abstract
Introduction An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults. Indications & Contraindications Step 1 Preoperative Planning Perform a comprehensive clinical and radiographic assessment. Step 2 Patient Positioning Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg. Step 3 Incision Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal. Step 4 Approach Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons. Step 5 Joint Preparation Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone. Step 6 Reduction and Fixation Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws. Step 7 Wound Closure Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position. Step 8 Postoperative Care The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks. Results Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications. Pitfalls & Challenges
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