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Zhu T, Qiu X, Deng H, Feng H, Chen J, Huang Z, Li J, Liu S, Wang S, Gu Z, Wu Z, Yang Q, Liu G, Sechi LA, Caggiari G, You C, Fu G. Clinical analysis of 1301 children with hand and foot fractures and growth plate injuries. BMC Musculoskelet Disord 2024; 25:270. [PMID: 38589862 PMCID: PMC11000401 DOI: 10.1186/s12891-024-07407-z] [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: 02/12/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment. METHODS We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed. RESULTS Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet. CONCLUSIONS In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.
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Affiliation(s)
- Tianfeng Zhu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Xin Qiu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Hansheng Deng
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
- Department of Biomedical Sciences, University of Sassari, 07100, Sassari, Italy
- Orthopaedic Department, Sassari University Hospital, 07100, Sassari, Italy
| | - Haoran Feng
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shantou, People's Republic of China
| | - Jianlin Chen
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shantou, People's Republic of China
| | - Zilong Huang
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Jiahui Li
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Shizhe Liu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Shuaiyin Wang
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Zhenkun Gu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | - Zhengyu Wu
- Clinical research center, Hefei cancer hospital, Chinese academy of sciences, Hefei, People's Republic of China
| | - Qisong Yang
- Hefei center for disease control and prevention, Hefei, People's Republic of China
| | - Gen Liu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China
| | | | | | - Chao You
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China.
| | - Guibing Fu
- Shenzhen Children's Hospital, Shenzhen, People's Republic of China.
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Wang B, Guan X, Hu Y, Jiang G, Lin Q, Ye J, Xiang D, Yu B. Multiple Reconstructive Osteotomy Treating Malunited Calcaneal Fractures Without Subtalar Joint Fusion. Orthop Surg 2023; 15:810-818. [PMID: 36718811 PMCID: PMC9977586 DOI: 10.1111/os.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Various surgical techniques have been reported in treating calcaneal malunions over the decades, while the operations on single plane were accompanied by respective limitations. The purpose of this study is to evaluate the efficacy of a novel multiple reconstructive osteotomy for treating malunited calcaneal fractures without subtalar joint fusion. METHODS From March 12, 2010, to August 17, 2017, 10 patients (10 feet) with malunited calcaneal fractures were treated with multiple reconstructive osteotomy with subtalar joint-preserving operations. All patients were treated with a corrective osteotomy, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 5.6 ± 2.41 months since the initial injury. With the utilization of the multiple reconstructive osteotomy, the posterior facet was restored to preserve the subtalar joint. All patients were evaluated clinically and radiographically at a mean follow-up of 3.04 ± 1.21 years. RESULTS All patients were subjectively satisfied with the treatment. The average time to union was 12.2 ± 1.11 weeks. The American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score was 86.3 ± 4.45 (t = 27.64, P < 0.0001, paired t-test), which was significantly higher than the preoperative assessment. Postoperative radiographic assessment revealed great improvement in Böhler's angle (from 25.4° to 86.3°), talocalcaneal height (65.15-72.68 mm) and Calcaneus-talus angle (from 34.46° to 39.7°). One patient had mild discomfort after a 1-h brisk walk. One patient was suspected to have early posttraumatic arthritis of the subtalar joint based upon radiographic evidence during the follow-up, but the patients could walk normally for a long time without pain. CONCLUSION Multiple reconstructive osteotomy is an effective way to restore the calcaneal morphology and preserve the subtalar joint for selected calcaneal malunion.
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Affiliation(s)
- Bowei Wang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Xin Guan
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yanjun Hu
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Guiyong Jiang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Qingrong Lin
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Jing Ye
- Department of OrthopaedicsYunfu People’s HospitalYunfuChina
| | - Dayong Xiang
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
| | - Bin Yu
- Division of Orthopaedic Trauma, Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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Ebben BJ, Myerson M. Management of the Subtalar Joint Following Calcaneal Fracture Malunion. Foot Ankle Clin 2022; 27:787-803. [PMID: 36368797 DOI: 10.1016/j.fcl.2022.08.001] [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: 11/09/2022]
Abstract
Subtalar joint arthrosis is common following intra-articular calcaneus fractures. The appropriate management of pain secondary to posttraumatic arthritis depends on the status of the remaining posterior facet articular cartilage, the magnitude of any residual joint displacement and distortions in the overall morphology of the calcaneus. In select circumstances, joint-preserving surgical techniques may be considered including lateral wall exostectomy, far lateral posterior facet joint debridement, and intra-articular osteotomies. When the subtalar joint is not salvageable, some form of arthrodesis procedure is pursued. Occasionally, an extra-articular osteotomy may be necessary in combination with arthrodesis to correct deformity.
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Affiliation(s)
- Benjamin J Ebben
- Department of Orthopedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA; Bellin Health Titletown Sports Medicine and Orthopedics, 1970 South Ridge Road, Green Bay, WI 54304, USA.
| | - Mark Myerson
- University of Colorado, Foot and Ankle Clinics of N. America, Steps2Walk, 11026 East Crestline Circle, Englewood, CO 80111, USA
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Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase. Appl Bionics Biomech 2022; 2022:7135040. [PMID: 35965839 PMCID: PMC9365579 DOI: 10.1155/2022/7135040] [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] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.
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Bloomer AK, McKnight RR, Johnson NR, Macknet DM, Wally MK, Yu Z, Seymour RB, Hsu JR. Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures. Foot Ankle Int 2022; 43:509-519. [PMID: 34996306 DOI: 10.1177/10711007211058689] [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: 02/01/2023]
Abstract
BACKGROUND The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. METHODS A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker's compensation claims. Plain radiographs were used to characterize injuries and review outcomes. RESULTS Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker's compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. CONCLUSION In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ainsley K Bloomer
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Nicholas R Johnson
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - David M Macknet
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Ziqing Yu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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Konovalchuk N, Sorokin E, Fomichev V, Chugaev D, Kochish A, Pashkova E, Mikhaylov K. Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option? Foot Ankle Int 2022; 43:42-48. [PMID: 34384274 DOI: 10.1177/10711007211027298] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning-even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. METHODS We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. RESULTS The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). CONCLUSION The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. LEVEL OF EVIDENCE Level III, retrospective cohort study, case series.
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Affiliation(s)
- Nikita Konovalchuk
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Evgenii Sorokin
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Viktor Fomichev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Dmitrii Chugaev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Alexander Kochish
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Ekaterina Pashkova
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Kirill Mikhaylov
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
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Guan X, Xiang D, Hu Y, Jiang G, Yu B, Wang B. Malunited calcaneal fracture: the role and technique of osteotomy-a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2663-2678. [PMID: 34240235 DOI: 10.1007/s00264-021-05130-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The research is aimed to introduce various corrective osteotomies utilized in treating calcaneal malunions in published papers, to further analyze the results, and to summarize recommended indications. METHODS The relevant research screening was conducted on the following search engines: the Cochrane Library, Web of Science, PubMed, Embase, Medline, and Academic Search Premier. Key words input included "calcaneal/calcaneus", "malunion," and "malunited fracture(s)" with Boolean operators "AND" and "OR." The inclusion criteria were researches containing surgical procedures treating calcaneal malunion with corrective osteotomy and published in the English language. For included research article, such information was extracted and analyzed: the type of calcaneal malunion, the time from initial injury to corrective surgery, the method of osteotomy, outcomes of each osteotomy (score systems, Bohler angle, talocalcaneal height and width of calcaneus, etc.), the function of the affected limb, post-operative complications, and patients' satisfaction. For included review, descriptive, commentary, or indicative sentences about corrective osteotomy were highlighted, analyzed, and summarized. RESULTS Ten research articles (170 patients with 184 feet) and nine reviews were included in this review, presenting seven types of corrective osteotomies (lateral wall exostectomy, Dwyer osteotomy, lateral wedge opening osteotomy, Romash osteotomy, tongue osteotomy, sagittal resection osteotomy, and modified Dwyer osteotomy). CONCLUSION A different corrective osteotomy with/without arthrodesis is recommended to be utilized based on the classification of the malunion and the condition of the cartilage in treating malunited calcaneal fractures. With adequate postoperative care and rehabilitation, the results of treatment could be associated with patients' satisfaction and good function.
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Affiliation(s)
- Xin Guan
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Dayong Xiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yanjun Hu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guiyong Jiang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bin Yu
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. .,Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Bowei Wang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Chraim M, Recheis S, Alrabai H, Wenzel-Schwarz F, Trnka HJ, Bock P. Midterm Outcome of Subtalar Joint Revision Arthrodesis. Foot Ankle Int 2021; 42:824-832. [PMID: 33940969 DOI: 10.1177/1071100721995187] [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 The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure. METHODS We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients' satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography. RESULTS A fusion rate of 80% was recorded whereas 20% of the cases ended with a painful pseudarthrosis requiring additional surgery. Pedobarographic measurements demonstrated that loading has a propensity toward the lateral column, but no substantial effect on the gait of patients. In this group, the following patient-reported outcomes were observed: 70% of the patients were satisfied, 20% of the patients found the result fair, and 10% were not satisfied with the results. Compared with the preoperative evaluation, postoperative functional scores showed significant improvement on the FOAS, AOFAS, and FFI outcome scales. CONCLUSION Revision arthrodesis of the subtalar joint remains a challenging issue with a relatively high rate of nonunion, especially in a population of patients with multiple risk factors. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Hamza Alrabai
- Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia
| | - Florian Wenzel-Schwarz
- Department of Paediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
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Gougoulias N, McBride D, Maffulli N. Outcomes of management of displaced intra-articular calcaneal fractures. Surgeon 2020; 19:e222-e229. [PMID: 33262043 DOI: 10.1016/j.surge.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
Despite the advances in operative management, displaced intra-articular calcaneal fractures (DIAFCs) are often associated with long term sequelae, permanent disability, a considerable reduction in quality of life, and a high socio-economic cost. Randomized controlled trials have shown that patient reported outcomes of surgery are no better than those of nonoperative management. Methodological flaws and selection bias may have influenced the results, however, and subgroup analysis showed that some patients could benefit from surgery, whilst patients' preference can be the decisive factor in choosing a management modality. Fractures with significant lateral wall displacement predisposing to impingements often require surgery, and management has to be individualized and tailored to the patient. Surgery does not usually achieve excellent results, though it exposes the patient to potential risks and complications. Wound healing problems and infections affect around 20% of patients when the extensile lateral approach has been used. Sinus tarsi approach and minimally invasive surgery may be viable alternatives, offering similar results with fewer wound complications, but most of the available studies are of low to moderate quality. Late subtalar joint arthrodesis is often required: however, such procedure would be less technically difficult and could result in better foot function should the shape of the calcaneus have been anatomically restored with surgery in the acute phase.
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Affiliation(s)
- Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley, United Kingdom; Foot & Ankle Clinic, Iaso Thessalias Hospital, Larisa, Greece
| | - Donald McBride
- University Hospital of North Midlands, Stoke on Trent, United Kingdom
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, United Kingdom; Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke-on-Trent, Staffordshire, ST4 7QB, United Kingdom.
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Abstract
Severe calcaneal malunions are debilitating conditions owing to substantial hindfoot deformity with subtalar arthritis and soft tissue imbalance. Type III malunions are best treated with a subtalar distraction bone block fusion. Additional osteotomies may be required for severe varus or superior displacement of the calcaneal tuberosity. Type IV malunions result from malunited calcaneal fracture-dislocations and require a 3-dimensional corrective osteotomy. Type V malunions warrant additional ankle debridement and reconstruction of the calcaneal shape to provide support for the talus in the ankle mortise. Accompanying soft tissue procedures include Achilles tendon lengthening, peroneal tendon release, and rerouting behind the lateral malleolus.
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