1
|
Deformity Correction of the Midfoot/Hindfoot/Ankle. Clin Podiatr Med Surg 2022; 39:233-272. [PMID: 35365325 DOI: 10.1016/j.cpm.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The correction of the deformed arthritic foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible bony procedures and arthrodesis that maybe performed. The appropriate work up and understanding of the pathomechanics is vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection is done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct deformity of the midfoot, hindfoot, and ankle. This article will also discuss the authors' technique and pearls.
Collapse
|
2
|
Valiyev N, Demirel M, Hürmeydan ÖM, Sünbüloglu E, Bozdağ E, Kılıçoğlu Ö. The Effects of Different Screw Combinations on the Initial Stability of Ankle Arthrodesis. J Am Podiatr Med Assoc 2021; 111. [PMID: 35294161 DOI: 10.7547/20-241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs. METHODS We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed. RESULTS There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation). CONCLUSIONS Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site.
Collapse
|
3
|
Arena CB, Roush EP, Kunselman AR, Juliano PJ, Aydogan U, Lewis GS. Distal fibula osteotomies improve tibiotalar joint compression: A biomechanical study in a cadaveric model. Clin Biomech (Bristol, Avon) 2019; 62:23-27. [PMID: 30658156 DOI: 10.1016/j.clinbiomech.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/30/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Successful tibiotalar joint fusion relies on adequate compression. Compression following joint preparation may be affected by the extent to which the fibula holds the joint out to anatomical length. The purpose of this study was to evaluate the effect of various distal fibula osteotomies on tibiotalar joint compression. METHODS Eight adult cadaveric lower extremity specimens with an intact ankle joint and syndesmotic complex were evaluated. The ankle joint cartilage was denuded to subchondral bone. The fibula was surgically modified with three progressing procedures including an oblique fibula osteotomy, 1 cm resection, and distal fibula resection. A transducer was utilized to measure tibiotalar joint force, contact area, and peak pressure values while compressive forces of 30 N, 50 N, and 100 N were applied to the proximal tibia/fibula. FINDINGS Distal fibula resection significantly increased tibiotalar joint force, contact area, and peak pressure the most of all fibula conditions tested compared to intact fibula control (p < .05). Tibiotalar joint force and peak pressures were significantly increased with a distal fibula oblique osteotomy, 1 cm resection, and complete resection under both 30 and 50 N applied compressive force (p < .05). INTERPRETATION Complete distal fibular resection results in higher tibiotalar joint force, contact area, and peak pressure which may improve clinical rates of successful ankle fusion.
Collapse
Affiliation(s)
- Christopher B Arena
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA
| | - Evan P Roush
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
| | - Paul J Juliano
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA
| | - Umur Aydogan
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA
| | - Gregory S Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA.
| |
Collapse
|
4
|
Williamson P, Lechtig A, Hanna P, Okajima S, Biggane P, Nasr M, Zurakowski D, Duggal N, Nazarian A. Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses. Foot Ankle Int 2018; 39:994-1000. [PMID: 29696991 DOI: 10.1177/1071100718770659] [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 Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. METHODS Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. RESULTS The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. CONCLUSION The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. CLINICAL RELEVANCE The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.
Collapse
Affiliation(s)
- Patrick Williamson
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,2 Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Aron Lechtig
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Okajima
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Biggane
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Nasr
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Zurakowski
- 3 Syracuse Orthopaedic Specialists, Department of General Orthopedics and Trauma, Foot and Ankle Division, Syracuse, NY, USA.,4 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Naven Duggal
- 3 Syracuse Orthopaedic Specialists, Department of General Orthopedics and Trauma, Foot and Ankle Division, Syracuse, NY, USA
| | - Ara Nazarian
- 1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Kamijo S, Kumai T, Tanaka S, Mano T, Tanaka Y. Comparison of compressive forces caused by various cannulated cancellous screws used in arthroscopic ankle arthrodesis. J Orthop Surg Res 2017; 12:7. [PMID: 28095870 PMCID: PMC5240347 DOI: 10.1186/s13018-016-0503-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background When performing arthroscopic ankle arthrodesis for end-stage ankle arthritis, internal fixation is performed using bone screws after appropriate preparation. However, optimal characteristics of bone screws have not been examined in terms of pressure force. Objective comparisons of bone-screw performance may provide information on procedures for arthroscopic ankle arthrodesis. The study objectives were to determine whether it was possible to measure compressive force changes using the newly developed device and to infer all screw characteristics from measurement results when used in actual surgeries. In addition, we performed experiments on cadavers to verify whether the experimental results could be applied to the joints of living subjects. Methods Three types of screws (S1, S2, and S3) were inserted into the unique measurement device, and the changes in pressure were measured for each 45° turn. Changes in pressure and maximum pressure force were recorded after the application of the screws. After reaching the maximum pressure in the simulated bone, further screw rotations were accompanied by a gradual pressure decrease to 0 MPa. We also measured pressure changes in a similar manner by inserting a miniature pressure sensor into the talocrural joints of cadavers. Results The mean maximum pressure ± standard deviation for S1, S2, and S3 were 0.832 ± 0.164 MPa, 0.434 ± 0.116 MPa, and 0.414 ± 0.127 MPa, respectively. Pressure slopes to the maximum did not significantly differ between the screws in the simulated bone, and a subsequent pressure decrease to 0 MPa was significantly more rapid for S1 than for S2 and S3. Although pressure failure after the overtightening of screws was only observed in the simulated bone, patterns of pressure vs. rotation angle were similar in simulated and cadaveric bones. The pressure profile characteristics of three different screw types were determined. Conclusions We were able to measure the compressive force changes using the newly developed device when the screws were inserted. On the basis of the measurement results, we were able to infer the characteristics of all screws when used in actual surgery.
Collapse
Affiliation(s)
- Satoshi Kamijo
- Department of Orthopaedic Surgery, Fujimori Hospital, Matsumoto, Nagano Pref., 390-0811, Japan.,Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan. .,Department of Sports Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara, 634-8522, Japan.
| | - Shogo Tanaka
- Industrial Research Institute of Shizuoka Prefecture, Aoi-ku, Shizuoka City, 421-1298, Japan
| | - Tsuyoshi Mano
- Industrial Research Institute of Shizuoka Prefecture, Aoi-ku, Shizuoka City, 421-1298, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| |
Collapse
|
6
|
Latt LD, Glisson RR, Adams SB, Schuh R, Narron JA, Easley ME. Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis. Foot Ankle Int 2015; 36:1235-42. [PMID: 26130579 DOI: 10.1177/1071100715589083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Transverse tarsal joint arthrodesis is commonly performed in the operative treatment of hindfoot arthritis and acquired flatfoot deformity. While fixation is typically achieved using screws, failure to obtain and maintain joint compression sometimes occurs, potentially leading to nonunion. External fixation is an alternate method of achieving arthrodesis site compression and has the advantage of allowing postoperative compression adjustment when necessary. However, its performance relative to standard screw fixation has not been quantified in this application. We hypothesized that external fixation could provide transverse tarsal joint compression exceeding that possible with screw fixation. METHODS Transverse tarsal joint fixation was performed sequentially, first with a circular external fixator and then with compression screws, on 9 fresh-frozen cadaveric legs. The external fixator was attached in abutting rings fixed to the tibia and the hindfoot and a third anterior ring parallel to the hindfoot ring using transverse wires and half-pins in the tibial diaphysis, calcaneus, and metatarsals. Screw fixation comprised two 4.3 mm headless compression screws traversing the talonavicular joint and 1 across the calcaneocuboid joint. Compressive forces generated during incremental fixator foot ring displacement to 20 mm and incremental screw tightening were measured using a custom-fabricated instrumented miniature external fixator spanning the transverse tarsal joint. RESULTS The maximum compressive force generated by the external fixator averaged 186% of that produced by the screws (range, 104%-391%). Fixator compression surpassed that obtainable with screws at 12 mm of ring displacement and decreased when the tibial ring was detached. No correlation was found between bone density and the compressive force achievable by either fusion method. CONCLUSION The compression across the transverse tarsal joint that can be obtained with a circular external fixator including a tibial ring exceeds that which can be obtained with 3 headless compression screws. Screw and external fixator performance did not correlate with bone mineral density. This study supports the use of external fixation as an alternative method of generating compression to help stimulate fusion across the transverse tarsal joints. CLINICAL RELEVANCE The findings provide biomechanical evidence to support the use of external fixation as a viable option in transverse tarsal joint fusion cases in which screw fixation has failed or is anticipated to be inadequate due to suboptimal bone quality.
Collapse
|
7
|
Kinmon K, Garzon D, Tacktill J, Vassello W. Benchtop comparison of a novel dynamic compression screw to a standard cortical screw: compression integrity and gap size over time during simulated resorption. Foot Ankle Spec 2013; 6:222-5. [PMID: 23548586 DOI: 10.1177/1938640013484794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature reports the incidence of failed isolated foot and ankle fusions as up to 23%. A contributing factor is the natural bone resorption, which occurs resulting in loss of compression and gapping at the fusion site when standard static compression plates and screws are used. However, an innovative dynamic compression screw may provide lasting compression despite resorption. This benchtop study shows that the FxDEVICES spring-loaded dynamic POGO screw maintains more compression and more consistent compression rate during simulated resorption, as compared with a standard compression screw. The novel screw maintained much greater compression strength within the first millimeter of simulated resorption (13.57 vs 4.38 lb) and maintained greater compression strength at the test completion (1.14 vs 0 lb). The novel screw revealed a more consistent resorption rate over the duration of the simulation. Clinically, this may result in more stability and improved fusion rates.
Collapse
Affiliation(s)
- Kyle Kinmon
- Bethesda Memorial Hospital, Boynton Beach, FL 33435, USA.
| | | | | | | |
Collapse
|
8
|
DeHeer PA, Catoire SM, Taulman J, Borer B. Ankle arthrodesis: a literature review. Clin Podiatr Med Surg 2012; 29:509-27. [PMID: 23044060 DOI: 10.1016/j.cpm.2012.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ankle joint arthrodesis should be considered the gold standard procedure for end-stage ankle arthritis in the appropriate patient. Incisional approach and fixation technique should be based on the patient and specific needs. Arthrodesis can be achieved with adequate resection of cartilage, good compression across the fusion site, stable fixation, proper postoperative protocol, and patient compliance. It is important to remember that positioning of the ankle joint is a keystone in ankle arthrodesis. There are complications that can arise from the ankle fusion, including the need for further surgical intervention owing to arthritis in the subtalar and midtarsal joints.
Collapse
|