1
|
Usuelli FG, Tamini J, Maccario C, Grassi M, Tan EW. Bone-block arthrodesis procedure in failures of first metatarsophalangeal joint replacement. Foot Ankle Surg 2017; 23:163-167. [PMID: 28865584 DOI: 10.1016/j.fas.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/10/2017] [Accepted: 03/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment for the failure of a first metatarsophalangeal joint (MTP1) prosthesis can be complex. There is no consensus regarding the ideal treatment. One of the main issues is the available bone stock after prosthesis removal. The aim of the study was to report the clinical and radiographic results for MTP1 arthrodesis with autologous calcaneus bone graft (bone-block fusion) as a revision procedure of a previous MTP1 implant failure. METHODS This study included 12 patients diagnosed with failure of a MTP1 prosthesis. All patients were treated with MTP1 arthrodesis using ipsilateral calcaneal bone graft. Patients were evaluated with the Foot Ankle Disability Index (FADI), the visual analogue pain scale (VAS) and AOFAS Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI), weight-bearing radiograph of the foot, and a computed tomography scan. The 1-2 intermetatarsal angle, hallux valgus angle, and first ray length were measured before surgery and at final follow-up. RESULTS Complications included 3 cases of arthrodesis nonunion, (1 symptomatic, 2 asymptomatic) with 2 of the 3 patients experiencing hardware failure and 1 superficial wound infection. The average FADI improved from 41.8 preoperatively to 84.6 at final follow-up (p<0.05); the average VAS improved from 8.5 preoperatively to 2 at final follow-up (p<0,05); the average AOFAS-HMI significantly improved from 50.7 preoperatively to 73.8 at final follow-up (p<0.05). The average length of the bone-block used was 14.3mm (range 11-19mm). The 1-2 intermetatarsal angle decreased from 9.5° preoperatively to 8.4° at final follow-up (p<0.05); hallux valgus angle improved from 19.7° preoperatively to 14.3° at final follow-up (p<0.05). CONCLUSIONS The management of a failed first metatarsophalangeal joint prosthesis remains controversial. Bone-block arthrodesis using ipsilateral calcaneal autograft appears to be a viable option restoring the bone loss, and avoiding hallux shortening. Nonunion is the most frequent complication with 25% of patients affected, but only 1/3 of patients with nonunion were symptomatic and required revision.
Collapse
Affiliation(s)
| | | | | | - Miriam Grassi
- Ospedale L. Sacco, divisione di Ortopedia e Traumatologia, Milan, Italy
| | - Eric W Tan
- University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
D'Ambrosi R, Maccario C, Serra N, Liuni F, Usuelli FG. Osteochondral Lesions of the Talus and Autologous Matrix-Induced Chondrogenesis: Is Age a Negative Predictor Outcome? Arthroscopy 2017; 33:428-435. [PMID: 27956234 DOI: 10.1016/j.arthro.2016.09.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess and evaluate healing and functional outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC) in 2 age groups: patients older than 33 years versus patients 33 years or younger. METHODS A total of 31 patients, of whom 17 were 33 years or younger (G1) and 14 older than 33 years (G2), were evaluated. All patients were treated with AT-AMIC repair for osteochondral talar lesion. Magnetic resonance imaging (MRI) and computed tomography (CT)-scan evaluations, as well as clinical evaluations measured by the visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society Ankle and Hindfoot score (AOFAS), and Short Form-12, were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. RESULTS G1 consisted of 17 patients (mean age: 25 years, standard deviation: ±5), whereas G2 consisted of 14 patients (mean age: 47 years, standard deviation: ±9). In both groups, we found a significant difference for clinical and radiological parameters with the analysis of variance for repeated measures through 4 time points (P < .001). In G1, AOFAS improved significantly between T0 and T1 (P = .025) and T1 and T2 (P = .011); CT showed a significant decrease between T1 and T2 (P = .003) and T2 and T3 (P < .0001), whereas MRI reduced significantly at each follow-up. In G2, AOFAS improved between T0 and T1 (P = .011) and T2 and T3 (P = .018); CT decreased between T1 and T2 (P = .025), whereas MRI showed a reduction between T1 and T2 (P = .029) and T2 and T3 (P = .006). AOFAS in G1 was significantly higher at T0 (P = .017), T2 (P = .036), and T3 (P = .039) compared with G2. A negative linear correlation between AOFAS and VAS at T1 (R = -0.756), T2 (R = -0.637), and T3 (R = -0.728) was found in G1, whereas in G2, AOFAS was negatively correlated with VAS at T1 (R = -0.702). CONCLUSIONS The study revealed that osteochondral lesions of the talus were characterized by similar sizes and features, both in young and old patients. We conclude that AT-AMIC can be considered a safe and reliable procedure that allows effective healing, regardless of age, with a significant clinical improvement; in particular, clinical results are related to starting conditions of the ankle. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Camilla Maccario
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Nicola Serra
- Dipartimento di Radiologia, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Federico Liuni
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Ortopedia e Traumatologia, Ospedale Santa Maria, Borgo Val di Taro, Parma, Italy
| | - Federico Giuseppe Usuelli
- Chirurgia Articolare Sostitutiva e Chirurgia Ortopedica - Piede e Caviglia, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
3
|
Ayerza MA, Piuzzi NS, Aponte-Tinao LA, Farfalli GL, Muscolo DL. Structural allograft reconstruction of the foot and ankle after tumor resections. Musculoskelet Surg 2016; 100:149-156. [PMID: 27324025 DOI: 10.1007/s12306-016-0413-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term. MATERIALS AND METHODS From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA). RESULTS The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion. CONCLUSION This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- M A Ayerza
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
| | - N S Piuzzi
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - L A Aponte-Tinao
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - G L Farfalli
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| | - D L Muscolo
- Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina
| |
Collapse
|
4
|
|
5
|
Bertelli JA, Santos MA, Kechele PR, Rost JR, Tacca CP. Flexor tendon grafting using a plantaris tendon with a fragment of attached bone for fixation to the distal phalanx: a preliminary cohort study. J Hand Surg Am 2007; 32:1543-8. [PMID: 18070642 DOI: 10.1016/j.jhsa.2007.08.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 08/21/2007] [Accepted: 08/31/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. METHODS Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. RESULTS Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). CONCLUSIONS The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Jayme A Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, SC, Brazil.
| | | | | | | | | |
Collapse
|
6
|
Abstract
The clinical outcomes of 19 patients requiring autogenous grafts for foot surgery were followed up until healing at the donor site occurred. In all cases, tricortical bone was extracted from the calcaneus for use at another pedal site. The first cohort of 9 patients had the calcaneal deficit replaced with allogenic cubes. The second cohort received no tissue replacement. Patients were reviewed postoperatively with a questionnaire and clinical examination to evaluate the outcome of the operations. Radiographic outcomes were observed at the donor and recipient sites in both groups until healing was confirmed as bridging trabeculation. Incorporation of the graft at the donor site was also reviewed. Clinical outcomes, namely pain, local sensory function, and return to footwear, were satisfactory in all patients and were not significantly different between groups. One patient from each group sustained a heel fracture. The donated autogenous grafts at the recipient sites were all incorporated uneventfully at 6 months. In the first cohort, allogenic graft incorporation in the calcaneus was complete in only 2 patients at the 12-month stage. The remaining 7 cases showed reduction of the deficit by new bone formation arising from the calcaneus. Donor sites with allogenic bone replacement healed at a median of 18 months (interquartile range, 18-18 months). In the group without replacement, healing occurred at a median of 6 months (interquartile range, 6-12 months), a highly statistically significant difference (P < .001). In the second cohort without allogenic graft replacement, radiographic filling at the donor site was complete within a 12-month period. Tricortical bone can be successfully harvested from the calcaneus, but there may an associated risk of heel fracture. The role of replacement allogenic bone in assisting healing at the donor site is unclear.
Collapse
Affiliation(s)
- Sally Feeney
- West Middlesex University Hospital, Middlesex, United Kingdom.
| | | | | |
Collapse
|
7
|
Affiliation(s)
- Thomas Roukis
- Limb Preservation Service, Vascular/Endovascular Surgery Service, Department of Surgery, MCHJ-SV, Madigan Army Medical Center, 9040-A Fitzsimmons Avenue, Tacoma, WA 98431, USA.
| |
Collapse
|
8
|
|
9
|
Tanaka Y, Omokawa S, Ryu J, Clovis N, Takakura Y. Anatomical consideration of vascularized bone graft transfer from the medial calcaneus to the talus. Clin Anat 2005; 18:115-20. [PMID: 15696530 DOI: 10.1002/ca.20065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To investigate the possibility of use of the calcaneal branches of the posterior tibial artery as the pedicle for the vascularized bone graft to the talus, a detailed anatomical study was carried out on 30 fresh cadaver feet. Although there are several branches from the posterior tibial artery to the calcaneus, the largest posterior branch was defined as the main calcaneal branch. We recognized frequently a large branch nourishing the superior part of the calcaneus and named it the superior calcaneal branch. Twenty feet had the superior calcaneal branches. Pedicled bone grafts using the superior calcaneal branch to the postero-medial portion of the talar body were possible in 18 of 20 feet. Pedicled bone grafts using the main calcaneal branches were possible in 9 of 12 feet in which the superior calcaneal branches were not available. Finally, vascularized bone grafts were judged to be feasible in 27 feet (90%).
Collapse
Affiliation(s)
- Y Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan.
| | | | | | | | | |
Collapse
|
10
|
Zhang Y, Wang J, Wen B. [Repair of calcaneus and skin defects with allograft and sural neurovascular flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2004; 18:468-70. [PMID: 15586704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To investigate the clinical results of allograft and sural neurovascular flap in repairing calcaneus and skin defects. METHODS From February 1996 to December 2002, allograft and sural neurovascular flap were used to repair calcaneus and skin defects in 6 cases. The causes included road accident in 3 cases, strangulation in 2 cases and crashing object in 1 case. The defect locations were at the back of the calcaneus (1/3, 1/2 and 2/3 of calcaneus in 3 cases, 2 cases and 1 case respectively). The flap area ranged from 6 cm x 7 cm to 12 cm x 17 cm. RESULTS The flaps survived completely in 4 cases; the distal flaps necrosed partly in 2 cases and the wound healed by dressing. The postoperative X-ray films showed that the repaired bone and joint had normal position and the arcus plantaris recovered. After a follow up of 6 months to 3 years all the patients were achieved bone union in allograft and had no complications of absorption, infection and repulsion. The weight-bearing and walking functions were restored and the injured foot obtained a satisfactory contour. After 3-6 months of operation, the sensory recovery of foot occurred. CONCLUSION The used allograft is easy to be obtained and arcus plantaris is easy to recover. The reverse sural neurovascular flap in repairing calcaneus and skin defects has the following advantages: the maintenance of blood supply for injured foot, the less dangerous operation, the simple procedure, the recovery of walking function, and the good appearance and sensation.
Collapse
Affiliation(s)
- Yanfeng Zhang
- Department of Orthopedics, 15th Hospital of PLA, Wusu Xinjiang, 833000, PR China
| | | | | |
Collapse
|
11
|
Peters CL, Dienst M, Erickson J. Reconstruction of the medial femoral condyle and medial collateral ligament in total knee arthroplasty using tendoachilles allograft with a calcaneal bone block. J Arthroplasty 2004; 19:935-40. [PMID: 15483814 DOI: 10.1016/j.arth.2004.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Absence or compromise of the medial collateral ligament (MCL) in conjunction with osseous defects of the medial femoral condyle in total knee arthroplasty (TKA) is a challenging reconstructive problem. Treatment usually requires a highly constrained TKA with or without ligamentous reconstruction. To restore the medial femoral condylar bone and to provide ligamentous stability on the medial side of the knee, the authors present a technique for reconstruction of the medial femoral condyle and MCL using a tendoachilles allograft with a calcaneal bone block. The construct also can be augmented with a semitendinosus tendon autograft. Two illustrative cases and a review of the literature are presented.
Collapse
|
12
|
Affiliation(s)
- M Stiebel
- Department of Surgery, University of California, San Francisco, USA
| | | | | |
Collapse
|
13
|
|
14
|
Abstract
Reported sites for retrieval of cancellous bone for grafts include the iliac crest, greater trochanter, proximal tibia, and distal tibia. A new lateral technique for retrieval of cancellous bone from the calcaneus is evaluated through anatomic review, quantitative analysis, and retrospective clinical assessment. Of 22 patients managed with this technique over a 2-year period, 17 returned for an evaluation by questionnaire, physical examination, and radiographic follow-up at an average of 7 months after surgery (range, 4-16 months). Complaints/complications were minor: three had minor incisional symptoms, five had medial heel pain (3 caused by plantar fasciitis), and one had unchanged preoperative heel pain secondary to clubfoot deformity. Compared with more extensive bone-grafting procedures, this procedure offers the advantages of bone harvested under local anesthesia using a readily accessible ipsilateral extremity and producing minor complications.
Collapse
Affiliation(s)
- K R Biddinger
- Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland, USA
| | | | | | | |
Collapse
|
15
|
Abstract
Autogenous bone grafts have several advantages over allogenic bone grafts, especially when being used for arthrodesis or for revision of malunions or nonunions. Procurement of these grafts can come from remote regions or from areas adjacent to the operative site. The lower extremity provides a source for obtaining cortical, corticocancellous, and cancellous bone for use in foot and ankle surgery. Harvesting techniques do not come without complications and the necessity for proper techniques in handling is crucial.
Collapse
Affiliation(s)
- R W Mendicino
- Podiatry Hospital of Pittsburgh, Department of Surgery, Pennsylvania, USA
| | | | | |
Collapse
|
16
|
Januszkiewicz JS, Mehrotra ON, Brown GE. Calcaneal fillet flap: a new osteocutaneous free tissue transfer for emergency salvage of traumatic below-knee amputation stumps. Plast Reconstr Surg 1996; 98:538-41. [PMID: 8700996 DOI: 10.1097/00006534-199609000-00030] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Traumatic below-knee amputations do not always leave enough soft tissue of bone with which to fashion a stump of sufficient length and durability to support a prosthesis. Composite free flaps can often be harvested from the amputated limb to provide immediate one-stage stump salvage and to preserve knee function. We report a new technique to increase stump length by incorporating the calcaneus into a foot fillet flap as a vascularized bone transfer. The calcaneal fillet flap is a useful addition to the inventory of available composite flaps. It is recommended for knee joint salvage when there is less than 11 cm of tibial remnant length.
Collapse
Affiliation(s)
- J S Januszkiewicz
- Regional Centre for Reconstructive, Plastic, Maxillofacial and Hand Surgery, Middlemore Hospital, Auckland, New Zealand
| | | | | |
Collapse
|
17
|
Abstract
The authors present a case report showing successful autogenous calcaneal bone graft stabilization of a first metatarsal closing base wedge osteotomy nonunion. The authors discuss the complications and clinical sequelae associated with first metatarsal base wedge osteotomy nonunions. The patient's clinical presentation, surgical procedure, and postoperative course are discussed. Comparative preoperative and postoperative objective gait analyses are presented. This approach to first metatarsal nonunion salvage appears to be clinically successful with a 15-month follow-up period.
Collapse
Affiliation(s)
- J Pontious
- Department of Podiatric Surgery, Pennsylvania College of Podiatric Medicine, Philadelphia 19107, USA
| | | |
Collapse
|
18
|
Abstract
Autogenous bone grafting is an important part of many foot and ankle surgical procedures. Although alternative bone graft materials such as allogeneic bone are available, autogenous bone continues to be the material of choice for many procedures. The calcaneus provides a source of small amounts of autogenous corticocancellous or cancellous bone. The author describes the surgical technique for procurement of calcaneal bone grafts. Twenty-five cases are reviewed. The morbidity associated with procuring calcaneal bone grafts is favorably compared with that associated with procuring bone from other donor sites.
Collapse
Affiliation(s)
- K T Mahan
- Department of Surgery, Pennsylvania College of Podiatric Medicine
| |
Collapse
|
19
|
Abstract
To minimize adhesions following tendon repair, early post-operative movement is recommended. This has proved difficult with tendon grafting because of weakness of the repair sites, particularly distally, and because of slow revascularization. A potential solution is the use of a composite tendon-bone graft in which a bone block is attached to the end of the tendon. The tendon is threaded through a hole in the distal phalanx from the dorsal to the palmar side and impacted like a cork to create an immediate strong fixation. The tendon itself is then tunnelled through the pulley system and the proximal repair is carried out with a multiple weave technique which can withstand immediate active movement. The ideal tendon-bone complex is the plantaris attached to a segment of calcaneus. A preliminary report with two case studies is presented.
Collapse
Affiliation(s)
- W A Morrison
- Department of Surgery, St Vincent's Hospital, Melbourne, Australia
| | | |
Collapse
|
20
|
Abstract
Comparative studies have shown that bone-bone union develops faster than a junction between grafted tendon and bone, and would thus allow earlier post-operative movement, limiting adhesion formation. In this context the nature of the insertion of the plantaris tendon into the calcaneus is reviewed as a possible source of composite bone-tendon grafts. It is proposed that the composite plantaris tendon with its bony block attachment is inserted through a hole in the distal phalanx of the finger creating an immediate firm distal fixation. From cadaver dissections it was found that in at least 80% of cases the insertion of the plantaris tendon was directly into the calcaneus, independent of the tendo Achilles, and was therefore suitable for use as the proposed tendon graft.
Collapse
Affiliation(s)
- S M Schlicht
- Department of Surgery, St Vincent's Hospital, Melbourne, Australia
| | | |
Collapse
|
21
|
Sinclair GG, Shoemaker SK, Seibert SR. Iatrogenic brachymetatarsia. J Foot Surg 1991; 30:580-4. [PMID: 1770211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors present a case report of iatrogenic brachymetatarsia. The literature was reviewed and various surgical treatments discussed. The metatarsal was lengthened using a sagittally placed Z lengthening step-up osteotomy, with an autogenous bone graft and rigid internal fixation.
Collapse
Affiliation(s)
- G G Sinclair
- Department of Podiatry, Kaiser Permanente Medical Center, Vallejo, California
| | | | | |
Collapse
|
22
|
Rude CC, Scurran BL, Karlin JM, Silvani SH. Calcaneal bone graft after enchondroma excision. J Foot Surg 1985; 24:283-7. [PMID: 4045121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Enchondroma is a commonly encountered bone tumor in the foot, frequently necessitating excision. The calcaneus is a convenient source of bone for a bone graft, should that be required. The patient's own calcaneus offers the advantages of both cortical and cancellous bone, accessibility, dependable bone healing, and the superior osteogenic potential of autologous bone.
Collapse
|
23
|
Romanini L, Carfagni A, Amorese V. Grice's operation for spastic flat foot. Ital J Orthop Traumatol 1983; 9:439-49. [PMID: 6676342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The authors report 24 cases of severe spastic pes valgus in children affected by cerebral palsy, treated surgically by a technique derived from that of Grice - taking the transplant from the calcaneus itself instead of from the usual sites. They discuss the parameters usually considered in assessing the results and describe their own method of interpreting the measurements derived from the angles usually employed in the evaluation of pes valgus.
Collapse
|
24
|
|
25
|
Pitanguy I, Bisaggio S. [Total transplantation of the cutaneous cover of the plantar regions]. Hospital (Rio J) 1969; 75:657-63. [PMID: 5311630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
26
|
DOBYCHIN BD. [Repair of the cervical heat by transplantation of the calcaneum]. Khirurgiia (Mosk) 1954; 8:76. [PMID: 13222545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
|