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Background: Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cadaveric study and a consecutive case series. Another aim was to determine the intra- and interobserver reliability of these observations. Methods: A prospective observational study was made between 2018 and 2019. First, a PATR was done on cadaveric specimens and, after the procedures, dissected to correlate what was seen fluoroscopically. The clinical group included 39 feet that presented mild-to-moderate HV deformity and were treated with percutaneous osteotomies associated with PATR. Results: Observers 1 and 2 saw a radioscopic radiolucent sign in 100% of cadavers and the patient population. They also observed a triangle-shaped image with an incidence of 75%, which we have named the "triangle sign." Conclusion: The triangle sign may be helpful in the intraoperative confirmation of PATR and latero-plantar capsule release using this percutaneous technique. Level of Evidence: Level II, development of diagnostic criteria.
RESUMO
Objetivo: Describir los resultados radiográficos y funcionales, y las complicaciones de la osteosíntesis de fracturas de calcáneo mediante el abordaje del seno del tarso. Materiales y Métodos: Se evaluaron 54 fracturas articulares de calcáneo desplazadas en 50 pacientes con radiografías de pie, de frente y de perfil, y tomografía computarizada preoperatorias. Se tomaron radiografías de pie, de frente y de perfil sin carga en el posoperatorio inmediato y con carga a las semanas 6 y 12, y al final del seguimiento. Se midió el ángulo de Böhler y se cuantificó el grado de artrosis subastragalina y calcaneocuboidea. Se determinó el puntaje de la AOFAS y se registraron las complicaciones de la herida, las lesiones neurológicas y la necesidad de cirugías adicionales, como retiro del material de osteosíntesis y artrodesis subastragalina. Resultados: El seguimiento fue de 30.8 meses. La serie estaba formada por 8 mujeres y 42 hombres, con una edad de 39.40 ± 14 años (rango 18-65). Cuarenta fracturas eran Sanders tipo II, 13 tipo III y 1 tipo IV. El puntaje de la AOFAS fue: excelente (12 casos), bueno (25 casos), regular (12 casos) y malo (5 casos). El ángulo de Böhler preoperatorio era de 10,8 ± 10,4° y 30,77 ± 8,24° al final del seguimiento (p <0,00001). El 3,7% tuvo complicaciones menores de la herida y el 5,6%, complicaciones mayores. Conclusión: El abordaje del seno del tarso permite una reducción aceptable con resultados buenos y excelentes en la mayoría de los pacientes y escasas complicaciones de partes blandas. Nivel de Evidencia: IV
Objective: To describe functional and radiographic outcomes, and complications of osteosynthesis in calcaneus fractures with the sinus tarsi approach. Materials and Methods: 54 displaced articular calcaneus fractures in 50 patients were assessed through preoperative foot radiographs (anteroposterior and lateral) and computerized tomography. AP and lateral radiographs were obtained in the immediate postoperative period (without weightbearing), after 6 and 12 weeks (with weightbearing), and at the end of follow-up, measuring the Böhler angle and quantifying the degree of subtalar and calcaneocuboid osteoarthritis. The AOFAS score was determined, registering wound complications, neurological injuries and necessary additional surgeries -such as osteosynthesis and subtalar arthrodesis hardware removal. Results: Follow-up time was 30.8 months. The series consisted in 8 women and 42 men. The patients' average age was 39.40±14 years (18-65). There were 40 Sanders type II, 13 type III, and 1 type IV fractures. The AOFAS score was excellent (12 patients), good (25), regular (12), and poor (5). The Böhler angle was 10.8°±10.4° before surgery, and 30.77°±8.24° at the end of follow-up (p<0.00001). 3.7% of the patients presented minor wound complications, while 5.6% presented major wound complications. Conclusion: The sinus tarsi approach allows for acceptable reduction with good and excellent outcomes in most patients, coupled with few soft-tissue complications. Level of Evidence: IV
Assuntos
Adulto , Calcâneo/lesões , Fraturas ÓsseasRESUMO
Objetivo: Describir los factores asociados con niveles de dolor mas severo en una cohorte de pacientes con fascitis plantar. El objetivo secundario fue analizar cuales de estos factores estaban asociados con niveles mas altos de mejoria clinica luego del tratamiento conservador. Materiales y Métodos: Se evaluo a una cohorte prospectiva de pacientes con diagnostico de fascitis plantar. Cada participante completo una escala ordinal visual de dolor (del 1 al 10) para dolor del primer paso y dolor al final del dia y encuestas FFI-R (Foot Function Index-Revised). Tambien se realizo una evaluacion demografica. La dorsiflexion de la articulacion del tobillo, el rango de movilidad de la primera articulacion metatarsofalangica, la rigidez del gastrocnemio y el angulo popliteo tambien se evaluaron de manera estandar. Resultados: Se incluyo a 214 pacientes. El 64% eran hombres (118 pacientes), la media de la edad era de 49.67 anos (DE 13.16) y el indice de masa corporal promedio, de 28,53 (DE 5,18). En el analisis multivariado, se observo que el riesgo de un puntaje ≥8 en la escala de dolor aumento cuando el paciente refirio estar de pie por mas de 6 h (OR 1,17; p = 0,03; IC95% 1,02-1,35). El riesgo de un puntaje >8 fue mayor cuando el grado de dorsiflexion del tobillo fue <0° (OR 1,20; p = 0,03; IC95% 1,02-1,41). Conclusión: Nuestros hallazgos apoyan indirectamente la hipotesis de que la dorsiflexion limitada del tobillo juega un papel como factor de riesgo asociado a un puntaje ≥8 en la escala de dolor, en los casos de fascitis plantar. Nivel de Evidencia: IV
Objective: The main purpose of our study was to describe the factors associated with more severe pain levels in a cohort of patients with plantar fasciitis (PF). The secondary purpose of this study was to determine which of these factors were associated with higher levels of clinical improvement after conservative therapy. Materials and Methods: We conducted a prospective study in a cohort of patients with PF. Each participant completed an ordinal pain scale (1-10) for first-step pain and end-of-day pain, and Foot Function Index-Revised (FFI-R) surveys at enrollment. Also, patient demographics were evaluated. The ankle joint dorsiflexion, the range of motion (ROM) for the first metatarsophalangeal joint (MTPJ), the gastrocnemius tightness, and the popliteal angle were evaluated through standard tests. Results: Our study included 214 participants, of which 64% (118 patients) were males, the average age was 49.67 years (SD 13.16) and the average BMI was 28.53 (SD 5.18). The multivariate analysis showed that the risk of having a Visual Analog Scale (VAS) score ≥8 increased when the patient reported standing for more than 6 hours (OR=1.17; P=0.03; CI95%: 1.02-1.359). The risk of a >8-VAS score was higher when the level of ankle dorsiflexion was <0 (OR=1.20; P=0.03; CI95%: 1.02-1.41). Conclusion: Our findings indirectly support the hypothesis that limited ankle dorsiflexion ROM plays a role as a risk factor associated with VAS scores ≥8 in PF patients. Level of Evidence: IV