Müller-Weiss disease: a functional and quality of life assessment.

PURPOSE: Evaluate the functional health status and quality of life of patients diagnosed with Müller-Weiss disease and, secondarily, determine the influence of factors such as gender, social status, race, body mass index, and surgical and non-surgical treatment in patient outcome. METHODS: This study included 30 affected feet (18 patients) with follow-up from 2002 to 2016. Five patients were excluded from reassessment, resulting in 20 feet (13 patients). Questionnaires for functional and quality of life assessments were administered, and statistical analysis was performed. RESULTS: Patients with obesity had poor functional results and low quality of life rates. Regarding quality of life, mainly in the mental health domain, there was a significant difference (p < 0.001) that was not observed in other domains investigated, except for surgical treatment, which was superior to non-surgical treatment in terms of the physical domain (p = 0.024). Bilateral treatment was also superior to unilateral treatment in Coughlin's classification (71.4% versus 66.7%). CONCLUSIONS: Müller-Weiss disease evolved with poor functional results and low quality of life rates in patients with obesity, with no method of treatment influence on patient outcome, except for the SF-12 physical domain, where surgical treatment showed better results than conservative treatment.

Utility of Routine Postoperative Radiographs After Fixation of Lower Extremity Fractures.

INTRODUCTION: The goal of this study was to investigate the clinical utility of radiographs at all time points after internal fixation of lower extremity fractures. METHODS: A retrospective chart review was conducted at a level I trauma center. Four hundred eighty-five patients with 586 fractures of the femur, tibia, and ankle were included. Data were analyzed to investigate the effect of radiographs on changes in management at all postoperative time points for each fracture type. RESULTS: Each fracture received, on average, 4.8 radiographs after fixation for a total cost of $938,469. The management of 31% (179 of 586) of fractures deviated from the expected postoperative course. Of the 179 fractures with a deviation, 93 (31%) resulted from radiographic findings alone and occurred (1) in the immediate postoperative period (2%) and (2) in the period from consideration of advancement to full weight bearing up until confirmation of fracture union (98%). Notable cost savings can be realized by using the findings to eliminate nonclinically indicated imaging at both the institutional and national levels. CONCLUSION: Routine radiographs in isolation contribute to changes in management (1) in the immediate postoperative period in select cases and (2) during the period when advancement to full weight bearing is being considered up until clinical fracture union. LEVEL OF EVIDENCE: Level III.

Low-Cost Intra-Articular Distraction Technique Using Kirschner Wires and a Toothed Lamina Spreader.

We describe a low-cost (instrument cost) technique for joint distraction using 2 Kirschner wires and a toothed lamina spreader in lieu of a Hintermann distractor. The described technique allows for temporary intra-articular distraction and visualization and preservation of the articular surface with extra-articular instrumentation. The technique can also allow for closed reduction and percutaneous treatment in cases of soft tissue compromise. Additionally, the technique uses common orthopedic surgical instruments, leading to a minimal learning curve for novice surgeons. We have found this distraction technique to be most effective for intra-articular preparation of hindfoot and midfoot arthrodeses and for navicular fracture reduction.

Radiographic assessment of medial cuneiform opening wedge osteotomy for flatfoot correction.

BACKGROUND: Opening wedge osteotomy of the medial cuneiform has become an established intervention for correction of forefoot varus in relation to a flatfoot deformity. The purpose of this study was to use a newly described radiographic measurement to determine the effectiveness and durability of the medial column correction with a plantarflexion opening wedge osteotomy of the medial cuneiform without internal fixation using an allograft. METHODS: Twenty-three feet underwent medial cuneiform opening wedge osteotomies for correction of forefoot varus associated with flatfoot deformity. The angle between the proximal and distal articular surfaces was measured on lateral radiographs preoperatively, postoperatively prior to weightbearing and at final followup visit. RESULTS: The average angle between the proximal and distal articular surfaces of the medial cuneiform on lateral foot radiographs was 1.0 degree preoperatively (±0.8 degrees). The average angle post-osteotomy, pre-weightbearing, was 8.4 degrees (±3.6 degrees) and at final followup was 7.5 degrees (±2.9 degrees). All patients achieved bony union. CONCLUSION: We describe a new radiographic measurement to focus on the correction achieved by a plantarflexion osteotomy of the medial cuneiform. It was found to be stable without internal fixation and reliably proceeded to union without significant loss of correction.

The use of tricortical autograft versus allograft in lateral column lengthening for adult acquired flatfoot deformity: an analysis of union rates and complications.

BACKGROUND: The management of adult acquired flatfoot is an evolving practice with the optimal lateral column lengthening procedure still left to considerable debate. The usual choices include lengthening with the use of autograft or allograft through a calcaneocuboid lengthening arthrodesis or Evans' calcaneal lengthening osteotomy. To our knowledge there is only one other study comparing autograft to allograft in adult lateral column lengthening procedures.(9) The purpose of this study was to evaluate differences with regard to union rates and complications when comparing the use of iliac tricortical autograft versus iliac tricortical allograft supplemented with platelet rich plasma (PRP) in adult acquired flatfoot lateral column lengthening procedures. MATERIALS AND METHODS: The charts and radiographs of 49 patients (51 feet) were evaluated. Twenty total procedures were performed using iliac tricortical autograft and 31 procedures were performed using iliac tricortical allograft with PRP. RESULTS: Successful union was achieved in 14 of 20 (70%) autograft procedures and 29 of 31 (94%) allograft procedures. Thirteen of 20 (65%) of the autograft group and 11 of 31 (35%) of the allograft group had a documented complication other than nonunion. Average length of hospital stay for patients who had procedures using autograft was 3.6 days and those who had allograft was 2.5 days. The average charge for those receiving allograft with PRP, including hospital stay, was roughly $2,500 more than those receiving an autograft procedure. CONCLUSION: Although the numbers were small, we believe that equivalent if not better healing and complication rates are possible with the use of allograft with PRP versus autograft for lateral column lengthening procedures while allowing for similar correction of deformity.

Cavovarus foot deformity with multiple tarsal coalitions: functional and three-dimensional preoperative assessment.

In rare instances, tarsal coalition leads to cavovarus foot deformity, although the pathologic mechanism leading to this deformity is not clear. This article reports a case of a 14-year-old boy presenting a severe cavovarus deformity of the right foot with talocalcaneal and calcaneonavicular coalitions, and a mild cavus deformity of the left foot with a single talocalcaneal coalition. Computed tomography and postoperative histologic analysis demonstrated a synostosis between talus and calcaneus and a fibrous calcaneonavicular coalition with partial ossification. Instrumented gait analysis revealed a limited range of ankle plantar flexion and increased external rotation of the ankle. Associated skeletal malformations including incomplete hemimelia of the forearm and scoliosis raised the possibility of a teratologic condition, but neurologic examination, spinal magnetic resonance imaging, and nerve conduction velocities were normal. The progressive ossification of combined coalitions during growth of the foot may have been one factor leading to this complex foot deformity. The fine-wire electromyogram showed normal tibialis anterior and posterior muscle activity. Small soft tissue tears in the sinus tarsi may have led to a mild reflexive increase of the muscle tone and tendon shortening, which pulled the forefoot into adduction and the heel into varus, and raised the medial arch. Mechanical alterations of the ankle appear secondary to the heel varus and to the progressive deformity of the talus. Three-dimensional computed tomography reconstruction and gait analysis appeared to be helpful additional parameters to understanding the pathomechanics of this complex foot deformity and for preoperative planning of triple arthrodesis.

Current concepts of absorbable fixation in first ray surgery.

Absorbable fixation has evolved from sutures and pins to screws. The current biomaterials available are polyparadiaxanone (PDS), polygycolide acid (PGA), and poly-L-lactic acid (PLLA). Extensive evaluation of PDS and PGA over the last several years has identified their benefits and weaknesses in reconstructive foot surgery. Future research will focus on PLLA rods and screws as they emerge as the latest advance in the search for the ideal internal fixation device.