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1.
Bone Joint J ; 102-B(6_Supple_A): 170-175, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475264

RESUMO

AIMS: Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. METHODS: We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m2 (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%). RESULTS: Survivorship free from amputation, persistent infection, and reoperation, other than removal of an external fixator, at five years was 95% (95% confidence interval (CI) 89% to 100%), 85% (95% CI 75% to 95%), and 64% (95% CI 46% to 82%), respectively. Reoperation, other than removal of an external fixator, occurred in 13 patients (32%). After the initial treatment, radiological nonunion developed in ten knees (24%). Nonunion was significantly correlated with persistent infection (p = 0.006) and external fixation (p = 0.005). Of those patients who achieved limb salvage, 34 (87%) remained mobile and 31 (79%) had 'absent' or 'minimal' pain ratings. CONCLUSION: Knee arthrodesis using a two-stage protocol achieved a survivorship free from amputation for persistent infection of 95% at five years with 87% of patients were mobile at final follow-up. However, early reoperation was common (32%). This is not surprising as this series included worst-case infected TKAs in which two-thirds of the patients had a disrupted EM, one-third required flap cover, and most had polymicrobial or multi-drug resistant organisms. Cite this article: Bone Joint J 2020;102-B(6 Supple A):170-175.


Assuntos
Artrodese/métodos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrodese/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Estudos Retrospectivos
2.
Orthop Clin North Am ; 51(3): 403-422, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498959

RESUMO

This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.


Assuntos
Ossos do Pé/cirurgia , Procedimentos Ortopédicos/métodos , Tornozelo/diagnóstico por imagem , Tornozelo/cirurgia , Artrodese/efeitos adversos , Artrodese/métodos , Pé/diagnóstico por imagem , Pé/cirurgia , Ossos do Pé/diagnóstico por imagem , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Ortopédicos/efeitos adversos , Osteotomia/efeitos adversos , Osteotomia/métodos , Falanges dos Dedos do Pé/diagnóstico por imagem , Falanges dos Dedos do Pé/cirurgia
3.
Zhongguo Gu Shang ; 33(3): 274-7, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233259

RESUMO

OBJECTIVE: To explore short-term curative effect of staging operation for large gouty stone on the first metatarsophalangeal joint. METHODS: From January 2015 to December 2016, 12 patients with giant gout stone on the first metatarsophalangeal joint were treated with staging operation, including 12 males, aged from 45 to 73 years old, 6 cases on the right side and 6 cases on the left side. After conservative treatment for more than 2 years, the size and location of ventilator stone were detected by dual energy CT. The bone destruction of the first metatarsophalangeal joint was observed on X-ray examination. All patients underwent stageⅠgout radical removal and temporary fixation with Kirschner wire, and metatarsophalangeal joint fusion and internal fixation were performed after local soft tissue conditions were stabilized. The level of blood uric acid before and after hand were compared, and correction and complications of limb deformity were observed, VAS score was applied to evaluate pain relieved degree. RESULTS: All patients were successfully completed two stages ' operation. Twelve patients were followed up for 9 to 13 months. VAS sco re and uric acid content at different time points were observed and recorded. VAS score before operation ranged from 6 to 9, and decreased to 0 to 1 at 7 weeks after operation; the level of blood uric acid ranged from 443 to 501 µmol/L before operation, and decreased to 307 to 330 µmol/L at 7 weeks after operation. The first metatarsophalangeal joint deformity of foot was corrected and the shape was recovered at 5 to 7 months after operation. One patient occurred incision infection and flap edgenecrosis, and the wound healed by debridement and dressing change. CONCLUSION: Staged operation for the treatment of giant gout stone on the first metatarsophalangeal joint of foot could correct joint deformity, restore shape of the first metatarsophalangeal joint, relieve pain of the affected foot, and beneficial for control content of serum uric acid, and has less complications.


Assuntos
Gota , Articulação Metatarsofalângica , Idoso , Artrodese , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ácido Úrico
4.
Bone Joint J ; 102-B(4): 470-477, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228076

RESUMO

AIMS: Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS: We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS: The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION: We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.


Assuntos
Articulação do Tornozelo/cirurgia , Artrite Infecciosa/cirurgia , Artrodese/métodos , Artropatia Neurogênica/cirurgia , Técnica de Ilizarov , Deformidades Articulares Adquiridas/cirurgia , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Artrodese/instrumentação , Artropatia Neurogênica/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/cirurgia , Feminino , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Radiografia , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Fatores de Tempo , Cicatrização
5.
Bone Joint J ; 102-B(3): 345-351, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114814

RESUMO

AIMS: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. METHODS: We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. RESULTS: Out of the 101 patients included in the study, 29 (28.7%) had nonunion, five (4.9%) required below-knee amputation (BKA), 40 (39.6%) returned to the operating theatre, 16 (15.8%) had hardware failure, and 22 (21.8%) had a postoperative infection. Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). CONCLUSION: We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. We found that patients with a Charcot or non-traumatic arthropathy had an increased risk of nonunion and postoperative infection compared to individuals with traumatic arthritis. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. These data can be useful to surgeons and patients when considering, discussing and planning TTC fusion. It helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. Cite this article: Bone Joint J. 2020;102-B(3):345-351.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Osteoartrite/cirurgia , Articulação Talocalcânea/cirurgia , Tíbia/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Risco , Articulação Talocalcânea/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Resultado do Tratamento , Estados Unidos/epidemiologia
6.
Einstein (Sao Paulo) ; 18: e0AO5052, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32159606

RESUMO

OBJECTIVE: To compare screw fixation strength for subtalar arthrodesis. METHODS: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. RESULTS: Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). CONCLUSION: In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.


Assuntos
Artrodese/métodos , Parafusos Ósseos , Articulação Talocalcânea/cirurgia , Artrodese/instrumentação , Fenômenos Biomecânicos , Cadáver , Calcâneo/cirurgia , Humanos , Reprodutibilidade dos Testes , Tálus/cirurgia , Torque , Falha de Tratamento
7.
Rev Med Suisse ; 16(680): 278-281, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022495

RESUMO

Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint.


Assuntos
Artrodese , Artropatia Neurogênica/patologia , Artropatia Neurogênica/cirurgia , Celulite (Flegmão) , Artropatia Neurogênica/complicações , Celulite (Flegmão)/complicações , Humanos , Siringomielia/complicações
8.
Medicine (Baltimore) ; 99(7): e18826, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049784

RESUMO

To analyze the efficacy of arthrodesis combined with osteotomy applied to subtalar, calcaneocuboid, and talonavicular joints for the treatment of adult rigid flatfoot.This retrospective study included 29 adult patients with rigid flatfoot who underwent triple arthrodesis combined with osteotomy from January 2015 to December 2017. All patients suffered from stage III of adult acquired flatfoot. Patients returned for a clinical and radiologic follow-up evaluation at an average of 19.5 (range, 15-27) months postoperatively. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment including Meary, Pitch, and Kite angles.Twenty six patients returned for final evaluation. Twenty four patients had an excellent or good outcome on patient subjective self-assessment. All the VAS scores, AOFAS scores, and Karlsson scores at final follow-up showed different extents of improvement. The mean Meary angle significantly decreased from 25.8 ±â€Š5.4 degrees preoperatively to 6.9 ±â€Š7.7 degrees at final follow-up, and the mean Pitch angle improved markedly from 12.5 ±â€Š3.7 points preoperatively to 23.2 ±â€Š4.1 points at final follow-up (P < .001).Arthrodesis combined with osteotomy can effectively correct calcaneal valgus deformity, restore arch structure, and relieve foot pain in adult rigid flatfoot.


Assuntos
Artrodese/métodos , Pé Chato/cirurgia , Osteotomia/métodos , Adulto , Terapia Combinada , Feminino , Pé Chato/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
9.
Instr Course Lect ; 69: 371-380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017739

RESUMO

Tarsal coalitions are common, but fortunately the majority of patients with coalitions are asymptomatic and do not require intervention. When symptomatic, preoperative radiographs and CT scans are useful to characterize the type and extent of coalition. If a trial of nonsurgical management fails, resection, deformity correction, and triple arthrodesis may be considered. Barring contraindications, resection has been shown to be an effective and reliable first line surgical option. Arthrodesis should be reserved for cases of failed resection or significant arthritis. Associated deformity should be factored into patient evaluation and surgical management.


Assuntos
Ossos do Tarso , Coalizão Tarsal/cirurgia , Artrodese , Humanos , Radiografia , Tomografia Computadorizada por Raios X
10.
Yonsei Med J ; 61(2): 198-200, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31997630

RESUMO

Pyogenic sacroiliitis is a relatively rare condition that often leads to surgical treatment, including debridement and arthrodesis. Here we introduce a new surgical technique using bilateral dual iliac screws to secure early ambulation and maximal fusion success rate for the treatment of pyogenic sacroiliitis. We retrospectively reported a case and technical reports of pyogenic sacroiliitis treated by a new bilateral dual iliac screw fixation arthrodesis technique using radiologic outcomes, including plain X-rays and MRI scans, as well as outcomes based on the visual analogue scale for pain measurement. This technique improved uncontrolled pyogenic sacroiliitis with immediate stability that enabled ambulation and secured firm fixation for extensive evacuation of infected debris and subsequent autograft bone arthrodesis. In conclusion, we recommend bilateral dual iliac screw fixation for the treatment of pyogenic sacroiliitis, as this technique can improve uncontrolled pyogenic sacroiliitis with immediate stability.


Assuntos
Artrodese , Parafusos Ósseos , Transplante Ósseo , Ílio/cirurgia , Sacroileíte/cirurgia , Pontos de Referência Anatômicos , Feminino , Humanos , Imagem por Ressonância Magnética , Estudos Retrospectivos , Sacroileíte/diagnóstico por imagem , Transplante Autólogo , Adulto Jovem
11.
World Neurosurg ; 136: 70-72, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931243

RESUMO

BACKGROUND: Although instrumented stabilization of pediatric atlanto-occipital dislocation (AOD) has been described in the literature, there is little evidence regarding instrumentation techniques in pediatric patients presenting with both AOD and a cervical fracture. We present a case of a 2-year-old male involved in a motor vehicle collision with an unstable C2 fracture and AOD, treated with an occiput-C4 posterior arthrodesis using a rod, crosslink, and cable construct. CASE DESCRIPTION: This patient suffered a type III C2 fracture and AOD with 4 mm craniocaudal and 3 mm anterior displacement. In the operating room, 2 cobalt chrome connecting rods (3.5 mm) were connected to 1 another with crosslinks at C2 and C4. These were affixed with suboccipital and sublaminar cables at C1, C2, and C4. At 14 months postoperatively, his spine is clinically and radiographically stable. He has spontaneous movement in all 4 extremities, and remains in a persistent vegetative state because of his underlying central nervous system injury. CONCLUSIONS: Although there is a breadth of literature investigating instrumentation approaches to pediatric AOD, there is minimal evidence on outcomes of patients presenting with both AOD and cervical fracture. The technique we describe has proven safe and effective for this patient.


Assuntos
Articulação Atlantoccipital/cirurgia , Vértebra Cervical Áxis/cirurgia , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes de Trânsito , Artrodese , Articulação Atlantoccipital/diagnóstico por imagem , Articulação Atlantoccipital/lesões , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/lesões , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Pré-Escolar , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Masculino , Estado Vegetativo Persistente , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem
12.
J Craniofac Surg ; 31(2): 517-519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895861

RESUMO

Primary carcinoma of the frontal sinus is very rare, with an incidence of 0.3% to 1.0% of all paranasal sinus carcinomas. Although complete resection with a clear margin is definitely essential to achieve tumor control, radical surgery with osteoplastic flap using bicoronal incision has significant postoperative morbidities including scalp numbness, hair loss, and frontalis palsy. This article reports a rare case of primary frontal sinus squamous cell carcinoma extending to the orbit, which was treated successfully by mini osteoplastic flap through supra-eyebrow incision combined transnasal endoscopic approach.


Assuntos
Seio Frontal/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos/cirurgia , Artrodese , Sobrancelhas , Seio Frontal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Ferida Cirúrgica
13.
Tech Hand Up Extrem Surg ; 24(1): 47-52, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31693572

RESUMO

Index finger metacarpophalangeal (MCP) joint arthrodesis is a potential reconstructive option for recalcitrant MCP arthritis. Due to lateral forces applied by the thumb, our institutional experience supports index finger MCP arthrodesis as a successful option in younger, higher demand patients and in the setting of significant joint instability. We present our technique of performing index finger MCP arthrodesis using a dorsal locking plate. The proposed benefits of this technique include the ability to position the MCP joint in the desired degree of flexion, generation of parallel fusion surfaces with even compression across the arthrodesis site, and stable fixation.


Assuntos
Artrodese/instrumentação , Placas Ósseas , Instabilidade Articular/cirurgia , Articulação Metacarpofalângica/cirurgia , Adulto , Idoso , Artrodese/métodos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escala Visual Analógica
14.
Oper Orthop Traumatol ; 32(1): 58-72, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31243472

RESUMO

OBJECTIVE: Restoration of a painless, weight-bearing extremity with a modular knee arthrodesis system based on a cementless modular revision stem for rotationally stable, diaphyseal anchorage. INDICATIONS: Severe bone loss and compromised soft tissue after failed total knee arthroplasty, two-stage revisions and non-reconstructible knee extensor mechanism deficiency. CONTRAINDICATIONS: Extensive osteolysis preventing diaphyseal anchorage of the prosthesis. Contralateral arthrodesis of the knee joint and/or ipsilateral arthrodesis of the hip joint and contralateral lower extremity amputation. SURGICAL TECHNIQUE: In revision cases, removal of the total knee arthroplasty, spacer, the bone cement and all intramedullary granulation tissue. Reaming the medullary cavity with intramedullary reamers to cortical contact. Restoring leg length and rotation with trial implants. After implantation of the femoral and tibial stems, placing and tensioning of the rotationally aligned coupling elements. POSTOPERATIVE MANAGEMENT: Mobilization on two forearm crutches from postoperative day 1. Removal of the Redon drains after 48 h. Partial weight bearing of 20 kg for 6 weeks postoperatively. If plain radiographs show unchanged seating of the prosthesis after 6 weeks, loading can be increased by 10 kg per week until full weight bearing is achieved. RESULTS: Between 2007 and 2012 clinical data were collected and analyzed retrospectively. A total of 27 patients had been treated within a two-stage exchange procedure with implantation of a modular intramedullary arthodesis nail TITAN (KAM-TITAN). The mean follow-up was 30.9 ± 12.0 months. A functional evaluation was performed using the Oxford Knee Score (OKS). The analyzed patients showed a mean score of 39.2 ± 8.3. To determine the pain level the Visual Analog Scale (VAS) for pain was used and showed a mean score of 2.9 ± 1.3. The rate of definitely free of infection (using Laffer criteria) at last follow-up was 85.2%.


Assuntos
Artrodese , Artroplastia do Joelho , Artrodese/métodos , Artroplastia do Joelho/métodos , Humanos , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
15.
Tech Hand Up Extrem Surg ; 24(1): 13-19, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31490319

RESUMO

Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb functionality for thumb hypoplasia IIIb to V. We performed second toe-to-hand transplantation with MTPJ arthrodesis for 3 pediatric patients (mean age, 69 mo) with congenital thumb hypoplasia IIIb (n=2), grade V (n=1). Long-term follow-up evaluated the functions and esthetics of the hands for grade IIIb patients (n=2). We believe the second toe transfer with MTPJ arthrodesis transplantation is a promising method for reconstructing a full-length congenital or traumatic thumb absence for the pediatric population.


Assuntos
Artrodese , Deformidades Congênitas da Mão/cirurgia , Articulação Metacarpofalângica/cirurgia , Polegar/cirurgia , Dedos do Pé/transplante , Pré-Escolar , Contraindicações de Procedimentos , Feminino , Deformidades Congênitas da Mão/classificação , Humanos , Polegar/anormalidades
16.
J Orthop Res ; 38(2): 450-458, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31502697

RESUMO

Tibiotalar arthrodesis is a common surgical treatment for end-stage ankle arthritis. Proper ankle alignment is important as malalignment can lead to complications that may require revision surgery. This study aimed to determine how anteroposterior (AP) translational malalignment of ankle arthrodesis affects distal foot joint kinematics and plantar pressure. Ankle arthrodesis was performed on 10 cadaveric foot specimens using a custom fixture that could fuse the ankle neutrally and induce discrete malalignments (3, 6, and 9 mm) anteriorly and posteriorly. Gait was simulated under each alignment with a robotic gait simulator, and foot bone motion and plantar pressure were quantified. AP translational malalignment did not substantially affect plantar pressure or joint range of motion, but there were several significant differences in joint position throughout stance phase. Differences were seen in five joints (talocalcaneal, talonavicular, calcaneocuboid, fifth tarsometatarsal, and first metatarsophalangeal) and in the position of the first metatarsal relative to the talus. The most extreme effects occurred when the talus was displaced 6 mm or more posteriorly. In vivo, this may lead to aberrant joint loading, which could negatively impact patient outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:450-458, 2020.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/efeitos adversos , Articulações do Pé/fisiologia , Marcha , Adulto , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Oper Orthop Traumatol ; 32(1): 47-57, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30806716

RESUMO

OBJECTIVE: Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. INDICATIONS: Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. CONTRAINDICATIONS: Local infection of the thumb metacarpophalangeal joint area. SURGICAL TECHNIQUE: Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K­wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. POSTOPERATIVE MANAGEMENT: Splint for 3 weeks. Full load after 6-8 weeks. RESULTS: The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.


Assuntos
Artrodese , Articulação Metacarpofalângica , Polegar , Artrodese/métodos , Ligamentos Colaterais , Humanos , Articulação Metacarpofalângica/cirurgia , Polegar/cirurgia , Resultado do Tratamento
18.
Vet Clin North Am Small Anim Pract ; 50(1): 241-261, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653536

RESUMO

Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.


Assuntos
Artrodese/veterinária , Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Animais , Artrodese/métodos , Fixação Interna de Fraturas/métodos
19.
Clin Podiatr Med Surg ; 37(1): 117-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735263

RESUMO

This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.


Assuntos
Artrodese/efeitos adversos , Articulações do Pé/cirurgia , Artropatias/etiologia , Complicações Pós-Operatórias/etiologia , Fenômenos Biomecânicos , Articulações do Pé/fisiopatologia , Humanos , Artropatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
20.
Clin Podiatr Med Surg ; 37(1): 39-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735268

RESUMO

Understanding of medial column biomechanics is paramount to a successful outcome in both conservative and surgical treatment. Dysfunctions of the dynamic stabilizers as well as the static stabilizers of the medial column play a role in pathomechanics. Conservative options for addressing the medial column include custom foot orthotics and bracing. Options for addressing the medial column surgically with the goal to restore a stable tripod configuration, include first tarsometatarsal joint arthrodesis, opening plantarflexory medial cuneiform osteotomy, and naviculocuneiform arthrodesis.


Assuntos
Artrodese , Pé Chato/cirurgia , Órtoses do Pé , Osteotomia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Articulações do Pé/cirurgia , Humanos , Ossos do Tarso/cirurgia
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