Influence of Isolated Talonavicular and Subtalar Joint Arthrodesis on Hindfoot Kinematics and Range of Motion During Cadaveric Gait Simulation.

BACKGROUND: Isolated subtalar and talonavicular joint arthrodeses have been associated with adjacent joint arthritis and altered hindfoot kinematics during simplified loading scenarios. However, the effect on kinematics during dynamic activity is unknown. This study assessed changes in subtalar and talonavicular kinematics after isolated talonavicular (TNiso) and subtalar (STiso) arthrodesis, respectively, during stance simulations. METHODS: Fourteen midtibia specimens received either a TNiso or STiso arthrodesis, with 7 randomized to each group. A 6-degree-of-freedom robot sequentially simulated the stance phase for the intact and arthrodesis conditions. Bootstrapped bias-corrected 95% CIs of the talonavicular and subtalar joint kinematics were calculated and compared between conditions. RESULTS: The TNiso decreased subtalar inversion, adduction, and plantarflexion in late stance (P < .05). The subtalar range of motion in the sagittal and coronal planes decreased by 40% (P = .009) and 46% (P = .002), respectively. No significant changes in talonavicular joint kinematics were observed after isolated subtalar arthrodesis; however, the range of motion was reduced by 61% (P = .007) and 50% (P = .003) in the coronal and axial planes, respectively. CONCLUSION: In this model for arthrodesis, changes in subtalar kinematics and motion restriction were observed after isolated talonavicular arthrodesis, and motion restriction was observed after isolated subtalar arthrodesis. Surprisingly, talonavicular kinematics did not appear to change after isolated subtalar arthrodesis. CLINICAL RELEVANCE: Both joint fusions substantially decrease the motion of the reciprocal adjacent joint. Surgeons should be aware that the collateral costs with talonavicular fusion appear higher, and it has a significant effect on subtalar kinematics during the toe-off phase of gait.

Hindfoot Arthrodeses and the Order of Joint Fixation Influence Tibiotalar Kinematics During Simulated Stance.

BACKGROUND: Although hindfoot arthrodeses relieve pain and correct deformity, they have been associated with progressive tibiotalar degeneration. The objective was to quantify changes in tibiotalar kinematics after hindfoot arthrodeses, both isolated subtalar and talonavicular, as well as double arthrodesis, and to determine if the order of joint fixation affects tibiotalar kinematics. METHODS: Hindfoot arthrodeses were performed in 14 cadaveric mid-tibia specimens. Specimens randomly received isolated fixation of the subtalar or talonavicular joint first, followed by fixation of the remaining joint for the double arthrodesis. A 6-degree-of-freedom robot sequentially simulated the stance phase of level walking for intact, isolated, and double arthrodesis conditions. Tibiotalar kinematic changes were compared for the intact and arthrodesis conditions. A subsequent analysis assessed the effect of the joint fixation order on tibiotalar kinematics. RESULTS: Isolated and double hindfoot arthrodeses increased tibiotalar plantarflexion, inversion, and internal rotation during late stance. Tibiotalar kinematics changes occurring after isolated arthrodesis remained consistent after the double arthrodesis for both the subtalar- and talonavicular-first conditions. The order of joint fixation influenced tibiotalar kinematics through some portions of stance, where the talonavicular-first double arthrodesis increased tibiotalar plantarflexion, eversion, and internal rotation compared to the subtalar-first double. CONCLUSION: Tibiotalar kinematics were modestly altered for all conditions, both isolated and double hindfoot arthrodeses. Changes in tibiotalar kinematics were consistent from the isolated to the double arthrodesis conditions and varied depending on which isolated hindfoot arthrodesis was performed first. Further research is needed to assess the clinical implications of the observed changes in tibiotalar kinematics, particularly as it pertains to the development of adjacent joint arthritis. CLINICAL RELEVANCE: These findings may correlate with clinical research that has cited hindfoot arthrodesis as a risk factor for adjacent tibiotalar arthritis. Once either the subtalar or talonavicular joint is fused, avoiding the arthrodesis of the second joint may not necessarily protect the tibiotalar joint.

Radiographic Outcomes of Isolated Subtalar Joint Arthrodesis With Varying Fixation Technique.

Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.

Tratamiento artroscópico en lesión osteocondral subtalar / Arthroscopic treatment of subtalar osteochondral lesion

Las lesiones osteocondrales de la articulación subtalar es una patología infrecuente y de incidencia variable, dado su reporte principalmente como hallazgo en el estudio de dolor crónico de tobillo y ya con cambios degenerativos articulares. La sospecha clínica y el estudio imagenológico dirigido, permiten investigar esas lesiones en estadios iniciales, evitando así el uso de técnicas que no preservan la articulación para su manejo. La artroscopía subtalar es una excelente herramienta tanto diagnóstica como terapéutica para la resolución de dichas lesiones. Dadas las características anatómicas y biomecánicas de la articulación, en estadios iniciales, el manejo mediante sinovectomía y microfracturas es una alternativa con excelentes resultados funcionales. Este trabajo incluye dos casos de lesiones osteocondrales de la faceta posterior de la articulación subtalar manejadas vía artroscópica mediante sinovectomía y microfracturas y su posterior evolución.

Osteochondral lesions in the subtalar joint are an uncommon pathology with a variable incidence, being mainly reported as a finding in chronic ankle pain studies and with already visible degenerative joint changes at time of diagnosis. Clinical suspicion and directed imaging study, allows to investigate these lesions during early stages, thus avoiding the use of invasive techniques with scarce joint preservation. Subtalar arthroscopy is an excellent diagnostic and therapeutic tool for the resolution of these lesions. Given the anatomical and biomechanical characteristics of the joint, in the early stages the management by synovectomy and microfractures is an alternative with excellent functional results. This study includes two cases of osteochondral lesions of the posterior facet of the subtalar joint managed through arthroscopically synovectomy and microfractures and their subsequent evolution.

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis.

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.

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis / Comparação biomecânica da força de fixação de parafuso com orientação de plantar para dorsal e vice-versa para artrodese subtalar

ABSTRACT 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.

RESUMO Objetivo Comparar a força de fixação dos parafusos para artrodese subtalar. Métodos Oito pares de pés de cadáveres frescos foram submetidos à artrodese da articulação subtalar com dois parafusos canulados de 7,3mm. A randomização foi usada para atribuir a orientação do parafuso, de modo que um pé em cada par foi designado com orientação de dorsal para plantar (Grupo DP), e o outro pé com orientação de plantar para dorsal (Grupo PD). Técnica cirúrgica padrão com radioscopia foi usada para os procedimentos. Após a fixação, cada amostra foi testada até a falha com um dispositivo Bionix®858 MTS, aplicando força axial descendente a uma distância para criar torque. O torque de falha foi comparado entre os Grupos DP e PD, usando o teste t de Student, com p=0,05 usado para determinar significância estatística. Resultados A análise estatística demonstrou que a média do torque até a falha favoreceu ligeiramente o Grupo DP (37,3Nm) em relação ao PD (32,2Nm). No entanto, a diferença entre os dois grupos não foi estatisticamente significativa (p=0,55). Conclusão Na artrodese subtalar, não há diferença significativa na força de compressão entre as orientações dos parafusos dorsal-plantar e plantar-dorsal. A abordagem escolhida pelo cirurgião deve ser baseada em outros fatores, sem preocupação com a força biomecânica da orientação dos parafusos.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series.

OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Subtalar Joint Distraction Arthrodesis Utilizing a Titanium Truss: A Case Series.

Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Role of Extra-articular Tibiotalocalcaneal Arthrodesis and Posterior Approach in Highly Complex Cases.

BACKGROUND: Tibiotalocalcaneal (TTC) arthrodesis is a procedure commonly used as salvage surgery for various pathologic processes that compromise the ankle and subtalar joints. It is a reasonably standardized procedure when performed as a primary surgery in advanced stages of TTC arthritis. For such cases, there are several alternative approaches, fixation materials, and bone substitutes that can be used. Most represent valid options with similar results in the literature. However, in highly complex cases requiring TTC arthrodesis, the options for the approach and fixation material can be limited. Understanding the alternative approaches and techniques is of great help to the surgeon when faced with highly complex cases, such as patients with multiple previous operations, lack of bone stock, severe deformities, or compromise of associated soft tissues. In this article, we describe the role of the posterior approach with some technical variation that allows extra-articular arthrodesis in highly complex cases, and we present a series of patients with tibiotalocalcaneal arthrodesis who were operated on using this technique. METHODS: Retrospective review of all patients who underwent tibiotalocalcaneal arthrodesis via posterior approach between 2008 and 2016. The surgeries were performed by 2 different surgeons with the same technique (posterior approach with sliding graft) but 2 different fixation methods. Radiographs and computed tomographic (CT) studies were reviewed and patient satisfaction was rated using the Coughlin scale. Mean follow-up was 38 months. We identified 20 patients. The mean age was 51.2 years; 11 patients had post-traumatic arthritis whereas the others had other causes of arthritis (inflammatory disease, neurologic deformity, etc). RESULTS: The arthrodesis was performed using a tibiotalocalcaneal plate in 9 patients and retrograde intramedullary nail in 11 patients. Radiographic fusion was observed at an average of 3.1 months. Four patients had complications and 15 reported good or excellent results after surgery. CONCLUSION: Our study found a fusion rate comparable to other studies in highly complex cases. There were no operative wound complications. We observed that the posterior approach, with an extra-articular fusion procedure, was a valid option for salvage surgery in highly complex cases that require tibiotalocalcaneal fusion. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation.

Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The primary aim of the present retrospective study was to evaluate the outcomes of patients who had undergone tibiotalocalcaneal arthrodesis with an intramedullary nail without formal subtalar joint cartilage resection. A multicenter medical record review was performed to identify consecutive patients. Pain was assessed using a visual analog scale, and osseous union at the tibiotalar joint was defined as bony trabeculation across the arthrodesis site on all 3 radiographic views. Progression of joint deterioration was evaluated across time at the subtalar joint, using a modified grading system developed by Takakura et al. Forty consecutive patients (aged 61.9 ± 12.9 years; 17 men) met the inclusion and exclusion criteria. Compared with the pain reported preoperatively (6.4 ± 2.7), a statistically significant decline was seen in the pain experienced after surgery (1.2 ± 1.8; p < .001). The mean time to consolidated arthrodesis at the ankle joint was 3.8 ± 1.5 months. A statistically significant increase in deterioration at the subtalar joint was observed across time [t(36) = -6.200, p < .001]. Compared with previously published data of subtalar joint cartilage resection, the present study has demonstrated a similar decline in pain, with a high rate of union, and also a decrease in operative time when preparation of the subtalar joint was not performed.

[Double bilateral talocalcaneal and calcaneonavicular coalition in a 15 year-old patient: treatment and results]. / Doble coalición astragalocalcánea y calcaneoescafoidea bilateral en un paciente de 15 años: tratamiento y resultados.

BACKGROUND: We report the case of a male, 15 year-old patient without any remarkable pathologic history, with double talocalcaneal and calcaneonavicular coalition in both feet. He underwent surgery of the left foot due to onset of refractory symptoms after conservative treatment. RESULTS: Both coalitions were resected and pedal muscle was interposed at the level of the calcaneonavicular joint as well as an endorthesis in the tarsal sinus. The patient became totally asymptomatic after surgery. CONCLUSIONS: Multiple bilateral tarsal coalitions, i.e., present in both feet, are very infrequent, except when they are associated with syndromic pictures or conditions such as fibular hemimelus, Alpert syndrome, Nievergelt-Pearlman syndrome, multiple synostosis or hereditary symphalangism. Treatment should be individualized based on the location of the synostosis.

Artroscopía de la articulación subastragalina: técnica quirúrgica, indicaciones, resultados y complicaciones / Subtalar joint arthroscopy: surgical technique, indications, results and complications

Introducción: El abordaje artroscópico para el tratamiento de la patología subastragalina se encuentra en pleno desarrollo. El propósito del presente trabajo es efectuar una descripción de las indicaciones, técnica quirúrgica, resultados y complicaciones en la realización de la artroscopía de la articulación subastragalina. Material y método: Se presenta 14 pacientes con patología de la articulación subastragalina, tratados durante los años 2003 al 2009. Se realizaron 11 artroscopías posteriores y 3 laterales. Seguimiento: 36 meses (R=15-69). Todos los pacientes fueron evaluados mediante el score AOFAS y a los 12 meses de la cirugía se les pregunto: 1- Si estaban satisfechos con el resultado de la cirugía. 2- Si volverían a realizar la intervención. Resultados: La indicación más frecuente de artroscopía para la articulación subastragalina ha sido en nuestra casuística la artrosis (35,71 por ciento). El score AOFAS promedio fue de 88,42 (R=46-100). El 78,58 por ciento de los pacientes estaban satisfechos con el resultado del procedimiento y un 85,72 por ciento volvería a operarse. Tuvimos una complicación de un paciente con hipoestesia del talón (7,14 por ciento). Conclusiones: La artroscopía de la articulación subastragalina es una herramienta diagnóstica y terapéutica segura, reproducible y confiable, exige un conocimiento de la anatomía artroscópica de la región y debe ser llevada a cabo por artroscopistas con experiencia. Diseño del estudio: Serie de casos. Nivel de evidencia: IV. (AU)

Artroscopía de la articulación subastragalina: técnica quirúrgica, indicaciones, resultados y complicaciones / Subtalar joint arthroscopy: surgical technique, indications, results and complications

Introducción: El abordaje artroscópico para el tratamiento de la patología subastragalina se encuentra en pleno desarrollo. El propósito del presente trabajo es efectuar una descripción de las indicaciones, técnica quirúrgica, resultados y complicaciones en la realización de la artroscopía de la articulación subastragalina. Material y método: Se presenta 14 pacientes con patología de la articulación subastragalina, tratados durante los años 2003 al 2009. Se realizaron 11 artroscopías posteriores y 3 laterales. Seguimiento: 36 meses (R=15-69). Todos los pacientes fueron evaluados mediante el score AOFAS y a los 12 meses de la cirugía se les pregunto: 1- Si estaban satisfechos con el resultado de la cirugía. 2- Si volverían a realizar la intervención. Resultados: La indicación más frecuente de artroscopía para la articulación subastragalina ha sido en nuestra casuística la artrosis (35,71 por ciento). El score AOFAS promedio fue de 88,42 (R=46-100). El 78,58 por ciento de los pacientes estaban satisfechos con el resultado del procedimiento y un 85,72 por ciento volvería a operarse. Tuvimos una complicación de un paciente con hipoestesia del talón (7,14 por ciento). Conclusiones: La artroscopía de la articulación subastragalina es una herramienta diagnóstica y terapéutica segura, reproducible y confiable, exige un conocimiento de la anatomía artroscópica de la región y debe ser llevada a cabo por artroscopistas con experiencia. Diseño del estudio: Serie de casos. Nivel de evidencia: IV.

Coalizöes tarsais: ressecçäo da barra óssea / The surgical treatment of calcaneonavicular and talocalcaneal coalition

Os autores avaliam o resultado do tratamento cirúrgico das coalizöes calcaneonavicular e talocalcânea em 20 pacientes (25 pés), todos sintomáticos, submetidos à ressecçäo da barra entre janeiro de 1986 e janeiro de 1998. O tempo médio de seguimento foi de 29 meses para as coalizöes talocalcâneas e 49 meses para as calcaneonaviculares. A média de idade no momento da cirurgia foi de 12 anos nas coalizöes talocalcâneas e 13 anos e seis meses nas calcaneonaviculares. Os resultados foram determinados pela escala clínico-funcional para tornozelo e retropé da American Orthopaedic Foot and Ankle Society (AOFAS). Correlacionam o resultado funcional com o nível de satisfaçäo do paciente, a idade do paciente no momento da cirurgia, o tempo transcorrido desde o início dos sintomas até o tratamento cirúrgico e o grau de artrose da articulaçäo subtalar presente no pré-operatório. Como conlusöes observam que: 1) O resultado clínico-funcional e a satisfaçäo pessoal com a cirurgia foram significativamente melhores nos pacientes submetidos à ressecçäo da coalizäo calcaneonavicular em relaçäo à coalizäo talocalcânea; 2) A idade no momento da cirurgia näo influenciou o resultado clínico-funcional nos pacientes submetidos à ressecçäo da coalizäo calcaneonavicular; 3) Quanto maior a idade no momento da cirurgia, piores foram o resultados obtidos com a ressecçäo da coalizäo talocalcânea; 4) Nos pacientes portadores de coalizöes talocalcâneas, a presença de artrose subtalar pré-operatória em grau moderado influenciou negativamente o resultado clínico-funcional após a ressecçäo cirúrgica da barra.

Técnica de liberación posteromedial para la deformidad del pie bot idiopático rígido / Postero-medial release technique for treatment of stiff idiopathic club-foot

El pie Bot es una de las deformidades congénitas más comunes de la extremidad inferior y un 20 por ciento se acompaña de una enfermedad muscular. Existen múltiples alteraciones anatomofuncionales de la pierna y del pie. Nosotros efectuamos un estudio retrospectivo, longitudinal, clínico y quirúrgico del 1§. de septiembre de 1993 al 30 de noviembre de 1997. Fueron 37 pacientes, 24 del sexo masculino y 13 del femenino, siete casos fueron bilaterales, 13 del pie izquierdo y 17 del derecho. La edad promedio de los pacientes fue 1.8 años. El tiempo promedio de seguimiento fue de 1.10 años. Los pacientes fueron operados de acuerdo a la técnica descrita por el Dr. Turco. Los resultados se catalogaron de acuerdo a la clasificación de Green y Lloyd Roberts; obteniendo 23 pacientes con excelentes o buenos resultados y el resto de pacientes con resultados regulares. Sabemos que a pesar de todos los esfuerzos, es imposible curar la patología completamente.

Avaliaçäo isocinética pré e pós-operatória nas coalizöes tarsais / Pre and postoperative isokinetic evaluation in tarsal coalitions

O objetivo deste trabalho é o de demonstrar os resultados da avaliaçäo funcional na resseçäo operatória das colizöes tarsais talocalcaneanas e calcaneonaviculares. O ângulo máximo de movimento e o torque muscular máximo isocinético para a inversäo e eversäo do pé säo determinados em 12 pacientes (17 pés) portadores de coalizäo tarsal talocalcaneana (8) e calcaneonavicular (4). Säo avaliados oito pacientes do sexo feminino e quatro do sexo masculino com idades entre 10 e 16 anos (média = 13,2 anos). Todas as barras talocalcaneanas haviam sido tratadas com a ressecçäo da barra e interposiçäo de enxerto autógeno livre de gordura. As barras calcaneonaviculares foram tratadas através da excisäo da barra seguida da interposiçäo do tendäo do músculo extensor curto dos dedos. Os testes isocinéticos foram realizados em dinamômetro isocinético marca Cybex, modelo 350, no pré e pós-operatório. Foram avaliados os valores torque máximo por porcentagem de peso corpóreo, nas velocidades angulares de 30 a 120 graus/segundo. Os resultados demonstraram aumento significante da força muscular e dos valores do ângulo de movimento articular (p<0,05) após período pós-operatório mínimo de seis meses. Os autores concluem que a ressecçäo operatória é boa opçäo terapêutica das coalizöes tarsais talocalcaneanas e calcaneonaviculares, permitindo bons resultados funcionais.

Artrodese subtalar nas seqüelas de fraturas do calcâneo / Subtalat artrodese after calcaneus fractures

Os autores avaliaram 11 artrodeses subtalares realizadas para tratamento de seqüelas dolorosas de fraturas complexas do calcâneo. Foram sete pacientes do sexo masculino e quatro do feminino, tratados no período de setembro de 1989 a setembro de 1994. A técnica cirúrgica consistiu de pequena exposiçäo lateral, fixaçäo com parafuso de esponjosa, colocaçäo de enxerto de ilíaco, imobilizaçäo com tala gessada por duas semanas. Na análise dos resultados, foram utilizados critérios subjetivos (opiniäo do paciente) e objetivos (limitaçäo da mobilidade, deformidade em varo ou valgo e alteraçäo do contorno do calcâneo). Todas as artrodeses consolidaram. Os resultados foram considerados bons e 91 porcento e regulares em 9 porcento. Näo houve resultado classificado como mau. Os autores consideram a técnica de fácil execuçäo e eficaz no tratamento de seqüela dolorosa das fraturas do calcâneo.

Coalizäo tarsal em pé cavo varo: relato de 3 casos / Tarsal coalition in cavus varus foot: report of 3 cases

Os autores apresentam três casos de coalizöes tarsais subtalares em pacientes jovens, com pés cavos varos dolorosos. Chamam a atençäo para o fato de que esta deformidade clínica dos pés näo é habitualmente encontrada nas coalizöes tarsais.