ABSTRACT
Surgical arthrodesis is effective for treating proximal interphalangeal joint (PIJ) injuries in horses. Despite several techniques described so far, the use of a 3-hole, 4.5mm-locking compression plate, associated with two 5.5-mm transarticular cortex screws, is currently considered the "gold standard." This review describes the anatomy of the pastern, as well as causes, indications, and possibilities for arthrodesis in the equine PIJ. A description of the current surgical technique for joint fixation is also presented.(AU)
A artrodese cirúrgica é efetiva para o tratamento de condições da articulação interfalangeana proximal (AIP) em equinos. Diversas técnicas são descritas, e o uso de uma placa de compressão bloqueada de três orifícios e 4,5 mm associada com dois parafusos corticais transarticulares de 5,5 mm é atualmente o padrão ouro. Esta revisão tem por objetivo descrever a anatomia da região da quartela, bem como as causas, indicações e possibilidades para a artrodese da AIP nos equinos. É apresentada também a descrição da técnica cirúrgica atualmente utilizada para realização da fixação da articulação.(AU)
Subject(s)
Animals , Osteoarthritis/surgery , Arthrodesis/classification , Arthrodesis/methods , Horses/anatomy & histology , Intermittent ClaudicationABSTRACT
Objetivos: hemos confeccionado una actualización de conceptos en cirugía artroscópica de pie y tobillo basada en una revisión de conceptos mediante el motor de búsqueda PubMed de acceso libre a la base de datos MEDLINE. Hemos introducido como palabras clave: "arthroscopy", "endoscopy", "tendoscopy", "foot" y "ankle". Material y métodos: hemos valorado los trabajos publicados desde el 2015 hasta la actualidad centrándonos en aquellos que por tener más repercusión o ser más innovadores tienen una mayor aportación a los profesionales. Resultados y conclusiones: en la mayoría de estos trabajos el nivel de evidencia científica es bajo, ya sea por diseño o más habitualmente por tratarse de muestras pequeñas de pacientes. No obstante, de la lectura de dichos artículos, podemos sacar algunas conclusiones y conceptos interesantes
Objectives: we made an update of concepts in foot and ankle arthroscopy based on a review of concepts by the search engine PubMed and MEDLINE database. We have introduced as keywords: "arthroscopy", "endoscopy", "tendoscopy", "foot" and "ankle". Methods: We evaluated the papers published from 2015 to the present, focus on those who have more impact and be more innovative. Results and conclusions: most of these papers, the level of scientific evidence is low, either by design or more usually because they are small samples of patients. However, reading these articles, we can draw some conclusions and interesting concepts
Subject(s)
Humans , Male , Female , Arthroscopy/methods , Ankle Injuries/pathology , Foot/pathology , Joint Instability/diagnosis , Arthrodesis/methods , Posterior Tibial Tendon Dysfunction/physiopathology , Metatarsophalangeal Joint/pathology , Arthroscopy/standards , Ankle Injuries/complications , Foot/physiology , Joint Instability/complications , Arthrodesis/classification , Posterior Tibial Tendon Dysfunction/complications , Talus/physiopathology , Metatarsophalangeal Joint/injuriesABSTRACT
To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis. One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training. The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power. Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.
Avaliar a concordância interobservadores da classificação de Glassman para artrodese posterolateral da coluna lombar. Cento e trinta e quatro tomografias de pacientes submetidos a artrodese posterolateral da coluna lombar e lombossacra foram avaliadas por quatro observadores, sendo dois ortopedistas experientes em cirurgia da coluna e dois ortopedistas em treinamento na área. Utilizando as imagens tomográficas reconstruídas no plano coronal oblíquo foram analisados, sistematicamente, 299 níveis operados, buscando-se sinais de artrodese. O aspecto da consolidação óssea em cada nível operado foi classificado como proposto por Glassman para artrodese posterolateral em cinco categorias: 1) artrodese sólida bilateral; 2) artrodese sólida unilateral; 3) artrodese parcial bilateral; 4) artrodese parcial unilateral; 5) ausência de artrodese. Em um segundo momento, a avaliação de cada nível operado foi dividida em duas categorias: consolidado (tipos 1, 2, 3, e 4 de Glassman) e não consolidado (tipo 5). A análise estatística foi feita pelo cálculo do coeficiente Kappa considerando-se a análise pareada entre os dois observadores experientes e entre dois observadores em treinamento. A reprodutibilidade interobservadores pelo coeficiente Kappa para a análise de consolidação da artrodese pela classificação proposta, dividida em 5 tipos, foi de 0,729 tanto para os cirurgiões experientes quanto em treinamento. Considerando apenas as duas categorias, obtivemos coeficiente Kappa de 0,745 entre os cirurgiões e de 0,795 entre os residentes. Em todas as análises obtivemos força de concordância alta. Foi observada reprodutibilidade interobservadores com concordância alta na classificação proposta por Glassman para as artrodeses posterolaterais da coluna lombar e lombossacra.
Evaluar la concordancia entre observadores de la clasificación de Glassman para artrodesis posterolateral de la columna lumbar. Ciento treinta y cuatro tomografías de pacientes sometidos a artrodesis posterolateral de la columna lumbar y lumbosacra fueron evaluados por cuatro observadores: dos cirujanos ortopédicos con experiencia en la cirugía de columna y dos cirujanos ortopédicos en formación para cirugía de columna. Por medio de las imágenes de TC reconstruidas en el plano coronal oblicuo se analizaron sistemáticamente 299 niveles operados, buscando señales de artrodesis. La aparición de la cicatrización ósea en cada nivel operado se clasificó como propone Glassman para la artrodesis posterolateral, en cinco categorías: 1) artrodesis sólida bilateral; 2) artrodesis sólida unilateral; 3) artrodesis parcial bilateral; 4) artrodesis parcial unilateral; 5) ausencia de artrodesis. En una segunda etapa, la evaluación de cada nivel operado fue dividida en dos categorías: fusión (tipos 1, 2, 3 y 4) y sin fusión (tipo 5). El análisis estadístico se realizó mediante el cálculo del coeficiente Kappa, teniendo en cuenta el análisis pareado entre los dos observadores experimentados y entre los dos observadores en formación. La reproducibilidad entre observadores por el coeficiente Kappa para el análisis de la consolidación de la artrodesis en la clasificación propuesta, dividida en 5 categorías, fue 0,729 para ambos cirujanos experimentados y en formación. Considerando solamente las dos categorías, se obtuvo el coeficiente Kappa de 0,745 entre los cirujanos experimentados y 0,795 entre los cirujanos en formación. En todos los análisis se obtuvo un alto poder de concordancia. Se observó reproducibilidad entre observadores con una alta concordancia en la clasificación propuesta por Glassman ...Subject(s)
Humans
, Arthrodesis/classification
, Diagnostic Imaging
, Tomography, X-Ray Computed
, Reproducibility of Results
ABSTRACT
Informamos la experiencia que se obtuvo con el uso de placas de titanio tipo Caspar para artrodesis cervical anterior, en el Servicio de Neurocirugía del Centro Médico Nacional 20 de Noviembre, ISSSTE, México, en pacientes con alteraciones cervicales diversas de origen degenerativo, traumático o neoplásico, que condicionaron síndrome de compresión radicular cervical. Se tuvieron 85 casos, 49 mujeres y 36 varones, edad de 15 a 78 años con una media de 52. Hubo antecedentes de traumatismo cervical en 63, 78 pacientes presentaron hernias de disco cervical, un caso de Schwannoma de C6, dos fracturas del arco posterior de C2, un caso con fractura del cuerpo de C5, uno con listesis C6-7 y el último con cirugía cervical previa e injerto intersomático migrado al canal. El síntoma preoperatorio principal fue: dolor radicular en 54 casos; disminución de la fuerza muscular en 23 y parestesias en miembros superiores en seis; hubo dos casos asintomáticos. La evolución posoperatoria fue satisfactoria, puesto que en 52 casos el dolor disminuyó o desapareció y mejoró la fuerza muscular; se logró la desparición de las parestesias en 37 casos. El procedimiento mostró su utilidad como método de fijación y de descompresión radiculomedular cervical. En casos con canal cervical estrecho, compresión posterior y persistencia de las parestesis, se recomienda un abordaje por vía posterir para descomprimir la porción dorsal de la médula y sus raíces, que permite al paciente alivio de su sintomatología
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Arthrodesis/classification , Arthrodesis/rehabilitation , Orthopedic Fixation Devices , Spinal Injuries/surgery , Spinal Injuries/therapyABSTRACT
Arthrodesis of the subtalar joint is well recognized treatment option for moderate or severe flatfoot associated with adult acquired flatfoot secondary to posterior tibial tendon dysfunction. The success of the subtalar arthrodesis is dependent on restoration of normal bony relationships in the hindfoot and midfoot. For this reason, a distinction is made between a repositional arthrodesis and the traditional in situ type of arthrodesis. An in vitro study of the adult acquired flatfoot identifies an anteroposterior subluxation of the subtalar articulation that can be corrected durably and reliably through a repositional talocalcaneal arthrodesis. Intraoperative reduction techniques are useful in obtaining reduction of the peritalar subluxation. There are certain clinical features that help identify patients with flatfoot deformities who are good candidates for subtalar fusion. As the pathoanatomy of the flatfoot deformity is better elucidated, treatment techniques are modified to better address the key elements of the deformity. A repositional subtalar arthrodesis was shown to produce excellent correction in a moderate to severe in vitro flatfoot example in the authors' clinical series.
Subject(s)
Arthrodesis , Flatfoot/surgery , Subtalar Joint/surgery , Adult , Arthrodesis/classification , Calcaneus/surgery , Female , Flatfoot/etiology , Flatfoot/pathology , Follow-Up Studies , Foot Deformities, Acquired/etiology , Foot Deformities, Acquired/pathology , Foot Deformities, Acquired/surgery , Humans , Intraoperative Care , Joint Dislocations/surgery , Male , Muscular Diseases/complications , Reproducibility of Results , Talus/surgery , Tendons/pathology , Treatment OutcomeABSTRACT
Twenty-four double arthrodeses (24 patients) were evaluated at an average of 56 months postoperatively. Sixteen arthrodeses were performed for adult acquired flatfoot attributable to posterior tibial tendon insufficiency (16 patients), and results were compared with the results of eight patients undergoing arthrodesis for other diagnoses. The overall satisfaction rate was 83%, with 76% of patients having good and excellent results. Considerable improvements were observed in pain and function indices, with similar outcomes observed in the patients with and without acquired flatfoot. However, complications were more frequent in the patients who had flatfoot deformities. Clinical deformity was corrected reliably and radiographic parameters confirmed correction of deformity. Progression of arthrosis in the surrounding joints was common, but most patients were asymptomatic. Talonavicular nonunion was the most frequent complication, occurring in four patients. Three of the patients underwent revision arthrodesis.
Subject(s)
Arthrodesis , Flatfoot/surgery , Adult , Aged , Aged, 80 and over , Arthrodesis/adverse effects , Arthrodesis/classification , Disease Progression , Female , Flatfoot/diagnostic imaging , Flatfoot/etiology , Flatfoot/physiopathology , Follow-Up Studies , Foot Deformities, Acquired/diagnostic imaging , Foot Deformities, Acquired/etiology , Foot Deformities, Acquired/physiopathology , Foot Deformities, Acquired/surgery , Humans , Joint Diseases/etiology , Male , Middle Aged , Muscular Diseases/complications , Patient Satisfaction , Radiography , Reoperation , Reproducibility of Results , Talus/pathology , Tarsal Bones/pathology , Tendons/pathology , Treatment Outcome , Wound HealingABSTRACT
The results of medial column stabilization, lateral column lengthening, and combined medial and lateral procedures were reviewed in the treatment of adult acquired flatfoot secondary to posterior tibialis tendon insufficiency. All bony procedures were accompanied by transfer of the flexor digitorum longus tendon to the medial cuneiform or stump of the posterior tibialis tendon and tendoachilles lengthening or gastrocnemius recession. Medial column fusion was performed for naviculocuneiform and cuneiform first metatarsal sag; lateral column lengthening was performed for calcaneovalgus deformity with a flat pitch angle; and combined procedures were performed for complex combined deformities. At 1 to 4 year followup of 65 feet, 88% of the feet that had lateral column lengthening, 80% that had medial column stabilization, and 88% of the feet that had medial and lateral procedures had a decrease in pain or were pain free. The lateral talar first metatarsal angle improved by 16 degrees in the patients in the lateral column lengthening group, 20 degrees in the patients in the medial column stabilization group, and 24 degrees in the patients in the combined medial and lateral procedures group. The anteroposterior talonavicular coverage angle improved by 14 degrees in the patients in the lateral column lengthening group, 10 degrees in the patients in the medial column stabilization group, and 14 degrees in the patients in the combined medial and lateral procedures group. These techniques effectively correct deformity without disrupting the essential joints of the hindfoot and midfoot.
Subject(s)
Flatfoot/surgery , Tarsal Bones/surgery , Achilles Tendon/surgery , Adult , Arthrodesis/classification , Calcaneus/surgery , Female , Flatfoot/etiology , Follow-Up Studies , Foot Deformities, Acquired/etiology , Foot Deformities, Acquired/surgery , Humans , Male , Metatarsal Bones/surgery , Middle Aged , Muscle, Skeletal/surgery , Muscular Diseases/complications , Orthopedic Fixation Devices , Talus/surgery , Tendon Transfer , Tendons/pathology , Treatment OutcomeABSTRACT
Numerous types of limited intercarpal arthrodeses have been reported in dozens of articles in the English-language medical literature. The nonunion rate varies considerably within and between the different types of arthrodeses. This may be due in part to the small number of cases in most studies. The data on the number of good results and nonunion rates for 27 different types of limited carpal arthrodeses reported in the English-language medical literature from 1946 to 1993 were collected, and for each study, the 95% confidence intervals (95% CI) were calculated. The studies were then combined for specific types of arthrodeses and the overall nonunion rates and confidence intervals were calculated to more accurately determine the actual nonunion rate expected for limited intercarpal arthrodeses. Nonunion rates (95% CI) for the most popular types of limited arthrodeses were as follows: of 385 scaphotrapezium-trapezoid arthrodeses reported, there was a 14% nonunion rate (95% CI, 11%-18%); of 104 lunotriquetral arthrodeses, the nonunion rate was 27% (95% CI, 19%-36%); and of 17 scapholunate arthrodeses, the nonunion rate was 47% (95% CI, 26%-69%).
