Osteotomies of the second phalanx of the great toe: A clinical experience.

BACKGROUND: At the time of the first report on the feasibility of corrective osteotomies of the distal phalanx (DP) of the great toe there were no published studies addressing this type of surgery. Along this line, and throughout our clinical experience, this paper tries to show the clinical benefits of hallux DP osteotomies when correcting interphalangeal valgus deformities (IHV) of the great toe, either with open or percutaneous procedure. MATERIAL AND METHODS: This is a review of 18 cases in which a DP osteotomy was performed in 2 different institutions, 8 cases were performed using open technique and 10 cases percutaneously. The correction obtained was analyzed by measuring the distal articular set angle (DASA), obliquity angle (AP1), asymmetry angle (AP2), and global distal phalanx deviation (GDPD) angle before and after the surgery on dorso-plantar weight-bearing radiographs in all cases. Clinical results were also recorded. RESULTS: Excellent clinical and radiological results were achieved with both techniques in all patients with no complications. The average DP angular deformity correction in terms of AP1, AP2 and GDPD angles were 4.58º ± 5.55º, 8.95º ± 4.77º and 16.53º ± 7.26 respectively. In 10 cases an Akin osteotomy was associated. CONCLUSION: In cases with valgus deviation in the hallux DP, a corrective osteotomy of the DP alone or associated to osteotomy of the PP should be considered as a useful tool. The technique is feasible and has no technical difficulties for an orthopedic surgeon with experience on feet surgery.

Minimally Invasive Chevron Surgery and Bosch Percutaneous Osteotomy in Hallux Valgus Treatment. Midterm Results. Comparative Radiological Study.

Objective The purpose of the present study is to compare the radiological results of angular correction and its maintenance in the medium term between two minimally invasive techniques for the treatment of hallux valgus (minimally invasive chevron surgery vs. Bosch technique). Methods A comparative prospective analysis of patients undergoing surgery for symptomatic hallux valgus deformity was performed. We compared two minimally invasive techniques in homogeneous groups of population. Two groups of 62 and 63 feet respectively, were constituted. We compared first ray angular corrections and consolidation as well as the correction power of both osteotomies and their maintenance over time. The postoperative complications and surgical time in both study groups were also evaluated. The minimum follow-up was 2 years. Results There were differences between both groups in the intermetatarsal angle at 24 months postsurgery. There were no differences between both groups regarding metatarsophalangeal angle, and distal metatarsal articular angle. There were no intraoperative complications in either group. The surgical time between both groups had statistically significant differences. Conclusions Both screw-stabilized, Bosch surgery and minimally invasive chevron (hybrid when associated with percutaneous Akin osteotomy) present adequate correction of moderate hallux valgus. However, patients treated with Bosch percutaneous surgery had a greater correction power of the intermetatarsal angle in the medium term, as well as a shorter surgical time, when compared with those who were treated with chevron osteotomy. Both techniques had a similar evolution over time regarding loss of correction and postoperative complications.

Minimally invasive treatment of AO B ankle fractures: Surgical technique and long-term outcomes.

BACKGROUND: Ankle fractures are the most common traumatic bone injuries of the lower limb. Over 50% of ankle fractures occur at the syndesmosis level (type AO B). The goal of treatment is to achieve an anatomical reduction and appropriate stabilization. The present study aimed to evaluate the clinical-functional and radiological results, and complications of minimally invasive reduction and fixation technique for ankle fractures type AO B. The surgical technique also is detailed. MATERIAL AND METHODS: A prospective analysis of 451 patients undergoing surgery for type AO B displaced ankle fracture was performed. All patients were treated with minimally invasive surgery. The following times were recorded: time between trauma and osteosynthesis, hospitalization length, surgical time, and exposure time to fluoroscopy. Age and gender, mechanism of injury, and characteristics of fractures were recorded. For functional outcome, AOFAS score, VAS, and Weber score were used. Radiographic analysis was performed. The average follow-up was 112 months. RESULTS: Mean age was 48.2 years old. Average length of stay in hospital was 5.72 h. Mean duration of the surgery was 32.8 min. Average fluoroscopic exposure time during surgery was 9.25 s. Mean bone union time was 38.2 days. Weber's score was on average 1.5/24 points and the long-term follow-up AOFAS score was on average 97.5/100. Postoperative complications incidence was 2.7%. CONCLUSIONS: Distal fibula fixation with the MIPO technique presented good functional outcomes and could be helpful in the avoidance of the complications associated with conventional open reduction and internal fixation. However, it needs more exposition to intraoperative fluoroscopy. LEVEL OF EVIDENCE: II.

Osteotomía percutánea de la falange distal del hallux. Indicaciones y técnica / Percutaneous osteotomy of the distal phalanx of the hallux. Indications and technique

Introducción: Las técnicas para corregir las deformidades del hallux incluyen osteotomías metatarsianas y falángicas. Las osteo-tomías sobre la falange proximal corrigen el DASA y el ángulo interfalángico. Sin embargo, no se han publicado las indicaciones para la osteotomía de la falange distal. El objetivo de este artículo es comunicar la técnica y las indicaciones de la osteotomía percutánea de la falange distal del hallux, y evaluar los resultados de una serie de casos. materiales y métodos: Se analizaron 14 pies en los que se realizó una osteotomía de la falange distal del hallux para corregir una deformidad. Se midieron el DASA, la oblicuidad interfalángica y el ángulo falange distal-interfalángico en las radiografías. La técnica quirúrgica fue percutánea con control fluoroscópico. Los resultados se evaluaron mediante las escalas analógica visual de dolor y AOFAS. Seguimiento medio: 52 meses. Resultados: 13 pies de mujeres y un pie de hombre. Edad promedio: 58 años. Los resultados clínico y estético fueron excelentes, con alivio del dolor. Mejoría de la escala AOFAS: promedio 37 puntos. Análisis comparativo de ángulos preoperatorios y posoperatorios: DASA (p = 0,01), excepto cuando se aisló de la muestra a los pacientes con osteotomía tipo Akin (p = 0,33); ángulos F2-IF y F2-MTF (p <0,00001). Se registraron las complicaciones. Conclusiones: En la deformidad en valgo de la falange distal del hallux sintomática, se debe considerar una osteotomía correctora sola o asociada a osteotomía de la falange proximal. La osteotomía percutánea de la falange distal es un método eficaz, seguro y rápido. Nivel de Evidencia: IV

Introduction. There are many techniques to correct the hallux deformity. Most of them include metatarsal and/or phalanx osteotomies. The Akin osteotomy of the proximal phalanx is used to correct the distal articular set angle (DASA), or the interphalangeal angle. However, indications for the distal phalanx osteotomy remain unpublished. The aim of this study is to communicate the technique of performing and the indications for percutaneous osteotomy of the distal phalanx of the hallux, and evaluate the results of a cases series. Materials and methods. We report 14 cases in which distal phalangeal osteotomy was performed. Radiographic measurements were performed on dorsal-plantar view foot, to analyze distal articular set angle (DASA), interphalangeal obliquity, and F2-IP angle. Surgical technique was performed by minimally incision surgery. The clinical and functional results were evaluate by the visual analogue scale pain, and the AOFAS score. Mean follow-up was 52 months. Results. The clinical result for all the patients was excellent, pain was relieved and deformities corrected. Pre- and post-operative comparative angles: DASA (p: 0.01), except when isolated from the sample for Akin-type osteotomy (p: 0.33). Angle F2-IF and angle F2-MTF (p: <0.00001). The patients where highly satisfied with both the aesthetic and functional results. Complications were registered. Conclusion. In the symptomatic hallux´s distal phalanx deformity a corrective distal phalanx osteotomy should be considered alone, or associated with the osteotomy of the proximal phalanx. Percutaneous distal phalanx osteotomy is an effective, safe, and fast procedure. Level of Evidence: IV

Estudio prospectivo de cirugía de hallux valgus con técnica de Bosch y técnica MICA. Análisis radiológico comparativo a mediano plazo / Bösch vs MICA techniques in hallux valgus surgery. Medium-term prospective comparative radiographic analysis

Introducción: Existen múltiples tratamientos quirúrgicos del hallux valgus. El propósito de este estudio fue comparar los resultados radiográficos de corrección angular y su mantenimiento a mediano plazo, entre dos técnicas percutáneas: MICA y Bösch. Materiales y Métodos: Análisis prospectivo comparativo de pacientes sometidos a cirugía de hallux valgus mediante dos técnicas percutáneas (grupo Bösch: 42 pies, grupo MICA: 36 pies). Se compararon las correcciones de los ángulos IM, MTF y AMD, y el poder de corrección de ambas osteotomías y su mantenimiento a mediano plazo. Se registraron las complicaciones posoperatorias. Seguimiento mínimo: 6 meses. Resultados: La corrección promedio de los ángulos IM, MTF y AMD fue: 20,22°; 7,74°; 8,26° a los 6 meses en el grupo Bösch; y de 15,8°; 1,6° y 1,98° en el grupo MICA. El potencial de corrección IM fue mayor en el grupo Bösch. No hubo diferencias significativas entre ambos grupos en cuanto a la pérdida de corrección entre las 6 semanas y los 6 meses, salvo el ángulo MTF en el grupo MICA. La corrección del ángulo AMD fue mejor en el tiempo con la técnica MICA. Hubo 4 complicaciones con la técnica MICA y 8 con la técnica de Bösch. Conclusiones: Ambas técnicas logran una corrección adecuada del hallux valgus moderado. Sin embargo, el poder de corrección del ángulo IM a mediano plazo fue mayor con la técnica de Bösch. En el otro grupo, aunque se perdió la corrección del ángulo MTF entre las 6 semanas y los 6 meses, los valores se mantuvieron dentro de los 20° de valgo MTF. Nivel de Evidencia: II

Introduction: Multiple surgical treatments for the hallux valgus have been described. The purpose of this study is to compare the radiological results for the angular correction and its stability on the middle term between two percutaneous techniques (MICA versus BOSCH technique). Materials and methods: Prospective comparative analysis of surgically treated patients with hallux valgus by two percutaneous techniques (BOSCH group: 42 feet; MICA group: 36 feet) in homogenous groups. Intermetatarsal, metatarsophalangeal and distal metatarsal articular angle corrections were compared, as well as the correction power of both osteotomies and its stability in the middle term. Postoperative complications were recorded. Minimum follow-up: 6 months. Results: Average angle correction of MTP, IM y DMAA 6 months after surgery in Bosch group: 20,22°; 7,74°; 8,26°; MICA: 15,8°; 1,6° and 1,98° respectively. BOSCH group had a higher IM correction power. There were no significant statistical differences between both groups in the loss of correction by 6 weeks to 6 months; except for the MTP angle in the MICA group. MICA presented a better correction of the DMAA in time. Postoperatively, MICA had 4 complications, while BOSCH 8. Conclusions: We obtained good results with both techniques in the treatment of moderate hallux valgus. However, patients undergoing the Bosch technique had greater correction on the intermetatarsal angle in the mid-term follow-up. Although the MTP angle correction decreased between 6 weeksand 6 months in MICA technique, the values remained within normal 20° of valgus MTP. Level of Evidence: II

Interdigital Commissural Approach for Morton's Neuroma.

BACKGROUND: Morton's neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton's neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications. METHODS: A retrospective study of 108 patients with Morton's neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma. RESULTS: The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively (P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%. CONCLUSION: The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Artroscopia anterior de tobillo. Complicaciones tempranas con técnica sin distracción / Anterior ankle arthroscopy. Early complications without joint distraction

Introducción: La artroscopia se ha convertido en una importante herramienta para tratar diversas afecciones del tobillo. El uso de portales anteriores y posteriores, asociados o no a distracción mecánica, permite una completa exploración de esta articulación. Como toda técnica quirúrgica, no está exenta de complicaciones. Objetivos: Evaluar las complicaciones tempranas de la artroscopia anterior de tobillo, sin distracción articular, y compararlas con las descritas en la bibliografía internacional. Materiales y Métodos: Estudio retrospectivo que evaluó a 198 pacientes sometidos a artroscopia anterior de tobillo por diversas patologías. Todos fueron operados por un único cirujano, en dos instituciones de salud, durante un período de 6 años, con un seguimiento posquirúrgico mínimo de 12 meses. Los pacientes fueron evaluados mediante el puntaje de la AOFAS y se consignaron las complicaciones intra y posoperatorias tempranas. Resultados: Se evaluó a 34 mujeres y 164 hombres (edad promedio 37.5 años). Hubo 23 complicaciones (11,61%): celulitis local (6 casos), parestesias transitorias del nervio peroneo superficial (4 casos), parestesia permanente del nervio peroneo superficial (1 caso), dolor residual en los portales (4 casos), artritis séptica (2 casos) y un caso de otras complicaciones. Conclusiones: Un conocimiento preciso de la anatomía, una asepsia y una técnica quirúrgica correctas, y los cuidados de manejo intraquirúrgico del instrumental permiten evitar la mayoría de las complicaciones. La artroscopia anterior de tobillo sin distracción por medio de los clásicos portales antero-lateral y antero-medial es una técnica segura, con un bajo índice de complicaciones y una muy baja morbilidad para el paciente. Nivel de Evidencia: IV

Introduction: Arthroscopy has become an important tool to treat various conditions of the ankle. The use of anterior and posterior portals, with or without mechanical distraction, allows for a complete exploration of this joint. Like all surgical techniques, it is not without complications. Objectives: To evaluate the early complications of anterior ankle arthroscopy with or without joint distraction, and to compare them with those described in the international literature. Materials and Methods: A retrospective study that evaluated 198 patients undergoing anterior ankle arthroscopy for various pathologies. All were operated on by a single surgeon, in two health centers, during a period of 6 years, with a postoperative follow-up of at least 12 months. Patients were evaluated by AOFAS score and early and postoperative complications were recorded. Results: 34 women and 164 men were evaluated (average age 37.5 years). There were 23 complications (11.61%): local cellulitis (6 cases), transient paresthesia of the superficial peroneal nerve (4 cases), permanent paresthesia of the superficial peroneal nerve (1 case), residual pain in the portals (4 cases), septic arthritis (2 cases) and one case of other complications. Conclusions: Most complications can be avoided by a precise knowledge of the anatomy and the aseptic techniques, as well as an adequate surgical approach and intra-operative management of the instrumentation. Anterior ankle arthroscopy without joint distraction through standard antero-lateral and antero-medial portals is a safe technique, having a low rate of complications and a very low morbidity for the patient. Level of Evidence: IV

Presentación inusual de una fractura-luxación peritalar / Unusual presentation of a peritalar fracture dislocation

Una luxación peritalar implica la ruptura simultánea de las articulaciones talocalcánea y talonavicular. Es relativamente poco frecuente y representa aproximadamente del 1% al 1,5% de todas las lesiones traumáticas del pie. La luxación medial es la más frecuente (alrededor del 80% de los casos comunicados). Las luxaciones peritalares laterales son menos frecuentes (17%) y las posteriores (2,5%) y anteriores son raras (1%). Aproximadamente el 55% del subtipo medial y el 72% del subtipo lateral se asocian con fracturas. Se presenta el caso de una mujer de 36 años que sufrió un traumatismo indirecto practicando kitesurf al caerse de la tabla tratando de evitar un accidente. Sufrió una luxación peritalar lateral con fracturas de escafoides tarsiano, calcáneo y peroné asociadas. A los tres días, se intentó una reducción cerrada y a los seis días, se realizó la cirugía. Se recomienda un diagnóstico precoz de las luxaciones peritalares y un rápido reconocimiento de las fracturas asociadas e infrecuentes, con el fin de evitar complicaciones frecuentes. Nivel de Evidencia: IV

A peritalar dislocation involves simultaneous disruption of the talocalcaneal and talonavicular joints. It is relatively uncommon and account for approximately 1% to 1.5% of all traumatic foot injuries. Medial dislocation is the most frequent type accounting for approximately 80% of reported cases. Lateral peritalar dislocations are less common (17%), and posterior (2.5%) and anterior dislocations are rare (1%). Approximately 55% of medial and 72% of lateral subtypes are associated with fractures. We report the case of a 36-year-old woman who suffered an indirect traumatism during kitesurf practice, after falling from the kite-board trying to avoid an accident. She presented a lateral peritalar dislocation with associated navicular, calcaneal and fibular fractures. A closed reduction was attempted three days from trauma. Six days after the lesion, surgery was performed. We recommend an early diagnosis of peritalar dislocations and a correct recognition of infrequent fractures to avoid usual complications. Level of Evidence: IV

Osteochondral Lesions of the Talus Treatment With Fresh Frozen Allograft.

INTRODUCTION: Symptomatic talar osteochondral lesions are about 50% refractory to conservative treatment requiring a surgical solution. In the case of large chronic lesions, the use of bone graft taken from tissue bank is an alternative that enables to fill the defect without causing donor site morbidity. MATERIAL AND METHODS: Eight patients treated with talar osteochondral allograft in lesions greater than 20mm in diameter were analyzed - 4 males and 4 females aging 39.5 years old on average. Evaluation was performed according to AOFAS scale and VAS as well as incorporation and continuation evaluations according to CT and MRI studies. A follow-up of 46.8 months on average was done. RESULTS: A 34.6-point improvement on average according to AOFAS. A 6.7-point pain improvement on average according to VAS. Incorporation in 100% of the cases. Two cases showed partial resorption and one case showed peri-graft lysis less than 30%. There was no collapse. CONCLUSIONS: Fresh frozen osteochondral allografts are a viable alternative when treating large osteochondral lesions, thereby avoiding morbidity of autologous donor areas or arthrodesis procedures.

Minimally invasive Akin osteotomy and lateral release: Anatomical structures at risk-A cadaveric study.

BACKGROUND: Among the many surgical techniques used for hallux valgus correction, different osteotomies may be performed in the proximal phalanx as well as lateral release as associated procedures. The aim of this study is to analyze the anatomical relationships and the risks for the soft tissue lessions when performing the dorsomedial minimally invasive surgery (MIS) portal for the Akin osteotomy, and the MIS dorsolateral portal for lateral release, in order to define a safety zone when conducting the procedure in order to avoid complications. MATERIALS AND METHODS: The procedures were carried out on 16 fresh-frozen cadaveric feet. A MIS dorsomedial and dorsolateral portals were performed. The anatomical dissection of the cadaveric pieces was carried out and the different anatomic and surgical relationships were analyzed and measured. RESULTS: No nerve injury was found. Injury of the extensor hallucis longus (EHL) paratendon were seen in 9 cases (56%). There was no injury of the flexor hallucis longus (FHL) tendon and or collateral plantar nerves. A partial injury of the FHL sheath was observed in 44% of the samples. CONCLUSIONS: Although percutaneous Akin osteotomy is clinically effective, the possibility of injury of anatomic structures is high (9-55%), however injuries upon vascular or nerve structures were not seen.

Fracturas de tobillo. comparación entre la cirugía abierta y el método mínimamente invasivo / Ankle fractures. comparison between open surgery and a minimally invasive method

Introducción: Las fracturas de tobillo son lesiones traumáticas frecuentes. El tratamiento, en general, es quirúrgico. La cirugía puede ser abierta o percutánea. El objetivo de este estudio es comparar el método mínimamente invasivo y el de la cirugía convencional abierta en el tratamiento de las fracturas detobillo AO B. Materiales y Métodos: Estudio prospectivo comparativo de 75 casosde fracturas AO B operados con MIPO y 58 casos operados por vía convencional. Se agruparon según la clasificación AO. Se evaluaron las características durante el período intraoperatorio y la hospitalización, los resultados funcionales, según los puntajes de la AOFAS y de Weber, y los resultados radiológicos El seguimiento promedio de ambos grupos fue de 20.4 meses. Resultados: Se mencionan los resultados comparativos del tiempo quirúrgico, la estadía hospitalaria, el tiempo de fluoroscopia, la carga del peso. El puntaje de la AOFAS a los 3 meses: grupo A: 96,5 y grupo B: 99. Reducción radiológica: 97,4% con MIPO y 98,3% de los casos convencionales. Retorno a la actividad laboral: grupo A, 3.6 meses promedio, grupo B: 2.5 meses promedio. Retorno a la actividad deportiva: grupo A: media 4.8 meses; grupo B: media 3.7 meses. Conclusiones: De este estudio, se desprende que la MIPO para tratar las fracturas transindesmales es una buena opción, la evolución y la recuperación son más rápidas que con la técnica abierta, y el índice de complicaciones es bajo.

Introduction: Ankle fractures are common traumatic injuries. Treatment is usually surgical. Surgery may be open or percutaneous. The aim of this study is to compare the minimally invasive method and the conventional open reduction internal fixation surgery in the treatment of AO type B ankle fractures. Methods: This prospective study included 75 patients with AO type B ankle fracture operated on with MIPO technique and 58 patients operated on by RAFI technique. They were grouped according to the AO classification. Intraoperative characteristics and hospitalization, functional outcomes according to AOFAS and Weber scores, and radiological results were evaluated. The follow-up was 20.4 months for both groups. Results: Comparative results of surgical time, hospital stay, fluoroscopy time, weight load. AOFAS at 3months: Group A, 96.5 points, and group B, 99 points. Anatomical reduction: 97.4% with MIPO technique and 98.3% using RAFI technique. Return to work activity: Group A, average 3.6 months; Group B: average 2.5 months. Return to sport: in Group A: mean 4.8 months; Group B: mean 3.7 months. Conclusions: It is clear from this study that the MIPO technique for the treatment of syndesmotic fractures isa good choice; the evolution and recovery are faster than with the open surgery, with a low complication rate.

Osteosíntesis de fractura de tobillo: análisis evolutivo con carga precoz: estudio preliminar / Osteosynthesis of ankle fracture: evolutionary analysis with early loading: preliminary study

Introducción: La reducción y la osteosíntesis de las fracturas de tobillo permiten una recuperación precoz. Sin embargo, clásicamente, no se permite la carga del peso durante casi seis semanas. El objetivo de este estudio es analizar si la carga inmediata del peso en pacientes con fracturas de peroné produce complicaciones y desplazamientos secundarios. Materiales y Métodos: Se estudió a 21 pacientes con fracturas de tipo AO 44B1 operados, a quienes se les indicó carga inmediata. Se analizó su evolución clínica y radiológica. El seguimiento fue superior a tres meses. Resultados: La carga del peso con protección con bota “walker” ocurrió, en promedio, a los dos días. El puntaje de la AOFAS para tobillo a los tres meses de la cirugía fue de 99. El tiempo promedio para el retorno a la actividad laboral fue de 2.1 meses y de 2.95 meses para la actividad deportiva. Conclusiones: Los pacientes con fracturas de tipo AO 44B1 de baja energía, tratados mediante reducción y osteosíntesis, pueden realizar carga del peso precoz, sin riesgo de desplazamientos secundarios. La carga precoz junto a la movilización temprana logra una muy buena evolución clínica, y no incide en un mayor índice de complicaciones.

Introduction: Reduction and fixation of ankle fractures allow early recovery. However, typically the weight load is not allowed for about 6 weeks. The aim of this study is to analyze if immediate weight bearing in patients with fibula fractures produces complications and/or secondary displacement. Methods: Twenty-one patients with AO type 44B1 operated fractures were analyzed, and immediate loading was indicated. Clinical and radiographic outcomes were evaluated. Follow-up was >3 months. Results: Weight load with a walker boot protection occurred, on average, at day 2. The AOFAS ankle score averaged 99 points three months after surgery. Patients returned to work at 2.1 months and to the previous sporting activity at 2.95 months, on average. Conclusions: Patients with low-energy AO type 44B1 fractures, treated by reduction and osteosynthesis, can support early weight load without risk of secondary movements. Early loading with early mobilization has a very good clinical outcome, and it does not induce a higher rate of complications.

Osteosíntesis mininvasiva con placas bloqueadas en fracturas metafisarias distales de tibia. Comparación de resultados entre fracturas AO 43A y AO 43C / Minimally invasive plate osteosynthesis in distal metaphyseal fractures of tibia. Comparison of results between AO 43A and 43C fractures

Introducción: Las fracturas distales de tibia son un desafío terapéutico debido a la escasa cobertura y la particular vascularización. Los objetivos de este estudio son analizar los resultados clínicos y funcionales de los pacientes con fractura de tibia distal, tratados con técnica MIPO con placas bloqueadas; comparar los resultados del grupo de fracturas AO 43A con el de fracturas AO 43C1-C2; y comparar los resultados de la técnica MIPO con el tratamiento abierto convencional. Materiales y Métodos: Entre 2004 y 2012, se evaluaron 32 fracturas de tibia distal tratadas con la técnica MIPO. El 59,4% tenía fracturas AO 43A y el 40,6%, AO 43C. Seguimiento promedio: 39.6 meses, mediante la escala de la AOFAS y radiología. Se consignaron las complicaciones. Se compararon los resultados de los grupos AO A y AO C. Resultados: El grupo AO A: media de 95,89 puntos en la escala AOFAS, en el posoperatorio. El grupo AO C1-2: media de 92,15 puntos en el posoperatorio. Carga del peso corporal: a las 8.7 semanas promedio. Comparación entre AO 43A y AO 43C: p = 0,46 (no significativa). Retorno a la actividad previa a la lesión: 9.3 meses promedio. Comparación entre tipo A y tipo C: p = 0,16 (no significativa). Se detectaron complicaciones en el 18,75% y se retiró la osteosíntesis en 14 casos. Conclusiones: La osteosíntesis mínimamente invasiva con placa y tornillos es una buena opción para las fracturas de tibia distal; con buena evolución clínico-funcional y escasas complicaciones cuando se la compara con la cirugía abierta. Las fracturas 43A presentan menos complicaciones mayores que las 43C, tratadas con la técnica MIPO. Nivel de evidencia: IV.

Introduction: Distal tibial fractures are a therapeutic challenge due to the limited coverage and specific vascularization. The aims of this study are to analyze the clinical outcome and functional results in patients with tibial fracture treated with MIPO technique with locked plates, and to compare AO 43A and AO 43C1-C2 fracture results, and conventional open treatment with MIPO technique. Methods: Between 2004 and 2012, 32 distal tibial fractures treated with MIPO technique were evaluated. The 59.4% were AO 43A fractures and 40.6% were AO 43C. Mean follow-up: 39.6 months using AOFAS Score and X-rays. Complications were recorded. Results in AO A and AO C groups were compared. Results: Mean postoperative AOFAS score was 95.89 and 92.15 in AO A fracture and AO C1-2 fractures respectively. The mean time of weight bearing was 8.7 weeks. The mean time to return to activities was 9.3 months. Complications were detected in the 18.75% and removal of the hardware was necessary in 14 cases. Conclusions: Minimally invasive plate osteosynthesis is a good choice for tibial distal fractures, clinical and functional outcomes are good, and there are fewer complications in comparison to open surgery. AO 43A fractures have less complications than AO 43C with this technique. Level of evidence: IV.

Non-irradiated frozen structural allograft in reconstructive surgeries of the hindfoot and midfoot.

BACKGROUND: A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. METHODS: We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications. RESULTS: We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen. CONCLUSION: This treatment is a good option to treat severe defects or fill sequelae deformities.

Tratamiento endoscópico para la luxación recurrente de los tendones peroneos / Endoscopic technique for recurrent dislocation of the peroneal tendons

Introducción: El propósito del presente trabajo es describir una técnica endoscópica a través de 3 portales posterolaterales (superior, medio e inferior) en el mismo eje vertical, para el tratamiento de la luxación recidivante de los tendones peróneos. Esta técnica resulta de una modificación de la original propuesta por van Dijk. La diferencia radica, en que a los dos portales clásicos utilizados para la tendoscopía de los tendones peróneos, se les suma un tercer portal entre ambos. Los tendones peróneos son desplazados mediante una clavija guía, insertada por el portal medio, permitiendo realizar la profundización del surco retromaleolar externo en forma reproducible y segura. Material y métodos: Desarrollamos la técnica en 3 especímenes cadavéricos y presentamos el resultado del tratamiento en 4 pacientes con luxación recidivante de los tendones peróneos, evaluados mediante score AOFAS y RM pre y postoperatoria. Seguimiento promedio de 23,5 meses (R=15-36). Resultados: En nuestro estudio tuvimos: 2 pacientes con buenos resultados y 2 con excelentes resultados clínicos y de RM (sin episodios de reluxación). Todos los pacientes practicaban Fútbol (3 recreacionales y 1 profesional). La edad promedio fue de 27,2 años (R=22-31). Obtuvimos un AOFAS promedio: 95 (R=90-100). Complicaciones: La única complicación fue 1 lesión del tendón del peróneo lateral corto evidenciado en RM postoperatoria, pero asintomático. Conclusiones: Esta técnica endoscópica presenta una alternativa reproducible y éficaz en relación a los procedimientos efectuados a cielo abierto para el tratamiento de la luxación recidivante de los tendones peróneos. Tipo de Estudio: Serie de casos. Nivel de evidencia: IV (AU)

Tratamiento endoscópico para la luxación recurrente de los tendones peroneos / Endoscopic technique for recurrent dislocation of the peroneal tendons

Introducción: El propósito del presente trabajo es describir una técnica endoscópica a través de 3 portales posterolaterales (superior, medio e inferior) en el mismo eje vertical, para el tratamiento de la luxación recidivante de los tendones peróneos. Esta técnica resulta de una modificación de la original propuesta por van Dijk. La diferencia radica, en que a los dos portales clásicos utilizados para la tendoscopía de los tendones peróneos, se les suma un tercer portal entre ambos. Los tendones peróneos son desplazados mediante una clavija guía, insertada por el portal medio, permitiendo realizar la profundización del surco retromaleolar externo en forma reproducible y segura. Material y métodos: Desarrollamos la técnica en 3 especímenes cadavéricos y presentamos el resultado del tratamiento en 4 pacientes con luxación recidivante de los tendones peróneos, evaluados mediante score AOFAS y RM pre y postoperatoria. Seguimiento promedio de 23,5 meses (R=15-36). Resultados: En nuestro estudio tuvimos: 2 pacientes con buenos resultados y 2 con excelentes resultados clínicos y de RM (sin episodios de reluxación). Todos los pacientes practicaban Fútbol (3 recreacionales y 1 profesional). La edad promedio fue de 27,2 años (R=22-31). Obtuvimos un AOFAS promedio: 95 (R=90-100). Complicaciones: La única complicación fue 1 lesión del tendón del peróneo lateral corto evidenciado en RM postoperatoria, pero asintomático. Conclusiones: Esta técnica endoscópica presenta una alternativa reproducible y éficaz en relación a los procedimientos efectuados a cielo abierto para el tratamiento de la luxación recidivante de los tendones peróneos. Tipo de Estudio: Serie de casos. Nivel de evidencia: IV