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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 70-75, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448202

RESUMO

Objective: To investigate the effectiveness of anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws. Methods: A clinical data of 46 patients with the anterior talofibular ligament rupture admitted between September 2015 and October 2019 and met the selection criteria were retrospectively analyzed. All anterior talofibular ligaments were reconstructed with partial peroneal brevis tendon and fixed with double intra-fix screws. There were 22 males and 24 females, with an average age of 28.1 years (range, 16-52 years). Forty cases had a history of ankle sprain, 1 case was injured by a heavy object, and 5 cases were suffered from falls. There were 17 cases on the left side and 29 cases on the right side. The disease duration ranged from 3 months to 10 years (median, 20.3 months). The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, varus angle of ankle, and the difference of the anterior talar translation between healthy and affected sides (looseness, similarity, tightness) were recorded before and after operation; 23 patients were evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS) score, including pain interference (PI) and physical function (PF) scores. Results: The operation time was 39-179 minutes, with an average of 65.8 minutes. All incisions healed by first intention. All patients were followed up 12-30 months (mean, 23 months). The VAS score, AOFAS ankle-hindfoot score, varus angle of ankle, difference of the anterior talar translation between healthy and affected sides, and PI and PF scores of PROMIS at 6 months and last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference in VAS score, PI score of PROMIS, and AOFAS ankle-hindfoot score between at 6 months and at last follow-up ( P>0.05). However, the PF score of PROMIS, the difference of the anterior talar translation between healthy and affected sides, and the varus angle of ankle were significant ( P<0.05). Conclusion: Anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon and double intra-fix screws has the advantages of small incision, convenient tendon removal, and firm graft fixation. The postoperative patients recover quickly and the effectiveness is satisfactory.


Assuntos
Ligamentos Laterais do Tornozelo , Adolescente , Adulto , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Feminino , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tendões , Resultado do Tratamento , Adulto Jovem
2.
Bone Joint J ; 103-B(2): 286-293, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33390020

RESUMO

AIMS: No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. METHODS: Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler's angle and calcaneal width, and posterior facet reduction. RESULTS: Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). CONCLUSION: The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant. Cite this article: Bone Joint J 2021;103-B(2):286-293.


Assuntos
Fraturas do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Calcâneo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Resultado do Tratamento
3.
Arthroscopy ; 37(1): 280-281, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384088

RESUMO

Arthroscopic techniques for the treatment of ankle instability are increasing. The possibility of treating concomitant ankle pathology and ankle instability in the same procedure with similar outcomes and minor complications is making foot and ankle surgeons rethink the role of the current gold standard technique, the open Broström-Gould procedure. The improvement of arthroscopic procedures in the ankle joint, as has happened before in other joints, is forcing the evolution of the classic open gold standard techniques toward an arthroscopic approach. A nondistraction and ankle dorsiflexion procedure is the key arthroscopic technique. The anterior talofibular ligament's superior fascicle, an intra-articular structure, is located on the floor of the lateral gutter, and distraction detrimentally narrows the view and access to this space.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo , Articulação do Tornozelo/cirurgia , Artroscopia , Humanos , Instabilidade Articular/cirurgia , Padrões de Referência
4.
Orthopade ; 50(2): 96-103, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33337505

RESUMO

Mini implants are increasingly used in foot and ankle surgery. They preserve the joints' functions, are easy to insert and easy to convert to an alternative treatment. Early surgical attempts using silastic implants did not bring the expected success. First achievements where reached with modern metallic mini implants in the first metatarsophalangeal (MTP) joint and the ankle joint. For a few years now, a polyvinyl alcohol implant has been used to treat the arthritic first MTP joint. Even severe arthritic joints can be treated with an implant made of polylactide. This implant can also be used in the treatment of Lisfranc joint pathologies. To address severe osteochondral defects of the talus, an innovative hemiarthroplasty implant has been suggested. This article gives a summary of currently used mini implants. Their application as possible alternatives to total joint replacement or joint fusion are critically reviewed in the light of the current literature.


Assuntos
Artroplastia de Substituição , Hemiartroplastia , Articulação Metatarsofalângica , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrodese , Humanos , Articulação Metatarsofalângica/cirurgia
5.
Medicine (Baltimore) ; 99(52): e23921, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350796

RESUMO

ABSTRACT: To analyze the efficacy of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis.This retrospective study included 88 patients with end-stage (stage-3) ankle osteoarthritis according to Morrey-Wiedeman classification who underwent arthrodesis with Ilizarov external fixator from January 2016 to January 2019. There were 47 males and 41 females with a mean age of (57.21 ±â€Š7.12) years old (range 49-76). Outcomes were measured by the American Orthopaedic Foot and Ankle society (AOFAS) Ankle Hindfoot Scale, Visual Analog Scale (VAS) pain scores, complications, subjective satisfaction, ankle function, correction of deformity, and complications.With an average follow-up of (13.50 ±â€Š5.41) months (range 10-21), all 88 patients returned for final follow-up. All patients achieved bony healing with a success rate of 100%. Mean postoperative healing time (3.56 ±â€Š1.04) months (range 3-6). Two patients developed sinus tract infection, delayed healing in 1 patient, and 2 patients had pain and swelling again in the ankle joint. No serious complications occurred in other patients. All the patients evaluated with the VAS scores and AOFAS scores at final follow-up showed significant improvement (P < .05). Through imaging analysis, medical tibial talar angle (MTTA) improved from (85.76 ±â€Š6.01) degrees to (88.98 ±â€Š1.35) degrees postoperative. Lateral talar station (LTS) decreased from (5.32 ±â€Š3.81) mm to (2.71 ±â€Š2.62) mm after operation (P < .05). The overall satisfaction of patients is 88.64%.In the treatment of end-stage ankle osteoarthritis, arthrodesis with Ilizarov external fixator can achieve good radiological and clinical outcomes with low prevalence of ankle joint malalignment and high fusion rates and satisfaction.


Assuntos
Articulação do Tornozelo , Artrodese , Osteoartrite , Complicações Pós-Operatórias , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Artrodese/efeitos adversos , Artrodese/instrumentação , Artrodese/métodos , China/epidemiologia , Progressão da Doença , Fixadores Externos , Feminino , Humanos , Técnica de Ilizarov , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Osteoartrite/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Estudos Retrospectivos
6.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370985

RESUMO

Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Case 2 presented with TTS as a result of compression of the posterior tibial nerve. Case 3 presented with deformity of the foot. In all the three cases, the mass was excised en bloc and histologically proven to be osteochondroma. In case 3, the ankle joint was reconstructed with plate, bone graft and arthrodesis of the inferior tibiofibular joint. All the three cases had good clinical outcomes.


Assuntos
Neoplasias Ósseas/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Osteocondroma/diagnóstico , Sinovite/etiologia , Tálus/patologia , Síndrome do Túnel do Tarso/etiologia , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Artrodese/instrumentação , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Placas Ósseas , Transplante Ósseo , Criança , Feminino , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteocondroma/complicações , Osteocondroma/patologia , Osteocondroma/cirurgia , Osteotomia , Sinovite/patologia , Sinovite/cirurgia , Tálus/diagnóstico por imagem , Tálus/cirurgia , Síndrome do Túnel do Tarso/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1387-1391, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191695

RESUMO

Objective: To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures. Methods: Between January 2016 and December 2018, 12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates, the fixation of the anterior colliculus of medial malleolus by cannulated screws, and the repair of the deltoid ligament by suture anchors. There were 8 males and 4 females, with an average age of 42 years (range, 18-56 years). According to the Lauge-Hansen classification criteria, there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type. According to the Weber classification criteria, all cases were type B. The time from injury to operation was 3-6 days, with an average of 4.7 days. In each patient, X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively. The motion range of ankle joints was observed. The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Olerud-Molander scoring system, and the visual analogue scale (VAS) score. Results: All cases were followed up 12-42 months (mean, 28 months). The 12 patients returned to their pre-injury jobs. Five patients with sports injury completely recovered to their pre-injury motor function. No patient experienced persistent medial ankle pain or ankle instability. At last follow-up, the ankle range of motion in dorsiflexion was 9°-25° (mean, 17.96°), which was 0°-11° (mean, 4.02°) less than that in normal side; the range of motion in plantar flexion was 38°-50° (mean, 43.90°), which was 0°-7° (mean, 2.53°) less than that in normal side. The AOFAS score was 88-100 (mean, 96.7); the Olerud-Molander score was 90-100 (mean, 96.5); the VAS score was 0-3 (mean, 1.1). Conclusion: It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle fracture, which include anterior colliculus fracture and deep deltoid ligament injury. A better outcome can be achieved by employing the suture anchor repair method.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Adolescente , Adulto , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Âncoras de Sutura , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 99(46): e22912, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181657

RESUMO

Peroneus longus and peroneus brevis tendon grafts have been frequently used to reconstruct the lateral ankle ligaments. However, there is no literature comparing the effect of the 2 methods. The purpose of this study was to compare the effects of 2 autologous tendon transplants on ankle joint activity.This retrospective study included 100 adult patients with chronic lateral ankle instability (CLAI) who underwent surgery from January 2014 to December 2017. Group A (50 patients): Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft; Group B (50 patients): Using the anterior half of peroneus brevis tendon graft. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment included talar tilt and anterior talar translation. A sensitive dynamometer was used before and after surgery to assess inversion, valgus, plantarflexion, and dorsiflexion strength to evaluate changes in muscle strength in the patients feet.Postoperatively, 88 patients were followed up for 12 to 24 months, including 46 cases in group A and 42 in group B. No severe complications were recorded in the 2 groups. There were significant pre- to post-operative differences between the groups. No significant differences were observed in the postoperative scores and muscle strength changes between the groups. However, the number of patients with decreased valgus strength in group B was statistically significant compared with group A.Both methods can improve the stability of the ankle joint, but the peroneus longus tendon has little effect on the postoperative muscle strength of the foot and should be used as the preferred surgical treatment for the treatment of CLAI.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Tendões/transplante , Adulto , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
9.
Bone Joint J ; 102-B(11): 1567-1573, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135449

RESUMO

AIMS: The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. METHODS: A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. RESULTS: Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. CONCLUSION: Preservation of the epiphysis in patients with a distal tibial bone tumour is a safe and effective form of limb-sparing treatment. It requires rigorous preoperative planning after accurate analysis of the imaging. When joint-sparing resection is not indicated, ankle arthrodesis, either isolated tibiotalar or combined tibiotalar and subtalar arthrodesis, should be preferred over osteoarticular reconstruction. Cite this article: Bone Joint J 2020;102-B(11):1567-1573.


Assuntos
Articulação do Tornozelo/cirurgia , Neoplasias Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Adolescente , Adulto , Artrodese , Neoplasias Ósseas/terapia , Criança , Feminino , Humanos , Salvamento de Membro , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Orthopade ; 49(11): 991-999, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33104862

RESUMO

Concomitant valgus deformities of the ankle joint are found in approximately 3% of patients with symptomatic flat foot deformities. Conservative treatment is mostly successful only in the short term or in low-demand patients. The operative treatment of flat foot deformities follows the standard algorithm for flat foot treatment. The ankle joint can be treated while retaining mobility or by arthrodesis depending on the degree and rigidity of the deformity, degenerative changes, patient factors and expectations. Achieving an orthograde hindfoot and midfoot is obligatory for successful treatment as well as in ankle reconstructive or arthrodesis procedures.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Artroplastia de Substituição do Tornozelo , Pé Chato/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , , Humanos
11.
Arthroscopy ; 36(10): 2748-2749, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039045

RESUMO

Traditional teaching has told us that arthroscopic ankle arthrodesis is reserved for those patients with severe osteoarthrosis but minimal deformity. However, it is not the size of the deformity that matters; rather, it is the ability to correct the deformity intraoperatively that leads to satisfactory results. Preoperative identification of those patients with significant deformity that can be corrected with an arthroscopic approach would allow for improved selection and likely lead to better patient-reported outcomes and fewer complications.


Assuntos
Articulação do Tornozelo , Tornozelo , Idoso , Articulação do Tornozelo/cirurgia , Artrodese , Artroscopia , Humanos , Resultado do Tratamento
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1346-1351, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063503

RESUMO

Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.


Assuntos
Traumatismos do Tornozelo , Fraturas Ósseas , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos
13.
Foot Ankle Spec ; 13(5): 372-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32924584

RESUMO

BACKGROUND: Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. METHODS: We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. RESULTS: FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). CONCLUSION: Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed.Level of Evidence: Level IV: Case series.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/métodos , Osteonecrose/cirurgia , Impressão Tridimensional , Tálus/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tálus/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Acta Chir Orthop Traumatol Cech ; 87(4): 225-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32940217

RESUMO

Ankle arthrodesis continues to be the golden standard in the treatment of end-stage ankle arthritis. Meticulous soft tissue handling, correct positioning of the foot, and stable fixation are crucial for obtaining a favorable result. With current techniques, mostly internal fixation with screws or plates, union rates between 87 and 100% are reported. Adjacent joint arthritis remains a concern in long-term follow-up, but does not always become symptomatic. It is pre-existing in a substantial number of cases and associated with fusion in less than optimal position, particularly equinus. With arthroscopic arthrodesis techniques, wound complications and scarring can be further reduced while obtaining similar fusion rates and equivalent, if not better, functional results when compared with open techniques. Key words: ankle, hindfoot, fusion, screws, plate, anterior approach, transfibular.


Assuntos
Tornozelo , Artrite , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artrodese , Placas Ósseas , Humanos
15.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 89-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856446

RESUMO

The treatment of posterior malleolus fractures has radically changed over the last few years, therefore this study aims to summarize the current evidence on the usefulness of posterior approaches in the management of malleolar fractures. The main elements that suggest the use of a posterior approach to the ankle are the posterior malleolus fragment shape and size, the presence of loose bodies at the fracture site: the possibility to obtain an anatomic fixation of the fracture; the presence of a posterior ankle subluxation; the eventually osteochondral impaction of the tibial plafond and the mechanical stability of the joint. The postero-lateral approach has been widely used to treat these fractures, but the posteromedial approach should be considered in specific cases. The anatomic reduction of these fractures lead to joint stability, with a consequent lesser occurrence of post-traumatic arthritis and better functional outcomes.


Assuntos
Fraturas do Tornozelo , Ossos do Tarso , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Fixação Interna de Fraturas , Humanos , Tíbia
16.
Medicine (Baltimore) ; 99(32): e21679, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769937

RESUMO

BACKGROUND: Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant. CONCLUSION: The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5793).


Assuntos
Articulação do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/normas , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imobilização/instrumentação , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
17.
J Am Acad Orthop Surg ; 28(14): e595-e603, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692095

RESUMO

Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.


Assuntos
Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé/diagnóstico por imagem , Pé/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga , Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Pé/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Planejamento de Assistência ao Paciente
18.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
19.
Yonsei Med J ; 61(7): 635-639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608208

RESUMO

Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Adulto , Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , , Calcanhar/diagnóstico por imagem , Calcanhar/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/diagnóstico por imagem , Masculino , Ossos do Metatarso , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Pé Cavo/diagnóstico por imagem , Pé Cavo/cirurgia , Resultado do Tratamento , Escala Visual Analógica
20.
Am J Sports Med ; 48(8): 1989-1998, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32510966

RESUMO

BACKGROUND: Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. PURPOSE: To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. RESULTS: The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. CONCLUSION: Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia , Tálus/cirurgia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto Jovem
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