RESUMEN
Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.
Asunto(s)
Osteoartritis , Articulación Talocalcánea , Artrodesis/métodos , Tornillos Óseos , Humanos , Estudios Retrospectivos , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/cirugíaRESUMEN
Forefoot varus develops as a result of longstanding adult-acquired flatfoot deformity (AAFD). This occurs with varying degrees of deformity and flexibility. Residual forefoot varus following hindfoot realignment in AAFD can lead to lateral column loading and a persistent pronatory moment in efforts to reestablish contact between the forefoot and the ground. The Cotton osteotomy may serve as a reasonable adjunct procedure to help avoid complications and poor outcomes associated with residual forefoot varus in patients undergoing hindfoot arthrodesis for stage III AAFD. The aim of this study was to compare the radiographic outcomes in patients undergoing isolated hindfoot arthrodesis to patients undergoing hindfoot arthrodesis with adjunctive cotton osteotomy. We retrospectively reviewed 47 patients matched based upon age, sex, and comorbidities who underwent hindfoot reconstruction for the treatment of stage III AAFD between 2015 and 2019. A retrospective radiographic review was performed on standard weightbearing radiographs including anterior-posterior and lateral views preoperatively, postoperatively at the initiation of full weightbearing, and at final follow-up. Statistical analysis utilizing paired t test to calculate p values where <.05 was statistically significant. At final follow-up, radiographic measurements showed statistically significant differences in CAA, calcaneal inclination, talo-calcaneal, and talar tilt (p value <.05). The Cotton osteotomy group showed a quicker return to presurgical activity level and a decreased incident of tibiotalar valgus. Our study suggests that the Cotton osteotomy can address residual forefoot varus and potentially prevent further progression of ankle valgus in AAFD when used in combination with hindfoot arthrodesis.
Asunto(s)
Pie Plano , Adulto , Artrodesis/métodos , Pie Plano/complicaciones , Pie Plano/diagnóstico por imagen , Pie Plano/cirugía , Humanos , Osteotomía/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Adult acquired flat foot deformity (AAFD) is a progressive, tri-planar deformity involving collapse of the medial longitudinal arch, valgus deformity of the rear foot, and abduction of the mid-foot on the rear foot. There are a wide variety of surgical treatment options for this deformity, including lateral column lengthening (LCL) which results in tri-planar correction of AAFD. We retrospectively reviewed weightbearing preoperative radiographs and weight-bearing 6-week postoperative radiographs of 34 patients with stage II AAFD who underwent LCL (with and without concurrent procedures) with a minimum of 1-year of follow up. Outcomes, including complications and postoperative differences in 6 types of angle measurements were evaluated. Radiographic evaluation showed statistically significant differences in preoperative and postoperative measures in the following angles: calcaneal inclination, Meary's, Simmons, talocalcaneal, and metatarsus adductus (each p ≤ .05). Postoperative Engel's angle difference did not reach statistical significance (p = .07). Paired t tests showed TN coverage angles increased greater with LCL plus a Cotton osteotomy as compared to isolated LCL. Additionally, there was no significant difference in TN coverage angle based on LCL graft size (p = .20). Furthermore, the distance of the osteotomy from the calcaneocuboid joint on anteroposterior and lateral radiographs did not significantly predict TN coverage angle change. Our study suggests that LCL corrects AAFD in three planes while decreasing the metatarsus adductus angle. LCL appears to be more effective when performed with a Cotton osteotomy. Wedge size (6 mm, 8 mm, 10 mm) and osteotomy location did not demonstrate a relationship with postoperative TN coverage angle or incidence of lateral column overload.
RESUMEN
Utilization of the talonavicular joint (TN) arthrodesis as an isolated procedure or in combination with hindfoot arthrodesis has been described in the literature for treatment of numerous hindfoot conditions. When used in isolation or with concomitant hindfoot arthrodesis, the TN joint has demonstrated nonunion rates reported as high as 37% in the literature. Despite previous research, there remains a lack of agreement upon the ideal fixation technique for TN joint arthrodesis with and without concomitant subtalar joint arthrodesis. The purpose of this study was to retrospectively compare the radiographic and clinical results of TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs in the treatment of advanced hindfoot malalignment in stage III adult-acquired flatfoot deformity. We retrospectively reviewed 105 patients who underwent TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs. Our results demonstrated a nonunion rate of 16.2%, with 17 nonunions identified within our patient population. One (2.4%) nonunion was observed in the 3-screw cohort, 7 (33.3%) nonunions were observed in the 2-screw cohort, 4 (16.0%) nonunions were observed in the 2-screw plus plate cohort, and 5 (29.4%) nonunions were observed in the 1-screw plus plate cohort. The difference in nonunion rate between the 4 cohorts was statistically significant. Based on these results, we conclude that the use of a 3-screw construct for TN joint arthrodesis as part of double arthrodesis procedure demonstrates a statistically significant reduction in nonunion rate and should be considered a superior fixation construct for this procedure.
Asunto(s)
Pie Plano , Articulaciones Tarsianas , Adulto , Artrodesis/métodos , Tornillos Óseos , Pie Plano/diagnóstico por imagen , Pie Plano/cirugía , Humanos , Estudios Retrospectivos , Articulaciones Tarsianas/diagnóstico por imagen , Articulaciones Tarsianas/cirugíaRESUMEN
Tarsometatarsal joint arthrodesis is a commonly accepted procedure for hallux valgus associated with severe deformity and first ray hypermobility or medial column instability. This study evaluates the correction of hallux valgus deformity and the maintenance of correction with and without the use of a stabilization screw between the first and second metatarsal bases. Through retrospective review of first tarsometatarsal joint arthrodesis within our institution we evaluated 63 patients. Twenty-seven patients did not have a first to second metatarsal base screw and were placed into the no screw cohort. Thirty-six patients did have a first to second metatarsal base screw and were placed into the screw cohort. This study population had an osseous union rate of 95%. Clinical and radiographic recurrence occurred in 5 of 63 patients (8%). At 1-y postop the measurements demonstrated that the screw cohort had an average intermetatarsal angle correction of 11.6 degrees while the no screw cohort had an average correction of 7.8 degrees. Additionally, at 1-y postop the screw cohort had greater maintenance of the intermetatarsal angle correction with an average change of 0.5 degrees compared to 2.3 degrees in the no screw cohort. We conclude that the addition of the stabilization screw improves the first tarsometatarsal joint arthrodesis construct resulting in a greater degree of realignment and maintenance of correction.
RESUMEN
Periarticular osseous defects pose a challenge when considering arthrodesis. Failure to restore the cubic content of bone can result in shortening and malalignment, as well as subsequent biomechanical issues. This study reports on 12 patients treated with patient-specific 3-D printed (7) and prefabricated titanium trusses (5). Twelve consecutive patients were treated for osseous defects of the forefoot, hindfoot, and ankle with patient-specific, 3D printed or prefabricated manufacturer titanium trusses. Seven were customized, patient-specific 3D printed trusses (4WEB, Frisco, Texas) and 5 were prefabricated manufacturer titanium trusses. All patients had a minimum of 6 months of clinical and radiographic follow-up. and no patients were lost to follow-up. Seven of the 12 patients had a computed tomography (CT) scan performed following surgery. Successful limb or ray salvage was achieved in 11 of 12 patients (91.7%). Six of 7 patients (85.7%) with a postoperative CT scan, went on to complete radiographic consolidation across all arthrodesis sites. The remaining 5 patients showed complete consolidation across the arthrodesis sites on plain film radiographs. Complications included one patient with a residual midfoot deformity that required a subsequent midfoot osteotomy in order to obtain a plantigrade foot following successful tibiotalocalcaneal (TTC) arthrodesis, and a below knee amputation in one patient who underwent revision TTC arthrodesis to salvage avascular necrosis of the talus that developed following the index procedure. Eleven of 12 patients undergoing arthrodesis demonstrated successful union with both customized, patient-specific 3D printed and prefabricated manufacturer titanium trusses on CT scans or radiographs. The average follow-up was 14 months. Reports on traditional methods of addressing periarticular defects in patients requiring arthrodesis show mixed results and relatively high complication rates. Custom, 3D printed and prefabricated titanium truss technology offers an alternative to traditional methods for large, periarticular osseous defects.
Asunto(s)
Titanio , Bragueros , Tobillo , Articulación del Tobillo , Artrodesis , Humanos , Estudios Retrospectivos , TexasRESUMEN
Long-segment disease involving the insertional region of the Achilles tendon can be a challenging problem. These patients often have significant disability and functional problems. Surgical management requires some type of tissue replacement, regional tissue rearrangement or tendon transfer. Various types of allograft tissue as well as synthetic materials have been described. Patients often have residual weakness and functional deficits following surgery. We have utilized an Achilles tendon-bone block allograft in combination with a flexor hallucis longus tendon transfer for long-segment Achilles tendon deficits involving the insertion. A retrospective review was performed on this group of patients to assess complication rates. A chart review was performed on 14 patients who underwent this procedure. The average postoperative follow-up duration was 24.7 months (range 6-48). Postoperatively, all patients exhibited grade 5 muscle strength with manual muscle testing and 12 of 14 patients were able to perform a single limb heel rise. This case series reviews the surgical technique as well as the patient demographics and complication rates. This procedure has been reliable for those patients with long-segment Achilles tendon deficits involving the insertion who desire to resume a high demand occupation or active lifestyle. The complication rate is relatively low.
Asunto(s)
Tendón Calcáneo , Tendinopatía , Tendón Calcáneo/cirugía , Aloinjertos , Humanos , Estudios Retrospectivos , Rotura , Tendinopatía/cirugía , Transferencia TendinosaRESUMEN
Charcot neuroarthropathy is a degenerative disorder that significantly impairs a patient's functional capacity. It has been reported that a Charcot patient's quality of life is significantly impacted by the disease state. The aim of this study is to compare measured energy expenditure to a patient's perceived quality of life and physical ability. The study enrolled 43 patients by set inclusion and exclusion criteria. Patients' total energy expenditure was measured with doubly labeled water. The patients also completed 2 quality of life assessments: 36-Item Short Form Survey (SF-36) and International Physical Activity Questionnaire-Long Form (IPAQ-LF). The measured energy expenditure was then compared to the patient's perceived functional capacity. Scores reaching statistical significance included general health (60 ± 21; pâ¯=â¯.011), pain (62 ± 27; pâ¯=â¯.025), emotional (61 ± 40; p < .017), physical limitation (45 ± 39; p < .0001), and physical function (50 ± 29; p < .001). SF-36 survey variables that did not reach statistical significance included mental (73 ± 26; pâ¯=â¯.690), energy (55 ± 21; pâ¯=â¯.205), and social (74 ± 26; pâ¯=â¯.105). The IPAQ-LF and physical activity level (PAL) were compared. No identified variation was noted between the 2 test methods (pâ¯=â¯.57). The patients' PAL was measured at 1.4 ± 0.42, which is comparable to the general population. Data from this study identify the Charcot population as comparable to the general population. The inferences taken from this study indicate that this population suffers from poor health outlooks compared with the general population but may be overestimating the level of perceived disability.
Asunto(s)
Esclerosis Amiotrófica Lateral , Ejercicio Físico , Calidad de Vida , Esclerosis Amiotrófica Lateral/fisiopatología , Humanos , Encuestas y CuestionariosRESUMEN
The purpose of this study is to demonstrate the effect of first tarsometatarsal (modified Lapidus) arthrodesis on hindfoot alignment. We reviewed the radiographs of 39 patients, 40 feet (16 right feet and 24 left feet in 6 males and 34 females; mean age 43 years) who underwent hallux valgus reconstruction and isolated first tarsometatarsal arthrodesis. Patients who had ancillary osseous procedures were excluded from the study, with the exception of proximal phalangeal osteotomy to address hallux interphalangeus. The mean time to follow up was 33.78 weeks (8.45 months), median 21.5 weeks. Statistically significant differences were found between preoperative and postoperative measurements for talar declination (-3.3 ± 3.5), lateral talocalcaneal angle (-3.1 ± 3.9), lateral Meary's angle (-4.2 ± 4.9), medial cuneiform height (3.5 ± 4.6), medial cuneiform to fifth metatarsal distance (4.7 ± 4.5), AP talocalcaneal angle (-2.8 ± 5.3), and percentage of talar head uncovering (-6.6 ± 7.6). Our results suggest that first tarsometatarsal arthrodesis can affect hindfoot alignment on AP and lateral radiographs.
Asunto(s)
Artrodesis , Hallux Valgus , Huesos Metatarsianos , Huesos Tarsianos , Adulto , Femenino , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Humanos , Masculino , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/cirugía , OsteotomíaRESUMEN
Surgical treatment for a stage II adult acquired flatfoot has consisted of reconstruction of the diseased posterior tibial tendon with flexor digitorum longus tendon transfer, combined with osteotomies to address the underlying deformity. This case series presents an alternative to tendon transfer using allograft tendon for posterior tibial tendon reconstruction. Four patients who underwent stage II flatfoot reconstruction with posterior tibial tendon allograft transplantation were included. All patients had preoperative radiographs demonstrating flatfoot deformity and magnetic resonance imaging showing advanced tendinopathy of the posterior tibial tendon. Allograft tendon transplant was considered in patients demonstrating adequate posterior tibial tendon excursion during intraoperative assessment. Additional procedures were performed as necessary depending on patient pathology. Postoperatively, all patients remained non-weightbearing in a short leg cast for 6 weeks. Radiographs performed during the postoperative course demonstrated well-maintained and improved alignment. No complications were encountered. Each patient demonstrated grade 5 muscle strength and were able to perform a single-limb heel rise at the time of final follow-up. The average follow-up duration was 19.0 months. Flexor digitorum longus transfer has been studied extensively for stage II adult acquired flatfoot. However, the flexor digitorum longus has been shown to be much weaker relative to the posterior tibial tendon, and concern remains regarding its ability to recreate the force of the posterior tibial tendon. Our results demonstrate that posterior tibial tendon allograft reconstruction combined with flatfoot reconstruction is a reasonable option. This alternative has the advantage of preserving the stronger muscle without disturbing regional anatomy.
Asunto(s)
Calcáneo , Pie Plano , Disfunción del Tendón Tibial Posterior , Adulto , Aloinjertos , Pie Plano/diagnóstico por imagen , Pie Plano/cirugía , Humanos , Disfunción del Tendón Tibial Posterior/diagnóstico por imagen , Disfunción del Tendón Tibial Posterior/cirugía , Transferencia Tendinosa , Tendones/cirugíaRESUMEN
Posterior tibial tendon dysfunction (PTTD) is a progressive disorder secondary to advanced degeneration of the posterior tibial tendon, leading to the abduction of the forefoot, valgus rotation of the hindfoot, and collapse of the medial longitudinal arch. Eventually, the disease becomes so advanced that it begins to affect the deltoid ligament over time. This attenuation and eventual tear of the deltoid ligament leads to valgus deformity of the ankle. Surgical correction of PTTD is performed to protect the ankle joint at all costs. Generally, this is performed using osteotomies of the calcaneus and repair or augmentation of the deltoid ligament. Unfortunately, there has been no universal procedure adapted by foot and ankle surgeons for repair or augmentation of the deltoid ligament. Articles have discussed the use of suture and suture anchors, suture tape, nonanatomic allograft repair, nonanatomic autograft repair with plantaris, peroneal and extensor halluces longus tendons to repair and augment the deltoid ligament. There is very little literature, however, in regard to using the posterior tibial tendon to augment the deltoid ligament in accordance with hindfoot fusion for end-stage PTTD deformity. In general, the posterior tibial tendon in triple and medial double arthrodesis is generally removed because it is thought to be a pain generator. This article presents a case study and novel technique using the posterior tibial tendon to augment and repair the laxity of the deltoid ligament in an advanced flatfoot deformity.
Asunto(s)
Ligamentos Articulares/cirugía , Disfunción del Tendón Tibial Posterior/cirugía , Transferencia Tendinosa/métodos , Adulto , Humanos , MasculinoRESUMEN
Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.
Asunto(s)
Artritis/cirugía , Artrodesis/métodos , Calcáneo/lesiones , Fracturas Mal Unidas/cirugía , Articulación Talocalcánea/cirugía , Tobillo/diagnóstico por imagen , Artritis/etiología , Calcáneo/diagnóstico por imagen , Femenino , Fracturas Óseas/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Osteogénesis por Distracción , Complicaciones Posoperatorias/cirugía , Radiografía , Rango del Movimiento Articular , Articulación Talocalcánea/diagnóstico por imagen , Titanio , Tomografía Computarizada por Rayos XRESUMEN
Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.
Asunto(s)
Deformidades Adquiridas del Pie/epidemiología , Ligamentos Laterales del Tobillo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Disfunción del Tendón Tibial Posterior/cirugía , Rango del Movimiento Articular/fisiología , Adulto , Anciano , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/diagnóstico por imagen , Estudios de Cohortes , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Pie Plano/diagnóstico por imagen , Pie Plano/etiología , Pie Plano/cirugía , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/fisiopatología , Humanos , Ligamentos Laterales del Tobillo/fisiopatología , Ligamentos Laterales del Tobillo/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Disfunción del Tendón Tibial Posterior/complicaciones , Disfunción del Tendón Tibial Posterior/diagnóstico por imagen , Prevalencia , Pronóstico , Recuperación de la Función/fisiología , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (nâ¯=â¯33) of the 45 patients responded to the following question: "Would you have this surgery done again?" Of these patients, 93.9% (nâ¯=â¯31) responded "Yes" and 6.1% (nâ¯=â¯2) responded "Unsure." Of the same 33 patients, 84.8% (nâ¯=â¯28) responded that they were "Very Satisfied" with the procedure and 15.2% (nâ¯=â¯5) responded that they were "Satisfied." Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.
Asunto(s)
Tendón Calcáneo/cirugía , Calcinosis/cirugía , Imagen por Resonancia Magnética/métodos , Satisfacción del Paciente , Tendinopatía/cirugía , Transferencia Tendinosa/métodos , Tendón Calcáneo/diagnóstico por imagen , Tendón Calcáneo/fisiopatología , Adulto , Anciano , Calcáneo/cirugía , Calcinosis/diagnóstico por imagen , Calcinosis/fisiopatología , Estudios de Cohortes , Terapia Combinada/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Osteotomía/métodos , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Factores de Riesgo , Tendinopatía/diagnóstico por imagen , Tendinopatía/fisiopatología , Resistencia a la Tracción , Resultado del TratamientoRESUMEN
Postoperative nonunion is not uncommon in the lower extremity, and significant morbidity can be associated with nonunion of the foot and ankle after surgical reconstruction. For the purposes of the present study, we retrospectively reviewed and compared a cohort of patients who had undergone elective foot and ankle reconstruction to better assess the modifiable risk factors associated with postoperative nonunion. We hypothesized that the presence of endocrine and metabolic abnormalities are often associated with nonunion after foot and ankle surgical reconstruction. We formulated a matched case-control study that included 29 patients with nonunion and a control group of 29 patients with successful fusion to assess the prevalence of certain modifiable risk factors known to have an association with nonunion after foot and ankle arthrodesis. The modifiable risk factors assessed included body mass index, tobacco use, diabetes mellitus, vitamin D abnormality, thyroid dysfunction, and parathyroid disease. A statistically significant (p < .05) difference was found between the 2 groups for endocrine and metabolic disease diagnoses in the medical records of the 58 patients identified. Thus, 76% versus 26% (p < .05) of patients experienced nonunion in the endocrine disease group versus the nonendocrine disease group, respectively. Patients with vitamin D deficiency or insufficiency were 8.1 times more likely to experience nonunion (95% confidence interval 1.996 to 32.787). No statistically significant differences were found between the groups in terms of age, sex, tobacco use, body mass index, or procedure selection (p = .56, p = .43, p = .81, p = .28, and p = 1.0, respectively). A greater prevalence of endocrine abnormalities, in particular, vitamin D deficiency and insufficiency, was associated with nonunion after elective foot and ankle reconstruction. Patients with such abnormalities appear to have a greater risk of developing nonunion after arthrodesis procedures.
Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis , Enfermedades del Sistema Endocrino/complicaciones , Articulaciones del Pie/cirugía , Deficiencia de Vitamina D/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/diagnóstico por imagen , Artrodesis/métodos , Estudios de Casos y Controles , Femenino , Articulaciones del Pie/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Radiografía , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
The Achilles tendon is among the most commonly injured tendons in the human body. The most common reason for delayed treatment is a missed diagnosis or a deficiency in presentation. The neglected or chronically ruptured Achilles tendon presents a unique treatment challenge. The surgical approach varies greatly depending on the extent of degeneration and the resultant gap between the opposing tendon ends. Most surgeons have recommended the use of a tendon transfer or augmentation to strengthen the Achilles tendon repair. The following technique uses a flexor hallucis longus tendon transfer with gastrocnemius aponeurosis turndown flap augmentation. This technique has been commonly performed by us with success.
Asunto(s)
Tendón Calcáneo/cirugía , Errores Diagnósticos , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tendones/cirugía , Tendones/cirugía , Enfermedad Crónica , Disección , Humanos , Rotura , Colgajos Quirúrgicos , Traumatismos de los Tendones/diagnóstico , Tendones/trasplanteRESUMEN
Obesity has been posited as a predictor for the development of Charcot neuroarthropathy, a severe form of degenerative joint disease associated with peripheral neuropathy and diabetes mellitus. The present case-control study investigated the relationship between elevated (overweight and obese) body mass index and acute Charcot neuroarthropathy in a diabetic population. The final data set consisted of 49 patients, 20 (40.82%) of whom had Charcot foot and 29 (59.18%) who served as controls. In the present investigation, no statistically significant association was found between an elevated body mass index and the development of acute Charcot neuroarthropathy involving the foot.
Asunto(s)
Índice de Masa Corporal , Neuropatías Diabéticas/complicaciones , Enfermedades del Pie/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Enfermedad Aguda , Artropatía Neurógena/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Jones fractures are a common injury treated by foot and ankle surgeons. Surgical intervention is recommended because of the high rate of delayed union, nonunion, and repeat fracture, when treated conservatively. Percutaneous intramedullary screw fixation is commonly used in the treatment of these fractures. We present techniques that can increase the surgical efficiency and decrease the complications associated with percutaneous delivery of internal fixation.
Asunto(s)
Traumatismos de los Pies/cirugía , Fracturas Óseas/cirugía , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/cirugía , Traumatismos de los Pies/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Huesos Metatarsianos/diagnóstico por imagen , RadiografíaRESUMEN
Combined ankle and subtalar joint instability can lead to severe disability of the lower extremity. Multiple procedures have been described for hindfoot and ankle instability, including anatomic and non-anatomic reconstructions. The authors present their technique consisting of a free autogenous split peroneus longus tendon graft combined with a modified Brostrom-Gould repair.
Asunto(s)
Articulación del Tobillo/cirugía , Inestabilidad de la Articulación/cirugía , Procedimientos Ortopédicos/métodos , Procedimientos de Cirugía Plástica/métodos , Articulación Talocalcánea/cirugía , Tendones/cirugía , Enfermedad Crónica , HumanosRESUMEN
Ankle fractures have been widely described in orthopedic and podiatric studies. These injuries have been associated with significant patient morbidity, infection, malunion, nonunion, and arthritis. Avoiding complications and optimizing outcomes demands an awareness of the factors affecting the healing of ankle fractures. The prognosis of surgical treatment of these injuries has varied according to patient factors or injury severity, or a combination. Cigarette smoking, obesity, and diabetes are some of the factors linked to the prognosis of ankle fractures. We conducted a retrospective cohort study of 58 patients treated for an ankle fracture at a single center. The objective of the present study was to comprehensively evaluate the factors affecting the clinical outcome of surgically treated ankle fractures.