scholarly journals Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation for Management of Foot and Ankle Deformity with Ulcers

2021 ◽  
Author(s):  
Ya‐xing Li ◽  
Xi Liu ◽  
Yu Chen ◽  
Ting‐jiang Gan ◽  
Bo‐quan Qin ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Foot And Ankle ◽  
Tibial Cortex

scholarly journals Tibial Cortex Transverse Distraction Followed by Open Correction with Internal Fixation: Two-stage Management for Foot and Ankle Deformity with Ulcers

2020 ◽  
Author(s):  
Yaxing Li ◽  
Xi Liu ◽  
Yu Chen ◽  
Jie Tan ◽  
Jun Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Case Series ◽  
Fixation Time ◽  
Foot And Ankle ◽  
Stage Management ◽  
Two Stage ◽  
Level Of Evidence ◽  
Wound Debridement ◽  
Correction Technique ◽  
Tibial Cortex

Abstract Aim Foot and ankle deformities with concurrent ulcers remain challenging. Conventional treatments are often time-consuming and difficult. This study aims at assessing the feasibility and results of tibial cortex transverse distraction (TCTD) followed by open correction with internal fixation (OCIF) for foot and ankle deformity with concurrent ulcers.Methods A retrospective analysis was conducted. Between 2010 and 2019, a two-stage management of TCTD followed by OCIF was performed in 13 patients (13 feet). The clinical data of all patients was recorded and analyzed.Results The TCTD and wound debridement were performed in all patients, and an additional Ilizarov correction technique was added in two patients. All ulcers were healed in 3 months after first-stage treatment. The average external fixation time was 135.5 (median, 138.0; range, 49-173) days. After second-stage operative correction, the patients were followed-up for an average of 28.0 (range, 24-33) months. At the final follow-up, the average Dimeglio score of deformity was decreased from 6.7 (range, 3-9) to 0.5 (median, 1; range, 0-1), and the average AOFAS score was improved from 42.9 (range, 14-80) to 82.6 (range, 70-97). Complications include one case of mild displacement of the osteotomized cortex and one case of pin-tract infection. No relapse of ulcers or deformity was observed.Conclusion The two-stage management of TCTD followed by OCIF could be considered as an alternative treatment for foot and ankle deformities combined with chronic ulcers.Level of Evidence Level IV, retrospective case series.

scholarly journals Identification of Postoperative Step-Offs and Gaps With Brodén’s View Following Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 40 (7) ◽  
pp. 797-802 ◽  
Author(s):  
Rosalie C. Looijen ◽  
Dominique Misselyn ◽  
Manouk Backes ◽  
Siem A. Dingemans ◽  
Jens A. Halm ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Excellent Agreement ◽  
Open Reduction ◽  
Interobserver Reliability ◽  
Case Series ◽  
Intraobserver Reliability ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Intraoperative Fluoroscopy ◽  
Level Of Agreement

Background: To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén’s view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. Methods: Six observers estimated the size of step-offs and gaps on Brodén’s view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). Results: An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. Conclusion: Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén’s view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. Level of Evidence: Level IV, case series.

scholarly journals Combined Internal and External Fixation for Charcot Neuroarthropathy: A Learning Curve

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0026
Author(s):  
Muhammed H. Iqbal ◽  
Sultan N. Qasim ◽  
Simon Chambers
Keyword(s):  
Learning Curve ◽  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Case Series ◽  
Deformity Correction ◽  
Fusion Rate ◽  
Ulcer Recurrence ◽  
Foot And Ankle ◽  
Soft Tissue Envelope

Category: Diabetes; Trauma Introduction/Purpose: Management of complex foot and ankle deformities secondary to charcot neuroathropathy represents a significant challenge. This is a consequence of medical co-morbidities, vascular disease, peripheral neuropathy, and immune compromise with the surgical challenges of progressive bony defomity and bone resorption. To combat these challenges ‘superconstructs’ have been developed to improve fixation. These aim for fusion beyond the zone of injury with adequate deformity correction all whilst maintaining viability of the soft tissue envelope and mechanical function. This can be achieved with internal fixation using indication specific plates and beaming techniques, external fixation with a circular frame or a combination of the two. The aim of this study was to evaluate of a tertiary referral hospital in the operative management of charcot neuroarthopathy. Methods: This is a retrospective two surgeon case series with all cases jointly operated upon. Cases were identified from a locally held diabetic patient registry as those undergoing charcot foot and ankle reconstruction from 2017 to 2019. No exclusion criteria were outlined. Patient demographics and co-morbidities were collected, pre-op radiological markers (meary’s angle) measured and repeated at 6 weeks and one year. Pre-op radiographs were classifed accroding to brodsky classification. Patient outcomes were recorded of amputation, mortality, ulcer recurrence, reported pain, stable heel, ability to ambulate, need for revision surgery, need for prolonged antibiotics, fusion and surgical complications. PROMS were requested and still awaited at time of submission. Results: Eleven Cases were identified from ten patients, all were included for analysis. Three patients had internal fixation, two had external fixation and six had combined internal with external fixation. Eight patients were Brodsky 1, two patients were Brodsky 3 and one patient was Brodsky 2. Limb salvage was 100% with nil amputations, mortality 0%, ulcer recurrence 0%, 100% improved pain score, and 100% with a stable heel. Meary’s angle improved by a mean of 14o from -16o to -2o at 1 year. Fusion rate determined clinically and radiologically with X-ray was 100% with mean of 129 days and range of (360 - 52). Mean follow-up 454 days and range (547-417). Complications of 2 tibial fractures and 1 deep infection with delayed wound healing. Conclusion: The outcomes of using all three methods is positive with 100% limb salvage, 100% fusion rate, 100% ulcer free and maintenace of Meary’s angle at 1 year post op. We believe that combined internal and external fixation, not widely reported in the literature, is a good option in these cases. The complications reported here were in the first three patients undergoing said technique and represent a learning curve.

Hallux Flexion Deformity Secondary to Entrapment of the Flexor Hallucis Longus Tendon after Fibular Fracture

1995 ◽  
Vol 16 (4) ◽  
pp. 232-235 ◽  
Author(s):  
Paul H. Leitschuh ◽  
Jeffrey P. Zimmerman ◽  
John M. Uhorchak ◽  
Robert A. Arciero ◽  
Lloyd Bowser
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Flexor Hallucis Longus ◽  
Foot And Ankle ◽  
Flexion Deformity ◽  
Longus Tendon ◽  
Fibular Fracture

This article presents a case of entrapment of the flexor hallucis longus tendon after open reduction and internal fixation of a Weber C ankle fracture resulting in interphalangeal joint contracture of the hallux. Pathology involving other tendons at the foot and ankle associated with ankle fractures is reviewed. Other scenarios of flexor hallucis longus pathology are discussed. Flexor hallucis longus anatomy, as related to distal fibular fractures, is outlined, and a recommendation is made to consider flexor hallucis longus entrapment as a cause of hallux dysfunction after open reduction and internal fixation of an ankle fracture.

scholarly journals TALUS FRACTURES - CLINICAL OUTCOMES - CLOSED REDUCTION AND MINIMAL INVASIVE OSTEOSYNTHESIS VERSUS OPEN REDUCTION AND INTERNAL FIXATION

2018 ◽  
Vol 1 (3) ◽  
pp. 97-102
Author(s):  
Cristina Cocor ◽  
D. M. Rădulescu ◽  
A. R. Rădulescu ◽  
A. Bădilă
Keyword(s):  
Internal Fixation ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Open Reduction ◽  
Minimal Invasive ◽  
Foot And Ankle ◽  
Average Value ◽  
Minimal Invasive Osteosynthesis ◽  
Group 2 ◽  
Group 1

The purpose of this paper is to evaluate and compare the clinical outcomes of closed reduction with minimal invasive osteosynthesis with the ones of open reduction with internal fixation in talus fractures. In this study we used the Bucharest University Hospital, Department of Orthopaedics and Traumatology database. We retrospectively reviewed the records of 65 patients with 70 talus fractures, 5 of them were bilateral) managed in our department between 2010-2013. The 65 patients were divided into two groups. In the first group, there were 26 patients with 27 talus fractures who were treated by closed reduction under C-arm control followed by minimal invasive osteosynthesis. We compared the results with the ones of the second group of 39 patients who had 43 talus fractures who were treated by open reduction with internal fixation. The mean age was 32.5 years (range: 22-79) for the first group and 35.1 years (range: 20–85). The gender distribution was 15 males/11 females for the first group and 27 males/12 females for the second group. The average follow-up was 4 years (range 2-7.3years). To evaluate properly the clinical outcome, we determined the American Foot and Ankle Score at 3,6,12 months and every year after that and we recorded the complications for each case: avascular necrosis, tibiotalar osteoarthritis and talocalcanean osteoarthritis. By groups, the complications were: for Group 1: avascular necrosis – 2, tibiotalar osteoarthritis – 1, talocalcanean osteoarthritis - 3, and for Group 2: avascular necrosis – 4, tibiotalar osteoarthritis – 1, talocalcanean osteoarthritis – 4. Group 1 had an average value of the American Foot and Ankle Score at of 85.6 +/- 9.2 (extremes: 54-96) at 3 months, of 89.4+/-8.9 (extremes:61-97) at 6 months and of 94.5 +/-8.8 (extremes: 64-100) at 1 year, while in Group 2 the average value for the American Foot and Ankle Score was 73.9 +/- 9,6 (extremes: 50-91) at 3 months, 82.1+/-7,6 (extremes: 55-90) at 6 months and of 89.5 +/-8,7 (extremes: 60-94) at 1 year. Talar fractures are most commonly followed by complications as osteoarthritis of the adjacent joints and avascular necrosis of the talus. Tibiotalar and talocalcanean osteoarthritis are well tolerated by patients, and the postoperative recovery is considerably faster in the case of closed reduction with minimally invasive osteosynthesis.

scholarly journals Correlation between Metal Allergy and Treatment Outcomes after Ankle Fracture Fixation

2011 ◽  
Vol 19 (3) ◽  
pp. 309-313 ◽  
Author(s):  
Sarah So ◽  
Ian A Harris ◽  
Justine M Naylor ◽  
Sam Adie ◽  
Rajat Mittal
Keyword(s):  
Stainless Steel ◽  
Internal Fixation ◽  
Positive Reaction ◽  
Patch Testing ◽  
Linear Regression Analysis ◽  
Ankle Fractures ◽  
Foot And Ankle ◽  
Metal Hypersensitivity ◽  
Surgical Scar ◽  
History Of

Purpose. To determine correlation between metal hypersensitivity and long-term foot and ankle function and pain after internal fixation using stainless steel implants. Methods. 60 men and 46 women (mean age, 47 years) who underwent internal fixation for ankle fractures completed a questionnaire 13 to 38 (mean, 26) months after surgery to assess their existing medical condition, history of metal hypersensitivity, problems and outcome of the implant (revision or removal), and the American Academy of Orthopaedic Surgeons (AAOS) foot and ankle score. A subset of 12 men and 15 women then underwent patch testing for metal hypersensitivity to molybdenum, chromium, iron, manganese, and nickel. Patients with positive and negative reactions were compared. Results. 21 of the 106 patients underwent removal of the metal implants. The AAOS score was not associated with any of the variables, except for a history of metal hypersensitivity from dental implants and irritation around the surgical scar. Multiple linear regression analysis showed that only irritation around the surgical scar remained associated with poorer AAOS scores. Five of the 27 tested patients had a positive reaction. The mean AAOS scores did not differ significantly between patients with positive and negative reactions (34 vs. 31, p=0.73). Gender was not associated with the test results (p=0.63). None of the 5 patients with a positive reaction underwent revision surgery or reported any history of asthma or metal hypersensitivity. Of the 27 patients, one of the 8 who reported itching, irritation, redness or rash around the surgical scar had a positive reaction, compared to 4 of 19 patients who reported no such symptoms (p=1). Two of the 27 patients reported development of eczema after fixation, one of whom had a positive reaction. Only one of the 27 patients reported a history of metal hypersensitivity to jewellery, but had a negative reaction‥ Conclusion. Neither a history of metal hypersensitivity nor positive patch testing correlated with poor outcomes after internal fixation for ankle fractures using stainless steel implants.

scholarly journals Functional Outcome Estimation of Calcaneum Fractures Treated by Open Reduction and Internal Fixation with Plate and Screws in A Tertiary Centre: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (229) ◽  
Author(s):  
Rajeev Dwivedi ◽  
Mandir Khatri ◽  
Arjun KC
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Bone Fractures ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Study Data ◽  
Foot And Ankle ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Calcaneum fractures constitute about 60% of all tarsal bone fractures. Intra-articularfractures account for 70% of all calcaneal fractures. There are controversies regarding the operativetreatment of calcaneum fractures. Therefore this study aimed to estimate the functional outcomes ofcalcaneum fractures treated by open reduction and internal fixation with plate and screws. Methods: This descriptive, cross-sectional study was carried out at the tertiary care center in thewestern region of Nepal among the patients with displaced intra-articular calcaneum fractures fromFebruary 2017 to July 2020 after approval from the Institutional review committee. Convenientsampling was done to reach the sample size. Fifteen cases were included in the study. Data wererecorded in proforma and Data analysis was done in the statistical package for social sciences. TheAmerican Orthopedic Foot and Ankle Society Hindfoot score was used to assess the final outcome. Results: According to the American Orthopedic Foot and Ankle Society hindfoot scores, there werefive excellent (33.33%), seven good (46.66%), two fair (13.33%) and one poor (6.66 %) results. Conclusions: In displaced intra-articular calcaneum fractures, open reduction and internal fixationwith plates and screws result in a good number of satisfactory outcomes with very few unsatisfactoryresults. Hence it can be a better option of treatment in displaced intra-articular calcaneum fractures.  

A Retrospective Analysis of Outcomes From Foot and Ankle Arthrodesis and Open Reduction and Internal Fixation Using Cellular Bone Allograft Augmentation

2020 ◽  
pp. 193864002095230
Author(s):  
Thomas E. Moran ◽  
Sean Sequeira ◽  
Minton Truitt Cooper ◽  
Joseph Park
Keyword(s):  
Internal Fixation ◽  
Complication Rate ◽  
Open Reduction ◽  
Bone Cells ◽  
Bone Matrix ◽  
Case Series ◽  
Matrix Product ◽  
Foot And Ankle ◽  
Bony Healing ◽  
Cellular Bone

Background ViviGen is an allogeneic cellular bone matrix product containing lineage-committed bone cells, and can be used as an alternative to autograft bone or other augments to aid in arthrodesis or to enhance bony healing in open reduction and internal fixation (ORIF) procedures. Methods This study included 153 consecutive patients undergoing ankle, midfoot, or hindfoot arthrodesis or ORIF procedures from January 2017 to October 2018, in which an allogeneic cellular bone matrix product was used to aid in bony healing. Retrospective chart review identified patient demographic factors and medical comorbidities and evaluated clinical and radiographic data to determine fusion/union rate and complications. Results The overall fusion rate for the arthrodesis cohort was 97/113 (85.8%). The overall complication rate in this cohort was 22/113 (19.5%). Smokers had significantly lower rates of fusion compared with nonsmokers ( P = .01). The observed bony healing rate for the ORIF cohort was 19/22 (86.4%), with a complication rate of 3/22 (13.6%). Conclusion With satisfactory fusion rates and relatively few complications, our findings suggest that ViviGen is a safe and efficacious alternative to other forms of bone graft augmentation for fusion and ORIF procedures about the foot and ankle. Further study is needed to compare the efficacy of ViviGen with autograft bone and other augments. Levels of Evidence: Level IV: Case series

scholarly journals Outcome of Charcot’s arthropathy of the midfoot treated by internal fixation as per PROMIS scoring system

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Pradeep Moonot ◽  
Arun Bal ◽  
Gaurav Sharma ◽  
Kalyan Tadepalli
Keyword(s):  
Internal Fixation ◽  
Physical Function ◽  
Scoring System ◽  
Social Role ◽  
Diabetic Patients ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Average Hospital ◽  
Patient Reported ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Charcot’s neuropathy is a chronic and destructive condition primarily affecting the joints of foot and ankle which can lead to severe disability sometimes even requiring amputation. Midfoot charcot’s can alter the normal biomechanics of the foot leading to point loading and ulcer formation. Different modalities with variable results have been proposed for this devastating condition. Patient reported outcome measurement information system (PROMIS) is a patient, fast and reliable validated tool with different clinical domains to assess the post-operative outcome measures in various aspects of foot and ankle surgery. The aim of the present study was to assess the Pre and post-operative PROMIS scoring of three parameters (Physical function, fatigue and social role) in diabetic patients with Charcot’s neuropathy affecting the midfoot. Methods: A prospective study was conducted at a tertiary care diabetic centre on 13 patients with Charcot’s midfoot treated with internal fixation by a single surgeon. Out of 13 patients who met the inclusion criteria, 3 patients had ulcer over the plantar aspect of the foot which was initially treated with contact cast for 6 weeks following which 2 patients were operated using internal fixation and 1 was excluded. Pre and post-operative PROMIS scores were recorded and the final outcomes were measured. The midfoot was fixed with either locking plates or long cannulated screws. Results: The mean age of the patients were 53.2±9.6 years with a mean duration of diabetes since 7.3 years. The average hospital stay was 3.7±1.5 days. Union was achieved in 13.4±2.7 weeks. The mean RAW scores for physical function, fatigue and social role measured pre-operatively were 8.33±2.53, 16.83±2.44 and 16.75±2.80 which later improved post-operatively to 16.75±2.63, 6.91±2.31 and 6.16±1.58 respectively. There was an improvement between the pre and post-operative PROMIS scores which was statistically significant (P<0.001). Two (16.66%) cases had deep infection which required screw removal 8 months from the index surgery. However, the final outcome was a stable and plantigrade foot. One (8.3%) case had superficial infection which responded well to antibiotics. No patient required amputation in the present study. Conclusion: PROMIS scoring is a patient based scoring system which can assess the prognosis and apply the same clinically. Midfoot charcot’s neuroarthropathy can we managed well by internal fixation (locking plates &/or screws) providing adequate stability and plantigrade foot

scholarly journals Functional Outcomes of Open Reduction and Internal Fixation Treatment of Lisfranc Injuries

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Trevor McBride ◽  
Ryan G. Rogero ◽  
Steven M. Raikin ◽  
Rachel J. Shakked
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Low Energy ◽  
Foot And Ankle ◽  
Lisfranc Injury ◽  
Functional Scores ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Prior reports have suggested that primary partial arthrodesis may be superior to open reduction and internal fixation (ORIF) for the ligamentous Lisfranc injury. Although this may be true for the high energy Lisfranc injury, little has been studied regarding outcomes after operative fixation of low energy Lisfranc injuries. The purpose of this study is to present a large case series of patients who underwent ORIF for low energy ligamentous Lisfranc injuries including functional outcomes, complications, and reoperation rates. Methods: We included adult patients who underwent ORIF for low-energy Lisfranc injuries with fellowship-trained foot and ankle surgeons at our institution within 6 weeks of injury. Patients were excluded if the mechanism of injury or initial radiographs were consistent with a high-energy mechanism such as significant subluxation of multiple tarsometatarsal joints rather than subtle diastasis with weight-bearing images. Patients were also excluded if there were any significant fractures aside from avulsion fractures, other associated injuries, or underlying neuropathic pathophysiology. Patients completed the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, Visual Analog Scale for Pain (VAS), and Short Form-12 questionnaires before their procedures and then at least 2 years post-operatively. Standard demographic data was collected. Spearman’s correlations and Student’s t-tests were performed to evaluate outcomes after surgery and any relationship between patient characteristics and functional scores. Results: Eighty-seven patients completed functional scores an average of 4.9 years following their procedure (range 2.0 - 8.9), with average age of 41 and average BMI of 27.5. Fifty-two patients (59.8%) were female, and average time from injury to procedure was 15.2 days (range 1-36). Average FAAM-ADL improved from 27.83 to 88.36 postoperatively (p<.001), average FAAM-Sports improved from 7.47 to 76.36 (p<.001), and average VAS pain rating was reduced from 62.83 to 21.78 (p<.001). Hardware removal was performed in 36 cases (41.4%). One patient required removal of hardware and revision ORIF 30 days after the index procedure as a result of hardware complication. Both age at the time of surgery and BMI were negatively correlated with followup SF-12 Physical Health scores (r=-0.254, p=0.018; r=-0.263, p=0.014 respectively). Conclusion: This study is one of the largest case series of low energy Lisfranc injuries. We demonstrate that ORIF for low- energy Lisfranc injuries results in significant functional improvement and pain reduction while maintaining low rates of loss of correction or reoperation. Further investigation is necessary to evaluate this subset of Lisfranc injuries in terms of optimal surgical treatment patient functional outcomes following the use of primary arthrodesis in the treatment of Lisfranc procedures, and to assess the efficacy of the various hardware choices available for the procedure. [Table: see text]

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