scholarly journals The circular arc internal fixation for tibio-talo-calcaneal arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Kaj Klaue
Keyword(s):  
Sagittal Plane ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Vertical Plane ◽  
Neurological Complications ◽  
Full Weight Bearing ◽  
Circular Arc ◽  
Full Contact ◽  
Heel Contact ◽  
Anatomical Alignment

Category: Hindfoot Introduction/Purpose: Stabilizing a tibio-talo-calcaneal arthrodesis in anatomical alignment allowing for weight bearing is a technical challenge. Normal anatomy demonstrates alignment of the heel, the posterior subtalar facet, the talus, the ankle joint and the distal tibia on a circular arc. This arc lies on a vertical plane which is slightly angulated inwards in relation to the sagittal plane. Today’s hindfoot nails do not respect this alignment. Complications include malalignment, primary instability, plantar neuropraxia. Purpose of the study is to optimize the technique to stabilize the hindfoot in anatomical alignment. Methods: An instrumentation was designed to create a circular arc bore hole crossing the heel, the posterior subtalar facet, the tibio-talar joint and the distal tibia metaphysis. At the operation, the desired definitive position of the hindfoot is fixed temporarily with Kirschner wires. A guiding frame is fixed to three critical spots of the hindfoot to drill the central hole. Using an image amplifier the hole is bored using a motor driven end cutting flexible reamer which is seated within a rigid curved hull. The nail has the same shape than the hull and is impacted up to the distal tibia. The nail allows for eventual secondary impaction without losing full contact with the surrounding bone. 30 patients have been treated so far using this technique and evaluated more than 6 months post-operatively. Results: The pathology of the operated patients include post-traumatic, congenital and metabolic (diabetes) conditions. The mean follow-up is 16 months. We did observe 3 ruptures of the tibial locking screw which allowed for more spontaneous impaction. All cases went to consolidation without malunion or other complications. One diabetic patient developed a stable pseudarthrosis at the midfoot joints. The patients were treated for 2 weeks post-op with a closed circular cast allowing heel contact to the floor. After 2 weeks our patients did practise partial to full weight bearing using a cam walker for other 6 weeks. Conclusion: The tibio-talo-calcaneal arthrodesis can be successfully treated using a central circular arc shaped nail allowing for full form fit between implant and bone. The anatomical bony alignment of the hindfoot is corrected or preserved. Due to the safe and limited approaches, the technique prevents complications such as neurological complications and non-unions. We expect a shorter period of time between surgical fixation and full weight bearing.

scholarly journals Standing interface stresses as a predictor of walking interface stresses in the trans-tibial prosthesis

2001 ◽  
Vol 25 (1) ◽  
pp. 34-40 ◽  
Author(s):  
S. G. Zachariah ◽  
J. E. Sanders
Keyword(s):  
Sagittal Plane ◽  
Weight Bearing ◽  
Bending Moment ◽  
Full Weight Bearing ◽  
Shear Stresses ◽  
Equal Weight ◽  
Interface Shear ◽  
Interface Shear Stress ◽  
Lateral Region ◽  
Interface Pressures

Interface pressures and shear stresses within the socket, in standing and walking, were measured for two unilateral, male, trans-tibial amputee subjects, during two sessions each. The ratios of equal weight-bearing standing stresses to peak walking stresses showed regional variation, ranging from 0.24:1 for pressure over the anterior region to 1.01:1 for resultant interface shear stress over the lateral region. Interface stresses in standing were only moderate predictors of peak walking stresses. The best correlation coefficient between standing in full weight-bearing and peak walking stress was 0.88 for pressure over the lateral region. As the amputees progressed from minimal to full weight-bearing in standing, and then to walking, the interface stresses increased in a nonlinear fashion, consistent with the assumption that the anterior tibia provides much resistance to the bending moment in the sagittal plane during walking.

scholarly journals TREATMENT OF TALAR BODY FRACTURES WITH CLOSED REDUCTION AND PERCUTANEOUS FIXATION AT ORTHOPAEDICS DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

2020 ◽  
pp. 1-3
Author(s):  
Ramashish Yadav ◽  
Ramsagar Pandit ◽  
Nand Kumar ◽  
Debarshi Jana
Keyword(s):  
Closed Reduction ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Functional Results ◽  
The Body ◽  
Radiographic Evaluation ◽  
Full Weight Bearing ◽  
Medial Malleolus ◽  
Percutaneous Fixation ◽  
Medial Malleolus Fracture

Background: Fractures of the talus have a relatively low incidence accounting for 0.3% of all bone fracturesand 3–6% of all foot fractures. These injuries affect the neck of the talus, more than the head or the body. Talar body fractures of the talus are uncommon accounting for 7–38% of all talus fractures. Patients and Methods: Fifteen patients with fracture of the talus were operated on using closed reductionand percutaneous screws fixation. The patients (Table 1) were followed up for an average of 20 months (range 12-30 months). In 12 patients the talar fracture was an isolated fracture of the talus in the foot and ankle region. Patient no. 2 had ipsilateral fractures of the distal tibia, fibula, and calcaneus. Patient no. 7 suffered from ipsilateral fracture of the fifth metatarsal. Patient 4 had ipsilateral medial malleolus fracture. Results: Radiographic evaluation postoperative showed exact reduction in all cases but three which had astep of 2mm and 1.5 mm displacement. There were no re-displacements of the fractures, and all patients achieved union radiologically and clinically and could walk without external aid with full weight bearing by third to sixth month postoperative. Functional results according to Hawkins were excellent in five patients, good in seven, fair in three, and no poor results. Conclusion: Closed reduction and percutaneous fixation of talar body fractures is a good technique withaccepted clinical and radiological results, and less complications

scholarly journals Osteosynthesis distal tibial metadiaphyseal fractures with intramedullary nailing versus plating

2017 ◽  
Vol 5 (5) ◽  
pp. 2104
Author(s):  
Deepak Vashisht ◽  
Manjit S. Daroch ◽  
Sanjeev Sreen ◽  
Kuldeep Rathi
Keyword(s):  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Operating Time ◽  
Distal Tibia ◽  
Full Weight Bearing ◽  
P Value ◽  
Operative Care ◽  
Diaphyseal Fractures ◽  
Time Required ◽  
Early Restoration

Background: The management of the tibial fracture remains controversial despite advances in both non-operative and operative care. Plates and intramedullary nails are two well-accepted and effective methods, but each has been historically related to complications. The present study was conducted to compare the results of displaced extra-articular distal tibia meta-diaphyseal fractures OTA/AO Type 42A- C (distal) and 43-A treated with intramedullary nailing versus plating with respect to union of fracture, early Restoration of function, the axial alignment and Complications, if any.Methods: In this study 30 patients of extra-articular distal tibia fracture AO type 42 A-C (distal) and 43 A were randomly selected and 15 were operated with intramedullary nailing and remaining 15 with plating. The patients were regularly followed up for a period of 9 months with radiological and clinical examination. Final assessment was done by Tenny and Wiss clinical assessment criteria.Results: In Interlocking group, average time for union was 20.33 weeks in Interlocking nail group compared to 23.21 weeks in plating group which was significant (p value 0.011). Also, the average time required for partial and full weight bearing in the nailing group was 7.2 weeks and 13.2 weeks respectively which was significantly less as compared to 9.33 weeks and 16.64 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in Interlocking group as compared to plating group.Conclusions: In present study ILN showed better outcome as it offers advantage in terms of mean operating time, less invasive surgery, hospital stay, partial and full weight bearing time and union time.

Union Rate and Rate of Hardware Removal Following Plate Fixation of Metatarsal Shaft and Neck Fractures

2018 ◽  
Vol 39 (3) ◽  
pp. 326-331 ◽  
Author(s):  
Tony Bryant ◽  
David M. Beck ◽  
Joseph N. Daniel ◽  
David I. Pedowitz ◽  
Steven M. Raikin
Keyword(s):  
Sagittal Plane ◽  
Plate Fixation ◽  
Statistical Significance ◽  
Weight Bearing ◽  
Linear Regression Analysis ◽  
Hardware Removal ◽  
Full Weight Bearing ◽  
Level Of Evidence ◽  
Final Fracture ◽  
Metatarsal Fractures

Background: There have been very few studies related to the treatment of first, second, third, and fourth (MT) metatarsal shaft and neck fractures. In order to reduce metatarsal fracture malunion, many surgeons have turned from K-wire to plate fixation of these fractures. This study reports the healing rates, final fracture angulation, and need for hardware removal of operatively treated first to fourth MT shaft and neck fractures with plate fixation. Methods: A retrospective review was performed on all metatarsal fractures at our institution between 2008 and 2014 to identify all first to fourth MT shaft and neck fractures. Medical records and radiographs were reviewed for evidence of union, sagittal, and coronal fracture angulation (degrees), time to full weight bearing, plate size, fracture location (neck vs shaft), and number of screws on each side of the fracture. Multiple linear regression analysis was used to make calculations of statistical significance. Results: Forty-five patients with a total of 75 first to fourth MT fractures treated with plate fixation were included in this study. All fractures went on to union and full weight bearing. The average time to union and time to full weight bearing was 10.9 ± 2 weeks and 7.5 ± 1.6 weeks, respectively. The average coronal and sagittal plane angulation was 3.9 and 2.2 degrees, respectively. Fractures located in the neck were found to have higher coronal plane angulation malunion compared with fractures in the shaft ( P = .019). No variable was found to be related to final sagittal plane angulation. No patient had a plate removed, and 26 of 27 of patients did not want to have the plate removed. Conclusion: Metatarsal fractures fixed with plates had high rates of union and low final fracture angulation. No patient included in this study underwent hardware removal. Level of Evidence: Level III, comparative study.

scholarly journals Limited Open Reduction and Percutaneous Plate Osteosynthesis - Alternative Option to Minimally Invasive Plate Osteosynthesis in Management of Distal Tibia Fractures

2017 ◽  
Vol 56 (208) ◽  
pp. 456-60
Author(s):  
Shambhu Sah ◽  
Bikash KC ◽  
Sailoj Jung Dangi ◽  
Rem Kumar Rai ◽  
Roshan Yadav
Keyword(s):  
Hospital Stay ◽  
Open Reduction ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Full Weight Bearing ◽  
Distal Tibia Fracture ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Radiological Union

Introduction: The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications. Methods: Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available. Results: In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks. Conclusions: The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures. Keywords:  distal tibia fracture; limited open reduction; percutaneous plate osteosynthesis.

scholarly journals Plate Fixation of Metatarsal Shaft and Neck fractures has high union rates and low rates of hardware removal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Beck ◽  
Steven Raikin ◽  
Tony Bryant ◽  
David Pedowitz
Keyword(s):  
Medical Records ◽  
Sagittal Plane ◽  
Plate Fixation ◽  
Statistical Significance ◽  
Weight Bearing ◽  
Hardware Removal ◽  
Full Weight Bearing ◽  
X Rays ◽  
Metatarsal Fractures

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Despite large numbers of traumatic 1st,2nd,3 rd, and 4th (1-4 MT) metatarsal shaft and neck fractures, there have be very few outcome studies related to their treatment. K- wire fixation of metatarsal fractures has been shown to lead to poor outcomes when residual displacement and angulation occurs. In order to maintain anatomic alignment, some surgeons use plates for fixation of metatarsal fractures. To the best of our knowledge, this is the first study to report the healing rates, fracture angulation and need for hardware removal of operatively treated 1-4 MT shaft and neck fractures with plate fixation. Methods: In this retrospective cohort study, we reviewed the medical records of all metatarsal fractures at our institution from October 1, 2006 – December 31, 2014 to identify all 1-4 MT shaft and neck fractures. All tarsometatarsal joint factures, isolated 5th metatarsal fractures, fractures treated at outside facilities, skeletally immature patients and fractures treated non operatively were excluded. Final available x-rays with a minimum of one year follow-up from the date of surgery were reviewed. Medical records and x-rays were reviewed for evidence of union, sagittal and coronal fracture angulation (degrees), time to full weight bearing, plate size, fracture location (neck vs shaft) and number of screws on each side of the fracture. Patients were also called to see if the plates were bothersome, if the plates had been removed, or if they desired to have the plate removed. Multiple linear regression analysis was used to make calculations of statistical significance. Results: 45 patients with 75 metatarsal fractures treated with plate fixation were included. All fractures went to union and full weight bearing. Average time to union and full weight bearing was 10.9 and 7.5 weeks respectively. The average coronal and sagittal plane angulation was 3.9 degrees and 2.2 degrees. No demographic variable showed statistical significance with regards to sagittal and coronal angulation. Fractures located in the neck were found to have higher coronal plane angulation malunion compared to fractures in the shaft (P=0.019). No variable was related to final sagittal plane angulation. 28/45 patients responded to our telephone interview with an average follow-up of 4.4 years. 10 stated the plate bothered them. No plates had been removed and 27/28 patients did not want the plate removed. Conclusion: Metatarsal fractures fixed with plates show high rates of union and low final fracture angulation. Patients did not report symptomatic hardware and did not desire to have plates removed. No patient included in this study underwent hardware removal.

scholarly journals Flecting Osteotomy of the Distal Tibia for Salvage of an Asymmetric Osteoarthritic Ankle Joint

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Beat Hintermann ◽  
Patric Scheidegger ◽  
Tamara Horn Lang ◽  
Lukas Zwicky
Keyword(s):  
Sagittal Plane ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Wedge Osteotomy ◽  
Consecutive Series ◽  
Tibiotalar Joint ◽  
Center Of Rotation ◽  
Joint Congruency ◽  
The Mean ◽  
Surface Angle

Category: Ankle Arthritis Introduction/Purpose: Deformity of the distal tibia in the sagittal plane with increased posterior tilt of the articular surface (recurvatum deformity) results in altered biomechanics and high contact pressure in the anterior tibiotalar joint with consecutive osteoarthritis (OA). As the talus becomes anteriorly extruded out of ankle mortise, the distance between its center of rotation and longitudinal axis of tibia is typically seen to be increased. In an attempt to restore physiologic load of such misaligned ankles in the sagittal plane, we have started to use a correcting osteotomy of the distal tibia to realign the center of rotation of talus and tibial axis. The aim of this study was to analyze the radiological and clinical outcome in a consecutive series of patients. Methods: 39 patients (female, 12; male 27; age 47 [28 to 72, SD 10.6] years) were treated with a flecting osteotomy of the distal tibia for a symptomatic misalignment in the sagittal plane with the use of an anterior opening wedge osteotomy (n = 28), posterior closing wedge osteotomy (n = 9), or dome-shaped osteotomy from medially (n = 2). If necessary, simultaneous corrections in the frontal plane were performed to address additional valgus/varus deformities. Standard weight-bearing radiographs were used pre- and postoperatively to evaluate the tibial anterior surface angle (TAS), tibiotalar surface angle (TTS), tibial lateral surface angle (TLS), calcaneal pitch and talar offset ratio (TOR). A four-staged flecting score was used to classify the grade of OA of the tibiotalar joint in the sagittal plane, also taking the coronal joint congruency into account. Results: The cumulative survival rate of the joint was 77% (95% CI: 48-86%) after 3 years, with 9 patients needing a joint sacrificing procedure (total ankle arthroplasty, 7; ankle fusion, 2). In the remaining 30 patients, pain decreased 2.0 points on the VAS (p <0.001), and the AOFAS hindfoot score improved by 17 points (p<0.001). The ROM did not change significantly. Patient satisfaction with the outcome was good in 68% and moderate in 25%, 7% were not satisfied. The mean TLS increased by 6.6 (SD 5.84) degrees, the mean TOR decreased 0.239 (SD 0.1814). TAS, TTS and calcaneal pitch did not change significantly. Ten ankles (26%) showed an improvement, 22 (56%) no change and 7 (18%) a worsening in the flecting score. Conclusion: The flecting osteotomy of the distal tibia was found to be an effective method to restore the tibiotalar joint congruency through moving the tibia axis anteriorly to the center of rotation of the talus, and lengthening the lever arm of the Achilles tendon. Besides normalizing the joint reaction forces of the tibiotalar joint, the procedure was also found to be effective to stabilize the talus against anterior extrusion. However, with a failure rate of 23%, there is need for further studies to determine the indication and limitation of this procedure.

scholarly journals Limb Salvage for Primary Malignant Bone Tumors of the Distal Leg in Skeletally Immature Patients: Ankle Arthrodesis Using Vascularized Ipsilateral or Contralateral Fibular Flap

2019 ◽  
Vol 04 (01) ◽  
pp. e36-e41
Author(s):  
Ahmed Mohamed El Ghoneimy ◽  
Mohamed Sokar ◽  
Nehal Kamal
Keyword(s):  
Bone Tumors ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Ankle Arthrodesis ◽  
Full Weight Bearing ◽  
Fibular Graft ◽  
Skeletally Immature ◽  
Malignant Bone Tumors ◽  
Fibular Flap ◽  
The Mean

Background Malignant bone tumors of the distal tibia or fibula in children are rare. Quality of functional outcome following limb salvage surgery is still controversial. This is a retrospective review of the functional outcome of ankle arthrodesis using vascularized fibular flap. Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six patients and the distal fibula in one patient. The average age at presentation was 10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range, 13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two patients and a free vascularized osteocutaneous fibular flap from the contralateral leg in five patients. External fixation was used in five and internal fixation in two patients. Patients were allowed full weight bearing following radiographic evidence of complete bone union. Results The mean time to complete bone union and full weight bearing was 7.1 months (range, 4–13 months). One patient developed nonunion at graft-host junction and one patient had stress fracture of the fibular graft. The mean limb length inequality was 0.57 cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5% (range, 73–100%). Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular flap can return to full weight bearing within the first year following surgery. A contralateral fibular flap has the advantage of preserving the contour of the ankle and reserving the ipsilateral fibula for initial stability at the fusion site. This study is of level IV evidence.

FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

2015 ◽  
Vol 21 (4.1) ◽  
pp. 638-642
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamosiunas ◽  
Janina Tutkuviene
Keyword(s):  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Full Extension ◽  
Low Degrees ◽  
Mri Study ◽  
Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

scholarly journals Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

2021 ◽  
Author(s):  
Franziska Leiss ◽  
Julia Sabrina Götz ◽  
Matthias Meyer ◽  
Günther Maderbacher ◽  
Jan Reinhard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enhanced Recovery ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Full Weight Bearing ◽  
Partial Weight Bearing ◽  
Fill Ratio ◽  
Stem Subsidence ◽  
Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

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