scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

scholarly journals Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

scholarly journals Risk Factors of Arthropathy Change of the Lateral Side of Subtalar Joint After Calcaneal Fracture Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Naohiro Hio ◽  
Atsushi Hasegawa ◽  
Satoshi Monden ◽  
Masanori Taki ◽  
Kazuhiko Tsunoda ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Subtalar Joint ◽  
Calcaneal Fracture ◽  
Joint Surface ◽  
Lateral Side ◽  
Anterolateral Approach ◽  
Sinus Tarsi Approach ◽  
Mean Width ◽  
The Mean

Category: Hindfoot, Trauma Introduction/Purpose: As a result of arthropathy change on the lateral side of subtalar joint after intra-articular calcaneal fracture, the secondary disorders such as pain or restricted range of motion occasionally occur. The purpose of this study is to examine factors that cause such arthropathy change. Methods: We divided 23 joints into two groups according to arthropathy change of the lateral side of subtalar joint: the existence of such arthropathy (O) group included 8 joints, the absence of arthropathy (N) group included 15 joints. The patients’ mean age at the time of surgery were 49.1 years and 54.9 years respectively, and the mean follow-up period were 16.1 months and 12.4 months respectively. The anterolateral approach or the sinus tarsi approach was used for both groups, and the medial approach was combined as needed. The fixing materials were a plate or screws, and in some cases, staples and Kirschner wires were used in combination. We assessed Sanders classification, postoperative clinical evaluation using Creighton-Nebraska scale, and the width, height and dislocation of subtalar joint surface of calcaneus. Results: The breakdown of the Sanders classification is as follows: N group consists of 3 joints of type 2A, 7 of type 2B, 3 of type 2C, 1 of type 3BC, 1 of type 4. O group consists of 5 joints of type 2A, 2 of type 2B, 1 of type 2C. The proportion occupied by Sanders classification type 2A in O group was larger than in N group. The average of the postoperative clinical evaluation was 94.9points in N group, 86.9points in O group. In postoperative image evaluation, the mean width in the was 106.2% in N group, 117.1% in O group, the mean dislocation of the subtalar joint surface was 0.4 mm in N group and 1.1 mm in O group. Conclusion: It was suggested that Sanders type 2A and the residual dislocation of the subtalar joint surface may be a cause of arthropathy change on the lateral side of subtalar joint.

scholarly journals A Comparative Study between Lateral Approach Alone and Combination of Medial and Lateral Approaches for Intra-Articular Calcaneal Fractures with Displaced Sustentaculum Fragment

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Naohiro Hio ◽  
Masanori Taki
Keyword(s):  
Comparative Study ◽  
Inclination Angle ◽  
Subtalar Joint ◽  
Lateral Approach ◽  
Joint Surface ◽  
Calcaneal Fractures ◽  
Significant Difference ◽  
The Mean ◽  
Type 3

Category: Hindfoot; Trauma Introduction/Purpose: In intra-articular calcaneal fractures, the sustentaculum fragment, which is the reference for reduction, often undergoes varus plantar flexion displacement and requires accurate reduction. Although the lateral approach is generally used as a surgical approach, it is considered that the use of the combination of medial and lateral approaches can achieve more accurate reduction. Here we report a comparative study of between the group with the lateral approach alone (L-group) and the group with the combination of the medial and lateral approaches (ML-group) for calcaneal fractures with displacement of sustentaculum fragment. Methods: L-group included 11 feet, six feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. ML-group included 14 feet, ten as type 2, two as type 3, two as type 4. In both groups, small incision such as sinus tarsi approach were used for lateral approach and screws and/or plates were used for fixation. We assessed Creighton-Nebraska scale, pre- and postoperative width and height of the calcaneal body, step of subtalar joint surface and inclination angle of the sustentaculum fragment. Results: The mean postoperative clinical evaluation for the L-group / ML-group was 90.5+-7.9 points / 87.2+-9.6 points respectively. The pre- and postoperative image assessments showed improvements in the mean width from 123.4+-15.3% to 110.3+-14.1% / 129.9+-23.1% to 109.9+-14.1%, in the mean height from 88.1+-5.2% to 98.1+-3.7% / 86.0+-9.6% to 95.4+-5.9%, in the step of subtalar joint surface from 9.0+-6.3mm to 0.9+-1.1mm / 10.0+-8.0mm to 0.7+-1.0mm, and in the inclination angle of sustentaculum fragment from 10.3+-5.1 ° to 5.5+-5.0 ° / 12.1+-7.5 ° to 0.5+-1.0 °, respectively. There was a significant difference between the two groups in the inclination angle of the sustentaculum fragment, but no significant difference was observed in the other assessments. Complications were more common with ML-group. Conclusion: Displacement of the sustentaculum fragment in calcaneal fractures can be more reduced accurately by using the combination of medial and lateral approaches, although there is no significant difference in clinical results.

scholarly journals Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng ◽  
R. Frank Henn
Keyword(s):  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires ◽  
Diagnostic Confidence ◽  
Joint Surfaces ◽  
Small Joint

Category: Arthroscopy, Midfoot/Forefoot Introduction/Purpose: Arthroscopy has been increasingly utilized to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized. Methods: Ten (10) fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. Arthrosocopy was performed with gravity distraction utilizing a 1.9 mm 30° arthroscope and small joint instruments. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The percentage of cartilage visualized (visualized / total cartilage x 100%) was measured using ImageJ® software. Measurements include surface area visualized on axial imaging as well as arc visualized on lateral imaging Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (49.6 – 65.3) of the metatarsal head and 100% (100-100) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72° (65-80) was visualized out of an average total articular arc of 199° (192-206), for an average 36.5% (32.2 – 40.8) of the articular arc. Conclusion: The results suggest that hallux MTP arthroscopy visualizes a sizable portion of the joint surfaces. However, incomplete visualization could potentially miss a hallux metatarsophalangeal lesion. Further imaging preoperatively may improve diagnostic confidence.

A New Methodology to Determine the Anatomical Center and Radius of Curved Joint Surfaces

2006 ◽  
Vol 1 (2) ◽  
pp. 173-175
Author(s):  
Dominik C. Meyer ◽  
Norman Espinosa ◽  
Urs Lang ◽  
Peter P. Koch
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Joint Surface ◽  
Joint Surfaces ◽  
The Mean ◽  
The Cross ◽  
Mechanical Tool ◽  
Isometric Point ◽  
Crossing Point

This study describes a mechanical tool which allows us to determine the radius and center of curved joint surfaces both intraoperatively and in vitro. The tool is composed of longitudinal parallel hinges, connected with cross bars on one end. In the middle of each cross bar, one needle is attached at an angle of 90deg to both the hinges and the cross bars. When the parallel hinges are held against a curved surface, they will adapt to the curvature and the needles on the cross bars will cross each other. The crossing point of two needles represents the mean center of the curvature within the plane spanned by the needles. The radius is the distance between the center of curvature and the joint surface. The proposed tool and method allow us to determine the mean center of convex or concave curvatures, which often represent the isometric point of a corresponding curved joint surface. Knowing the radius and center of curvature may facilitate various surgical procedures such as collateral or cruciate ligament reconstruction. Appropriate adaptations of the tool appear to be a useful basis for biomechanical and anatomical joint analyses in the laboratory.

scholarly journals Comparison of Computed Tomography Articular Surface Geometry of Male Versus Female Thumb Carpometacarpal Joints

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 33-39
Author(s):  
Jessica G. Shih ◽  
James G. Mainprize ◽  
Paul A. Binhammer
Keyword(s):  
Sex Differences ◽  
Articular Surface ◽  
Joint Space ◽  
Joint Surface ◽  
Surface Geometry ◽  
Significant Difference ◽  
The Mean ◽  
Joint Congruence ◽  
Cmc Joint ◽  
Space Volume

Background: Given the predilection of first carpometacarpal (CMC) joint osteoarthritis in women compared with men, we aim to determine the differences in first CMC joint surface geometry and congruence between young healthy males and females. Methods: Wrist computed tomographic scan data of 11 men and 11 women aged 20 to 35 years were imported into 3-dimensional software programs. The first metacarpal and the trapezium were aligned in a standardized position according to landmarks at key points on Gaussian and maximum curvature maps. Measurements of joint congruence and surface geometry were analyzed, including joint space volume, distance between the bones at the articular surface edges, area of the joint space, and radii of curvature in the radial-ulnar and volar-dorsal planes. Results: The mean thumb CMC articular space volume was 104.02 ± 30.96 mm3 for females and 138.63 ± 50.36 mm3 for males. The mean first metacarpal articular surface area was 144.9 ± 10.9 mm2 for females and 175.4 ± 25.3 mm2 for males. After normalizing for size, the mean thumb CMC articular space volume was 119.4 ± 24.6 mm3 for females and 117.86 ± 28.5 mm3 for males. There was also no significant difference for the articular space volume, articular surface distances, articular space, and mean radii of curvatures. Conclusions: This study found that there are sex differences in the first CMC joint articular volume without normalizing for size; however, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence of young, healthy patients after normalizing for joint size.

Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study

2021 ◽  
Author(s):  
Brianna R. Fram ◽  
Bryan Hozack ◽  
Asif M. Ilyas ◽  
Christopher Jones ◽  
Michael Rivlin
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Total Surface Area ◽  
High Rate ◽  
Joint Surface ◽  
Level Of Evidence ◽  
Large Variability ◽  
Thumb Carpometacarpal ◽  
Intraoperative Visualization ◽  
Cmc Joint

Abstract Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint (p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.

A Comparison of Talar Surface Area Occupied by 2- Versus 3-Screw Fixation for Ankle Arthrodesis

2019 ◽  
Vol 13 (1) ◽  
pp. 50-53
Author(s):  
Eric So ◽  
Roberto A. Brandão ◽  
Patrick E. Bull
Keyword(s):  
Surface Area ◽  
Screw Fixation ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Joint Surface ◽  
Fusion Construct ◽  
Ankle Fusion ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background. Ankle arthrodesis is a procedure utilized in the treatment of end-stage ankle arthritis. Internal fixation with screws is traditionally relied on to achieve union. Although the use of screw fixation alone has produced satisfactory outcomes, nonunion rates can range from 9% to as high as 35%. Adding an additional screw to the traditional 2-screw fixation construct may improve the likelihood of union by adding strength and stiffness; however, this addition may counteract the theoretical fusion enhancement benefit by reducing the joint surface area (SA) available for fusion. Methods. A cadaver study was performed to compare the amount of SA lost from a standard 2-screw (group 1) versus the 3-screw ankle fusion construct (group 2). A total of 10 fresh cadaveric below-knee specimens were used. Cannulated 7.0-mm partially threaded screws were placed across the ankle joint. Each talus was examined to precisely determine joint SA loss following each procedure. Results. The mean total talus SA in group 1 was 1833.71 mm2 compared with 2125.76 mm2 in group 2. The mean SA lost by the 2-screw construct was 5.91%, versus 9.51% in the 3-screw construct group. The talus SA loss percentage difference between groups reached statistical significance (P = .0220). Conclusion. The addition of a third 7.0-mm screw to a 2-screw ankle fusion construct raised the percentage of joint surface lost from 5.91% to 9.5%. Clinical Relevance. Surgeons may consider using extra-articular plates with 1 or 2 intra-articular screws instead of the traditional 3-screw construct if there is an elevated concern for nonunion. Levels of Evidence: Level IV: Cadaveric case series

Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

2019 ◽  
Vol 13 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim C. Pinto ◽  
Zachary L. Littlefield ◽  
Leonardo V. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Cadaver Study ◽  
Joint Surface ◽  
Lateral Sinus ◽  
Total Percentage ◽  
Sinus Tarsi ◽  
Lateral Incision ◽  
Sinus Tarsi Approach ◽  
Fresh Frozen

Introduction. The open, lateral sinus tarsi approach is the most commonly used technique for subtalar arthrodesis. In this cadaver study, we measured the maximum joint surface area that could be denuded of cartilage and subchondral bone through this approach. Methods. Nine fresh frozen above-knee specimens were used. The subtalar joint was accessed through a lateral incision from the fibular malleolus distally over the sinus tarsi area to the level of the calcaneocuboid joint. Cartilage was removed from the anterior, middle, and posterior facets of the calcaneus and talus using an osteotome and/or curette. ImageJ was used to calculate the surface areas of undenuded cartilage. Results. No specimens were 100% denuded of cartilage on all 6 measured surfaces. The greatest percentages of unprepared surface area remained on the middle facet of the talus (18.66%) and the middle facet of the calcaneus (14.51%). The anterior facet of the talus was 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 specimens. The anterior facet of the calcaneus was also 100% denuded in 6 specimens, while the middle and posterior facets were 100% denuded in 3 and 4 specimens, respectively. The average total unprepared surface area per specimen was 8.67%. Conclusion. The lateral sinus tarsi approach provides adequate denudation of cartilage of the subtalar joint in most cases. Total percentage of unprepared joint surface may range from approximately 2% to 18%. Future clinical studies are warranted to assess whether this technique results in optimal union rates. Levels of Evidence:V, Cadaveric Study

Pilon Fractures of the Wrist

1992 ◽  
Vol 17 (1) ◽  
pp. 63-68 ◽  
Author(s):  
M. L. PORTER ◽  
R. M. TILLMAN
Keyword(s):  
Articular Surface ◽  
High Energy ◽  
Joint Line ◽  
Joint Surface ◽  
Wrist Injuries ◽  
Associated Injuries ◽  
Prognostic Feature ◽  
The Mean ◽  
Complex Injuries

22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radio-ulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2½ years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radio-ulnar joint were also important.

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