Results of surgical treatment of patients with acute injuries of the lateral ligamentous apparatus of the ankle joint

Aim. To evaluate the results of treatment using the authors’ proposed method of arthrodesis of the ankle and subtalar joints, based on the combination of bone grafting with compression in the Ilizarov apparatus. Methods. Conducted was a clinical and radiographic evaluation of the results of arthrodesis in the Ilizarov apparatus in 286 patients with osteoarthritis of the ankle and subtalar joints (during the last 15 years). 36 (12.6%) patients (the main group) were operated on using the authors’ proposed technique. Results. Bone adhesion as a result of arthrodesis was achieved in all patients of the main group. Excellent functional results were achieved in 11 out of 36 patients (30.5%), good results - in 22 (61.1%) patients, satisfactory results - in 3 (8.4%) patients. Bone adhesion as a result of arthrodesis in 250 patients of the comparison group was achieved in 243 patients (97.2%). In this group excellent functional results were achieved in 76 out of 250 patients (30.4%), good results - in 145 (58%) patients, satisfactory results - in 21 (8.4%) patients, poor results - in 8 (3.2%) patients. Conclusion. The proposed method of biarticular arthrodesis makes it possible to improve the trophism of the arthrodesis zone, to conduct the correction of posttraumatic deformities in the region of the ankle and subtalar joints, provides a durable and solid bone ankylosis of the ankle and subtalar joints, and makes it possible to achieve adhesion even in severe forms of osteoarthritis of the ankle and subtalar joints.

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METHOD OF SURGICAL TREATMENT OF PATIENTS WITH RECURRENT ACHILLES TENDON RUPTURES

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2010-0-3-126-130 ◽

2010 ◽

Vol 16 (3) ◽

pp. 126-130

Author(s):

L. A. Rodomanova ◽

A. Yu. Kochish ◽

D. V. Romanov ◽

S. V. Valetova

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Ankle Joint ◽

Clinical Experience ◽

New Method ◽

Clinical Use ◽

Anatomic Study ◽

Anatomical Studies ◽

Results Of Treatment ◽

Tendon Ruptures

In order to justify a new method of surgical treatment of patients with recurrent and chronic Achilles tendon ruptures conducted applied topographic-anatomic study of 12 fixed and 8 fixed preparations of the lower extremities was performed. In the developed technique were carried out operations in 18 patients aged from 30 to 72 years with repeated ruptures Achilles tendon. The results of treatment were followed-up in all 18 patients in the period from 6 months to 3 years. Repeated tears of Achilles tendon were not observed. The range of motions in ankle joint reconstructed almost in its entirety. Performed topographic and anatomical studies and accumulated clinical experience allow us to recommend the proposed method for a wider clinical use.

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Comparative evaluation of methods of surgical treatment of posterior marginal fractures of the tibia based on the analysis of vascular supply

Kazan medical journal ◽

10.17816/kazmj74792 ◽

1937 ◽

Vol 33 (7) ◽

pp. 891-895

Author(s):

A. M. Zholondz

Keyword(s):

Surgical Treatment ◽

Ankle Joint ◽

Comparative Evaluation ◽

Plaster Cast ◽

Vascular Supply ◽

The State ◽

Posterior Edge ◽

X Ray ◽

Evaluation Of Methods ◽

Entire Limb

December 23, 1930 in the State. a 37-year-old patient was delivered to the trauma institute. An hour before admission, she twisted her right foot and received a posterior marginal fracture of the tibia from the outside. Large hemorrhage and rapidly growing swelling in the ankle joint prevented the reposition of the fragments, and a two-fold attempt to establish the displaced fragments along the axis was unsuccessful. At the same time, X-ray showed the presence of two fragments in the region of the posterior edge of the tibia, between which there is a gap 2.5 cm wide. The ratio of the bones forming the fork is broken. Despite the fixation of the limb with a plaster cast, unbearable pains remained along the entire limb, the patient did not sleep.

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Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients

Neurosurgical FOCUS ◽

10.3171/foc.2000.9.1.2 ◽

2000 ◽

Vol 9 (1) ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Jürgen Piek

Keyword(s):

Surgical Treatment ◽

Traumatic Injury ◽

Olfactory Nerve ◽

Success Rates ◽

One Stage ◽

Acute Injuries ◽

Additional Surgery ◽

Maxillofacial Fractures ◽

Extradural Approach ◽

Planum Sphenoidale

Object The author's personal series included 148 patients who sustained traumatic frontobasal injuries and were treated between 1986 and 1999. Included in this study are 74 of 148 patients with acute injuries and complex fronto-basal lesions involving the frontal sinus, the cribriform/ethmoid roof complex, one or both orbital roofs, and the planum sphenoidale. Methods Surgery was delayed for up to 4 weeks postinjury in most patients (67 cases), whereas 17 with space-occupying hematomas and perforating injuries required early surgery. In 30 patients additional surgery was required to treat maxillofacial fractures, which was performed as a one-stage procedure together with the neurosurgical operation. The author performed a standard bifrontal craniotomy in which an intradural or combined intradural–extradural approach was used in all cases. Four patients developed ascending meningitis in the preoperative period. As a result of surgical treatment one patient died, another two patients suffered from permanent defects, and three suffered from transitory neurological worsening. In two patients recurrence of a cerebrospinal fluid fistula occurred within a 3-month period posttreatment but was successfully obliterated during reoperation. In the author's experience the intradural approach is comparable in terms of the morbidity, mortality, and success rates with extracranial approaches; additionally the intradural approach provides full visualization of the intracranial lesion. Useful olfactory nerve function can only be preserved if both olfactory nerves are left intact and not crushed during initial injury; this occurred in only five patients in this series. Conclusions If possible, surgical treatment of more complex lesions should be delayed until the 2nd or 3rd week following traumatic injury. With antibiotic prophylaxis the risk that ascending meningitis will occur prior to surgery is low. If the patient is systemically stable and brain swelling has resolved, even extensive one-stage neurosurgical/ maxillofacial procedures are well tolerated.

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Surgical treatment of tibiofibular syndesmosis in injuries of the ankle joint

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872010127-32 ◽

2010 ◽

Vol 0 (1) ◽

pp. 27

Author(s):

Yevgeny Kulazhenko ◽

Sergey Varzar

Keyword(s):

Surgical Treatment ◽

Ankle Joint ◽

Tibiofibular Syndesmosis

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Comparison between buttress plate and anteroposterior screw internal fixation for posterior pilon fracture: a retrospective study

10.21203/rs.3.rs-18058/v2 ◽

2020 ◽

Author(s):

linyuan zhang ◽

zhiqing liu ◽

yueting wang ◽

chao yu ◽

jian tang ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Fixation ◽

Ankle Joint ◽

Joint Pain ◽

Healing Time ◽

Pilon Fracture ◽

Significant Difference ◽

Vas Scores ◽

Buttress Plate

Abstract Background: Posterior pilon fracture (PPF) is a serious ankle injury caused by combined vertical and rotational trauma. Surgical treatment includes buttress plate (BP), anteroposterior screw (APS) and posteroanterior screw (PAS) fixation. This study aimed to compare the therapeutic effects after PPF internal fixation with BPs and APSs. Methods: From January 2015 to June 2018, 37 patients with PPFs underwent surgical treatment in our institution. The patients were divided into the BP (11 patients) and APS (26 patients) groups according to the internal fixation method. Bone healing time and postoperative complications were recorded. At the last follow-up, American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores and Burwell-Charnley scores were used to evaluate ankle joint function, ankle joint pain, and fracture reduction on imaging, respectively. Results: No significant difference in bone healing time was found between the two groups (P > 0.05). Local necrosis of the posterolateral incision and chronic ankle pain occurred in 1 case each in the BP group. Chronic ankle joint pain occurred in 4 cases in the APS group. Two cases of soft tissue irritation were caused by screws that were too long. Local numbness of the posterolateral incision occurred in 1 case. At the last follow-up, no significant difference in VAS scores between the two groups at rest (P = 0.477), but a significant difference during exercise was noted (P = 0.033). AOFAS scores were better in the BP group than those in the APS group (P = 0.002). According to the Burwell-Charnley scoring system, 11 cases were anatomically reduced in the BP group. In the APS group, anatomical reduction was achieved in 19 cases and fair in 7 cases. Conclusion: Compared with APSs, BPs resulted in better reduction, ankle joint functional recovery and complication rates. BPs are recommended for internal fixation of PPFs.

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Ankle Osteoarthritis – Arthroplasty or Arthrodesis?

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.7282 ◽

2018 ◽

Vol 20 (5) ◽

pp. 361-371

Author(s):

Jakub Wąsik ◽

Tomasz Stołtny ◽

Maria Leksowska-Pawliczek ◽

Jarosław Pasek ◽

Maciej Szcześniak ◽

...

Keyword(s):

Surgical Treatment ◽

Ankle Joint ◽

Irreversible Loss ◽

Ankle Osteoarthritis ◽

Talocrural Joint ◽

Ankle Arthroplasty ◽

Joint Axis ◽

Surgical Methods ◽

History Of ◽

Neurological Conditions

Osteoarthritis of the talocrural joint accounts for only 4% of cases of degenerative disease of the musculoskeletal system. Unlike other joints, idiopathic OA of the ankle joint is identified in only 7% of patients. Until the end of the 1960’s, arthrodesis was the treatment of choice in advanced OA of ankle joint. Absolute indications for arthrodesis include irreversible loss of joint anatomy, neurological conditions, advanced osteoporosis and chronic inflammation. Currently, the surgical treatment of ankle joint OA relies on third-generation endoprostheses of the ankle. Arthroplasty is indicated in patients under 60 years of age with no history of non-orthopaedic co-morbidities, engaging in little physical activity, with an intact joint axis and satisfactory mobility and non-smoking. This article analyzes the available literature on the results of surgical treatment in patients with osteoarthritis of the talocrural joint treated with arthrodesis or arthroplasty, taking into consideration the strict indications for each of these surgical methods.

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The Efficacy of Surgical Treatment in the Correction of Adult Acquired Flatfoot Deformity: A Three- dimensional Biometric Weightbearing Computed Tomography Evaluation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00036 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0003

Author(s):

Cesar de Cesar Netto ◽

Jonathan Day ◽

Alexandre L. Godoy-Santos ◽

Jonathan H. Garfinkel ◽

Chris Cychosz ◽

...

Keyword(s):

Surgical Treatment ◽

Ankle Joint ◽

Surgical Procedures ◽

Three Dimensional ◽

Spring Ligament ◽

Patient Reported ◽

Significant Correction ◽

Adult Acquired Flatfoot Deformity ◽

The Mean

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Multiple surgical techniques are used in the correction of Adult Acquired Flatfoot Deformity (AAFD). Assessment of the efficacy of a surgical treatment in the correction of the deformity is usually performed by clinical evaluation and conventional radiographic imaging. Weightbearing CT (WBCT) allows a more reliable and multiplanar evaluation of AAFD. The Foot and Ankle Offset (FAO) is a WBCT biometric semi-automatic measurement that gauges the relative positioning between the foot tripod and the center of the ankle joint. This study aimed to investigate the efficacy of surgical treatment in correcting AAFD, comparing preoperative and postoperative FAO measurements. We hypothesized that surgical treatment would provide significant correction of the deformity, centering the tripod of the foot underneath the ankle joint. Methods: In this prospective comparative study, 21 adult patients (22 feet) with flexible AAFD were included, mean age 55 (range, 23-81) years, 13 females and eight males. Patients underwent preoperative and postoperative standing WBCT examination. Three-dimensional coordinates (X, Y and Z planes) of the foot tripod (weightbearing point of the first and fifth metatarsals and calcaneal tuberosity) and center of the ankle (apex of the talar dome) were harvested by two independent and blinded observers. The FAO was automatically calculated from the harvested 3D coordinates by dedicated software. Data regarding the surgical technique used was recorded. Patient Reported Outcomes (PROs) were collected preoperatively and postoperatively at a mean follow-up of 22 (range, 8-36) months. Pre and postoperative FAO measurements were compared by paired T-tests. Multivariate analysis was used to assess the influence of surgical procedures in the amount of FAO correction. P-values of less than 0.05 were considered significant. Results: We found excellent intra (0.98) and interobserver reliability (0.96) for FAO measurements. The mean preoperative FAO was 10.4 (95% CI, 8.5 to 12.1). There was a significant correction of the deformity postoperatively (p<0.0001), with a mean postoperative FAO of 1.4 (CI, -0.1 to 2.9), and mean improvement of 8.9 (95% CI, 6.6 to 11.2). Average increase in PROs was (p<0.05): physical function (8; CI, 4 to 12), pain interference (10.3; CI, 4.8 to 15.9), pain intensity (5.3; CI, -10:20.6), mental health (4.2; CI, 0.2:8.2), physical health (4.3; CI, 0.9 to 9.8), and depression (10.4; CI, -0.6 to 21.4). The mean number of surgical procedures performed was 8 (range, 2-12). Spring ligament reconstruction was the only technique that influenced the amount of FAO correction (P<0.001). Conclusion: To the author’s knowledge, this is the first study to assess the amount of surgical correction of AAFD using standing WBCT images and semiautomatic 3D measurements. We found that surgical treatment provided a significant and pronounced amount of correction in the FAO, with the foot tripod more centered underneath the ankle joint. We also found a significant improvement in the PROMIS after an average postoperative follow-up of 22 months. Among multiple different surgical procedures performed, reconstruction of the spring ligament was the only technique that significantly influenced the amount of FAO correction. Longer-term follow-up studies are needed. [Figure: see text]

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