scholarly journals Charcot foot reconstruction—how do hardware failure and non-union affect the clinical outcomes?

2020 ◽  
Vol 5 ◽  
pp. 25-25
Author(s):  
Ingvild Kummen ◽  
Ngwe Phyo ◽  
Venu Kavarthapu
Keyword(s):  
Clinical Outcomes ◽  
Charcot Foot ◽  
Hardware Failure ◽  
Non Union ◽  
Foot Reconstruction

SCAPHOID BONE BRUISING – PROBABLY NOT THE PRECURSOR OF ASYMPTOMATIC NON-UNION OF THE SCAPHOID

2007 ◽  
Vol 32 (3) ◽  
pp. 337-340 ◽  
Author(s):  
N. LA HEI ◽  
I. MCFADYEN ◽  
M. BROCK ◽  
J. FIELD
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Classification System ◽  
Complete Resolution ◽  
Scaphoid Bone ◽  
Bone Bruise ◽  
Radiological Findings ◽  
Non Union ◽  
Bone Bruising

The MRI finding of bone marrow oedema, without fracture, following trauma to the scaphoid has been called a ‘bone bruise’. A similar injury is found in the knee, considered benign and managed conservatively. In the scaphoid, there is the concern that this lesion may lead to scaphoid non-union. This study addresses that concern. The clinical and radiological findings of 41 patients with a scaphoid bone bruise on MRI are described, an MRI classification system proposed and clinical outcomes investigated. Patients were immobilised for 6 weeks. At 3 months, 8 remained symptomatic and had repeat MRI. Four of these showed complete resolution of the bruise, the others improvement. At 6 months, 2 of the 8 complained of minor, intermittent discomfort but progressed to resolution of symptoms. This study suggests that the scaphoid bone bruise is a benign injury with predictable recovery and is unlikely to result in long-term morbidity in the form of non-union.

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

2018 ◽  
Vol 40 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Elizabeth A. Harkin ◽  
Andrew M. Schneider ◽  
Michael Murphy ◽  
Adam P. Schiff ◽  
Michael S. Pinzur
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Ankle Joint ◽  
Chronic Wounds ◽  
Surgical Techniques ◽  
Case Series ◽  
Lessons Learned ◽  
Charcot Foot ◽  
Operative Correction ◽  
Therapeutic Footwear

Background: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusions: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level of Evidence: Level IV, case series.

scholarly journals Deformity and Clinical Outcomes Following Surgical Correction of Charcot Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0043
Author(s):  
Stephen Wallace ◽  
Tomas E. Liskutin ◽  
Adam P. Schiff ◽  
Michael S. Pinzur
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Ankle Joint ◽  
Chronic Wounds ◽  
Surgical Techniques ◽  
Lessons Learned ◽  
Surgical Correction ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Therapeutic Footwear

Category: Ankle, Ankle Arthritis, Diabetes, Hindfoot, Trauma Introduction/Purpose: Deformity associated with Charcot Foot Arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following surgical correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot Foot Arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent surgical reconstruction of Charcot Foot deformity involving the ankle joint by a single surgeon over a fourteen year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between preoperative or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusion: Surgical correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly co-morbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques.

Mid-term walking ability after Charcot foot reconstruction using the Ilizarov ring fixator

2020 ◽  
Vol 140 (12) ◽  
pp. 1909-1917 ◽  
Author(s):  
Stephan H. Wirth ◽  
Arnd F. Viehöfer ◽  
Timo Tondelli ◽  
Rebecca Hartmann ◽  
Martin C. Berli ◽  
...  
Keyword(s):  
Walking Ability ◽  
Charcot Foot ◽  
Ring Fixator ◽  
Ilizarov Ring Fixator ◽  
Foot Reconstruction

Clinical outcomes with the corticotomy-first technique associated with the Ilizarov method for the management of the septic long bones non-union

2018 ◽  
Vol 42 (12) ◽  
pp. 2933-2939 ◽  
Author(s):  
Gamal Ahmed Hosny ◽  
Abdel-Salam Abdel-Aleem Ahmed ◽  
Mohamed Abd-Elaal Hussein
Keyword(s):  
Clinical Outcomes ◽  
Ilizarov Method ◽  
Long Bones ◽  
Non Union

scholarly journals Clinical Outcomes of the Ilizarov Method After an Infected Tibial Non Union

2013 ◽  
Vol 2 (2) ◽  
Author(s):  
Mohammad Shahid ◽  
Abid Hussain ◽  
Phillipa Bridgeman ◽  
Deepa Bose
Keyword(s):  
Clinical Outcomes ◽  
Ilizarov Method ◽  
Non Union

External Fixation for Charcot Foot Reconstruction

2005 ◽  
Vol 62 (6) ◽  
pp. 618-623 ◽  
Author(s):  
Lee Russell Sayner ◽  
Barry I. Rosenblum
Keyword(s):  
External Fixation ◽  
Charcot Foot ◽  
Foot Reconstruction

scholarly journals Autogenous Onlay Graft with Compression Plate for Treatment of Persistent Humeral Shaft Aseptic Non-union with Failed Previous Surgery

2021 ◽  
Vol 9 (C) ◽  
pp. 118-123
Author(s):  
Falih Waheed Hashmi ◽  
Mohammed Baqir Al-Shara ◽  
Mohammed Al-Edanni
Keyword(s):  
Functional Outcome ◽  
Nonoperative Treatment ◽  
Humeral Shaft ◽  
Teaching Hospitals ◽  
Previous Surgery ◽  
Infected Nonunion ◽  
Hardware Failure ◽  
Non Union ◽  
Onlay Graft ◽  
Compression Plate

BACKGROUND: The humeral shaft fractures have a good rate of union, despite this fact, still there is a significant rate of nonunion after nonoperative treatment and more often after operative treatment. AIM: The aim of the study is to evaluate the autogenous onlay graft with compression plate for treatment of persistent humeral shaft non-union with failed previous surgery both radiological and functional outcome. MATERIALS AND METHODS: A prospective study on twenty patients having persistent aseptic non-union age between 20 and 60 years old, after failed surgical treatment of fractures humeral shaft in Al-Zahra teaching and Al-Kindy teaching hospitals, while infected nonunion, diabetes mellitus, secondary metastasis, smoking, alcoholism, and patients on long medication with corticosteroid were excluded from the study. All our patients were treated with corticocancellous onlay bone grafting harvesting from the ipsilateral upper tibia and compression plating (graft parallel to plate) and follow-up for at least 18 months post-operative to evaluate both radiology and functional using Mayo elbow performance index. RESULTS: All the patients ended with a solid union without hardware failure, and no one patient needs further surgery, even with significant resorption of the graft, there is a good chance of graft re-calcification and solid union with good to excellent functional outcome. CONCLUSION: Very successful solid union results achieve in those patients with established aseptic nonunion and pseudoarthrosis of the humerus.

scholarly journals Fusion Rates of Ankle Arthrodesis with Anterior Plate Fixation Based on Computerized Tomography and Clinical Outcomes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0027
Author(s):  
Philip Kaiser ◽  
W. Hodges Davis ◽  
J. Kent Ellington ◽  
Bruce E. Cohen ◽  
Todd A. Irwin ◽  
...  
Keyword(s):  
Ct Scan ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Plate Fixation ◽  
Ankle Arthrodesis ◽  
Ct Scans ◽  
Anterior Plate ◽  
Tibiotalar Joint ◽  
Non Union ◽  
Ankle Fusion

Category: Ankle; Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is a common treatment for tibiotalar joint arthritis and anterior plate fixation is often utilized. Prior series reporting on anterior plate fixation for ankle arthrodesis have been relatively small and none have exclusively used post-operative computerized tomography (CT) scans for confirmation of fusion. The purpose of this study was to determine radiographic and clinical outcomes of patients who underwent ankle arthrodesis with anterior plate fixation. The primary outcome of the study was whether or not successful arthrodesis was obtained based on a quantitation of the fusion mass on CT scan. Furthermore, correlation between ankle fusion and clinical outcomes along with complications were evaluated. Methods:: Adult patients who underwent ankle arthrodesis with anterior plate fixation (including straight anterior and anterolateral plates) were eligible for this study. Charts were retrospectively reviewed and data was collected in a prospective fashion. In total, 102 patients were included in the study and obtained a CT scan at least 90 days after surgery. The primary outcome was tibiotalar fusion, defined as osseous bridging of 50% or more of the tibiotalar joint based on CT scan reviewed by a single musculoskeletal radiologist. Secondary outcomes included patient reported outcome measures (PROMs): the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot function index (FFI), Visual analog scale (VAS) pain score, and Coughlin satisfaction scale. Additional surgeries and complications including nonunion, painful hardware, tibial stress fractures, wound dehiscence, deep infection, superficial infection, and nerve injury/deficit were recorded. Results: Post-operative CT scans demonstrated tibiotalar fusion in 85 of 102 (83.3%) patients. Of the 17 (16.7%) patients who were classified as non-unions, only 8 (47.1%) of them were symptomatic. Five patients (3.9%) in the union group and 2 patients (7.1%) in the non-union group developed tibial stress fractures. In the union group, 13.3% of patients underwent at least one secondary procedure compared to 53.6% in the non-union group (p<0.001). FFI (p=0.04) and Coughlin (p=0.03) scores were statistically lower in patients who underwent secondary procedures. Eighty-six patients (84.3%) did not demonstrate fusion between the lateral talus and fibula by CT but PROM scores were not statistically different compared to patients who demonstrated talofibular fusion. Conclusion: Tibiotalar arthrodesis utilizing anterior plate fixation is a reliable procedure to achieve ankle fusion based on 50% osseous bridging on post-operative CT scan. However, our results utilizing the accuracy of CT scanning demonstrated a lower rate of ankle fusion than historically reports which are primarily based on plain film imaging. Rates of tibial stress fracture and post-operative wound complications are relatively low with anterior plating, supporting this ankle arthrodesis procedure. Post- operative evaluation of ankle fusions using CT scan should be highly consider regardless of technique.

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