scholarly journals PO 18133 - Internal fixation of displaced intra-articular fractures of the hallux through a dorsomedial approach

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S27
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Augusto César Monteiro ◽  
Bruno Rodrigues de Miranda ◽  
Guilherme Honda Saito ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Clinical Evaluation ◽  
Interphalangeal Joint ◽  
Rigid Fixation ◽  
Aofas Score ◽  
Articular Fractures ◽  
The Mean

Introduction: Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation. The aim of this study is to present the results of the surgical treatment of displaced interphalangeal joint (IPJ) fractures of the hallux using a dorsomedial approach. It is our understanding that this approach minimizes injury to the soft tissue envelope without the need to detach or create a tenotomy of the extensor hallucis longus tendon (EHL), allowing rigid fixation and early weight bearing and range of motion. Methods: A retrospective case series was performed of 5 patients with displaced IPJ fractures of the hallux treated with the dorsomedial approach from July 2013 to October 2017. Two patients were male and three female, with a mean age of 37,4 years and a mean follow-up of 36 months. The surgical indication for open reduction and internal fixation through a dorsomedial approach of the IPJ was displaced (>2 mm) bicondylar fractures of the proximal phalanx of the hallux. The incision was performed along the medial border of the EHL tendon without the need to detach or create a tenotomy of this tendon. In the postoperative period, follow-up included clinical evaluation and radiographic exams. All patients were assessed by visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients presented bone consolidation and returned to their previous activities without limitations. At the final follow-up, the mean VAS score was 0, and the mean AOFAS score was 92,6. Clinical evaluation revealed preservation of approximately 50% of the range of motion of the IPJ compared with the contralateral side. Conclusion: We concluded that a dorsomedial approach should be considered in the surgical management of displaced intra-articular fractures of the hallux. It preserves soft tissue and most of the IPJ motion, preventing postoperative joint pain and stiffness.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

Fractures of the Phalanges: Results of Internal Fixation Using 1.5mm and 2mm A. O. Screws

1987 ◽  
Vol 12 (1) ◽  
pp. 28-33
Author(s):  
D. J. FORD ◽  
S. EL-HADIDI ◽  
P. G. LUNN ◽  
F. D. BURKE
Keyword(s):  
Internal Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Active Movement ◽  
Flexion Deformity ◽  
The Mean ◽  
Condylar Fractures ◽  
Phalangeal Fractures ◽  
Mean Time

Thirty-six patients were treated for 38 phalangeal fractures using 1.5 mm and 2 mm A. O. screws. Plates were not used in the fingers. Oblique fractures of the condyles, shafts or bases of the proximal or middle phalanges were treated by internal fixation because of instability, displacement or rotation. 40% of fractures had associated skin wounds, were comminuted or had damage to the extensor mechanism. The mean duration of post-operative immobilization was 9 days and the mean time off work was 6 weeks. Total active movement in the involved ray was 220 degrees or greater in 24 cases, 180 degrees to 215 degrees in eight cases, and less than 180 degrees in two patients at follow up. The patients were reviewed between three and 54 months after treatment and the mean duration of follow up was 24 months. The most frequent complication was 10 degrees to 30 degrees of flexion deformity of the proximal interphalangeal joint after internal fixation of condylar fractures. Results were satisfactory in 90% of cases.

scholarly journals Internal Fixation of Displaced Intra-articular Fractures of the Hallux Through a Dorsomedial Approach: A Technical Tip

2017 ◽  
Vol 11 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Cesar de Cesar Netto ◽  
Augusto César Monteiro ◽  
Rômulo Ballarin Albino ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Interphalangeal Joint ◽  
Rigid Fixation ◽  
Degenerative Arthritis ◽  
Soft Tissue Envelope ◽  
Articular Fractures ◽  
Extensor Hallucis Longus ◽  
Joint Fractures ◽  
Phalangeal Fractures ◽  
Type Of Injury

Phalangeal fractures of the toes represent common injuries of the forefoot. In the hallux, most fractures occur at the distal phalanx and frequently result from a direct crushing type of injury. Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation, hindering gait and weightbearing. The aim of this study was to present an option of operative approach in the treatment of displaced interphalangeal joint fractures of the hallux, along the medial border of the extensor hallucis longus tendon. It is our understanding that this approach minimizes injury to the soft tissue envelope, allowing a rigid fixation and early weightbearing and range of motion. Levels of Evidence: Level V: Expert opinion

Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts

2016 ◽  
Vol 42 (2) ◽  
pp. 188-193 ◽  
Author(s):  
M. Burnier ◽  
T. Awada ◽  
F. Marin Braun ◽  
P. Rostoucher ◽  
M. Ninou ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Pinch Strength ◽  
Middle Phalanx ◽  
Level Of Evidence ◽  
Active Flexion ◽  
The Mean

The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. Level of evidence: IV

MatOrtho proximal interphalangeal joint arthroplasty: minimum 2-year follow-up

2016 ◽  
Vol 41 (9) ◽  
pp. 910-916 ◽  
Author(s):  
O. Flannery ◽  
O. Harley ◽  
R. Badge ◽  
A. Birch ◽  
D. Nuttall ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Cobalt Chromium ◽  
Retrospective Case ◽  
Replacement Arthroplasty ◽  
Functional Scores ◽  
The Mean

The MatOrtho proximal interphalangeal replacement is a cementless cobalt–chromium metal-on-polyethylene mobile-bearing surface replacement arthroplasty. The aim of this study is to report the outcome and complications of this implant at a minimum of 2 years follow-up from a single institution. A retrospective case review was performed on all MatOrtho proximal interphalangeal joint replacements performed with a minimum of 2 years follow-up. Patient demographics, diagnosis, implant revision and other surgical interventions were recorded. Subjective and objective outcomes were evaluated at latest follow-up, including pain scores, range of motion, function and radiographic assessment. A total of 109 implants were inserted in 56 patients. Nine implants (six patients) were lost to follow-up. Of the remaining 100 implants, 75 had been undertaken in females. The mean age at time of surgery was 64 years and the principal diagnosis was osteoarthritis in 74%. The mean follow-up was 47 months (range 24–77). Within the group there was a statistically significant diminution in pain. There was also an improvement in functional scores post-operatively. Improvement in range of motion was seen in those joints with a pre-operative range of motion greater than 20°. Radiologically there was no evidence of loosening or of implant subsidence at final follow-up. The revision rate was 13%. Nine joints were revised to the NeuFlex (silicone rubber) prosthesis, three were converted to an arthrodesis and one had exchange of the MatOrtho prosthesis. The survival of the MatOrtho proximal interphalangeal joint arthroplasty was 85% at a minimum of 2-years follow-up. Patients can be advised that the procedure achieves good pain relief, improvement in functional scores and may improve range of motion. We would, however, caution against this implant’s use in joints that are either stiff or have significant deformity and/or instability pre-operatively.

scholarly journals Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Andrew Stith ◽  
Matthew Griffin ◽  
Wesley Flint ◽  
Michael Coughlin
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Hallux Valgus ◽  
Hardware Removal ◽  
Metatarsal Osteotomy ◽  
Titanium Plate ◽  
Aofas Score ◽  
Low Profile ◽  
First Ray

Category: Bunion Introduction/Purpose: Proximal first metatarsal crescentic osteotomies are an effective means for correction of moderate to severe hallux valgus deformities. The originally described fixation construct included an intramedullary screw and a Kirschner wire which crossed the joint and required removal at 6 weeks. Elevation malunion of the first ray was also frequently noted postoperatively. The purpose of this study was to evaluate the outcomes of utilizing a low-profile titanium plate and screw construct for rigid fixation of proximal crescentic osteotomies. Methods: There were 53 patients (60 feet, 7 bilateral) with hallux valgus deformities enrolled in the study. They were all treated operatively with a proximal crescentic osteotomy and distal soft tissue correction with or without an Akin osteotomy. The crescentic osteotomy was fixed with a low-profile titanium plate and screws. Postoperatively patients were assessed at 3 months, 6 months and 1 year. Outcomes assessed included the need for hardware removal, change in elevatus of the first ray, as well as pre- and post-op VAS pain scores, radiographic evaluation, AOFAS score, MTP joint range of motion, and complications. Results: Of the 60 hallux valgus cases enrolled, 56 have completed their final follow-up (93%). At 1 year 55/56 patients had achieved radiographic union of their osteotomy. Nine patients had their hardware removed (16%). Range of motion at the 1st MTP joint decreased from 76.5 to 59.6 degrees. Hallux valgus angle improved from a mean of 28.8 to 9.6 degrees. The mean 1-2 intermetatarsal angle decreased from 14.1 to 6.4 degrees. Elevatus of the first ray increased from a mean of 2.5 mm pre-op to 3.2 mm (<1 mm) post-op. Mean VAS score improved from 4.43 to 0.68 (3.75 points). AOFAS score improved from 54.7 to 88.5 points. Complications included 4 superficial infections, 2 delayed wound healing cases and one DVT. Conclusion: Proximal crescentic metatarsal osteotomy with distal soft tissue repair is a safe and reliable method for operative treatment of hallux valgus. Utilization of a low-profile titanium plate and screw construct to rigidly fix the osteotomy yields a high rate of union and deformity correction with a low incidence of hardware removal and minimal increase in elevation of the first ray at final follow up.

scholarly journals Simulated operation combines patient-specific guide technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

2020 ◽  
Author(s):  
Chenggong Wang ◽  
Can Xu ◽  
Yusheng Li ◽  
Mingqing Li ◽  
Da Zhong ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Range Of Motion ◽  
Preoperative Planning ◽  
Patient Specific ◽  
Aofas Score ◽  
Curative Effect ◽  
Supramalleolar Osteotomy ◽  
Conventional Technology ◽  
The Mean

Abstract Background: Over the past seven years, our team has designed a simulated operation combines patient-specific guide (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it to the clinic. This study aimed to determine the difference between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application and postoperative curative effect. Methods: We retrospectively analyzed the data of SMOT in our hospital between October 2014 and December 2018; 28 patients were enrolled and divided into CO group (n=17) and SO-PSI group (n=11); the mean follow-up time was 33.4 (range, 13 to 59) months. We analyzed and compared perioperative data, accuracy of preoperative planning and intraoperative application, difference between pre- and post-operative of radiologic ankle angles, and change of AOFAS score, VAS, range of motion of ankle and Takakura stage after operation. Then we performed statistical analyses. Results: All ankle alignments and positions of two groups have been recovered. Compared with CO group, SO-PSI group has a shorter operative time and a postoperative hospital stay, a decreased number of fluoroscopies and a reduction of albumin, a longer preoperative planning time and a preoperative hospital stay and an increased hospitalization expenses. In SO-PSI group, the ankle angles between preoperative planning and postoperative shown good correlation, but not in CO group; the mean tibial ankle center discrepancy of SO-PSI group was 1.86±1.06 mm. After follow-up, all radiologic parameters of two groups significantly improved, but the improvement of tibial anterior surface angle and tibiotalar tilt angle of SO-PSI group were more obvious than that of CO group; AOFAS score, VAS, range of motion of ankle and Takakura stage of two groups improved after operation; but overall the improvements of SO-PSI group were better than the CO group. Conclusions: SO-PSI technology can carry out the preoperative plan accurately and quickly in SMOT; In general, compared with the conventional technology, SO-PSI technology has advantages in preoperative planning, intraoperative application and postoperative curative effect. Keywords: Supramalleolar osteotomy; Simulated operation; Patient-specific guide; Accuracy of preoperative planning; Practicability of application

Free Vascularized Toe Joint Transfer to the Hand. A Technique for Simultaneous Reconstruction of the Soft Tissue

2001 ◽  
Vol 26 (4) ◽  
pp. 314-320 ◽  
Author(s):  
K. KIMORI ◽  
Y. IKUTA ◽  
O. ISHIDA ◽  
M. ICHIKAWA ◽  
O. SUZUKI
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Joint Pain ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Functional Deficits ◽  
Simultaneous Reconstruction ◽  
Second Toe ◽  
The Average Range

Twelve patients underwent reconstruction of injured finger joints using our technique of a vascularized transfer of the second toe proximal interphalangeal joint. The age of the patients at operation ranged from 7 to 47 years and the postoperative follow-up was 9 to 48 months. All the joint transfers survived and united with resolution of the preoperative joint pain, deformity and instability. The average range of motion of the reconstructed joints was 59° in the proximal interphalangeal and 54° in the metacarpophalangeal joints. No patient complained of pain or functional deficits in the donor foot.

Limited Wrist Arthrodesis for Scapholunate Advanced Collapse Wrist: Triangle Fixation for Four-Corner Fusion

2016 ◽  
Vol 21 (02) ◽  
pp. 207-211 ◽  
Author(s):  
Kosuke Shintani ◽  
Kenichi Kazuki ◽  
Kiyohito Takamatsu ◽  
Masahiro Yoneda ◽  
Takuya Uemura
Keyword(s):  
Internal Fixation ◽  
Range Of Motion ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Cast Immobilization ◽  
Wrist Arthrodesis ◽  
The Mean ◽  
Tract Infections ◽  
Slac Wrist

Background: Limited wrist arthrodesis with scaphoid excision is a useful treatment for scapholunate advanced collapse (SLAC) of the wrist. Multiple Kirschner wires were originally used for internal fixation of the four carpal bones, however long-term cast immobilization, pin tract infection, and hardware removal are still problematic. We introduce and evaluate the clinical outcomes of an internal fixation technique; triangle fixation for four-corner fusion, using three headless screws, as an alternative to conventional multiple Kirschner wires for the treatment of SLAC wrist. Methods: Five male patients with SLAC wrist secondary to three scaphoid nonunions and two scapholunate dissociations were treated with four-corner fusion using triangle fixation with three Double-threaded Japan screws. The mean age was 59.5 years (35–79 years) and the mean follow-up period was 40 months. After surgery, short arm splints were applied for 3–4 weeks, and then range of motion exercises were initiated. Results: Wrist range of motion and grip strength both improved postoperatively. At the final follow-up evaluation, bone union was completely achieved and satisfactory pain relief was observed in all patients. Conclusions: Compared with the conventional Kirschner wire technique, the present technique shortens the period of splint immobilization due to a strong compression force in a skewed position, does not require pin removal or cause pin tract infections, and provides satisfactory results.

Treatment of Calcaneal Fractures with Closed Reduction and the Endobutton-Assisted Technique

2015 ◽  
Vol 105 (1) ◽  
pp. 33-41
Author(s):  
Halil Atmaca ◽  
Kaya Memisoglu ◽  
Tuncay Baran ◽  
Cumhur Cevdet Kesemenli
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Soft Tissue Injuries ◽  
Mean Value ◽  
Calcaneal Fractures ◽  
Aofas Score ◽  
Minimally Invasive Osteosynthesis ◽  
The Mean ◽  
American Orthopaedic

Background Closed reduction and percutaneous pinning, open reduction and internal fixation, and primary arthrodesis are procedures used in the surgical treatment of calcaneal fractures. This study presents short-term clinical and radiologic results of patients with calcaneal fractures treated by closed indirect reduction with Endobutton-assisted minimally invasive osteosynthesis. Methods Twenty-one feet of 18 patients (four women and 14 men) with calcaneal fractures were retrospectively analyzed. Böhler and Gissane angles were measured from the preoperative, postoperative, and latest follow-up lateral radiographs of the feet. American Orthopaedic Foot and Ankle Society (AOFAS) scores were used for the 6-month and latest follow-up clinical assessments. Results The mean preoperative Böhler angle of 17.1° was corrected to a mean of 20.4° postoperatively. The mean value of this angle measured at the time of latest follow-up was 21.3°. The mean preoperative and postoperative Gissane angles were 116° and 117.8°, respectively. The mean value of this angle measured at the time of latest follow-up was 117.4°. The mean 6-month postoperative AOFAS score was 59.8 points. The mean AOFAS score at the time of latest follow-up (79.1 points) was significantly higher than the mean score 6 months postoperatively (P &lt; .001). Regarding the latest follow-up AOFAS scores, four were poor, four were moderate, ten were good, and three were excellent. Conclusions With a low learning curve and satisfactory clinical outcomes, this technique can be used in acute, edematous cases with soft-tissue injuries to avoid calcaneal enlargement, infection, and soft-tissue problems.

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