scholarly journals TL 18097 - Role of bone graft and bone graft substitutes in isolated subtalar joint arthrodesis

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 80S
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Ibukunoluwa Araoye ◽  
Osama Elattar ◽  
Sameer Naranje ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Graft ◽  
Subtalar Joint ◽  
Bone Grafts ◽  
Union Rate ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Subtalar Arthritis ◽  
Bone Graft Substitutes

Introduction: Subtalar joint (STJ) arthrodesis is a well-established operative procedure in the treatment of subtalar arthritis and hindfoot deformities. Nonunion remains an important complication, with an incidence and role of risk factors varying in the literature. Recent reports have highlighted a decrease in overall union rates between 96% and 100% to 84%, further strengthening the need for an understanding of risk factors that may be implicated in nonunion rates. Some possible factors have been identified, including smoking, revision surgery, the presence and extent of devascularized bone, and previous ankle joint fusion. Current practice suggests that using bone grafts or bone graft substitutes decreases the risk of its occurrence. Objective: To compare union rates of isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all operations. Graft materials included β-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft and an 83% (78/93) union rate with bone graft use. The odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the nongraft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.

scholarly journals ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS

2017 ◽  
Vol 25 (5) ◽  
pp. 183-187 ◽  
Author(s):  
ASHISH SHAH ◽  
SAMEER NARANJE ◽  
IBUKUNOLUWA ARAOYE ◽  
OSAMA ELATTAR ◽  
ALEXANDRE LEME GODOY-SANTOS ◽  
...  
Keyword(s):  
Bone Graft ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Case Series ◽  
Bone Grafts ◽  
Union Rate ◽  
Level Of Evidence ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Bone Graft Substitutes

ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.

scholarly journals 2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0007
Author(s):  
Chamnanni Rungprai ◽  
Aekachai Jaroenarpornwatana ◽  
Yantarat Sripanich ◽  
Nusorn Chaiprom
Keyword(s):  
Functional Outcomes ◽  
Subtalar Joint ◽  
T Test ◽  
Return To Sports ◽  
Subtalar Arthrodesis ◽  
Sf 36 ◽  
Significant Difference ◽  
Subtalar Arthritis ◽  
Joint Arthritis

Category: Hindfoot Introduction/Purpose: Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques. Methods: A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables. Results: There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications. Conclusion: Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.

scholarly journals Subtalar arthrodesis with bone graft. Is it needed for smokers?

2019 ◽  
Vol 13 (1) ◽  
pp. 49-54
Author(s):  
Gil Galvão Bernardes Silveira ◽  
Isnar Moreira Castro Junior ◽  
Henrique Mansur ◽  
Guilherme Ferreira Morgado
Keyword(s):  
Retrospective Study ◽  
Bone Graft ◽  
Donor Site ◽  
P Value ◽  
Union Rate ◽  
Chi Square ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Chi Square Test ◽  
Autologous Bone

Objective: To evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and effect of the use of different types of autologous bone grafts. Methods: This was a retrospective study with radiological evaluation of patients with subtalar arthrosis who underwent primary arthrodesis at a reference hospital between January 2008 and December 2014. Patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years (range: 19-74 years) were evaluated, among whom 90 (40%) were smokers and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was due to sequelae of calcaneal fractures. A bone graft was used in 65 (27.7%) patients. The overall union rate was 85.4%, and 14.6% of the patients progressed to pseudoarthrosis. A statistically significant difference was found in the nonunion rate in smokers (p-value=0.015 by chi-square test), especially in those who did not receive a bone graft (p-value=0.014 by chi-square test). However, no significant difference was found between smokers who received a bone graft and those who did not (p-value=0.072 by chi-square test). The union rate was related to the donor site, with pseudoarthrosis in 33.3% of surgeries with an autologous calcaneal bone graft (p-value=0.011). Conclusion: Smoking increased the likelihood of pseudoarthrosis in subtalar arthrodesis by 2.5-fold, and pseudoarthrosis is related to the autologous bone graft donor site. Level of Evidence III; Therapeutic studies; Comparative Retrospective Study. 

scholarly journals PO 18164 - Subtalar arthrodesis with bone graft

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S34
Author(s):  
Henrique Mansur ◽  
Gil Galvão Bernardes Silveira ◽  
Isnar Moreira De Castro Junior
Keyword(s):  
Bone Graft ◽  
Donor Site ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Union Rate ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Different Types ◽  
Bone Autograft

Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.

scholarly journals Relationship between serum leptin levels, non-cardiovascular risk factors and mortality in hemodialysis patients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ivona Risovic ◽  
Vlastimir Vlatkovic ◽  
Snjezana Popovicpejicic ◽  
Gabrijela Malešević
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Survival Rates ◽  
Inverse Correlation ◽  
Study Groups ◽  
Mineral And Bone Disorder ◽  
Serum Leptin ◽  
Significant Difference

Abstract Introduction. Hemodialysis (HD) patients have higher mortality rate than the general population. Recent studies indicate a significant role of non-cardiovascular risk factors in for mortality in HD patients. Leptin is protein hormone and may indicate malnutrition in HD patients. Its role in mortality in these patients is being examined. This study aimed to investigate the correlation between serum leptin levels and non-cardiovascular risk factors and relationship between leptin level and mortality in HD patients. Methods The prospective study included 93 patients on maintenance HD and follow-up period was 12 months. We measured leptin level and evaluated non-cardiovascular risk factors: nutritional status, anemia, volemia, parameters of mineral and bone disorder. Results. Out of 93 patients 9 died during study and 1 underwent kidney transplantation. Malnutrition and hypervolemia were two main non-cardiovascular risk factors among deceased subjects. Leptin showed a significant direct correlation with nutritional BMI (r = 0.72, P <0.001), fat tissue index (r = 0.74, P <0.001) and statistically significant inverse correlation with leantissue index (r = -0.349, P <0.05) and inverse correlation with volemic parameters (overhydration / extracellular water ratio (r = -0.38, P <0.001), but no association with anemia and mineral bone parameters was observed. Elevated leptin levels were associated with better survival. However, no statistically significant difference in survival rates was observed between the study groups (Log-Rank P =0.214, Breslow P =0.211, Tarone-Ware P=0.212). Conclusion: Deceased patients had significantly lower leptin values. Leptin was associated with two non-cardiovascular risk factors for mortality: malnutrition and hypervolemia.

scholarly journals Reconstruction of Calcaneal Fracture Malunion With Osteotomy and Subtalar Joint Salvage

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Confidence Interval ◽  
Bone Graft ◽  
Subtalar Joint ◽  
Preoperative Assessment ◽  
Calcaneal Fracture ◽  
Autogenous Bone Graft ◽  
Average Score ◽  
Autogenous Bone ◽  
Superficial Infection ◽  
Subtalar Arthritis

Category: Hindfoot Introduction/Purpose: The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. Methods: From May 2005 to November 2016, 85 patients (88 feet) with calcaneal malunions after a displaced intraarticular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 8.9 months (95% confidence interval, 4.5-11.6 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the lateral exostosis that had been removed, iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Sixty two patients (63 feet) were followed for a mean of 45.4 months (29.0-52.3 months). Results: According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 81.6 points (95% confidence interval, 78.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Eight patients had wound edge necrosis, and 4 had superficial infection. Two patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. Conclusion: Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.

scholarly journals Predictive Role of F2-Isoprostanes as Biomarkers for Brain Damage after Neonatal Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
L. J. Stolwijk ◽  
P. M. A. Lemmers ◽  
M. Y. A. van Herwaarden ◽  
D. C. van der Zee ◽  
F. van Bel ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Brain Injury ◽  
Multivariable Analysis ◽  
Major Surgery ◽  
Oxidative Stress Biomarkers ◽  
Stress Biomarkers ◽  
Significant Difference ◽  
Predictive Role

Objective. Neonates have a high risk of oxidative stress during anesthetic procedures. The predictive role of oxidative stress biomarkers on the occurrence of brain injury in the perioperative period has not been reported before. Methods. A prospective cohort study of patients requiring major surgery in the neonatal period was conducted. Biomarker levels of nonprotein-bound iron (NPBI) in plasma and F2-isoprostane in plasma and urine before and after surgical intervention were determined. Brain injury was assessed using postoperative MRI. Results. In total, 61 neonates were included, median gestational age at 39 weeks (range 31–42) and weight at 3000 grams (1400–4400). Mild to moderate brain lesions were found in 66%. Logistic regression analysis showed a significant difference between plasma NPBI in patients with nonparenchymal injury versus no brain injury: 1.34 umol/L was identified as correlation threshold for nonparenchymal injury (sensitivity 67%, specificity 91%). In the multivariable analysis, correcting for GA, no other significant relation was found with the oxidative stress biomarkers and risk factors. Conclusion. Oxidative stress seems to occur during anaesthesia in this cohort of neonates. Plasma nonprotein-bound iron showed to be associated with nonparenchymal injury after surgery, with values of 1.34 umol/L or higher. Risk factors should be elucidated in a more homogeneous patient group.

Biofilm formation on bone grafts and bone graft substitutes: Comparison of different materials by a standard in vitro test and microcalorimetry

2010 ◽  
Vol 6 (9) ◽  
pp. 3791-3797 ◽  
Author(s):  
Martin Clauss ◽  
Andrej Trampuz ◽  
Olivier Borens ◽  
Marc Bohner ◽  
Thomas Ilchmann
Keyword(s):  
Bone Graft ◽  
Biofilm Formation ◽  
Bone Grafts ◽  
In Vitro Test ◽  
Vitro Test ◽  
Bone Graft Substitutes

scholarly journals Biomechanical Comparison of Plantar-To-Dorsal and Dorsal-To-Plantar Screw Fixation Strength for Subtalar Arthrodesis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Ramon Rodriguez ◽  
Schouchen Dun ◽  
Jun Kit He ◽  
Haley McKissack ◽  
Glenn S. Fleisig ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Statistical Significance ◽  
Fixation Strength ◽  
Hard Data ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Fixation Techniques ◽  
The Difference ◽  
Student’S T ◽  
Dorsal Fixation

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Arthrodesis of the subtalar joint is performed for various arthritic and instability problems to correct alignment and relieve pain. For talocalcaneal pathologies, isolated subtalar arthrodesis has been advocated with the advantages of lower risk of adjacent joint arthritis and nonunion of the transverse tarsal joint. Internal fixation techniques have varied over time and use of compression screws is common. The screws may be oriented from dorsal to plantar or plantar to dorsal. Arguments favoring one approach over another are based more on “expert opinion” than hard data. The goal of this study was to compare the biomechanical stability of these two constructs to evaluate which creates a more stable construct. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3-mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP group), and the other foot plantar to dorsal orientation (PD group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD groups using Student’s T-test, with p = 0.05 used to determine statistical significance. Results: The force to failure was 585.9 ± 201.1 N for the plantar-to-dorsal fixation and 667.2 ± 449.4 N for the dorsal-to-plantar fixation. The moment arm was 55.1 ± 4.7 mm for the dorsal-to-plantar fixation and 54.8 ± 3.9 mm for the plantar-to-dorsal fixation. Statistical analysis demonstrated that the mean torque to failure slightly favored the DP group (37.3 N-m) to the PD group (32.2 N-m). However, the difference between the two groups was not statistically significant (p = 0.55). Conclusion: There is no significant difference in strength between subtalar arthrodesis performed with dorsal-to-plantar screw orientation and plantar-to-dorsal screw orientation. This suggests that selection of technique should depend on the situation and the required advantages of each. Placing the screw from the heel up has the benefit of being an easier approach, allows access to tenser talar bone once the screw is through, and has less risk of neurovascular injury. The dorsal-to-plantar technique allows simple supine positioning of the patient, needs only two fluoroscopic views to check pin position, and allows the surgeon to manipulate the foot more easily.

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