Tibiocalcaneal Arthrodesis Using the Ilizarov Technique in the Presence of Bone Loss and Infection of the Talus

2008 ◽  
Vol 29 (10) ◽  
pp. 1001-1008 ◽  
Author(s):  
Robert Rochman ◽  
James Jackson Hutson ◽  
Oladapo Alade
Keyword(s):  
Bone Loss ◽  
Circular Ring ◽  
Successful Outcome ◽  
Ilizarov Technique ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ring Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Final Followup ◽  
Retrospective Case Study

Background: Infected nonunions and extrusions of the talus can often lead to below-knee amputation. Limb-salvage procedures have goals of eradicating infection and creating a painless, stable limb. Often, a tibiocalcaneal fusion is the best option; however, in the presence of infection and bone loss, it can be difficult to achieve a successful outcome using internal fixation. We review the results of circular ring external fixation to obtain a tibiocalcaneal arthrodesis despite these obstacles. Methods: A retrospective review of 11 patients who underwent tibiocalcaneal arthodesis using an Ilizarov external fixator for infected talar nonunions or extrusions was performed. Each patient had a debridement of all nonviable talus. The bony surfaces were prepared for the fusion followed by application of a circular ring fixator. Clinical outcomes were measured using the AOFAS ankle-hindfoot scale. There was a mean followup of 35 months. Results: Nine of the 11 patients had successful fusions. One fused successfully after a revision and the other developed a stable pseudoarthrosis. Eight patients underwent concomitant lengthening with the Ilizarov fixator. Mean AOFAS score at final followup was 65. This was out of a maximum of 86 since the tibiotalar and subtalar joint motion were removed. There were no recurrent deep infections or amputations. Conclusions: Tibiocalcaneal arthrodesis using the Ilizarov technique is a viable alternative to amputation in patients with infected nonunions or large bone loss of the talus. Level of Evidence: IV, Retrospective Case Study

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

Lateral Talar Process Fracture and Peroneal Tendon Dislocation: A Previously Unrecognized Injury Complex

2008 ◽  
Vol 29 (10) ◽  
pp. 1020-1024 ◽  
Author(s):  
Sandra E. Klein ◽  
Kevin E. Varner ◽  
John V. Marymont
Keyword(s):  
Retrospective Chart Review ◽  
High Energy ◽  
Activity Level ◽  
Peroneal Tendon ◽  
Type Ii ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lateral Process ◽  
Subtalar Arthritis ◽  
Final Followup

Background: Lateral talar process fractures and peroneal tendon dislocations are frequently unrecognized at the time of injury. Lateral process fractures were initially classified by Hawkins as three types. Type II injuries are comminuted fractures involving both the talofibular and talocalcaneal articular surfaces. The purpose of this retrospective chart review was to describe an injury complex of Type II lateral talar process fracture with peroneal tendon dislocation. Materials and Methods: Between January of 1995 and December 2006, 13 patients were seen for a lateral talar process fracture. Patients' charts were reviewed for fracture classification, mechanism of injury, radiographic studies, treatment, secondary procedures, length of followup and return to previous activity level. Concurrent peroneal tendon dislocations were identified in a subset of these patients. Results: Thirteen patients were identified with lateral talar process fractures all of which were classified as a Hawkins Type II. Six patients (46%) had a simultaneous peroneal tendon dislocation. All patients underwent operative excision of the comminuted lateral process. Patients with the injury complex were more likely to undergo additional operative procedures, and were more likely to develop subtalar arthritis. At final followup, 71% of patients with isolated lateral process fractures and 33% of injury complex patients had returned to their previous level of activity Conclusion: An injury complex of Hawkins Type II lateral talar process fractures and peroneal tendon dislocation exists. Patients with comminuted lateral talar process fractures, especially those resulting from high-energy injuries, should be carefully evaluated for the possibility of concurrent peroneal tendon dislocation. Level of Evidence: IV, Retrospective Case Study

scholarly journals Assessment and Trends in the Methodological Quality of the Top 50 Most Cited Articles in Shoulder Instability

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096708
Author(s):  
Avinesh Agarwalla ◽  
Kaisen Yao ◽  
Anirudh K. Gowd ◽  
Nirav H. Amin ◽  
J. Martin Leland ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Methodological Quality ◽  
Surgical Techniques ◽  
Case Series ◽  
Cross Sectional Study ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Number Of Citations

Background: Citation counts have often been used as a surrogate for the scholarly impact of a particular study, but they do not necessarily correlate with higher-quality investigations. In recent decades, much of the literature regarding shoulder instability is focused on surgical techniques to correct bone loss and prevent recurrence. Purpose: To determine (1) the top 50 most cited articles in shoulder instability and (2) if there is a correlation between the number of citations and level of evidence or methodological quality. Study Design: Cross-sectional study. Methods: A literature search was performed on both the Scopus and the Web of Science databases to determine the top 50 most cited articles in shoulder instability between 1985 and 2019. The search terms used included “shoulder instability,” “humeral defect,” and “glenoid bone loss.” Methodological scores were calculated using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS) score. Results: The mean number of citations and mean citation density were 222.7 ± 123.5 (range, 124-881.5) and 16.0 ± 7.9 (range, 6.9-49.0), respectively. The most common type of study represented was the retrospective case series (evidence level, 4; n = 16; 32%) The overall mean MCMS, Jadad score, and MINORS score were 61.1 ± 10.1, 1.4 ± 0.9, and 16.0 ± 3.0, respectively. There were also no correlations found between mean citations or citation density versus each of the methodological quality scores. Conclusion: The list of top 50 most cited articles in shoulder instability comprised studies with low-level evidence and low methodological quality. Higher-quality study methodology does not appear to be a significant factor in whether studies are frequently cited in the literature.

scholarly journals Complications of Syndesmotic Screw Removal

2011 ◽  
Vol 32 (11) ◽  
pp. 1040-1044 ◽  
Author(s):  
Tim Schepers ◽  
Esther M.M. Van Lieshout ◽  
Mark R. de Vries ◽  
Maarten Van der Elst
Keyword(s):  
Wound Infection ◽  
Preoperative Planning ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Syndesmotic Screw ◽  
Screw Breakage ◽  
Routine Removal ◽  
Retrospective Case Study ◽  
Level 2

Background: Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures. Methods: This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery. Results: A total of 76 patients were included. A wound infection occurred in 9.2% (N=7) of which 2.6% (N=2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N=5) of patients, and in 6.6% (N=5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann- Whitney U-test; p= 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage ( p = 0.038). Conclusion: A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal. Level of Evidence: IV, Retrospective Case Study

scholarly journals Tibiocalcaneal arthrodesis in fixed equinus deformity with ring fixator

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Rafael Bispo de Souza ◽  
Antônio Carlos Faloni Nunes Pereira ◽  
Rafael Costa Nerys ◽  
Jefferson Soares Martins ◽  
Edegmar Nunes Costa
Keyword(s):  
Quality Of Life ◽  
Case Series ◽  
Tertiary Hospital ◽  
Limb Function ◽  
Level Of Evidence ◽  
Ring Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Sf 36 ◽  
Equinus Deformity

Objective: To evaluate the limb function and quality of life of patients with posttraumatic fixed equinus deformity treated at a tertiary hospital after arthrodesis with the Ilizarov external fixator. Methods: A study was conducted from January 2015 to June 2018 in which 6 patients were evaluated at outpatient follow-up in the late postoperative period. First, an identification questionnaire was administered to assess limb function using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and quality of life was assessed using the SF-36 questionnaire. Results: A total of 66.6% of the sample had an AOFAS score below 70 (mean total = 57.5), which is considered poor. The mean SF-36 score was low (below 60) in all domains evaluated. The pain domain had the highest score (mean = 57.2). Conclusions: Even after surgery to correct the deformity, patients had impaired function and quality of life. Level of Evidence IV; Therapeutic Studies; Case Series.

The Development of a Neuropathic Ankle following Successful Correction of Non-Plantigrade Charcot Foot Deformity

2012 ◽  
Vol 33 (8) ◽  
pp. 644-646 ◽  
Author(s):  
Michael S. Pinzur
Keyword(s):  
External Fixator ◽  
Weight Bearing ◽  
Case Series ◽  
Disease Process ◽  
Circular Ring ◽  
Surgical Correction ◽  
Charcot Foot ◽  
Foot Deformity ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of Charcot foot arthropathy has traditionally involved immobilization during the acute phase followed by longitudinal management with accommodative bracing. In response to the perceived poor outcomes associated with nonoperative accommodative treatment, many experts now advise surgical correction of the deformity, especially when the affected foot is not clinically plantigrade. The significant rate of surgical and medical-associated morbidity accompanying this form of treatment has led surgeons to look for improved methods of surgical stabilization, including the use of the circular ring external fixation. Methods: Over a 7-year period, a single surgeon performed surgical correction of non-plantigrade Charcot foot deformity on 171 feet in 164 patients with a statically applied circular external fixator. Following successful correction, five patients developed a neuropathic deformity of the ipsilateral ankle after removal of the external fixator and subsequent weight bearing total contact cast. Results: Three of the five patients progressed to successful healing of the neuropathic (Charcot) ankle arthropathy following treatment with a series of weightbearing total contact casts. Two underwent successful ankle fusion with retrograde locked intramedullary nailing. Discussion: This unusual clinical scenario likely represents either a progression of the disease process in the foot or a complication associated with surgical correction of the original neuropathic foot deformity. A better understanding of this observation will likely become apparent as we acquire more experience with this disorder. Level of Evidence: IV, Retrospective Case Series

Proximal Medial Gastrocnemius Release in the Treatment of Recalcitrant Plantar Fasciitis

2012 ◽  
Vol 33 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Ali Abbassian ◽  
Julie Kohls-Gatzoulis ◽  
Matthew C. Solan
Keyword(s):  
Plantar Fasciitis ◽  
Case Series ◽  
Medial Gastrocnemius ◽  
Consecutive Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Foot Biomechanics ◽  
Objective Evidence ◽  
Final Followup ◽  
A Minor

Background: Isolated gastrocnemius contracture has been implicated as the cause of a number of foot and ankle conditions. Plantar fasciitis (PF) is one such condition that can be secondary to altered foot biomechanics as a result of gastrocnemius contracture. In this paper, we report our results with an isolated release of the proximal medial head of gastrocnemius for recalcitrant PF. Methods: We prospectively followed a consecutive series of 21 heels in 17 patients following a Proximal Medial Gastrocnemius Release (PMGR). PF was diagnosed clinically and confirmed radiologically in all cases. To be included, at least 1 year of conservative treatment must have been tried and an isolated gastrocnemius contracture confirmed clinically using Silfverskiold's test preoperatively. Outcome measures included a 5-point Likert scale as well as subjective and objective calf weakness assessments. Final followup was on average 24 (range, 8 to 36) months after the surgery. Results: Seventeen of the 21 heels (81%) reported total or significant pain relief following the surgery and none reported worsening of their symptoms. The majority did not have subjective or objective evidence of calf weakness. There were no ‘major’ complications and only one case that suffered a ‘minor’ complication. Conclusion: We believe a PMGR is a simple way of treating a patient with PF who has failed to respond to conservative management. In our series, the results were favorable, the recovery fast and the morbidity low. Level of Evidence: IV, Retrospective Case Series

Treatment of Severe Rigid Posttraumatic Equinus Deformity With Gradual Deformity Correction and Arthroscopic Ankle Arthrodesis

2021 ◽  
pp. 107110072110182
Author(s):  
Patricio Fuentes ◽  
Natalio Cuchacovich ◽  
Paulina Gutierrez ◽  
Maximiliano Hube ◽  
Gonzalo F. Bastías
Keyword(s):  
Case Series ◽  
Deformity Correction ◽  
Ankle Arthrodesis ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ring Fixator ◽  
Gradual Correction ◽  
Screw Augmentation

Background: Posttraumatic ankle equinus is associated with rigid deformity, poor skin condition, and multiple prior surgeries. Open acute correction has been described using osteotomies, talectomy, and arthrodesis, but concerns exist about skin complications, neurologic alterations, secondary limb discrepancy, and bone loss. Gradual correction using a multiplanar ring fixator and arthroscopic ankle arthrodesis (AAA) may decrease these complications. Methods: We retrospectively reviewed patients undergoing correction of posttraumatic rigid equinus with at least 1 year of follow-up after frame removal. The procedure consisted of percutaneous Achilles lengthening, gradual equinus correction using a multiplanar ring fixator, and AAA retaining the fixator in compression with screw augmentation. Frame removal depended on signs of union on the computed tomography scan. Visual analog scale (VAS) and Foot Function Index (FFI) scores were assessed as well as preoperative and postoperative x-rays. Complications were noted throughout the follow-up period. Results: Five patients were treated with a mean age of 35 years and mean follow-up of 31 months. Deformities were gradually corrected into a plantigrade foot over an average duration of 6 weeks. Union was achieved in all patients with a mean time of an additional 25 weeks, for a mean total frame time of 31 weeks. The mean preoperative tibiotalar angle was 151 degrees and was corrected to 115 degrees. FFI score improved from a mean of 87 to 24 and VAS from 8 to 2. Conclusion: Posttraumatic rigid equinus can be treated effectively using gradual correction followed by integrated AAA in a safe and reproducible manner. Patients in this series had excellent functional, radiological, and satisfaction results. Level of Evidence: Level IV, retrospective case series.

Complications Encountered with Circular Ring Fixation in Persons with Diabetes Mellitus

2008 ◽  
Vol 29 (10) ◽  
pp. 994-1000 ◽  
Author(s):  
Dane K. Wukich ◽  
Ronald J. Belczyk ◽  
Patrick R. Burns ◽  
Robert G. Frykberg
Keyword(s):  
Group Versus ◽  
Circular Ring ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
Duration Of Treatment ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Charcot Neuroarthropathy ◽  
Patients With Diabetes

Background: The purpose of this study was to identify and report the complications associated with the use of circular ring fixation in diabetic patients, and to compare the frequency of complications in patients without diabetes. We hypothesized that complications with circular ring fixation occurred more frequently in patients with diabetes than patients without diabetes. Materials and Methods: Institutional Review Board approval was obtained and patient charts were retrospectively reviewed from June 2004 and February 2007. Fifty six consecutive patients undergoing midfoot, hindfoot and/or ankle surgery were treated with circular ring fixation which included 33 diabetic patients in the study group and 23 non-diabetic patients in the control group. Patient demographics, the duration of treatment with the external fixator, and complications were recorded. Results: Males had a greater number of complications compared to females ( p = 0.0014). The total number of complications was statistically greater in diabetic patients (study group) versus non-diabetic patients (control group) ( p = 0.003). In multivariate logistic regression, diabetes and male sex were the only significant variables associated with wire complications (OR 7.35, 95% CI 1.93-28.04 and OR 0.22, 95% CI 0.05-8584111, respectively). Conclusion: Women are protected from wire complications with a risk reduction of 78% compared to males. Diabetics have a 7-fold risk for any wire complication compared to patients without diabetes. We found no adverse effects of BMI, obesity, age, smoking, neuropathy, or Charcot neuroarthropathy on a satisfactory recovery. Level of Evidence: IV, Retrospective Case Study

Mid-Term Outcome of Talocalcaneal Coalition Treated with Interposition of a Pedicle Fatty Flap After Resection

2012 ◽  
Vol 33 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Yukari Imajima ◽  
Masato Takao ◽  
Wataru Miyamoto ◽  
Shinji Imade ◽  
Hideaki Nishi ◽  
...  
Keyword(s):  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Talocalcaneal Coalition ◽  
A New Technique ◽  
Final Followup ◽  
American Orthopaedic

Background: We have previously reported a new technique to treat symptomatic talocalcaneal coalition. The purpose of the present study was to evaluate the mid-term outcome of the interposition of a pedicle fatty flap after the resection of a talocalcaneal coalition. Methods: Six feet of 5 patients with persistently symptomatic talocalcaneal coalition were treated with this method. We investigated the clinical outcome using the visual analog scale (VAS) for hindfoot pain including around coalition and the American Orthopaedic Foot and Ankle Society (AOFAS) score pre- and postoperatively, and investigated whether or not recurrence was present using computed tomography (CT) at the final followup. Results: The VAS score was significantly improved from 5.5 ± 1.0 (mean ± SD) to 9.7 ± 0.5 points ( p = 0.0006). The AOFAS hindfoot score was also improved significantly (from 73.3 ± 26.7 points to 96.7 ± 7.1 points). No recurrence was detected by CT at the final followup. Conclusion: The interposition of a pedicle fatty flap after resection has been a durable procedure for treating a symptomatic talocalcaneal coalition. Level of Evidence: IV; Retrospective Case Series

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