Hinged circular fixator construct for correction of congenital metatarsal deformity in a foal

2014 ◽  
Vol 27 (01) ◽  
pp. 74-79
Author(s):  
L. C. Cuddy ◽  
A. S. Graham ◽  
D. J. Reese ◽  
M. B. Porter ◽  
A. J. Morton ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Varus Deformity ◽  
Metatarsal Bone ◽  
Osteotomy Site ◽  
The Third ◽  
Initial Surgery ◽  
Circular External Fixator ◽  
Quarter Horse ◽  
Centre Of Rotation ◽  
Partial Correction

SummaryA five-week-old American Quarter Horse colt was presented for evaluation of a left hindlimb deformity and lameness. Radiographs of the left hindlimb revealed a varus deformity with recurvatum originating in the middiaphysis of the third metatarsal bone. Surgical correction was undertaken by performing an osteotomy through the centre of rotation of angulation located within the mid-diaphysis of the third metatarsal bone, and a fourring hinged circular external fixator construct was applied. Distraction of the osteotomy site was performed over an 11 day period. Notable complications included failure of a fixation pin, infection of the surgical site, and temporary laxity of the supporting tendons and ligaments of the contralateral metatarsophalangeal joint. The fixator was maintained until there was sufficient bone formation to allow frame removal, 152 days after the initial surgery. Use of a hinged circular construct allowed for partial correction of the deformity with resultant lengthening and resolution of the lameness in this colt.

scholarly journals Osteosynthesis with Blocked Nail (“interlocking nail”) as a Treatment for Fracture of the Third Metatarsal after Metatarsophalangeal Arthrodesis with Modified Intramedullary Nail in Equine

2020 ◽  
Vol 48 ◽  
Author(s):  
Luis Fagner Da Silva Machado ◽  
Peterson Triches Dornbusch ◽  
Mariana Cocco ◽  
Jackson Schade ◽  
Eric Danilo Pauls Sotelo ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Dynamic Compression ◽  
Metatarsophalangeal Joint ◽  
Type A ◽  
Metatarsal Bone ◽  
Joint Stabilization ◽  
Aesthetic Result ◽  
The Third ◽  
Main Technique ◽  
Metatarsophalangeal Joints

Background: The metacarpal/metatarsophalangeal joints, as well as the suspensory apparatus, are usually affected by injuries, due to the intense physical demand during sports and great range of motion, predisposing to degenerative processes, trauma and rupture of the suspensory apparatus. In this case, arthrodesis is the main technique indicated. Such surgical techniques have a poor prognosis due to post-surgical complications, such as implant infection. Therefore, the study of procedures that promote better joint stabilization is important, with reduced surgical time and tissue exposure, decreasing significantly the chance of infection and other possible complications.Case: A 5-year-old male horse was referred to the hospital with a history of trauma and a lacerating wound in the metatarsal plantar region of the left hindlimb. The animal presented grade IV (I-V) claudication of the left hindlimb with hyperextension of the metatarsophalangeal joint and significant pain on palpation, evidencing the rupture of the superficial, deep digital flexor tendons and suspensory ligament of the fetlock. The initial surgical treatment was performed using the arthrodesis technique described by [16]. The intramedullary nail was used with fixation of the plate on the plantar face of the first phalanx together with a single plate fused to the pin, adjusted according to size of the first phalanx, 13 mm thick x 15 cm long, forming an angle between 120º and 140º. 24 hours after surgery, there was a simple spiral diaphyseal fracture (type A), in the middle third of the third metatarsal bone in the region of the proximal end, due to the lever held by the short nail against the diaphysis cortex. To treat the complication, an intramedullary 316 L surgical steel rod 13 mm thick x 21 cm long was used, filling the entire spinal canal. The nail had three holes at the proximal end and two holes at the distal end allowing the fixation of screws for cortical bone of 5.5 mm at the ends of the third metatarsal bone, stabilizing the fracture. Radiographic control of the limb was performed each 15 days, with immobilization for 90 days after surgery, thus verifying total consolidation. Concomitantly with the immobilization time, the patient showed improvement in the condition and adequate joint stabilization, presenting degree II (I-V) of lameness, due to the process of ankyloses elapsed from joint degeneration. After 10 months, the horse showed a reduction in claudication, classified as grade I (I-V). The owner was satisfied with the functional and aesthetic result of the treatment, where the animal started to be mounted and used for walks.Discussion: In this case, the treatment indicated was an arthrodesis of the metatarsophalangeal joint, due to the hyperextension of the metatarsophalangeal joint and rupture of the suspensory apparatus, since they play a fundamental supporting role. There are many arthrodesis techniques for the metacarpal/metatarsophalangeal joints; however, most of them present several complications, such as implant failure, infections and laminitis of the contralateral limb. For this reason, the development of new techniques that show satisfactory results and less disadvantages in the post-surgical period are fundamental. The nails are advantageous in relation to other fixation methods, presenting lower cost, practical application and allow the support of the fractured limb after return from anesthesia. In the case of simple spiral shaft fractures (type A), the blocked nail system promotes satisfactory stability in the fracture focus, especially for open fractures. When compared to the dynamic compression plate, it is less invasive and can be implanted as a semi-closed surgical procedure, beyond to supporting high loads in vivo.

scholarly journals Radiographic features of the dorsal condylar sagittal ridge of the third metacarpal and metatarsal bones in young Warmblood stallions

2010 ◽  
Vol 23 (06) ◽  
pp. 411-416 ◽  
Author(s):  
A. Martens ◽  
J. Declercq ◽  
V. Busoni ◽  
K. Vanderperren ◽  
H. van Bree ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Research Fund ◽  
Bone Surface ◽  
Radiographic Appearance ◽  
The Third ◽  
Dorsal Aspect ◽  
Metatarsal Bones ◽  
The Individual ◽  
Metatarsophalangeal Joints

Summary Objectives: To describe the radiographic appearance of the dorsoproximal aspect of the sagittal ridge of the third metacarpal/metatarsal bone in Warmblood horses. Methods: The lateromedial radiographic projections of the metacarpo-/metatarsophalangeal joints performed on horses as a part of stallion selection were used. The dorsal aspect of the distal third metacarpal/metatarsal bone was divided in two areas. The appearance of the bone surface in area I was classified as normal, irregular, notch, indentation and lucency. For area II, the categories were normal, irregular, depression or lucency and flattening of the sagittal ridge. Other abnormalities at the dorsal aspect were also noted. Results: In area I, 51.5% of the ridges appeared normal, 19.3% were irregular, 8.9% had a notch, 8.1% had a lucency, and 12.2% had an indentation. In 1.2% of the horses a fragment was present, and in 1.7% a fragment was suspected.In area II, 90.6% of the metacarpo-/metatarsophalangeal joints were normal, 6.2% were irregular, 2.9% showed a depression or lucency, and the sagittal ridge in 0.2% was flattened. A fragment was present in 0.3%, and suspected in 0.4%. Clinical significance: Morphological variation is present at the dorsal aspect of the metacarpo-/metatarsophalangeal joint in young Warmblood stallions. These various aspects should be recognised and described in horses presented for prepurchase examination. However, their clinical relevance in the individual horse is unclear and needs further investigation.Funding: Stijn Hauspie is a research fellow of the “Special Research Fund”, Ghent University (Belgium).

scholarly journals Involvement of the Inconstant Bursa of the Fifth Metatarsophalangeal Joint in Psoriatic Arthritis: A Clinical and Ultrasonographic Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Giovanni Ciancio ◽  
Stefania Volpinari ◽  
Maria Fotinidi ◽  
Federica Furini ◽  
Ilaria Farina ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Healthy Subjects ◽  
Statistical Significance ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
The Other ◽  
Control Group ◽  
Asymptomatic Patients ◽  
Seronegative Spondyloarthritis ◽  
The Difference

Objective. To evaluate the involvement of the bursa located next to the head of the 5th metatarsal bone in patients with psoriatic arthritis (PsA) in comparison with the other seronegative spondyloarthritis (SpA).Methods. All patients with PsA seen during a period of 24 months were enrolled. The control group included healthy subjects and patients with the other SpA. All subjects underwent clinical and ultrasound (US) examination of the lateral surface of the 5th metatarsal.Results. 150 PsA patients (88 M; 62 F), 172 SpA (107 M; 65 F), and 95 healthy controls (58 M; 37 F) were evaluated. Based on clinical and US evaluation, bursitis was diagnosed in 17/150 (11.3%) PsA patients but in none of the SpA (P<0.0001) and healthy (P=0.0002) controls. In detecting bursitis, US was more sensitive than clinical examination, although the difference did not reach statistical significance (P=0.09).Conclusion. The bursa of the 5th metatarsophalangeal joint appears to be involved in PsA more frequently than by chance. If confirmed by other studies, this finding could be considered as a distinctive clinical sign of PsA, useful for differential diagnosis with the other SpA. In asymptomatic patients, US proved to be more sensitive in the detection of bursitis.

Lateral Collateral Ligament Repair for Hallux Metatarsophalangeal Joint Instability in a Collegiate Sumo Wrestler: A Case Report

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Sadanori Shimizu ◽  
Tetsuya Sato ◽  
Tomohiko Tateishi ◽  
Tsuyoshi Nagase ◽  
Teruhiko Nakagawa ◽  
...  
Keyword(s):  
Athletic Performance ◽  
Joint Instability ◽  
Lateral Collateral Ligament ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Bone ◽  
Burr Hole ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Surgical Treatments

Although sprains of the hallux metatarsophalangeal (MTP) joint ligaments occur in barefooted martial arts athletes, few studies discuss the surgical treatments for lateral collateral ligament damage. We report herein a case of lateral collateral ligament repair for chronic hallux MTP joint instability. A 21-year-old male collegiate sumo wrestler injured his left hallux by snagging it on a sumo straw bale at 14 years of age. After entering university (4 years after the injury), he could no longer put weight on his foot at the left hallux; his athletic performance deteriorated, and he was referred to our department by his doctor. He had instability in the MTP joint of the left hallux, and magnetic resonance imaging revealed a tear in the attachment of the lateral collateral ligament to the metatarsal bone. Conservative treatment, such as taping, did not improve the symptoms; thus, surgery was performed, which consisted of passing a strong suture attached to the capsular ligament through a burr hole made in the metatarsal bone and fixing it to the burr-hole wall using an anchor. Postoperatively, the patient's joint instability improved, and he returned to competitive wrestling 4 months after surgery. He was able to put weight on his left hallux, and his athletic performance improved. The follow-up period after surgery was 2 years. In competitive sumo wrestling, hallux weakness and joint instability lead to a significant reduction in performance. Thus, ligament repair is an effective treatment for hallux MTP joint instability that cannot be treated by conservative means.

scholarly journals Is Fibular Sesamoidectomy a Viable Option for Sesamoiditis? A Retrospective Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Leonardo V. M. Moraes ◽  
Jeffrey Pearson ◽  
Kyle Paul ◽  
Jianguang Peng ◽  
Karthikeyan Chinnakkannu ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Metatarsophalangeal Joint ◽  
Retrospective Chart Review ◽  
Extended Period ◽  
Varus Deformity ◽  
Operative Management ◽  
Superficial Infection ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Varus

Category: Midfoot/Forefoot Introduction/Purpose: Although the first metatarsophalangeal joint sesamoids have biomechanical value in the foot, pathologic conditions of these sesamoids are a source of disabling pain for patients, particularly during toe-off. Underlying causes include acute fracture, acute separation of bipartite sesamoids, sesamoiditis caused by repetitive trauma, infection, chondromalacia, osteochondritis dissecans, and osteoarthritis. Nonoperative treatment is the initial standard of care and has satisfactory outcomes overall, but operative management may be indicated in cases of pain refractory to conservative management. Surgical management includes tendo-Achilles or gastrocnemius lengthening, dorsiflexion osteotomy at the base of first metatarsal, corrective osteotomies, fusions for fixed pes cavus foot. Sesamoidectomy is a relatively uncommon procedure but should be considered if 6- 12 months of conservative managements fail or if the patient experiences ongoing debilitating symptoms. Methods: A retrospective chart review was conducted at our institution from 2009-2018. Twelve patients diagnosed with fibular sesamoiditis were treated with sesamoidectomy. Baseline patient demographics as well as postoperative outcomes were recorded. All patients were initially treated for an extended period conservatively with orthotics, anti-inflammatory medications, physical therapy, limitation of activity and a trial of non-weight bearing. Despite these measures, symptoms persisted for these twelve patients - all of who then underwent fibular sesamoidectomy for their symptoms. The fibular sesamoidectomy was performed by one of the three fellowship trained foot and ankle surgeons. All surgeons used plantar approach with a longitudinal incision on the lateral edge of the first metatarsal fat pad. Postoperatively, patients were kept non–weight bearing for 2 weeks and in a post-op walking shoe for 6 weeks. Results: Average age of the patients was 38 years. Ten of twelve patients (83%) were female. Majority of the patients (10) had no history of trauma, only two referred forefoot injury in the past. Average follow-up was 35 months. Two patients had both hallux valgus and hallux rigidus. One had preexisting rheumatoid arthritis with involvement of the first MTP. MRI showed 5 of 12 (42%) of patients had avascular necrosis of the sesamoid based on magnetic resonance imaging. None of the patients developed cock-up deformity of the lesser toes or hallux varus deformity, clinically or radiologically. Two patients experienced transient neuritis, one developed a superficial infection, and one had painful postoperative scarring. Hallux varus deformity was not observed in any patients. None underwent reoperation. Conclusion: Our study contradicts earlier studies which associate sesamoidectomy with high incidence of complications, particularly hallux varus. But, most of these earlier reports focus on combinations of medial, lateral, and paired excision, rather than lateral excision alone, unlike our study. Hence, fibular sesamoidectomy can be a safe, viable procedure for patients who fail conservative measures for sesamoiditis. The plantar lateral approach allows for adequate exposure of the fibular sesamoid, repair of the plantar plate, and preservation of flexor hallucis brevis, and is beneficial in preventing the occurrence of hallux varus deformity.

Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses

2020 ◽  
Vol 49 (4) ◽  
pp. 648-658 ◽  
Author(s):  
Sophie Boorman ◽  
Dean W. Richardson ◽  
Patricia M. Hogan ◽  
Darko Stefanovski ◽  
David G. Levine
Keyword(s):  
Surgical Repair ◽  
Metatarsal Bone ◽  
Condylar Fracture ◽  
The Third ◽  
Racing Performance ◽  
Thoroughbred Racehorses

scholarly journals Large Cell Acanthoma of the Conjunctiva: Clinicopathologic and Immunohistochemical Features

2019 ◽  
Vol 5 (5) ◽  
pp. 312-318
Author(s):  
Frederick A. Jakobiec ◽  
Paula Cortes Barrantes ◽  
Lina Ma ◽  
John Mandeville
Keyword(s):  
Large Cell ◽  
Accurate Diagnosis ◽  
Proliferation Index ◽  
Real Potential ◽  
Ki 67 ◽  
The Third ◽  
Exposed Skin ◽  
Eyelid Skin ◽  
Initial Surgery ◽  
Clinical Photograph

Large cell acanthoma (LCA) was first described as a lesion on sun-exposed skin. All LCAs feature keratinocytes twice the size of normal cells (cytomegaly). Although infrequently diagnosed in the skin, it has been even more rarely described by ophthalmic pathologists in the eyelid skin and the conjunctiva. This report describes the third case of a conjunctival epithelial LCA, with the first published clinical photograph highlighting its leukoplakic and well-circumscribed character, as well as the most thorough analysis of the immunohistochemical features of this lesion. It is contrasted with squamous dysplasias and papillomas of the conjunctiva. A review of previous conjunctival LCA lesions discloses frequent recurrences after initial surgery and the remote but real potential for squamous dysplastic transformation. Immunohistochemical stains for certain cytokeratins, p53, and Ki-67 (proliferation index) will in the future be particularly helpful in establishing an early and accurate diagnosis of conjunctival LCA.

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