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BMC Musculoskeletal Disorders Jul 2022Müller-Weiss disease (MWD), a rare dysplastic disorder of the foot, is characterized by deformity, sclerosis, and fragmentation of the lateral part of navicular bone....
BACKGROUND
Müller-Weiss disease (MWD), a rare dysplastic disorder of the foot, is characterized by deformity, sclerosis, and fragmentation of the lateral part of navicular bone. Arthrodesis is the mainstay treatment for MWD. Generally, arthrodesis can be achieved through internal fixation with metallic implants, and morselized chip bone may be packed into the gap for better bone union. However, with this procedure, the original foot size is not maintained and support for the foot arch is not provided. Sequela of short foot, or flatfoot is commonly observed even though these complications of surgery had not been reported with cases of MWD treated by arthrodesis. Herein, we present a retrospective analysis of treating MWD through midfoot and hindfoot arthrodesis combined with strut allograft.
METHODS
From August 2006 to June 2019, 20 patients with MWD (mean age, 59.6 years; range, 40-80 years) underwent midfoot and hindfoot arthrodesis with strut bone allograft and were followed for at least 24 months. The patients were able to ambulate and participate in rehabilitation programs 3 months postoperatively.
RESULTS
The used four radiographic parameters (Meary's angle in anteroposterior and lateral view, talonavicular coverage angle, calcaneal pitch) demonstrated significant differences (P < .05) preoperatively and postoperatively, but those between the postoperative values and the values at the last follow-up session did not, indicating that strut allograft was able to maintain normal alignment. The mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scores at 2 years postoperatively revealed significant improvement from baseline, from 60.2 to 84.2 (P < .05). The 12-item Short Form Health Survey scores also improved significantly (P < .05). All patients reported substantial pain relief and exhibited improved functional outcomes and gait patterns.
CONCLUSIONS
For advanced-stage MWD, arthrodesis with a precisely shaped, size-matched strut allograft provided strong support for biomechanical alignment and enhanced functional performance.
Topics: Allografts; Arthrodesis; Bone Diseases; Cartilage Diseases; Foot Diseases; Humans; Middle Aged; Radiography; Retrospective Studies; Tarsal Bones; Treatment Outcome
PubMed: 35897013
DOI: 10.1186/s12891-022-05629-7 -
The Journal of the American Academy of... Dec 2020Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of... (Review)
Review
Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces. The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies. This technique can be implemented in a variety of fractures and avulsions about the upper extremity as well as small bone arthrodeses.
Topics: Arthrodesis; Biomechanical Phenomena; Bone Wires; Bone and Bones; Fractures, Bone; Humans; Orthopedic Procedures; Tensile Strength; Upper Extremity
PubMed: 32991386
DOI: 10.5435/JAAOS-D-19-00449 -
Journal of Equine Veterinary Science Mar 2023The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.
Topics: Horses; Animals; Retrospective Studies; Horse Diseases; Arthrodesis; Extremities; Hospitalization
PubMed: 36649830
DOI: 10.1016/j.jevs.2023.104226 -
The Orthopedic Clinics of North America Jan 2019There are several reconstructive procedures in foot and ankle surgery wherein structural grafts are needed to fill defects, restore height, and maintain correction while... (Review)
Review
There are several reconstructive procedures in foot and ankle surgery wherein structural grafts are needed to fill defects, restore height, and maintain correction while providing an osteoconductive environment until fusion occurs. Traditionally used autografts and allografts have their disadvantages and limitations. Porous tantalum, with stiffness similar to bone and its biocompatibility, can be a viable option in foot and ankle reconstructive procedures.
Topics: Ankle Joint; Arthrodesis; Arthroplasty; Humans; Prosthesis Design; Tantalum
PubMed: 30477701
DOI: 10.1016/j.ocl.2018.08.006 -
Journal of Orthopaedics and... Dec 2015Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary... (Review)
Review
BACKGROUND
Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature.
MATERIALS AND METHODS
A literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded.
RESULTS
Nine publications were included. Of the patients' reports, 93-100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5-100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire.
CONCLUSION
The use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment.
Topics: Arthrodesis; Hammer Toe Syndrome; Humans; Toe Phalanges
PubMed: 26115745
DOI: 10.1007/s10195-015-0360-0 -
Journal of Orthopaedic Surgery and... May 2017The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved... (Comparative Study)
Comparative Study Review
BACKGROUND
The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved outcomes after both ankle arthrodesis (AA) and total ankle arthroplasty (TAA), yet a clear consensus regarding the most ideal form of treatment is lacking. In this study, the outcomes and complications following AA and TAA are compared in order to improve our understanding and decision-making for care and treatment of symptomatic tibiotalar arthritis.
METHODS
Studies reporting on outcomes and complications following TAA or AA were obtained for review from the PubMed database between January 2006 and July 2016. Results from studies reporting on a minimum of 200 total ankle arthroplasties or a minimum of 80 ankle arthrodesis procedures were reviewed and pooled for analysis. All studies directly comparing outcomes and complications between TAA and AA were also included for review. Only studies including modern third-generation TAA implants approved for use in the USA (HINTEGRA, STAR, Salto, INBONE) were included.
RESULTS
A total of six studies reporting on outcomes following TAA and five reporting on outcomes following AA met inclusion criteria and were included for pooled data analysis. The adjusted overall complication rate was higher for AA (26.9%) compared to TAA (19.7%), with similar findings in the non-revision reoperation rate (12.9% for AA compared to 9.5% for TAA). The adjusted revision reoperation rate for TAA (7.9%) was higher than AA (5.4%). Analysis of results from ten studies directly comparing TAA to AA suggests a more symmetric gait and less impairment on uneven surfaces after TAA.
CONCLUSIONS
Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. Based on the existing literature, the decision to proceed with TAA or AA for end-stage ankle arthritis should be made on an individual patient basis.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Postoperative Complications; Reoperation; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 28521779
DOI: 10.1186/s13018-017-0576-1 -
Hand Surgery & Rehabilitation Feb 2022Palliative surgery aims to restore or compensate for the loss of a function for which nerve repairs are no longer or not feasible. It includes tendon transfer,... (Review)
Review
Palliative surgery aims to restore or compensate for the loss of a function for which nerve repairs are no longer or not feasible. It includes tendon transfer, tenodesis, arthrodesis and osteotomy techniques. Palliative surgery is based on several well-established principles that are essential to know. The purpose of this introductory chapter is to review the various basic principles before undertaking palliative surgery.
Topics: Arthrodesis; Humans; Osteotomy; Palliative Care; Tendon Transfer; Tenodesis
PubMed: 34146745
DOI: 10.1016/j.hansur.2020.10.020 -
The Journal of Foot and Ankle Surgery :... 2023Proximal interphalangeal (PIP) arthrodesis technique utilizing the peg-in-hole arthrodesis was founded to avoid the use of retained internal fixation implants and...
Proximal interphalangeal (PIP) arthrodesis technique utilizing the peg-in-hole arthrodesis was founded to avoid the use of retained internal fixation implants and thereby potentially decrease the concern of hardware complication. The specific aim of this study was to report the complication rates of the modified peg-in-hole arthrodesis technique and the end-to-end arthrodesis with single screw fixation technique for correcting symptomatic hammertoe deformities in lesser digits. This retrospective chart review included patients who underwent surgical hammertoe correction of lesser digits between the dates of January 2012 and December 2019. Patient demographic data and charts were reviewed to evaluate need for revision including screw/pin removal and complications related to corrective surgery. Five hundred ninety-three symptomatic hammertoe deformity cases (443 female, 150 male) were identified, with 113 cases (88 female, 25 male) treated with peg-in-hole arthrodesis technique and 480 cases (355 female, 125 male) treated with end-to-end arthrodesis with a single screw technique. The deformity recurrence rate was not significantly different between the two techniques (peg-in-hole: 10%, end-to-end: 13%, p = .428). There were 97 cases with postoperative complications that required re-operation (peg-in-hole: 7 cases, end-to-end: 90 cases) with the majority detected at <6 months. There was no statistically significant difference in reoperation rate between the peg-in-hole technique and the end-to-end arthrodesis technique reoperated with reasons excluding simple screw removal (p = .068). This study tended to show these two arthrodesis techniques have equivalent risks and similar success in bone healing; however, the peg-in-hole arthrodesis technique offers an advantage that does not result in retained hardware.
Topics: Humans; Male; Female; Retrospective Studies; Bone Screws; Arthrodesis; Hammer Toe Syndrome; Reoperation
PubMed: 36697330
DOI: 10.1053/j.jfas.2022.12.011 -
Der Orthopade May 2017The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still... (Review)
Review
The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still a debatable indication. Using stable osteosynthesis techniques allows early postoperative weight bearing. Plantar plating combined with a lag screw is the biomechanical most stable construct. An additional intermetatarsal screw can improve the horizontal stability. Clinical results are good and radiological parameters stay constant, even in the long term.
Topics: Arthrodesis; Evidence-Based Medicine; Hallux Valgus; Humans; Joint Instability; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Plastic Surgery Procedures; Treatment Outcome
PubMed: 28361194
DOI: 10.1007/s00132-017-3411-9 -
The Orthopedic Clinics of North America Jul 2019Nitinol compression implants are fast and simple to insert and have a high radiographic union rate for midfoot and hindfoot arthrodeses. Applications of nitinol... (Review)
Review
Nitinol compression implants are fast and simple to insert and have a high radiographic union rate for midfoot and hindfoot arthrodeses. Applications of nitinol technology in orthopedic surgery are rapidly expanding with the improved and broadened portfolio of implants available.
Topics: Alloys; Ankle; Arthrodesis; Biomechanical Phenomena; Compressive Strength; Foot; Humans; Postoperative Complications; Sutures
PubMed: 31084842
DOI: 10.1016/j.ocl.2019.02.003