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Hand (New York, N.Y.) May 2022Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity...
BACKGROUND
Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity of literature on patient-specific preoperative risk factors that are associated with adverse outcomes after PIPJ arthrodeses. Therefore, the primary purpose of this study was to assess preoperative predictors of nonunion and reoperation after PIPJ arthrodesis.
METHODS
This study identified all patients who underwent PIPJ arthrodesis at a single community practice between 1987 and 2013. The final analysis included 415 PIPJs treated with arthrodesis. The mean follow-up was 1.3 years. Data on preoperative diagnosis, demographics, comorbidities, and operative techniques were recorded, as well as the occurrence of nonunions and reoperations. Logistic regression models were used to identify independent risk factors of nonunion and reoperation.
RESULTS
There were 40 nonunions (10%) and 62 reoperations (15%). Of the reoperations, there were 39 incidences of isolated hardware removal, 9 irrigation and debridement, 8 amputations, 5 revision arthrodeses, and 1 corrective osteotomy. The highest number of nonunions occurred in the traumatic diagnosis group (37%), followed by the rheumatoid group (23%) and the scleroderma group (15%). The highest number of reoperations occurred within the traumatic joint disorder group (40%), followed by the rheumatoid group (24%) and the scleroderma group (11%). Multivariate analysis revealed that male sex ( < .01) and hepatic disease ( = .03) were significant risk factors of nonunion. Male sex was also significantly associated with increased reoperation risk ( < .01).
CONCLUSION
Risks of nonunions and reoperations after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks.
Topics: Arthritis; Arthrodesis; Finger Joint; Humans; Male; Postoperative Complications; Reoperation
PubMed: 32772578
DOI: 10.1177/1558944720939196 -
Foot and Ankle Clinics Dec 2023Cavovarus foot is a complex 3-dimensional deformity. Clinical history, physical examination, and comorbidity assessment are essential for preoperative evaluation. In... (Review)
Review
Cavovarus foot is a complex 3-dimensional deformity. Clinical history, physical examination, and comorbidity assessment are essential for preoperative evaluation. In severe cases, ankle or tibiotalocalcaneal arthrodesis can provide symptomatic relief and result in a plantigrade foot. This article emphasizes the importance of weight-bearing computed tomography for surgical planning and presents the authors' preferred technique for tibiotalocalcaneal, which includes a novel curved anterolateral incision, partial fibular onlay bridging graft, and patient-specific instrumentation for forefoot deformity correction. The tips and tricks aim to assist surgeons in better treating these challenging patients while optimizing preoperative planning.
Topics: Humans; Ankle Joint; Ankle; Foot; Tomography, X-Ray Computed; Arthrodesis; Retrospective Studies
PubMed: 37863537
DOI: 10.1016/j.fcl.2023.06.003 -
Hand Clinics Aug 2023Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient... (Review)
Review
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
Topics: Humans; Wrist; Wrist Joint; Arthritis; Arthroplasty, Replacement; Arthrodesis
PubMed: 37453763
DOI: 10.1016/j.hcl.2023.04.001 -
Foot and Ankle Clinics Jun 2022One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The... (Review)
Review
One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The hindfoot joints consist of the subtalar, talonavicular, and calcaneocuboid (CC) joints. These joints are commonly fused for degenerative changes, deformity correction, inflammatory or neuropathic arthropathy, tarsal coalition, or primarily after trauma. Goals of hindfoot fusion are a painless plantigrade foot capable of fitting in shoes without orthotics or a brace. Many believe that deformity correction is achievable without inclusion of the CC joint. Managing patient expectations is important when counseling a patient especially regarding potential complications.
Topics: Arthrodesis; Foot; Humans; Pain; Subtalar Joint; Tarsal Joints
PubMed: 35680291
DOI: 10.1016/j.fcl.2021.11.019 -
Clinics in Podiatric Medicine and... Jul 2023Recently, there have been new advances in the arthroscopic approach to small joints of the foot. This is directly related to the improvement of surgical equipment, new... (Review)
Review
Recently, there have been new advances in the arthroscopic approach to small joints of the foot. This is directly related to the improvement of surgical equipment, new techniques, and publications. These improvements led to broadening indications as well as minimizing complications. Several articles recently presented the uses of arthroscopic surgery in the small joints of the foot; however, the use is still relatively limited. Arthroscopic evaluation of the small joints of the foot includes the first metatarsophalangeal, lesser metatarsophalangeal, tarsometatarsal, talonavicular, and calcaneocuboid joints as well as the interphalangeal joint to the great toe and lesser toes.
Topics: Humans; Arthroscopy; Metatarsophalangeal Joint; Joint Diseases; Hallux; Tarsal Joints; Arthrodesis
PubMed: 37236682
DOI: 10.1016/j.cpm.2023.02.005 -
Hand Clinics Nov 2023The use of staple technology in the upper extremity has continued to evolve with the development of shape-memory alloys (SMAs) such as Nitinol that display superelastic... (Review)
Review
The use of staple technology in the upper extremity has continued to evolve with the development of shape-memory alloys (SMAs) such as Nitinol that display superelastic properties that can be exploited for persistent compression. Clinical and biomechanical studies support the use of SMA staples for upper extremity fracture fixation and joint arthrodesis. To optimize biomechanical strength and clinical outcomes, it is recommended to place two staples, if possible, at the site of interest as well as to trough the staples to prevent hardware prominence.
Topics: Humans; Fractures, Bone; Sutures; Arthrodesis; Fracture Fixation
PubMed: 37827603
DOI: 10.1016/j.hcl.2023.05.010 -
Foot and Ankle Clinics Mar 2022After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal... (Review)
Review
After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal joints. In a tibiotalocalcaneal arthrodesis, the subtalar may be fixed with the correct valgus. Comparison between ankle and tibiotalocalcaneal arthrodesis does not clearly favor one over another for pain relief, satisfaction, and gait analysis. Compensatory sagittal plane motion through the midtarsal joints when the subtalar is fixed in valgus may be responsible for these results. Tibiotalocalcaneal arthrodesis has become our procedure of choice over isolated tibiotalar for end-stage ankle arthritis regardless of the radiographic state of the subtalar.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Humans; Subtalar Joint
PubMed: 35219367
DOI: 10.1016/j.fcl.2021.11.012 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Iatrogenic hallux varus is a dreaded complication of hallux valgus surgery, consisting in 1st-ray deformity in the form of medial malalignment of the 1st phalanx with... (Review)
Review
Iatrogenic hallux varus is a dreaded complication of hallux valgus surgery, consisting in 1st-ray deformity in the form of medial malalignment of the 1st phalanx with respect to the metatarsal axis. Such over-correction results from imbalance between excessive medial capsule retraction or tensioning and excessive lateral laxity or soft-tissue release. There may be loss of medial stability of bone origin due to excessive "exostosectomy" or excessive intermetatarsal angle closure. Following excessive lateral release, the imbalance gradually induces a varus deformity of the 1st phalanx due to traction by the medial muscles: abductor hallucis and medial head of flexor hallucis brevis inserting to the medial sesamoid. The deformity comprises 3 components, of varying importance: medial deviation of the hallux at the 1st metatarsophalangeal joint, supination of the phalanx, and interphalangeal flexion (i.e., claw deformity of the hallux). Treatment strategy is determined by the various clinical and radiological data explaining the postoperative hypercorrection. The clinical analysis is decisive, while radiology contributes more technical factors once the treatment option has been decided on. There are two main options for surgical revision to restore 1st ray propulsion: 1) static or dynamic reconstruction of the ligamentous structures, conserving metatarsophalangeal motion; or 2) metatarsophalangeal and/or interphalangeal fusion. Factors guiding choice are mainly range of motion, and reducibility of the metatarsophalangeal and interphalangeal deformity. We describe the procedures in detail, emphasizing the essential points for success. Joint sparing is to be sought in flexible deformities and young patients. Ligament reconstruction can be anatomic or palliative by tenodesis effect, which makes adjustment difficult. Alongside soft-tissue reconstruction, the metatarsal osteotomy should also be revised if the intermetatarsal angle has been unduly closed. Metatarsophalangeal fusion is the most reliable solution and is unavoidable if the joint is stiff or degenerative; it undoubtedly reduces risk of failure. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Arthrodesis; Hallux Varus; Humans; Iatrogenic Disease; Metatarsophalangeal Joint; Osteotomy; Radiography
PubMed: 31521558
DOI: 10.1016/j.otsr.2019.05.018 -
Foot and Ankle Clinics Sep 2020Described in the early 1900s by Albrecht and Lapidus, the Lapidus procedure became an important tool in the armamentarium. With the increase of percutaneous techniques,... (Review)
Review
Described in the early 1900s by Albrecht and Lapidus, the Lapidus procedure became an important tool in the armamentarium. With the increase of percutaneous techniques, the development of a percutaneous Lapidus seemed obvious.
Topics: Arthrodesis; Fluoroscopy; Foot Deformities; Hallux Valgus; Humans; Minimally Invasive Surgical Procedures; Osteotomy; Tarsal Joints
PubMed: 32736738
DOI: 10.1016/j.fcl.2020.05.010 -
Clinics in Podiatric Medicine and... Jul 2021Cavus foot is a complex podiatric deformity that requires precise and in-depth work-up through an objective, physical, and radiographic examination. The goal of surgical... (Review)
Review
Cavus foot is a complex podiatric deformity that requires precise and in-depth work-up through an objective, physical, and radiographic examination. The goal of surgical treatment is to eliminate pain while establishing a plantigrade foot structure. Triple arthrodesis has proven to be an effective surgical procedure for treatment of moderate to severe rearfoot deformity with or without the presence of rearfoot arthritic changes. The foot and ankle surgeon must always be aware that no two cavus deformity cases are alike, therefore one may require additional surgical procedures including soft tissue balancing, joint-sparing osteotomies, and/or supplementary arthrodesing procedures.
Topics: Arthrodesis; Conservative Treatment; Foot; Humans; Physical Examination; Postoperative Care; Radiography; Talipes Cavus; Tarsal Joints
PubMed: 34053652
DOI: 10.1016/j.cpm.2020.12.014