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Clinics in Podiatric Medicine and... Apr 2023Different types of arthrodesis for flatfoot deformity have a long history in foot and ankle surgery. Arthrodesis of the rearfoot can be a useful tool in helping correct... (Review)
Review
Different types of arthrodesis for flatfoot deformity have a long history in foot and ankle surgery. Arthrodesis of the rearfoot can be a useful tool in helping correct deformity and maintaining that correction with good long-term results. Questions have risen recently however about the necessity of including the calcaneocuboid joint in the traditional rearfoot arthrodesis or triple arthrodesis. The double arthrodesis of the talonavicular and subtalar joints has grown in popularity and this review helps the reader choose with a review of the biomechanics, surgical approaches, fixation techniques and recent literature outcomes of both procedures.
Topics: Humans; Flatfoot; Arthrodesis; Tarsal Joints; Subtalar Joint; Foot Deformities, Acquired
PubMed: 36841582
DOI: 10.1016/j.cpm.2022.11.009 -
Hand (New York, N.Y.) Jan 2023Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including... (Review)
Review
Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including screws, Kirschner wires, tension band wiring, intramedullary devices, and plate fixation. There remains no consensus as to the optimum method, and no recent summary of the literature exists. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases. English-language articles reporting PIPJ arthrodesis outcomes were included and presented in a systematic review. Pearson χ and 2-sample proportion tests were used to compare fusion time, nonunion rate, and complication rate between arthrodesis techniques. The mean fusion time ranged from 5.1 to 12.9 weeks. There were no statistically significant differences in fusion time between arthrodesis techniques. Nonunion rates ranged from 0.0% to 33.3%. Screw arthrodesis demonstrated a lower nonunion rate than wire fusion (3.0% and 8.5% respectively; = .01). Complication rates ranged from 0.0% to 22.1%. Aside from nonunions, there were no statistically significant differences in complication rates between arthrodesis techniques. The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. The existing data have significant limitations, and further research would be beneficial to elucidate any differences between techniques.
Topics: Humans; Bone Wires; Bone Screws; Arthrodesis; Joint Diseases; Finger Joint
PubMed: 33682483
DOI: 10.1177/1558944721998019 -
Foot and Ankle Clinics Dec 2022Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling... (Review)
Review
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
Topics: Humans; Ankle; Arthrodesis; Arthroplasty, Replacement, Ankle; Ankle Joint; Osteoarthritis; Retrospective Studies; Treatment Outcome
PubMed: 36368793
DOI: 10.1016/j.fcl.2022.08.007 -
JBJS Reviews Mar 2020Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for... (Review)
Review
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
Topics: Arthritis; Arthrodesis; Carpal Bones; Humans; Wrist Joint
PubMed: 32149931
DOI: 10.2106/JBJS.RVW.19.00078 -
Clinics in Podiatric Medicine and... Apr 2023Rigid flatfoot deformity with valgus ankle instability is a complex condition to treat. Thorough clinical and radiographic evaluation is vital to determine treatment... (Review)
Review
Rigid flatfoot deformity with valgus ankle instability is a complex condition to treat. Thorough clinical and radiographic evaluation is vital to determine treatment strategies. Nonoperative treatment usually relies on bracing or various orthoses. Surgical interventions include ligament reconstruction, osteotomies, arthrodesis, arthroplasty, or a combination of these procedures. Before addressing the ankle deformity, a plantigrade foot is important so a staged approach may be necessary. Misalignment of the ankle replacement can lead to edge loading and early failure. As the implants and our understanding of ankle arthroplasty improve, more patients may benefit from a motion-preserving procedure rather than an arthrodesis.
Topics: Humans; Flatfoot; Ankle Joint; Foot; Arthrodesis; Arthroplasty, Replacement, Ankle
PubMed: 36841583
DOI: 10.1016/j.cpm.2022.11.010 -
Techniques in Hand & Upper Extremity... Sep 2022Distal interphalangeal joint fusion is usually the surgical treatment for primary or posttraumatic osteoarthrosis when conservative measures fail. All fusion techniques...
Distal interphalangeal joint fusion is usually the surgical treatment for primary or posttraumatic osteoarthrosis when conservative measures fail. All fusion techniques aim for solid fusion with joint chondral resection, bone to bone contact and stable fixation in an adequate position. This is performed with an open dorsal approach considering the risks of soft tissue complications. We describe a technique of resecting bone cartilage and getting stable fixation with 2 mini incisions, 1 lateral and 1 in the digital pulp. Using a digital block anesthesia and under fluoroscopy, a small round burr is introduced into the joint by a lateral joint line stab incision. The joint space is enlarged by manual traction on the finger. After adequate cartilage resection, good bone to bone contact in an adequate position is fixed with a cannulated Herbert screw inserted percutaneously by the finger pulp. We describe 4 cases operated with this technique, 3 for pain and 1 for esthetics. All 4 demonstrated good results and were satisfied. X-rays showed solid fusion in 8 to 12 weeks. There was one complication with skin burning because of the burr heating and the authors describe how to avoid it. Minimally invasive distal interphalangeal joint fusion is a simple, reproducible technique that maintains the important steps for a solid arthrodesis with the advantage of preserving the soft tissue envelope.
Topics: Arthritis; Arthrodesis; Bone Screws; Finger Joint; Humans; Radiography
PubMed: 34856595
DOI: 10.1097/BTH.0000000000000375 -
The Journal of Hand Surgery Jan 2024Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the... (Review)
Review
Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the hand has gained increasing interest, specifically in the metacarpals and phalanges, corresponding with the development of improved cannulated headless screw technology. Along with the advantages of increased operative speed and less surgical dissection, which can promote rapid healing, many benefits exist, supporting their use despite some drawbacks. This article reviews the background and biomechanics of intramedullary fixation with a specific focus on cannulated headless screws, describes the application and techniques of intramedullary screw fixation in the hand, and details the associated outcomes and costs for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis.
Topics: Humans; Fractures, Bone; Fracture Fixation, Internal; Hand; Finger Phalanges; Metacarpal Bones; Hand Injuries; Arthrodesis
PubMed: 37777934
DOI: 10.1016/j.jhsa.2023.08.011 -
Clinics in Podiatric Medicine and... Apr 2023A stable medial column is important to the normal function of the foot and ankle. Medial column instability and forefoot varus can result in compensatory hindfoot motion... (Review)
Review
A stable medial column is important to the normal function of the foot and ankle. Medial column instability and forefoot varus can result in compensatory hindfoot motion leading to stress along the medial soft-tissue structures. Medial column stabilization should therefore be considered when (1) forefoot varus deformity is identified following hindfoot realignment; (2) pronounced medial column instability is present, even in the absence of forefoot varus; and (3) when degenerative changes are present within the medial column articulations. Common surgical procedures include arthrodesis of the talonavicular joint, naviculocuneiform joint, and first tarsometatarsal joint, as well as osteotomy of the medial cuneiform (Cotton osteotomy).
Topics: Humans; Flatfoot; Tarsal Bones; Foot Joints; Osteotomy; Arthrodesis
PubMed: 36841579
DOI: 10.1016/j.cpm.2022.11.003 -
Foot & Ankle International Feb 2022Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at... (Review)
Review
Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.
Topics: Arthrodesis; Bone Transplantation; Humans; Osteonecrosis; Risk Factors; Talus
PubMed: 34753345
DOI: 10.1177/10711007211051013 -
Clinics in Podiatric Medicine and... Jul 2020"Lapidus arthrodesis is becoming more of a common procedure for treatment of hallux valgus deformities. Like other procedures, complications are possible. The common... (Review)
Review
"Lapidus arthrodesis is becoming more of a common procedure for treatment of hallux valgus deformities. Like other procedures, complications are possible. The common complications associated with Lapidus arthrodesis procedures include nonunion and malunion. Malunion is typically broken down into recurrence, elevated first ray, shortened first ray, or plantarflexed first ray. This article discusses these common complications after Lapidus arthrodesis.
Topics: Arthrodesis; Bone Malalignment; Bunion; Hallux Valgus; Humans; Postoperative Complications
PubMed: 32471615
DOI: 10.1016/j.cpm.2020.03.010