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Hand (New York, N.Y.) May 2022T-plate fixation is a popular method for trapeziometacarpal arthrodesis in patients with osteoarthritis. Previous studies report an 8% to 18% rate of symptomatic...
T-plate fixation is a popular method for trapeziometacarpal arthrodesis in patients with osteoarthritis. Previous studies report an 8% to 18% rate of symptomatic nonunion and a 26% rate of radiographic nonunion. In this study, we present our surgical technique of trapeziometacarpal arthrodesis using the addition of an oblique interfragmentary screw to T-plate fixation on the rate of symptomatic and radiographic nonunion. A retrospective review of all trapeziometacarpal arthrodeses for osteoarthritis was completed by a single surgeon between 2010 and 2018. Preoperative demographics, pain, and Eaton classification were included. The technique was identical in all surgical cases, using a T-plate and oblique interfragmentary screw across the arthrodesis site from the metacarpal to the trapezium. Postoperative nonunion rate and time to clinical healing (absence of pain) and radiographic union were reviewed. A total of 22 trapeziometacarpal arthrodeses were performed on 17 patients using the above technique. The average age was 53 years, 71% were women, and 53% involved the dominant hand. Mean preoperative Eaton classification was 2.74 (±0.73). Mean time to clinical healing was 34 days (±12 days), and mean time to radiographic union was 55 days (±23 days). Mean follow-up was 9 months, and no patients were found to have symptomatic or radiographic nonunion. Hardware removal was required bilaterally in 1 patient after complete healing. The addition of an oblique interfragmentary screw to T-plate fixation is a novel technique in trapeziometacarpal arthrodesis, resulting in no symptomatic or radiographic nonunion.
Topics: Arthrodesis; Bone Plates; Bone Screws; Female; Humans; Male; Middle Aged; Osteoarthritis; Pain
PubMed: 32696675
DOI: 10.1177/1558944720937366 -
Der Unfallchirurg Oct 2016Tibiotalocalcaneal arthrodesis has recently become more popular as a form of reconstructive surgery. The precise anatomical orientation and the functional extrinsic...
Tibiotalocalcaneal arthrodesis has recently become more popular as a form of reconstructive surgery. The precise anatomical orientation and the functional extrinsic musculature of the hindfoot are essential for a satisfactory result. Fixation of the arthrodesis is a mechanical problem. Straight and angulated nails are not anatomically or mechanically ideal. A circular arc nail can fix the tibia, the talus and the calcaneus in anatomical alignment. This is a pure "bone nail", in contrast to the "intramedullary nail," which is driven through an existing opening in long bones. The nail is driven through a circular arc-shaped opening in the bone, which results in optimal form-fit between nail and bone. A corresponding aiming device permits the precise shaping of the bone tunnel, which follows the orientation of the bone trabeculae. The instrumentation was applied in 11 cases, with the following indications: post-traumatic conditions, congenital deformities, chronic polyarthritis and diabetic Charcot arthropathy. The desired alignment of the hindfoot is not affected while the nail is being introduced. The fixation achieves primary stability thus allowing for early functional treatment.
Topics: Ankle Fractures; Arthrodesis; Bone Nails; Evidence-Based Medicine; Foot Diseases; Humans; Prosthesis Design; Treatment Outcome
PubMed: 27392451
DOI: 10.1007/s00113-016-0210-4 -
The Journal of Hand Surgery Mar 1995Seventy-three wrist arthrodeses (71 patients) using AO/ASIF dorsal plate fixation and iliac crest bone graft were retrospectively reviewed to assess complications of...
Seventy-three wrist arthrodeses (71 patients) using AO/ASIF dorsal plate fixation and iliac crest bone graft were retrospectively reviewed to assess complications of this technique. There were 82 complications in 50 wrists. Nonunion of the radius to the carpus did not occur. Forty-five of the complications were related to the soft tissues; 29 were bone or articular complications. Chronic unexplained pain represented 8 of the complications. Overall, 63 of the 82 complications resolved. Nineteen wrists required additional surgery, most frequently for plate removal. Eighteen wrists were left with one or more residual difficulties after fusion. Thus, 55 of the wrist arthrodeses ultimately resulted in a stable, pain-free wrist.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Plates; Bone Screws; Bone Transplantation; Female; Follow-Up Studies; Humans; Joint Instability; Male; Middle Aged; Postoperative Complications; Radiography; Retrospective Studies; Time Factors; Wrist Joint
PubMed: 7775781
DOI: 10.1016/S0363-5023(05)80037-1 -
Chirurgie de La Main Apr 2015Various indications exist for thumb interphalangeal and finger distal interphalangeal arthrodesis. Various fixation techniques (compression screws, tension band wiring,...
Various indications exist for thumb interphalangeal and finger distal interphalangeal arthrodesis. Various fixation techniques (compression screws, tension band wiring, K-wires) have been described with fusion rates varying between 80 and 100%. The objective of this study was to evaluate the outcomes of interphalangeal arthrodesis using the X-Fuse(®) intramedullary implant in terms of fusion rate and fusion position. A continuous series of 38 arthrodesis procedures was reviewed retrospectively to determine the fusion rate and evaluate complications linked to this fixation technique. The position of the fused joint was compared to that obtained at the end of the procedure so as to evaluate the reliability of implant placement. The fusion rate was 94.8%; two arthrodeses had to be redone with satisfactory results. A moderate change of less than 10 degrees in the arthrodesis position between the immediate postoperative period and fusion was observed in the frontal and sagittal planes that had no clinical consequences. The fusion rate reported here is similar to the best rates published with other fusion techniques, and few complications occurred. Use of this intramedullary implant seems to be a viable alternative to the other techniques.
Topics: Adolescent; Adult; Aged; Arthrodesis; Female; Finger Joint; Humans; Male; Middle Aged; Prostheses and Implants; Prosthesis Design; Retrospective Studies; Young Adult
PubMed: 25771025
DOI: 10.1016/j.main.2015.01.002 -
The Journal of Foot and Ankle Surgery :... 2015Hindfoot fusion is capable of correcting hindfoot deformities. Typically, this has been done through triple arthrodesis. Recently, there has been some discussion of a... (Comparative Study)
Comparative Study
Hindfoot fusion is capable of correcting hindfoot deformities. Typically, this has been done through triple arthrodesis. Recently, there has been some discussion of a double arthrodesis, sparing the calcaneocuboid joint. We compared the radiographic corrective ability of these 2 fusion techniques. A retrospective radiographic review was performed of 20 consecutive triple arthrodeses (triple) and 20 consecutive talonavicular and subtalar arthrodesis with calcaneocuboid preservation (double). Additional midfoot arthrodesis or osteotomy was performed as needed in each group. The preoperative measurements were compared to those from standing weightbearing films after fusion postoperatively. The angular measurements included the anteroposterior and lateral talar–first metatarsal line (Meary's and Simmons) and the anteroposterior and lateral talocalcaneal angle. Both groups demonstrated a statistically significant reduction in deformity and a return to more normal radiographic findings after arthrodesis (p < .05). The 2 groups did not differ statistically in preoperative deformity or correction obtained (p > .05). Traditionally, triple arthrodesis has been advocated for significant hindfoot deformity that is irreducible. Recent studies have questioned the need for inclusion of the calcaneocuboid joint in the arthrodesis, in particular, in a pronated, valgus-type foot. In addition, others have advocated a strictly medial approach to hindfoot fusion, necessarily avoiding the calcaneocuboid joint. Our findings agree with the assertion that hindfoot deformity can be adequately and reliably corrected through hindfoot arthrodesis whether or not the calcaneocuboid joint is included.
Topics: Aged; Arthrodesis; Female; Foot Deformities, Acquired; Humans; Male; Middle Aged; Radiography; Retrospective Studies; Tarsal Joints; Treatment Outcome; Weight-Bearing
PubMed: 25432460
DOI: 10.1053/j.jfas.2014.09.020 -
Acta Chirurgiae Orthopaedicae Et... Oct 2006Arthrodesis of the carpometacarpal (CMC) joint of the thumb is an option for treatment of degenerative and post-traumatic conditions affecting the CMC thumb joint. This...
PURPOSE OF THE STUDY
Arthrodesis of the carpometacarpal (CMC) joint of the thumb is an option for treatment of degenerative and post-traumatic conditions affecting the CMC thumb joint. This procedure is indicated most frequently in patients with primary or secondary stage III rhizarthritis (by the Eaton classification of basal joint arthritis) of idiopathic, rheumatic or post-traumatic etiology. Patients with multidirectional CMC instability, usually traumatic in origin, undergo this surgery only occasionally. In our institution, the treatment is based on the Carroll technique.
MATERIAL AND METHODS
Between 1990 and 2005 a total of 14 arthrodeses of the CMC joint of the thumb were performed in 12 patients. The Carroll technique used in all cases involved a conical shaping of the first metacarpal base and a corresponding shaping of the trapezium articular surface, their subsequent set-up and fixation with Kirschner's wires. The patients were assessed for the presence of pain, changes in mobility and muscle strength before and after surgery. The comprehensive evaluation of the whole group was carried out by means of the Cooney score.
RESULTS
Arthrodesis resulted in complete union of the CMC joint of the thumb in all cases. The patients were followed up for 5 years on average. The initial painful hand grip subsided in most of them. The initial restriction of motion remained, but was painless in almost all cases. However, broad grip strength improved on average by 35 %. The comprehensive Cooney score showed 64 % of excellent and very good results.
DISCUSSION
All characteristics of the patient group and the results achieved by this technique, including the Cooney score evaluation, are discussed. It is concluded that this technique is indicated particularly in middle-aged male patients with stage III rhizarthritis (Eaton classification) who do hard manual work, and in whom rhizarthritis of the other thumb joints can be excluded. Also, unstable CMC joints are indicated for this treatment. The resulting position of arthrodesis and methods of joint fixation are discussed. Different methods of osteosynthesis and their advantages are described. From a comparison with the relevant literature results it appears that the absence of postoperative pseudoarthrosis, a marked reduction of grip pain, improvement of grip strength and the values of Cooney score are encouraging results of arthrodesis for the CMC thumb joint performed by the Carroll method.
CONCLUSIONS
It is concluded that the Carroll arthrodesis is an effective technique which, if correctly indicated, alleviates pain, restores the axis of the thumb and, consequently, its stability necessary for thumb function in achieving a hand grip.
Topics: Adolescent; Adult; Arthritis; Arthrodesis; Carpometacarpal Joints; Female; Humans; Male; Middle Aged; Thumb
PubMed: 17140517
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Oct 2012In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot... (Comparative Study)
Comparative Study
INTRODUCTION
In rheumatoid diseases, hindfoot arthrodesis abolishes pain and corrects deformity. The choice between selective and double arthrodesis depends on whether the hindfoot malalignment is fixed or not. Indications for surgery are well codified. The various types of arthrodesis have never been assessed together on a large series. We here report a series that is substantial in numbers and in follow-up.
MATERIALS AND METHODS
A continuous single-center retrospective study included patients with native hindfoot inflammatory disease treated by arthrodesis between 1996 and 2009.
RESULTS
Around 80% of patients were followed up, for a mean 7 years. Fifty-four isolated talonavicular arthrodeses, 14 talocalcaneal arthrodeses and 39 double arthrodeses were performed. 96% of patients had rheumatoid arthritis and 4% spondylarthritis. 62% were completely pain-free at follow-up. The satisfaction rate was 91% and mean AOFAS score 70%. 6% of patients showed symptomatic non-union, mainly associated with talonavicular arthrodesis. In 22% of double arthrodeses and 11% of talonavicular arthrodeses, ankle status required surgical revision. In double arthrodesis, there was no correlation between hindfoot deviation and secondary deterioration in ankle status. Talocalcaneal arthrodesis was associated with radiologic hindfoot varus, both preoperatively and at follow-up.
DISCUSSION
Non-union was the main complication in talonavicular arthrodesis. The rate of secondary ankle surgery was significantly elevated in double arthrodesis. These findings support Suckel's cadaver studies, which, in 2007, reported early deterioration in ankle status in double arthrodesis, due to mechanical overloading. Talocalcaneal arthrodesis proved reliable and simple, free of major complications and with a 100% satisfaction rate.
CONCLUSION
Double arthrodesis showed the greatest benefit in terms of restoring foot architecture, but was associated with a higher rate of deterioration in ankle status. Preventive double arthrodesis is not recommended in case of isolated arthritis with reducible hindfoot malalignment.
Topics: Adult; Aged; Arthritis, Rheumatoid; Arthrodesis; Bone Malalignment; Cohort Studies; Female; Foot Deformities, Acquired; Humans; Male; Middle Aged; Pain Measurement; Postoperative Complications; Prognosis; Radiography; Range of Motion, Articular; Recovery of Function; Reoperation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Subtalar Joint; Tarsal Joints; Treatment Outcome
PubMed: 22939106
DOI: 10.1016/j.otsr.2012.06.006 -
Foot & Ankle International Dec 1994A modification of internal fixation compression arthrodesis for ankle fusion is described using two 6.5-mm cancellous bone screws and a lateral T plate. Using this...
A modification of internal fixation compression arthrodesis for ankle fusion is described using two 6.5-mm cancellous bone screws and a lateral T plate. Using this technique, 20 consecutive arthrodeses by one surgeon were reviewed. Solid union was attained in 19 of 20 patients (95%). Average follow-up was 18 months (range 6-59 months). Time to obtain solid arthrodeses averaged 18 weeks. In 11 patients who returned for follow-up, clinical grading using the Mazur scale score averaged 70 of 90 points. Diagnoses included posttraumatic degenerative arthritis, failed ankle arthrodesis and rheumatoid arthritis (2 each), failed ankle arthroplasty, and post-tuberculous arthritis (1 each). Complications included one malunion and one asymptomatic screw malposition. All patients attaining union were pleased with the procedure.
Topics: Aged; Ankle Joint; Arthrodesis; Female; Humans; Internal Fixators; Male; Middle Aged; Postoperative Complications; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 7894636
DOI: 10.1177/107110079401501204 -
Foot and Ankle Surgery : Official... Jun 2018We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint...
BACKGROUND
We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1).
METHODS
Of 438 MTP1 arthrodeses performed over a 13-year period, 12 feet returned with a painful keratoma beneath a gradually hyperextending interphalangeal joint of the great toe (IPJ1) from unexcised, unrecognized or recognized HIPJS. We identified another 7 feet with HIPJS, which did not develop symptoms after MTP1 arthrodesis. Angles at which arthrodesis had been performed were measured.
RESULTS
All big toes had been arthrodesed in good position, clinically and radiologically, with no difference between the two groups in angles subtended by the proximal phalanx of the arthrodesed big toe with the ground. Good outcomes followed surgical excision of the symptomatic HIPJS.
CONCLUSIONS
The presence of a HIPJS should be excluded in the differential diagnosis of IPJ1 symptoms developing after MTP1 arthrodesis. Furthermore, one should look out for and consider prophylactic excision of a HIPJS at time of MTP1 arthrodesis.
Topics: Aged; Arthrodesis; Bone Plates; Bone Screws; Female; Follow-Up Studies; Hallux; Hallux Valgus; Humans; Metatarsophalangeal Joint; Middle Aged; Radiography; Retrospective Studies
PubMed: 29933965
DOI: 10.1016/j.fas.2018.04.001 -
Medizinische Klinik Sep 1951
Topics: Arthrodesis; Humans; Joints
PubMed: 14882033
DOI: No ID Found