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Operative Orthopadie Und Traumatologie Feb 2020Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. (Review)
Review
OBJECTIVE
Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis.
INDICATIONS
Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint.
CONTRAINDICATIONS
Local infection of the thumb metacarpophalangeal joint area.
SURGICAL TECHNIQUE
Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K‑wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis.
POSTOPERATIVE MANAGEMENT
Splint for 3 weeks. Full load after 6-8 weeks.
RESULTS
The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.
Topics: Arthrodesis; Collateral Ligaments; Humans; Metacarpophalangeal Joint; Thumb; Treatment Outcome
PubMed: 30806716
DOI: 10.1007/s00064-019-0592-x -
Clinics in Podiatric Medicine and... Jan 2009Salvage of a failed hindfoot arthrodesis is an extensive undertaking for the surgeon and patient. With increased morbidity and postoperative convalescence and... (Review)
Review
Salvage of a failed hindfoot arthrodesis is an extensive undertaking for the surgeon and patient. With increased morbidity and postoperative convalescence and complications, patients must understand the risk involved in this type of revisional surgery. This article provides a systematic approach to revisional hindfoot arthrodeses, focusing on patient evaluation, surgical technique, and postoperative treatment.
Topics: Ankle Joint; Arthrodesis; Arthroscopy; Bone Malalignment; Foot; Foot Deformities, Acquired; Humans; Orthopedic Fixation Devices; Osteomyelitis; Patient Selection; Podiatry; Postoperative Care; Radiography; Reoperation; Risk Factors; Treatment Failure
PubMed: 19121754
DOI: 10.1016/j.cpm.2008.09.009 -
Handchirurgie, Mikrochirurgie,... Feb 2019These review article analyses the described techniques for fusion of the proximal interphalangeal joint regarding their advantages and disadvantages with respect to the... (Review)
Review
These review article analyses the described techniques for fusion of the proximal interphalangeal joint regarding their advantages and disadvantages with respect to the approach, surgical technique resecting the articular surface, angle of fusion, and the postoperative treatment.
Topics: Arthrodesis; Finger Joint; Humans
PubMed: 30836414
DOI: 10.1055/a-0833-8729 -
The Veterinary Clinics of North... Sep 2012Arthrodesis is an elective surgical procedure designed to eliminate articular pain and dysfunction by deliberate osseous fusion. A percutaneous approach can be used to... (Review)
Review
Arthrodesis is an elective surgical procedure designed to eliminate articular pain and dysfunction by deliberate osseous fusion. A percutaneous approach can be used to perform tarsal and carpal arthrodeses in dogs and cats. Intraoperative imaging facilitates cartilage debridement performed with a burr inserted through stab incisions. The plate is introduced through an epiperiosteal tunnel and secured with screws inserted through the skin insertion incisions. Additional screws can be placed through separate stab incisions. The primary advantage of this technique is a decreased risk of soft tissue complications such as plantar necrosis or wound dehiscence. Preliminary clinical results are promising.
Topics: Animals; Arthrodesis; Bone Plates; Carpus, Animal; Cats; Debridement; Dogs; Metatarsal Bones; Postoperative Complications; Tarsus, Animal
PubMed: 23040310
DOI: 10.1016/j.cvsm.2012.07.001 -
Foot & Ankle Specialist Dec 2013Although the gold standard to address hallux rigidus that fails conservative treatment is an arthrodesis, some surgeons have attempted to use arthroplasty to improve... (Review)
Review
INTRODUCTION
Although the gold standard to address hallux rigidus that fails conservative treatment is an arthrodesis, some surgeons have attempted to use arthroplasty to improve range of motion and to simulate a normal joint. When these implants do fail, a salvage MTP arthrodesis is the only surgical option for these patients. This research aims to outline various methods to arthrodese the MTP joint in salvage situations.
METHODS
We retrospectively looked at patients who underwent a first-MTP fusion after failure of an implant arthroplasty. All fusions involved either bone allograft or autograft and internal fixation. The patients were assessed clinically, radiographically, and with the Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS MTP-IP) clinical questionnaire preoperatively and postoperatively.
RESULTS
In all, 11 patients met the inclusion criteria. The average age of patients at the time of the salvage MTP arthrodesis was 57 years. The interval time between primary surgery and revision arthrodesis was on average 84.2 months. There was a high reoperation rate, with 7 operative procedures occurring per 12 arthrodeses (58%). The average time to radiographic fusion was 6.9 ± 4.8 months; 41.7% of patients had a delayed union (>6 months to fusion). Two patients had symptomatic nonunions (16.7%). All the patients had an improvement in their AOFAS MTP-IP score.
CONCLUSION
Although salvage arthrodeses for failed arthroplasties generally have favorable satisfaction rates and are a powerful tool in treating this painful condition, they are fraught with complications. They unite slower, have a significantly higher reoperation rate, and have lower AOFAS scores than primary fusions.
Topics: Adult; Aged; Arthrodesis; Arthroplasty, Replacement; Cohort Studies; Female; Follow-Up Studies; Hallux Rigidus; Humans; Joint Prosthesis; Male; Metatarsophalangeal Joint; Middle Aged; Pain Measurement; Patient Satisfaction; Prosthesis Failure; Radiography; Range of Motion, Articular; Recovery of Function; Reoperation; Retrospective Studies; Risk Assessment; Salvage Therapy; Treatment Outcome
PubMed: 24026086
DOI: 10.1177/1938640013502725 -
Clinics in Podiatric Medicine and... Jan 2004First MTP joint arthrodesis continues to be a time-honored, effective, and valuable procedure as a primary or secondary surgery for various pathologies afflicting the... (Review)
Review
First MTP joint arthrodesis continues to be a time-honored, effective, and valuable procedure as a primary or secondary surgery for various pathologies afflicting the first ray segment. Though commonly thought of as a salvage procedure, it has proven beneficial in the management of primary hallux limitus and rigidus, geriatric hallux valgus deformity, severe arthritis of any etiology, and conditions in which joint instability or deformity are not readily correctable by more traditional approaches. Since its initial description in the 1800s, the procedure has continued to be popular among orthopedic and podiatric surgeons. Success of the procedure is highly dependent on the position of fusion. Though surgeons are often fascinated and at times obsessed with a particular fixation technique, it cannot be over-emphasized that this takes a back seat to the importance of achieving proper position to meet the needs of an individual patient. Unlike joint resection or implant arthroplasty procedures, which commonly leave the hallux lacking stability and propulsion, first MPJ fusion has been shown to be effective during weight bearing and propulsion. The success enjoyed by the senior author continues to reinforce that motion is not necessary at the first MTP joint for good, pain-free function.
Topics: Arthrodesis; Foot Deformities; Humans; Metatarsophalangeal Joint; Orthopedic Fixation Devices
PubMed: 15012033
DOI: 10.1016/S0891-8422(03)00111-3 -
Hand (New York, N.Y.) Sep 2022Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion...
BACKGROUND
Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation.
METHODS
The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications.
RESULTS
Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; < .0001). Opioid use within 90 days before surgery ( = 1.00), positive smoking history ( = 1.00), race ( = .30), comorbidity count ( = .25), and body mass index ( = .19) were not associated with increased risk of reoperation.
CONCLUSIONS
At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.
Topics: Analgesics, Opioid; Arthrodesis; Follow-Up Studies; Humans; Retrospective Studies; Wrist
PubMed: 33106027
DOI: 10.1177/1558944720964972 -
Hand Surgery & Rehabilitation Jun 2023A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with... (Meta-Analysis)
Meta-Analysis Review
A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.
Topics: Humans; Carpal Bones; Wrist; Wrist Joint; Osteoarthritis; Arthrodesis
PubMed: 37031919
DOI: 10.1016/j.hansur.2023.03.006 -
Operative Orthopadie Und Traumatologie Jun 2016Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. (Clinical Trial)
Clinical Trial
OBJECTIVE
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.
INDICATIONS
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.
CONTRAINDICATIONS
Inflammation, vascular disturbances, nicotine abuse.
SURGICAL TECHNIQUE
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.
POSTOPERATIVE MANAGEMENT
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle.
RESULTS
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Screws; Bone Wires; Exercise Therapy; Female; Flatfoot; Humans; Male; Middle Aged; Subtalar Joint; Treatment Outcome; Young Adult
PubMed: 26895251
DOI: 10.1007/s00064-016-0438-8 -
Der Orthopade Aug 2005For the correction of hallux valgus, as one of the most common deformities of the lower limbs, a modified Lapidus arthrodesis is applied at the base of the hallux. After... (Review)
Review
For the correction of hallux valgus, as one of the most common deformities of the lower limbs, a modified Lapidus arthrodesis is applied at the base of the hallux. After using a lateral tissue technique with medial capsular reefing, a general arthrodesis of the tarsometatarsal 1 joint is carried out. An unstable hallux is the indication for a classic Lapidus arthrodesis. Before determination of the indication, an exact clinical x-ray examination should be made in the dorsoplanar position as well as laterally standing. Complications associated with the Lapidus arthrodesis are postoperative metatarsalgia and pseudoarthrosis. Advantages of this technique are, for example, a high correction potential and better healing, although the surgical technique and post-operative care are more time consuming than for other methods.
Topics: Arthrodesis; Bone Screws; Follow-Up Studies; Foot Joints; Hallux Valgus; Humans; Joint Instability; Metatarsalgia; Postoperative Care; Postoperative Complications; Pseudarthrosis; Radiography; Reoperation; Time Factors; Treatment Outcome
PubMed: 16028050
DOI: 10.1007/s00132-005-0832-7