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Journal of Nippon Medical School =... 2024Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel.
BACKGROUND
Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel.
METHODS
Between August 2020 and July 2022, we operated on 117 sides with TTS. This retrospective study examined data from 8 consecutive patients (8 sides: 5 men, 3 women; average age 67.8 years) with an extraneural ganglion in the tarsal tunnel. We investigated the clinical characteristics and surgical outcomes for these patients.
RESULTS
The mass was palpable through the skin in 1 patient, detected intraoperatively in 1 patient, and visualized on MRI scanning in the other 6 patients. Symptoms involved the medial plantar nerve area (n = 5), lateral plantar nerve area (n = 1), and medial and lateral plantar nerve areas (n = 2). The interval between symptom onset and surgery ranged from 4 to 168 months. Adhesion between large (≥20 mm) ganglia and surrounding tissue and nerves was observed intraoperatively in 4 patients. Of the 8 patients, 7 underwent total ganglion resection. There were no surgery-related complications. On their last postoperative visit, 3 patients with a duration of symptoms not exceeding 10 months reported favorable outcomes.
CONCLUSIONS
Because ganglia eliciting TTS are often undetectable by skin palpation, imaging studies may be necessary. Early surgical intervention appears to yield favorable outcomes.
Topics: Male; Humans; Female; Aged; Tarsal Tunnel Syndrome; Retrospective Studies; Magnetic Resonance Imaging; Skin
PubMed: 38462440
DOI: 10.1272/jnms.JNMS.2024_91-203 -
Journal of Orthopaedic Case Reports Feb 2024The main differentials of non-traumatic heel pain are plantar fasciitis (PF), plantar heel fat pad atrophy, worn-out footwear, especially asymmetric wear and tear,...
INTRODUCTION
The main differentials of non-traumatic heel pain are plantar fasciitis (PF), plantar heel fat pad atrophy, worn-out footwear, especially asymmetric wear and tear, hyperuricemia, corns, callosities, tumors of the calcaneum, osteomyelitis, calcaneal stress fractures due to overweight or unaccustomed over usage, radiating pain from S1 nerve root compression, and seronegative spondyloarthropathies. Compression of the tibial nerve or the medial calcaneal nerve at or around the flexor retinaculum is the other possibility. In this case report, we want to highlight a sparsely known pathology, caused due to the entrapment of the first branch of the lateral plantar nerve or inferior calcaneal nerve, also known as Baxter's nerve that may present independently or accompany the common PF. Non-steroidal anti-inflammatory medications or injections of local steroids are typically used for conservative management. However, hydro-dissection or surgical release may be needed in non-responsive cases.
CASE REPORT
We present the case of a 57-year-old female with complaints of chronic pain and tenderness in the middle of the heel radiating laterally. She underwent magnetic resonance imaging that revealed chronic denervation changes in the form of marked atrophy and near complete fatty replacement of abductor digiti minimi muscle suggesting chronic Baxter neuropathy. A mildly thickened and hyperintense plantar fascia adjacent to the calcaneal spur and significant heel fat pad edema were seen too. The patient responded well to a local steroid injection and remains pain-free at the 1-year follow-up.
CONCLUSION
When heel pain is present, Baxter's nerve impingement presents as a challenging clinical diagnosis that may accompany the common PF and is often overlooked. MRI can be used to assess the denervation effects of both the acute and chronic stages of Baxter's nerve impingement by identifying abnormalities of the abductor digiti minimi muscle belly.
PubMed: 38420250
DOI: 10.13107/jocr.2024.v14.i02.4252 -
JBJS Essential Surgical Techniques 2023Painful neuromas of the foot and ankle frequently pose a treatment dilemma because of persistent pain or recurrence after resection. Primary surgical treatment of...
BACKGROUND
Painful neuromas of the foot and ankle frequently pose a treatment dilemma because of persistent pain or recurrence after resection. Primary surgical treatment of painful neuromas includes simple excision with retraction of the residual nerve ending to a less vulnerable location. The use of a collagen conduit for recurrent neuromas is advantageous, particularly in areas with minimal soft-tissue coverage options, and is a technique that has shown 85% patient satisfaction regarding surgical outcomes. Additionally, the use of a collagen conduit limits the need for deep soft-tissue dissection and reduces the morbidity typically associated with nerve burial.
DESCRIPTION
Specific steps include appropriate physical examination, preoperative planning, and supine patient positioning. The patient is placed supine with a lower-extremity bolster under the ipsilateral extremity in order to allow improved visualization of the plantar surface of the foot. A nonsterile tourniquet is placed on the thigh. The incision site is marked out, and a longitudinal plantar incision is made until proximal healthy nerve is identified-typically approximately 1 to 2 cm, but the incision can be extended up to 6 cm. The incision is made between the metatarsals, with blunt dissection carried down to the neuroma. The neuroma is sharply excised distally through healthy nerve, and a whip stitch is placed to facilitate the collagen conduit placement. The collagen conduit is passed dorsally into the intermetatarsal space and secured to the dorsal fascia of the foot. The wound is closed with 3-0 nylon horizontal mattress sutures. Postoperatively, a soft dressing is applied to the operative extremity, and patients are advised to be non-weight-bearing for two weeks. At two weeks, patients begin partial weight-bearing with use of a boot, and physical therapy is initiated. No antibiotics are necessary, and 300 mg of gabapentin is prescribed and tapered off by the six-week follow-up visit. Follow-ups are conducted at 2, 6, 12, 24, and fifty-two weeks. It is necessary to monitor for signs and symptoms of infection, surgical complications, and neuroma recurrence during follow-up appointments.
ALTERNATIVES
Simple excision of the neuroma with proximal burial into muscle or bone is a common surgical technique. However, inadequate resection of the nerve or poor surgical technique can lead to recurrent neuromas. For neuromas not responding to simple excision, other techniques have been utilized, including cauterization, chemical agents, nerve capping, and muscle or bone burial. The results of these techniques have varied, and none has gained clinical superiority over the other.
RATIONALE
A study analyzing the use of collagen conduits for painful neuromas of the foot and ankle has shown this technique to be a safe and successful alternative to the previously discussed methods of resection. That study by Gould et al. found that 85% of patients had a substantial reduction in pain, with mean visual analog scale (VAS) pain scores reducing from 8 to 10 preoperatively to 0 to 4 postoperatively. Moreover, alternative biological conduits, such as the greater saphenous vein, have proven to be costly in time and resources, as this structure is often utilized in cardiovascular bypass surgery and its harvest conveys a risk of iatrogenic nerve injury to the patient.Numerous studies focusing on excision of recurrent Morton neuromas via a plantar approach have found variable success rates. Of the patients surveyed in those studies, 75% reported substantial pain improvement. However, <50% of these queried patients reported complete pain relief. Studies analyzing the dorsal approach for revision Morton neuroma excision found similar success rates. Approximately 78% of patients reported good or excellent postoperative outcomes, and significant improvements were observed in patient postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for pain interference, intensity, and global physical health. One study comparing outcomes following plantar versus dorsal approaches for recurrent Morton neuroma found no significant difference in postoperative patient outcomes. That study suggested that surgeons utilize the approach with which they are most comfortable. Gould et al. reported an 85% success rate with collagen conduit, which was similar to if not slightly improved compared with the other prior studies. The utilization of a collagen conduit technique thus offers comparable patient outcomes for patients with difficult neuromas.
EXPECTED OUTCOMES
Recurrent neuroma resection with the use of a collagen conduit has proven to provide satisfactory patient outcomes regarding pain and neuritis symptoms. The goal of any neuroma resection is to greatly diminish or entirely eliminate nerve pain. Based on the available evidence, there has been no proven clinical superiority of any particular technique over the others. However, in the present example case, the location of the patient's neuroma in this video makes it 85% likely that the patient will report satisfactory outcomes and 50% likely that the patient will be entirely symptom-free. At two weeks postoperatively, the patient reported well controlled pain, absence of burning or tingling sensation, full range of movement in the foot, and intact sensation throughout all major nerve distributions, including the saphenous; superficial peroneal nerve; deep peroneal nerve; and sural, medial, and lateral plantar nerves. However, sensation is absent distal to the site of a neuroma resection.
IMPORTANT TIPS
Careful preoperative planting is of utmost importance.Ruling out other potential pathologies is necessary to ensure proper outcomes.Meticulous dissection should be carried out, with delicate handling of the proximal nerve ending.Excision of the nerve should be done sharply through the healthy portion of the nerve.Appropriate sizing of the nerve conduit (with a commercially available industry sizer) should be performed.The nerve conduit should be passed dorsally and secured to the dorsal fascia without any tension.
ACRONYMS AND ABBREVIATIONS
MRI = magnetic resonance imagingUS = ultrasoundVAS = visual analog scale.
PubMed: 38357467
DOI: 10.2106/JBJS.ST.22.00065 -
Frontiers in Neurology 2024ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in...
Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial.
BACKGROUND
ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD.
METHODS
This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score.
RESULTS
TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred.
CONCLUSION
The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential.
CLINICAL TRIAL REGISTRATION
https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.
PubMed: 38348165
DOI: 10.3389/fneur.2024.1327448 -
BMC Musculoskeletal Disorders Feb 2024Malignant femoral soft tissue tumors are occasionally resected together with the femoral nerves, but this can cause loss of knee extensor muscle activity. To the best of...
BACKGROUND
Malignant femoral soft tissue tumors are occasionally resected together with the femoral nerves, but this can cause loss of knee extensor muscle activity. To the best of our knowledge, no previous reports have detailed the gait analysis of such cases in combination with electromyography. Herein, we report the gait analysis of a patient who underwent left groin synovial sarcoma and left femoral nerve resection 12 years ago.
CASE PRESENTATION
We analyzed the gait of a 38-year-old man who was able to walk unaided after the resection of a synovial sarcoma in the left groin together with the ipsilateral femoral nerve. The muscle activities of the affected medial (MH) and lateral hamstrings (LH), and lateral heads of the gastrocnemius (GL) were increased during 50-75% of the stance phase. The hip flexion angle of the affected limb was smaller, and the ankle plantar flexion angle of the affected limb was larger than that of the non-affected limb. This means that in the affected limb, the hip and ankle angles were adjusted to prevent knee collapse, and the MH, LH, and GL muscles contributed in the mid- and late-stance phases. Moreover, we found that the hamstring and gastrocnemius of the affected limb worked together to keep the ipsilateral knee extended in the mid-stance phase and slightly flexed in the late-stance phase.
CONCLUSIONS
Patients capable of walking after femoral nerve resection may control their hamstrings and gastrocnemius muscles collaboratively to prevent ipsilateral knee collapse in the mid- and late-stance phases.
Topics: Male; Humans; Adult; Femoral Nerve; Gait Analysis; Sarcoma, Synovial; Gait; Walking; Knee Joint; Muscle, Skeletal; Sarcoma; Biomechanical Phenomena
PubMed: 38347547
DOI: 10.1186/s12891-024-07258-8 -
JBJS Essential Surgical Techniques 2023Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more...
BACKGROUND
Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more traditional open approaches such as medial, lateral, or even dual anterolateral. The TARIF approach allows for nearly anatomic fracture reduction and fixation of talar neck, body, and posterior dome fractures while minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach.
DESCRIPTION
Following initial closed fracture reduction and any associated procedures, we recommend obtaining computed tomography scans of the injured ankle in order to evaluate the fracture pattern and allow for preoperative planning. Most patients can be positioned prone for this procedure, except for those with fractures associated with anterior loose bodies and those with neck fractures requiring reduction, which are both amenable to lateral positioning. The feet are positioned off the end of the bed in a neutral position with room to plantar flex and dorsiflex the ankle freely for reduction maneuvers. Following induction of anesthesia and positioning of the patient, the fluoroscopic screen and arthroscopy equipment are positioned on the side opposite the surgeon. A mini C-arm is utilized for the fluoroscopy. The team may then proceed with preparing and draping the surgical field. The surgeon proceeds with creating posteromedial and posterolateral portals to view the fracture site. For talar neck fractures, we utilize standard posterolateral and posteromedial portals directly adjacent to the Achilles tendon at the level of the tip of the medial malleolus, which have previously been established as safe with respect to neurovascular structures. Of note, for talar body fractures these portals are placed slightly more distal at the level of the distal fibula, allowing the screws to be placed perpendicular to the fracture site. An accessory sinus tarsi portal can be established if further reduction to correct varus is needed. The flexor hallucis longus tendon serves as a landmark throughout the case to maintain orientation. We prefer to utilize a 1.9-mm malleable arthroscopic NanoScope (Arthrex), which maximizes our view in the small subtalar space and allows for visualization over the talar dome. A shaver is then utilized to clear out the deep joint capsule and remove fracture hematoma. In our experience, after the initial primary reduction attempt by the orthopaedic trauma provider, the fracture is relatively stable and often held by an external fixator. The remaining reduction is performed with use of manipulation of the ankle in combination with an accessory sinus tarsi portal, utilizing an elevator or a small reduction tool in 1 of the posterior portals. We have also utilized percutaneous Kirschner wires to "joystick" the fragments prior to the placement of the guidewires. We then place multiple 1.1-mm guidewires under direct arthroscopic and fluoroscopic visualization, utilizing the flexor hallucis longus tendon as our safe margin to ensure that we are lateral on the posterior talar dome. This approach in turn allows us to ensure the integrity of the neurovascular structures, such as the tibial artery and nerve medially as well as the sural nerve laterally. Finally, cannulated headless compression screws are passed over the guidewire to achieve fixation. The senior author (K.D.M.) prefers fully threaded, cannulated 3.5-mm titanium headless compression screws because the cannulation allows the guidewires to be placed through the posterolateral and posteromedial portals, while the headless design allows the screws to be placed under the articular cartilage. Additionally, the use of titanium allows for improved postoperative magnetic resonance imaging quality as well as favorable biomechanics as titanium has a modulus of elasticity similar to bone. After drilling is complete, we sequentially tighten the screws by hand to prevent varus or valgus angulation. Although we have not experienced failure or a poor bite when utilizing the 3.5-mm fully threaded compression screw, we have found that the partially threaded screw can at times have a poorer bite. Additionally, we select a 3.5-mm screw rather than a larger screw-say 5.5 mm-as we have found that the larger screws do not easily pass through our portals, which are minimal in size when utilizing this approach. Throughout this process, fluoroscopy, in tandem with arthroscopy, is obtained in multiple views to ensure that fixation and orientation are appropriate and the screws are in the optimal position, off of the articular surface. If large osseous defects or collapse are encountered, an accessory anteromedial portal is utilized to add grafting material. Following confirmation of adequate fracture fixation, final arthroscopic images of the talar dome continuity, subtalar continuity, and ankle joint during range of motion are obtained. The portal sites are closed with use of 3-0 nonabsorbable sutures, and a well-padded L and U splint is applied postoperatively.
ALTERNATIVES
Alternatives include the standard anterolateral approach to fixation or dual anterior approach, a medial or lateral approach, and external fixation with interval operative fixation.
RATIONALE
TARIF is indicated for reduction of a wide variety of talar fractures, including neck, body, and posterior facet fractures, and offers the added advantage of minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach. Additionally, TARIF is well suited for patients with a compromised soft-tissue envelope or associated vascular injury, such as those with open-fracture pathology, because the approach avoids further disruption of these tissues. The overall aim of the procedure is to obtain adequate fracture reduction while avoiding the neurovasculature and soft-tissue envelope that would commonly be encountered anteriorly. The procedure is completed through 2 incisions, a posteromedial portal and a posterolateral portal, through which the fracture is visualized, reduced, and fixated using cannulated screws. The fixated talus is tested through its range of motion while under arthroscopy and fluoroscopy to ensure adequate fixation while preserving range of motion.
EXPECTED OUTCOMES
The TARIF procedure has been shown to successfully treat many complex talar fractures. We theorize that this procedure produces equivalent outcomes when compared with the standard approaches to fracture fixation, with the added benefit of avoiding excessive soft-tissue disruption and neurovascular compromise. Our arthroscopic approach allows for direct visualization of articular injuries and reduction, with the ability to evacuate loose bodies and fracture hematoma, reducing matrix metalloproteinases (MMPs) known to cause posttraumatic ankle arthritis. Multiple case series have assessed the use of this technique, showing preserved range of motion and minimal residual pain or disability, as measured with use of multiple scoring systems such as the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot scale.
IMPORTANT TIPS
Immediately after accessing the ankle via the operative portals, identify the flexor hallucis longus tendon to prevent iatrogenic injury to the neurovascular bundle.Plantar flexion of the ankle while applying anterior force to the talar body often aids in reduction.Place the medial guidewire directly adjacent to the flexor hallucis tendon in order to ensure that it is medial enough.Utilize anterior-to-posterior fluoroscopic images of the foot and ankle to ensure screw placement.Directly visualize the fracture site as the screws are sequentially tightened in order to prevent malalignment.Countersink all screw heads and directly verify with arthroscopic visualization.
ACRONYMS & ABBREVIATIONS
MVC = motor vehicle collisionXR = x-ray (radiograph)CT = computed tomographyEx-fix = external fixatorMRI = magnetic resonance imagingFT = fully threadedFHL = flexor hallucis longusAP = anteroposteriorROM = range of motionDVT = deep vein thrombosisBID = bis in die (twice daily dosing).
PubMed: 38274280
DOI: 10.2106/JBJS.ST.22.00007 -
JBJS Essential Surgical Techniques 2023In patients with irreparable damage to the articular surfaces of the hindfoot, hindfoot arthrodesis is frequently chosen to provide pain relief and improve activities of...
BACKGROUND
In patients with irreparable damage to the articular surfaces of the hindfoot, hindfoot arthrodesis is frequently chosen to provide pain relief and improve activities of daily living. Common etiologies leading to hindfoot arthrodesis procedures include osteonecrosis, failed total ankle arthroplasty, and deformities resulting from Charcot arthropathy or rheumatoid arthritis. Traditionally, this operation utilizes an intramedullary nail to obtain fusion of the tibiotalocalcaneal joint. Although 80% to 90% of patients achieve postoperative union, the remaining 10% to 20% experience nonunion. Factors affecting the rate of nonunion include Charcot neuroarthropathy, use of nonsteroidal anti-inflammatory drugs or methotrexate, osteopenic bone, and smoking. In the present video article, we describe a tibiotalocalcaneal arthrodesis performed with use of a fibular strut autograft for repeat arthrodesis following failure of primary tibiotalocalcaneal arthrodesis or as a salvage operation in end-stage pathologies of the hindfoot. Our surgical technique yields union rates of approximately 80% and provides surgeons with a viable surgical technique for patients with complex hindfoot pathologies or fusion failure.
DESCRIPTION
The patient is placed in the supine position, and a 10-cm curvilinear incision is made including the distal 6 to 8 cm of the fibula. The incision is centered directly lateral on the fibula proximally and transitions to the posterolateral aspect of the fibula distally. As the incision continues distally, it extends inferiorly and anteriorly over the sinus tarsi and toward the base of the 4th metatarsal, using an internervous plane between the superficial peroneal nerve anteriorly and the sural nerve posteriorly. Exposure of the periosteum is carried out through development of full-thickness skin flaps. The periosteum is stripped, and a sagittal saw is used to make a beveled cut on the fibula at a 45° angle, approximately 6 to 8 cm proximal to the ankle. The fibular strut is decorticated, drilled, and stripped of the cartilage on the distal end. Preparation of the tibiotalar and subtalar joints for arthrodesis are completed through the lateral incision. The foot is placed in 0° of dorsiflexion, 5° of external rotation in relation to the tibial crest, and 5° of hindfoot valgus while maintaining a plantigrade foot. This placement can be temporarily maintained with Kirschner wires if needed. Next, the plantar surface overlying the heel pad is incised, and a guidewire is passed through the center of the calcaneus and into the medullary cavity of the tibia. Correct alignment of the guidewire is then confirmed on fluoroscopy. The fibular strut autograft is prepared for insertion while the tibiotalocalcaneal canal is reamed to 1 to 2 mm larger than the graft. The graft is tapped into position, followed by placement of two 6.5-mm cancellous screws to immobilize the joint, taking care to avoid excess contact of the fibular graft with the screws.
ALTERNATIVES
Alternatives to this procedure include traditional arthrodesis techniques, nonoperative treatment (such as rehabilitation or bracing), or no intervention. Patients with failed primary hindfoot arthrodesis may undergo an additional traditional arthrodesis, but may face an increased risk of complications and failure.
RATIONALE
A recent study has shown that the use of a fibular strut autograft for tibiotalocalcaneal arthrodesis produces union rates similar to those seen with the traditional intramedullary nailing technique. These results are important to note, as the presently described technique, which is used as a salvage procedure, produces outcomes that are equivalent to those observed for primary tibiotalocalcaneal arthrodesis with nailing, which is used for the treatment of severe trauma, extensive bone loss, or severe hindfoot pathologies. We recommend using this technique particularly in cases of failed primary tibiotalocalcaneal arthrodesis or in patients with end-stage hindfoot pathologies. The fibular strut autograft is a viable salvage option to decrease daily pain and provide quality improvement in patient activities of daily living.
EXPECTED OUTCOMES
Tibiotalocalcaneal arthrodesis with a fibular strut autograft has been shown to produce a union rate (81.2%) similar to that of the traditional arthrodesis technique with intramedullary nailing (74.4% to 90%). The strut graft provides an osteoinductive environment for healing and increases the post-arthrodesis load tolerance. Mean visual analog scale pain scores improved from 6.9 preoperatively to 1.2 postoperatively with use of this procedure. The most common complication was wound dehiscence requiring additional wound care (37.5%); its rate was higher than the rates reported in other studies of tibiotalocalcaneal arthrodesis, possibly because of the small sample size of patients undergoing such a complex procedure for a complex medical issue. Although 7 patients required a reoperation, all ultimately experienced a union and recovered postoperatively. All non-retired patients were all able to return to work.
IMPORTANT TIPS
Place your incision precisely to allow adequate exposure of both the tibiotalar and subtalar joints.Curvilinear incision should begin 6 to 8 cm proximal to, and directly lateral to, the distal end of the fibula. It should continue posterolaterally to the fibula distally and extend inferiorly and anteriorly over the sinus tarsi, toward the base of the 4th metatarsal.Prepare the tibiotalar and subtalar joints this same incision.Decorticate the fibular strut autograft; this plays a key role in obtaining fusion.Harvest the fibula 6 to 8 cm above the ankle joint line. Once the graft is harvested, smooth the edges of the fibula with a burr; this facilitates graft insertion.Finally, when immobilizing the joint, take care to avoid excessive perforation of the graft as this increases the likelihood of fracture.
ACRONYMS AND ABBREVIATIONS
OR = operating roomIM = intramedullaryCT = computed tomographyTTCA = tibiotalocalcaneal arthrodesisTTC = tibiotalocalcanealK-wire - Kirschner wire.
PubMed: 38274151
DOI: 10.2106/JBJS.ST.22.00004