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Journal of Feline Medicine and Surgery Jan 2018Case series summary Pantarsal arthrodesis (PTA) was performed in seven tarsi of six cats, using orthogonal (dorsal and medial) veterinary cuttable plates (VCPs) without...
Case series summary Pantarsal arthrodesis (PTA) was performed in seven tarsi of six cats, using orthogonal (dorsal and medial) veterinary cuttable plates (VCPs) without postoperative external coaptation. Short-term outcomes, arthrodesis progression and complications were assessed using a retrospective review of case notes (veterinary examination) and radiographs. Long-term outcomes were assessed via owner questionnaire (Feline Musculoskeletal Pain Index [FMPI]). Mean angle of PTA was 136° (range 116-166°). Intraoperative complications were recorded in two cases, both involving failure of the drill bit during drilling for calcaneotibial screws. Postoperative complications were encountered in a case of bilateral single-session PTA. These included gastrocnemius myotendinopathy on the right, and long-term protrusion of a screw head from the skin on the left. Both complications were resolved surgically, through resection of the implicated gastrocnemius tendon of insertion and removal of the plate, respectively. FMPI assessment was performed for all six cats a mean of 8.8 months (range 6-16 months) following surgery. Mean score for the first part (assessing ability to perform normal activities) was 92.2% (range 80.9-97.1%). Mean score for the second part (owner perception of pain) was 95.8% (range 87.5-100%). Mean overall score (mean score for parts 1 and 2 combined) was 92.3% (range 81.6-97.4%). PTA may be performed in cats using orthogonal VCPs to treat severe tarsal injuries. It may be prudent to avoid single-session bilateral PTA in cats. Relevance and novel information This case series documents a novel technique as an alternative for PTA in cats with talocrural injuries. Long-term outcome and complications presented in this case series are evaluated and discussed.
Topics: Animals; Arthrodesis; Bone Plates; Cat Diseases; Cats; Fracture Fixation, Internal; Retrospective Studies; Tarsus, Animal
PubMed: 29172960
DOI: 10.1177/1098612X17698264 -
Clinical Orthopaedics and Related... Dec 2014Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure....
BACKGROUND
Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns.
QUESTIONS/PURPOSES
(1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used?
METHODS
During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation.
RESULTS
All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion.
CONCLUSIONS
Primary ankle arthrodesis combined with fracture reduction for the severely comminuted tibial pilon fracture reliably healed and restored acceptable function in this highly selective patient group. Ring external fixation may be a useful adjunct to internal fixation, and this concept should be further studied.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Ankle Joint; Arthrodesis; Disability Evaluation; External Fixators; Female; Fracture Fixation; Fracture Fixation, Internal; Fracture Healing; Fractures, Comminuted; Humans; Male; Middle Aged; Reoperation; Retrospective Studies; Severity of Illness Index; Tibia; Tibial Fractures; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24844887
DOI: 10.1007/s11999-014-3683-x -
Acta Orthopaedica Et Traumatologica... May 2020The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal arthrodesis using a retrograde nail.
OBJECTIVE
The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcaneal arthrodesis using a retrograde nail.
METHODS
A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)] who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery was massive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfoot derangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by their American Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed.
RESULTS
The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able to walk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing. The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points; p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of the surgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patients had deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed after the treatment but never recovered full weight bearing and the other one died from other complications. These two deep infections occurred after 23 months of follow-up.
CONCLUSION
Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfoot disorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated, it is a safe procedure with good clinical outcomes and low risk of below-knee amputation.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
Topics: Arthrodesis; Calcaneus; Comorbidity; Diabetes Mellitus; Female; Fracture Fixation, Intramedullary; Humans; Joint Diseases; Male; Middle Aged; Outcome and Process Assessment, Health Care; Postoperative Complications; Radiography; Recovery of Function; Reoperation; Retrospective Studies; Tibia
PubMed: 32544061
DOI: 10.5152/j.aott.2020.03.334 -
Foot and Ankle Surgery : Official... Aug 2020Biomechanical studies have shown a higher compressive force and higher torsional stiffness for fixation with three screws compared to two screws. However, clinical data...
BACKGROUND
Biomechanical studies have shown a higher compressive force and higher torsional stiffness for fixation with three screws compared to two screws. However, clinical data to compare these fixation techniques is still lacking.
METHODS
A retrospective analysis of 113 patients was performed, who underwent isolated subtalar fusion between January 2006 and April 2018.
RESULTS
Revision arthrodesis was required in 8% (n=6/36) for 3-screw-fixation and 38% (n=35/77) for 2-screw-fixation. For 3-screw-fixation, non-union, was observed in 14% (n=5/36) compared to 35% (n=27/77) in 2-screw fixation. Non-union (p=.025) and revision arthrodesis (p=.034) were significantly more frequent in patients with 2 screws. A body mass index ≥30kg/m (p=.04, OR=2.6,95%CI:1.1-6.3), prior ankle-fusion (p=.017,OR=4.4,95%CI:1.3-14.5) and diabetes mellitus (p=.04,OR=4.9,95%CI:1.1-17.8) were associated with a higher rate of revision arthrodesis.
CONCLUSIONS
Our findings suggest that successful subtalar fusion is more reliably achieved with use of three screws. However, future prospective studies will be necessary to further specify this recommendation.
Topics: Adult; Arthrodesis; Body Mass Index; Bone Screws; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Prospective Studies; Reoperation; Retrospective Studies; Subtalar Joint
PubMed: 31522872
DOI: 10.1016/j.fas.2019.08.017 -
The Bone & Joint Journal Nov 2013Hip arthrodesis remains a viable surgical technique in well selected patients, typically the young manual labourer with isolated unilateral hip disease. Despite this,... (Review)
Review
Hip arthrodesis remains a viable surgical technique in well selected patients, typically the young manual labourer with isolated unilateral hip disease. Despite this, its popularity with patients and surgeons has decreased due to the evolution of hip replacement, and is seldom chosen by young adult patients today. The surgeon is more likely to encounter a patient who requests conversion to total hip replacement (THR). The most common indications are a painful pseudarthrosis, back pain, ipsilateral knee pain or contralateral hip pain. Occasionally the patient will request conversion because of difficulty with activities of daily living, body image and perceived cosmesis. The technique of conversion and a discussion of the results are presented.
Topics: Activities of Daily Living; Arthrodesis; Arthroplasty, Replacement, Hip; Body Image; Esthetics; Hip Joint; Humans; Patient Selection; Postoperative Complications; Reoperation; Risk Factors
PubMed: 24187367
DOI: 10.1302/0301-620X.95B11.32908 -
Veterinary and Comparative Orthopaedics... 2010To evaluate and compare long-term functional outcome after partial carpal arthrodesis and pancarpal arthrodesis in dogs using kinetic gait analysis.
OBJECTIVES
To evaluate and compare long-term functional outcome after partial carpal arthrodesis and pancarpal arthrodesis in dogs using kinetic gait analysis.
METHODS
Fourteen dogs with 19 partial carpal or pancarpal arthrodeses were retrospectively examined and underwent force-plate gait analysis. Mean times since surgery were 29.4 and 24.4 months for pancarpal and partial carpal arthrodesis respectively. Vertical and braking-propulsive ground reaction force profiles were compared between treatment groups, and to those of normal dogs (control group) using Kruskal-Wallis one-way analysis of variance.
RESULTS
With the exception of time to vertical peak that occurred earlier in dogs with pancarpal than in dogs with partial carpal arthrodesis (p <0.01), there was no difference between the two treatment groups. Several parameters differed significantly between operated and healthy dogs (p <0.01): vertical impulses were significantly lower in both treatment groups, braking forces and impulses were also reduced after both techniques. Propulsive forces and impulses were only reduced in dogs with pancarpal arthrodesis. When comparing gait parameters of sound limbs of unilateral operated dogs to those of control dogs, braking forces and impulses (p <0.01; p <0.05) were significantly higher in the sound legs of unilateral operated dogs.
CLINICAL SIGNIFICANCE
Long-term outcome after partial carpal and pancarpal arthrodesis is good and comparable to each other. Propulsive action may be altered more in dogs with pancarpal arthrodesis.
Topics: Animals; Arthrodesis; Biomechanical Phenomena; Carpal Bones; Dog Diseases; Dogs; Gait; Kinetics; Movement; Retrospective Studies
PubMed: 19997672
DOI: 10.3415/VCOT-09-03-0030 -
Journal of Orthopaedic Surgery and... Aug 2016Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for...
BACKGROUND
Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint.
METHODS
From 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis. All surgeries were completed by a senior surgeon in the same hospital. These patients were 18~76 years (mean 54.6 years) old; the duration of their disease was 9~38 months (mean 13.2 months). The study population included 12 males and 11 females; 12 patients underwent surgery on the left and 11 on the right. Indications for surgery included avascular necrosis of the talus (n = 14), severe posttraumatic arthritis (n = 4), osteoarthritis (n = 2), terminal tuberculous arthritis (n = 1), rheumatoid arthritis (n = 1) and Charcot neuroarthropathy (n = 1). A lateral oblique incision was performed to expose the subtalar joint, and an anteromedial longitudinal incision was used to expose the ankle joint. After the articular surfaces were removed, the tibia, talus and calcaneus were carefully aligned and fixed with two headless compression screws. Patients were followed up at 6 weeks and 3, 6 and 9 months after surgery; they were evaluated by Roles and Maudsley patient satisfaction scores, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) score and radiographic evaluation.
RESULTS
Seventeen patients were studied, with a mean follow-up time of 6.5 months (range 5-24). The mean Roles and Maudsley patient satisfaction score was 1.41 at the last follow-up; most of the patients were satisfied with the surgery results. The mean preoperative AOFAS Ankle-Hindfoot Score was 29.6 (range 18-37), while the mean last follow-up AOFAS Ankle-Hindfoot Score was 68.5 (range 61-80). The VAS score for preoperative functional pain was 6.95 (range 3-10) compared to 1.56 (range 0-3) postoperatively (P < 0.001). The mean surgical duration was 57 (range 42-125) min. The mean time to union was 3.8 months (range 3-12 months); fusion of the ankle and subtalar joint was successful in all patients. One patient experienced delayed wound healing.
CONCLUSIONS
Tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint is an effective treatment that is minimally invasive and is associated with a short operation time, high fusion rate, low incidence of complications and good postoperative recovery.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Screws; Compressive Strength; Female; Follow-Up Studies; Humans; Male; Middle Aged; Subtalar Joint; Tibia
PubMed: 27542719
DOI: 10.1186/s13018-016-0425-7 -
Orthopaedics & Traumatology, Surgery &... May 2023Total wrist arthrodesis is effective in reducing pain in osteoarthritic wrist, but at the cost of range of motion. The aim of the present study was to assess patient... (Observational Study)
Observational Study
INTRODUCTION
Total wrist arthrodesis is effective in reducing pain in osteoarthritic wrist, but at the cost of range of motion. The aim of the present study was to assess patient satisfaction after post-traumatic total wrist arthrodesis, complications and risk factors.
HYPOTHESIS
Post-traumatic total wrist arthrodesis provides a high rate of satisfaction.
PATIENTS AND METHODS
A single-center retrospective observational satisfaction survey was carried out for the period 2005-2020 by telephone interview.
RESULTS
Forty-two post-traumatic dorsal plate total wrist arthrodeses were included. Mean follow-up was 97 months. Total arthrodesis achieved a mean 75% reduction in pain, with good functional results (QuickDASH: 23±9.1 [11-42]) and satisfaction (83% of patients very satisfied or satisfied). Seventy-two percent of patients continued in their previous work. The complications rate was 48%. Twenty patients had complications, including 14 (33%) requiring surgical revision. Thirteen patients (31%) had hardware removed due to plaque discomfort and 1 due to bone and joint infection. Seven patients showed CRPS.
CONCLUSION
Total wrist arthrodesis provided good results in terms of pain relief and satisfaction, at the cost of loss of motion. It is a reliable surgical technique, with an essential place in the therapeutic algorithm for post-traumatic osteoarthritic wrist, particularly in manual workers.
LEVEL OF EVIDENCE
IV, single-center retrospective observational study.
Topics: Humans; Arthrodesis; Follow-Up Studies; Pain; Patient Satisfaction; Range of Motion, Articular; Retrospective Studies; Wrist; Wrist Joint
PubMed: 36627050
DOI: 10.1016/j.otsr.2023.103546 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jul 2023Ankle arthritis affects approximately 1% of the adult population worldwide and represents a serious global disease burden. However, compared with hip arthritis and knee...
Ankle arthritis affects approximately 1% of the adult population worldwide and represents a serious global disease burden. However, compared with hip arthritis and knee arthritis, the clinical understanding and treatment of ankle arthritis are still in their infancy. For end-stage ankle arthritis, ankle arthrodesis was considered as the "gold standard" in the past. However, ankle arthrodesis will result in loss of joint mobility, altered gait, limited daily activities, and accelerated degeneration of adjacent joints. Therefore, how to preserve the range of motion of the ankle joint while relieving pain is the key to the treatment of ankle arthritis. Currently, the surgical treatment of ankle arthritis includes arthroscopic debridement, periarticular osteotomies, osteochondral transplantation, ankle distraction arthroplasty, ankle arthrodesis, and total ankle arthroplasty. The choice of treatment should be individualized and based on various factors such as the patient's symptoms, signs, imaging performance, complaints, and financial situation. However, there are no guidelines that give clear treatment recommendations. Therefore, it is necessary to conduct extensive and in-depth discussions on the diagnosis and treatment of ankle arthritis.
Topics: Adult; Humans; Ankle; Arthritis; Arthroplasty, Replacement, Ankle; Ankle Joint; Physical Therapy Modalities; Arthrodesis; Treatment Outcome
PubMed: 37460170
DOI: 10.7507/1002-1892.202306039 -
Hand (New York, N.Y.) May 2023Hand deformities secondary to scleroderma can limit activities of daily living and be associated with substantial disability. This study aimed to evaluate the outcomes...
BACKGROUND
Hand deformities secondary to scleroderma can limit activities of daily living and be associated with substantial disability. This study aimed to evaluate the outcomes following arthrodesis performed to treat digital contractures secondary to scleroderma.
METHODS
We performed a retrospective review of all patients with scleroderma who underwent arthrodesis by a single surgeon from 2015 to 2020. We collected demographic information, operative variables, and outcomes variables. Our primary outcome was occurrence of any postoperative complication, which we defined to include wound dehiscence, digital ischemia, malunion, nonunion, cellulitis, and osteomyelitis. We calculated descriptive statistics and performed all analyses at the joint level.
RESULTS
We identified 9 patients who underwent arthrodesis of 19 joints. All patients were women with a mean age of 55.3 years. At the time of surgery, most patients were taking disease-modifying antirheumatic drugs (DMARDs). Kirschner wires (K-wires) were used in most cases (n = 18), 15 of which were removed uneventfully at an average of 4.8 months after surgery. With a mean follow-up time of 15.4 months, the overall complication rate was 5.3% (n = 1). This patient developed digital ischemia in 1 of 4 operative digits, which became gangrenous and required amputation.
CONCLUSIONS
Our study suggests that arthrodesis can be performed safely in the scleroderma hand, even when patients are taking DMARDs. Given the uneventful K-wire removal in all joints and the high risk of exposure of buried hardware in this population, we recommend nonpermanent placement of K-wires. Hand surgeons may consider arthrodesis in the scleroderma hand before proceeding to revision amputation.
Topics: Humans; Female; Middle Aged; Male; Activities of Daily Living; Hand; Arthrodesis; Bone Wires; Postoperative Complications; Ischemia
PubMed: 34521226
DOI: 10.1177/15589447211043190