Objective To evaluate the effectiveness of Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects. Methods Between January 2014 and April 2016, 14 patients with ankle joints infection and bone defects were treated by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage. There were 12 males and 2 females with an average age of 39.8 years (range, 25-61 years). The causes of ankle infection included falling from height injury in 5 cases, falling injury in 4 cases, traffic accident injury in 1 case, crushing injury in 1 case, sprain injury in 1 case, and hematogenous reason in 2 cases. All the patients received surgery for 0-8 times (mean, 3.7 times) before admission. The modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was 30.25±3.54 before operation. The disease duration was 1-30 months (mean, 10.3 months). Results All the incisions healed by first intension without recurrence of infection, and two-stage bone grafting operation did not performed. One case felt slight local pain and swell of ankle joint after weight-bearing walking more than 30 minutes, and without special treatment. All the patients had different degree skin redness and swelling of Kirschner wire pinhole for 0-3 times, and relieved after symptomatic treatment. All the patients were followed up 6-27 months (mean, 16.8 months). Except for 2 cases who did not remove the external fixator (with external fixation time of 6 months and 8 months respectively), the other patients removed the external fixator at 6-14 months (mean, 9 months) after operation, all patients recovered the walk function and without ankle pain. The modified AOFAS ankle and hindfoot score after removal of external fixator (70.92±1.0) was significantly higher than preoperative one (t=–10.992, P=0.000). Conclusion It is a simple and effective method for one-stage treatment of ankle joints infection and bone defects by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis.
Objective To compare the effectiveness of supramalleolar osteotomy (SMOT) and ankle arthrodesis (AA) in the treatment of inverted ankle osteoarthritis (OA) in Takakura 3A stage with talus tilt. Methods The clinical data of 41 patients with inverted ankle OA in Takakura 3A stage with talus tilt admitted between January 2016 to January 2020 and met the selection criteria were retrospectively analyzed, and they were divided into SMOT group (21 cases) and AA group (20 cases) according to the surgical method. There was no significant difference in baseline data such as gender, age, affected side, cause of injury, and preoperative talar tilt angle (TT), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, short-form 36 health survey scale (SF-36) score, and sagittal range of motion (ROM) between the two groups (P>0.05). The operation time, intraoperative blood loss, partial weight-bearing time, and complications were recorded in the two groups. AOFAS ankle-hindfoot score, VAS score, SF-36 score, and sagittal ROM were used to evaluate the effectiveness. Bone healing was observed and the time of bony healing was recorded. In the SMOT group, the tibial lateral surface angle (TLS), TT, and the tibial articular surface angle (TAS) were measured on ankle joint weight-bearing anteroposterior and lateral X-ray films and compared with those before operation. And Takakura staging assessment was also performed. ResultsThe operation time and intraoperative blood loss in AA group were significantly less than those in SMOT group (P<0.05). Patients in both groups were followed up 24-36 months, with an average of 28.9 months. Incision infection occurred in 2 patients in SMOT group and 1 patient in AA group, respectively, and no vascular or nerve injury occurred in both groups. The partial weight-bearing time of SMOT group was significantly less than that of AA group (P<0.05), but there was no significant difference in bony healing time between the two groups (P>0.05). At last follow-up, the difference of VAS score and SF-36 score before and after operation of AA group were less than those of SMOT group, and the difference of sagittal ROM before and after operation in SMOT group was less than that of AA group, with significant differences (P<0.05). The difference of AOFAS ankle-hindfoot score before and after operation in AA group was slightly greater than that in SMOT group, but the difference was not significant (P>0.05). The above scores in both groups significantly improved when compared with those before operation (P<0.05). Sagittal ROM in AA group was significantly less than that before operation (P<0.05), while there was no significant difference in SMOT group (P>0.05). In the SMOT group, 17 patients (81.0%) showed improvement in imaging staging, 2 patients (9.5%) showed no improvement in staging, and 2 patients (9.5%) showed stage aggravation. TLS, TAS, and TT significantly improved when compared with those before operation (P<0.05). At last follow-up, 2 patients in SMOT group received AA due to pain and stage aggravation, and 1 patient with bone nonunion underwent bone graft. Subtalar joint fusion was performed in 1 case of subtalar arthritis in AA group.Conclusion For inverted ankle OA in Takakura 3A stage with talus tilt, both SMOT and AA can significantly releave pain, improve foot function and quality of life, but AA has more definite effectiveness and better patient satisfaction.
Objective To review the latest research progress of fixation techniques of ankle arthrodesis.Methods The l iterature concerning the research of fixation techniques of ankle arthrodesis in recent years was reviewed. Then the characteristics and new research progress of different internal and external fixation techniques were analysed and compared. Results There are plenty of different types of internal and external fixation devices, each with distinct characteristics. Now it is widely considered that internal fixation is the first choice for end-stage ankle arthropathy. However, under the circumstances that patients with serious bone defect, chronic active infection, or extensive soft tissue damage are not suitable for internal fixation, ankle arthrodesis with external fixation is still a safe and effective method. Conclusion For severe or end-stage ankle arthropathy, ankle arthrodesis is a mature therapeutic way with exact effect. Researches on these two aspects, expansion of indications of internal fixation and comparison and combination of internal and external fixation techniques, need to be deepened, which is of great significance for choosing a better fixation method and acquiring a better therapeutic effect.
ObjectiveTo compare the parameters of screw implantation in capitolunate arthrodesis between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach based on CT images of the normal wrist, and provide reference for the selection of surgical approaches and planning of screw insertion trajectory. MethodsCT data of 50 patients who met the criteria between February 2022 and April 2022 were selected as the study objects. There were 30 males and 20 females, and the age ranged from 18 to 69 years (mean, 37 years). The normal wrist alignment was conformed in all CT images. All CT data from the unilateral wrist of the patients was imported into Mimics Medical 20.0 software to construct a three-dimensional plane model, in which a virtual 3.5 mm screw was implanted between the 2nd and 3rd metacarpal bones and via the distal dorsal capitate bone approach. The angle between screw and coronal, sagittal, and transverse planes, the total length of the screw, the length of the screw in the lunate bone and the capitate bone were measured. The ratios of the length of the screw in capitate bone to the length of the long axis of the capitate bone, the length of the screw in lunate bone to the length of the long axis of the lunate bone, and the length of screw in lunate bone to the length of the screw in capitate bone were calculated. Assuming that the result of screw implantation between the 2nd and 3rd metacarpal bones was better than that via the distal dorsal capitate bone approach, the difference in length of the screw in the lunate bone between the two approaches was calculated, and the superiority test was performed. ResultsCompared with the distal dorsal capitate bone approach, the total length of the screw increased, the length of the screw in the capitate bone decreased, and the length of the screw in the lunate bone increased, the angle between the screw and coronal plane decreased, the angles between screw and sagittal, transverse planes increased after the screw was implanted between the 2nd and 3rd metacarpal bones. And the ratio of the length of the screw in capitate bone to the length of the long axis of capitate bone decreased, the ratio of the length of the screw in lunate bone to the length of the long axis of lunate bone increased, and the ratio of the length of the screw in lunate bone to the length of the screw in capitate bone also increased. All the differences were significant (P<0.05). The difference in the length of the screw in the lunate bone between the two approaches was 1.86 mm [95%CI (1.54, 2.18) mm], which was greater than the superiority margin (1.35 mm). The superiority hypothesis was supported. ConclusionCompared with the distal dorsal capitate bone approach, the screws implanted between the the 2nd and 3rd metacarpal bones in the capitolunate arthrodesis are longer in lunate bone and more vertical to the articular surface of the capitolunate joint. Theoretically, the capitolunate joint are more firmly fixed.
ObjectiveTo explore the feasibility and short-term effectiveness of ankle arthrodesis by ankle osteotomy-tool. MethodsA retrospective analysis was made on the data of 38 patients with end-stage ankle arthritis undergoing ankle arthrodesis between February 2009 and March 2012. There were 24 males and 14 females, with an average age of 67 years (range, 40-85 years). The left ankle was involved in 18 cases and the right ankle in 20 cases. There were 20 cases of post-traumatic arthritis, 7 cases of avascular necrosis of talus, 5 cases of rheumatoid arthritis, 5 cases of primary osteoarthritis, and 1 case of post infective arthritis. The disease duration ranged 3.2-6.1 years (mean, 4.7 years). The ankle osteotomy-tool was used to remove the joint surfaces, and proximal humeral locking plate combined with compression screws were used for internal fixation. ResultsThe operation time was 40-90 minutes (mean, 60 minutes). The healing of incisions by first intention was obtained in the other cases except 1 case of superficial infection, which was cured after dressing change. Thirty-eight patients were followed up 10 to 36 months (mean, 23 months). The ankles in 4 patients started to swell repeatedly when they walked early after operation and the swelling subsided at 1 year after rehabilitation therapy. The X-ray films showed that bone fusion was obtained at 12 weeks after operation on average (range, 10-19 weeks). No internal fixation failure or malunion occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was improved significantly from 43.11±17.49 at preoperation to 85.03±13.17 at last follow-up (t=14.412, P=0.000). The short-form 36 health survey scale (SF-36) showed that physical component summary score was increased significantly from preoperative 54.30±12.32 to postoperative 77.95±8.21 (t=7.723, P=0.000), and mental component summary score was significantly increased from preoperative 63.16±8.30 to postoperative 77.05±10.12 (t=2.523, P=0.021). According to the patients' satisfaction, 32 patients were very satisfied, 5 patients were satisfied, and 1 patient was not satisfied. The subjective satisfaction of patients was 97.37%. ConclusionAnkle arthrodesis by lateral malleolus osteotomy with ankle osteotomy-tool and internal fixation using proximal humeral locking plate and compression screws has the advantages of simple operation, less complications, rigid fixation, and high fusion rate. It may obtain a good short-term effectiveness.
Objective To investigate the clinical efficacy of selective tarsometatarsal arthrodesis for old Lisfranc injury without significant post-traumatic osteoarthritis (PTOA). Methods The clinical data of patients with old Lisfranc injury without significant PTOA who were treated by selective tarsometatarsal arthrodesis at Chengdu Pidu District People’s Hospital between June 2013 and June 2021 were analyzed retrospectively. The improvement of patients’ Visual Analogue Scale (VAS) score, American Orthopedic Foot Ankle Society (AOFAS) midfoot score and Short Form 12 (SF-12) score before surgery and at the final follow-up were compared. Results Seventeen oldLisfranc injury patients (17 feet) without significant PTOA were finally recorded, including 12 males and 5 females. All patients completed the surgery successfully, and the surgical incisions healed smoothly after surgery without complications such as poor incision healing, soft tissue ischemic necrosis, and deep and superficial infections. All patients were followed up for an average of 22.6 months (12 to 36 months). Three months after surgery, follow-up X-ray films showed bony healing of the fused ends in all patients, and the patient satisfaction was 94.1%. Compared with the preoperative scores, VAS score (6.0±0.3 vs. 0.8±0.2), AOFAS score (50.5±1.5 vs. 86.5±0.9), SF-12 physiological score (21.9±0.6 vs. 46.1±0.5) and SF-12 psychological score (31.1±0.8 vs. 47.3±0.7) at the last follow-up improved (P<0.05). Conclusion Selective tarsometatarsal arthrodesis for the old Lisfranc injuries without significant PTOA can restore the midfoot force lines and stability, avoid stiffness after full feet fusion, preserve midfoot function, and improve patient satisfaction.
Objective To evaluate the clinical results of subtalar arthrodesis and calcaneal thalamus reconstruction for malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From December 1994 to January 2006, 84 cases(96 feet) of malunion of calcaneal fractures were treated with subtalar arthrodesis and calcaneal thalamus reconstruction. The L-shaped approach lateral to calcaneus was used. The bone autograft was harvested from iliac crest. Fiftyone cases were male and 33 cases were female, aging from 21 to 58 years (mean 385 years).One side was in volved in 72 cases and two sides in 12 cases. The injury was caused by falling from height in 57 cases, by traffic accident in 22 cases and other in 5 cases. It was 6-31 months from injury to operation (mean 9.5 months). Results Among the patients, all cases were followed up 1 to 132 months. The total excellent and good rate was 87.5%, including excellent in 31 feet, good in 53 feet and fair in 12 feet,according to Hindfoot scores system (American Orthopaedics Foot and Ankle Society). The B[AKo¨]hler’s and Gissane’s angles, the height of calcaneal thalamus and width of calcaneus were significant different from those of preoperation (Plt;0.01). Conclusion The treatment by bone autograft combined with subtalar arthrodesis and calcaneal thalamus reconstruction is an effective operation for malunion of calcaneal fractures, with advantages of correcting deformity, restoring the function of indfoot and relieving the pain of walking.
Objective To evaluate the cl inical results of arthroscopical subtalar arthrodesis for malunion of calcaneal fractures. Methods Between July 2006 and December 2008, 12 cases of malunion of calcaneal fractures were treated witharthroscopical subtalar arthrodesis, inculding 10 males and 2 females with an age range of 38-54 years (44.8 years on average). The location was left side in 5 cases and right side in 7 cases. The injury was caused by fall ing from height in 8 cases, by traffic accident in 3 cases, and other in 1 case. It was 3-7 months from injury to operation. All cases were classified as Stephens type II. The total score was 35.68 ± 10.35 and the pain score was 8.14 ± 1.83 before operation according to Hindfoot scores system of American Orthopaedic Foot amp; Ankle Society (AOFAS). Results All incisions achieved parimary heal ing and the patients were all followed up 14-32 months (18 months on average). The X-ray films showed bony fusion after 10-14 weeks (11.5 weeks on average). The total score was 76.45 ± 9.83 and the pain score was 1.52 ± 1.48 after operation according to Hindfoot scores system of AOFAS, showing significant difference when compared with those before operation (P lt; 0.01). Conclusion Arthroscopical subtalar arthrodesis can get satisfactory fusion rate with few compl ications for malunion of calcaneal fractures.
ObjectiveTo summarize the surgical treatment methods for avascular necrosis of the talus. Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized. Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied. ConclusionThe surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
ObjectiveTo investigate the effectiveness of double arthrodesis to correct flatfoot deformity with pes valgus. MethodsBetween May 2009 and May 2012, 12 patients with flatfoot deformity and pes valgus were treated using subtalar and talonavicular joints arthrodesis through a single medial incision approach. There were 5 males and 7 females with an average age of 53.3 years (range, 21-78 years), including 5 left feet and 7 right feet. Of them, 11 cases had posterior tibial tendon dysfunctions; 6 cases were at Johnson-Strom stageⅢ, 5 cases at stageⅡ(c); and 1 case had tarsal coal ition. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 48.75±3.46 and 6.08±1.14, respectively. ResultsThe mean operation time was 85.6 minutes (range, 65-125 minutes). Eleven patients were followed up for 19.4 months on average (range, 13-30 months). All of the cases obtained primary healing of incision, with no complication of infection and nerve or blood vessel injury. X-ray film showed that the mean time of bone union was 9.8 weeks (range, 7-18 weeks); no bone nonunion occurred. No loosening or breakage of internal fixation was observed. Pain occurred at the calcaneal-cuboid joint (1 case) and at fixation site (1 case), and was relieved after symptomatic treatment. The mean AOFAS score and VAS score were significantly increased to 81.36±2.98 and 0.72±0.11 respectively, showing significant differences when compared with preoperative scores (t=19.946, P=0.000; t=16.288, P=0.000). ConclusionSubtalar and talonavicular joints arthrodesis by a single medial incision approach is a useful alternative to tri ple arthrodesis for the correction of flatfoot deformity with pes valgus