Trauma
Mohamed A. Imam; James Holton; Abdel Hassan; Ahmed Matthana
Abstract
Background: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap ...
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Background: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. Methods: Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm long suture needle with slotted end. This technique was supported with the use of the image intensifier. Results: The AOFAS score improved significantly from a mean of 32.4 to 94.2 (P˂0.004). Radiologically, the medial clear space (MCS), tibio-fibular clear space (TFCS) (P=0.05) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (P=0.02). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%). Conclusion: We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries. Level of evidence: IV
Ankle
E. Carlos RODRIGUEZ-MERCHAN
Abstract
replacement (TAR) in patients with advanced ankle osteoarthritis (OA). AJD could a tenable option to ankle fusion orTAR.Methods: A review has been performed on the role of AJD in advanced OA of the ankle. The exploration machinewas MedLine. The keywords utilized were: joint distraction ankle. Three hundred ...
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replacement (TAR) in patients with advanced ankle osteoarthritis (OA). AJD could a tenable option to ankle fusion orTAR.Methods: A review has been performed on the role of AJD in advanced OA of the ankle. The exploration machinewas MedLine. The keywords utilized were: joint distraction ankle. Three hundred and eleven articles were found. Ofthe above-mentioned, only 14 were chosen and analyzed because they were rigorously focused on the issue and thequestion of this paper.Results: Forty-seven patients met inclusion criteria with 15 in the acute RSA group and 32 in the secondary RSA group.The acute RSA group demonstrated better external rotation (28˚) than the secondary RSA group (18˚, P=0.0495). Theacute RSA group showed a trend towards better Single Assessment Numeric Evaluation (SANE) scores. Tuberosityhealing rate was higher in the acute RSA group.Conclusion: The types of articles published until now have a poor level of evidence (levels III and IV). The overallnumber of patients managed until now by way of AJD is 249. The published mean follow-up is very variable, from 1year to 12 years. The rate of good outcomes ranged between 73% and 91%. The percentage of failure (final anklearthrodesis or TAR) ranged between 6.2% and 44%. A minimum of 5.8 mm of distraction gap must be achieved. Anklefunction after AJD deteriorates over time. Putting together ankle movement and distraction will result in an early andmaintained profitable influence on outcome.
Mohammad Gharehdaghi; Hasan Rahimi; Alireza Mousavian
Abstract
Background: There is still controversy regarding the best technique for ankle arthrodesis to acheive stable rigid fixation along with reconstructing a functional plantigrade foot. Moreover, existing techniques have complictions related to stability, soft tissue covering, fusion rate, and exposure. ...
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Background: There is still controversy regarding the best technique for ankle arthrodesis to acheive stable rigid fixation along with reconstructing a functional plantigrade foot. Moreover, existing techniques have complictions related to stability, soft tissue covering, fusion rate, and exposure. Methods: With the anterior approach exactly on the tibialis anterior sheath, the joint was exposed and previous hardware, if any, was removed and with the safe direct approach, the ankle, hindfoot, and indirectly the subtalar joints were accessed. Then fresh cancellous bone was obtained and complete denudation was preformed. Lastly, a narrow 4.5 millimeter plate was carefully placed on what was determined to be the best final position.In this prospective study, 12 patients with severe ankle pain and arthritis enrolled from February 2010 to January 2012. Eight of them had posttraumatic arthritis and deformity with hardware, two had rheumatoid arthritis, one had poliomyelitis with severe deformity of the foot and knee, and another had chronic ulcerative ynovitis of the ankle joint. The patients were assessed clinically and radiographically for an average of two years (range: 13 months to 4 years) for functional recovery, range of motion, stability of the ankle, and imaging evidence of union. Results: Ankle deformities and pain in all 12 cases were corrected. With a short healing time and rapid recovery period, after six weeks all of the patients could walk independently. Also, scores of the Manchester–Oxford Foot Questionnaire (MOXFQ) improved significantly from 69 preoperatively to 33 postoperatively). Conclusions: Anterior ankle arthrodesis with molded plating can be an easy and safe way to manage deformities and it has excellent fusion rate and sufficient rigid fixation.