Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.993
Evandro Junior Christovan Ribeiro, F. Farias, Sérgio Damião Prata, M. Rizzo
Objective: This study evaluated the reproducibility of the Lauge-Hansen classification among orthopedic residents and more experienced orthopedists. Methods: The inclusion criteria were ankle fractures with adequate radiographs taken in anteroposterior (AP), true AP and P (profile) views, which were individually analyzed by physicians. The analysis was performed based on the Lauge-Hansen classification. The raters were 5 orthopedic professionals from our department: 3 residents and 2 board-certified orthopedists (one with less than 10 years of experience, and the other with more 10 years of experience in the field). The professionals first analyzed and classified 30 ankle fracture radiographs; then, after 1 week, they were asked to perform a new evaluation. The radiographs were shown without names or other identifying information. The classifications were subsequently examined based on the analysis of the supporting material that had been previously provided for each individual. A consensus decision regarding the classification was made among all professionals at the end of the study. Results: The professionals were asked to analyze radiographs from 30 patients with ankle fracture, among whom supination-external rotation was the most common diagnosis. The results were outlined in tables and plotted in graphs; in a second evaluation performed after 1 week, there were 66% hits and 34% errors, whereas the percentage of hits in the first evaluation was 61.33%. Conclusion: The routine use of management classifications by physicians facilitates the understanding of these classifications by other professionals in the field while increasing interobserver agreement.
{"title":"PO 18116 - Reproducibility assessment of the Lauge-Hansen classification for ankle fractures","authors":"Evandro Junior Christovan Ribeiro, F. Farias, Sérgio Damião Prata, M. Rizzo","doi":"10.30795/scijfootankle.2019.v13.993","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.993","url":null,"abstract":"Objective: This study evaluated the reproducibility of the Lauge-Hansen classification among orthopedic residents and more experienced orthopedists. Methods: The inclusion criteria were ankle fractures with adequate radiographs taken in anteroposterior (AP), true AP and P (profile) views, which were individually analyzed by physicians. The analysis was performed based on the Lauge-Hansen classification. The raters were 5 orthopedic professionals from our department: 3 residents and 2 board-certified orthopedists (one with less than 10 years of experience, and the other with more 10 years of experience in the field). The professionals first analyzed and classified 30 ankle fracture radiographs; then, after 1 week, they were asked to perform a new evaluation. The radiographs were shown without names or other identifying information. The classifications were subsequently examined based on the analysis of the supporting material that had been previously provided for each individual. A consensus decision regarding the classification was made among all professionals at the end of the study. Results: The professionals were asked to analyze radiographs from 30 patients with ankle fracture, among whom supination-external rotation was the most common diagnosis. The results were outlined in tables and plotted in graphs; in a second evaluation performed after 1 week, there were 66% hits and 34% errors, whereas the percentage of hits in the first evaluation was 61.33%. Conclusion: The routine use of management classifications by physicians facilitates the understanding of these classifications by other professionals in the field while increasing interobserver agreement.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83272991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1024
Henrique Mansur, J. Paiva, Isnar Castro Júnior
Introduction: There is no consensus in the literature on the most effective technique for subtalar arthrodesis, particularly the optimal number of screws for adequate fixation. Our objective is to determine whether there is a difference in the fusion rates of subtalar arthrodesis when one or 2 compression screws are used. Methods: Retrospective study assessing the fusion rate of patients who underwent subtalar arthrodesis between January 2012 to December 2016. Fusion was determined clinically using radiographs and, when necessary, computed tomography. Results: The final sample consisted of 80 patients, 78.8% of whom were male, and the mean final evaluation time was 23.27 months. Subtalar arthrosis due to calcaneal fracture was the etiologic factor in 95% of the patients. The group that underwent arthrodesis with one screw accounted for 68.75% patients, and the group with 2 screws accounted for 31.25% patients. The incidence of nonfusion was 10.9% in the group for which one screw was used, in contrast to 4.0% in the group in which 2 screws were used, and the difference was not significant (p=0.425). Conclusion: The use of a second screw did not improve the fusion rates of subtalar arthrodesis.
{"title":"PO 18169 - Subtalar arthrodesis","authors":"Henrique Mansur, J. Paiva, Isnar Castro Júnior","doi":"10.30795/scijfootankle.2019.v13.1024","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1024","url":null,"abstract":"Introduction: There is no consensus in the literature on the most effective technique for subtalar arthrodesis, particularly the optimal number of screws for adequate fixation. Our objective is to determine whether there is a difference in the fusion rates of subtalar arthrodesis when one or 2 compression screws are used. Methods: Retrospective study assessing the fusion rate of patients who underwent subtalar arthrodesis between January 2012 to December 2016. Fusion was determined clinically using radiographs and, when necessary, computed tomography. Results: The final sample consisted of 80 patients, 78.8% of whom were male, and the mean final evaluation time was 23.27 months. Subtalar arthrosis due to calcaneal fracture was the etiologic factor in 95% of the patients. The group that underwent arthrodesis with one screw accounted for 68.75% patients, and the group with 2 screws accounted for 31.25% patients. The incidence of nonfusion was 10.9% in the group for which one screw was used, in contrast to 4.0% in the group in which 2 screws were used, and the difference was not significant (p=0.425). Conclusion: The use of a second screw did not improve the fusion rates of subtalar arthrodesis.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"151 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78824394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1090
L. Lara, Lucio Carlos Torres, G. Cervone, J. Grajales, Fábio Lemos Rodrigues
Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown. Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.
{"title":"TL 18237 - First metatarsophalangeal joint arthrodesis using a minimally invasive technique","authors":"L. Lara, Lucio Carlos Torres, G. Cervone, J. Grajales, Fábio Lemos Rodrigues","doi":"10.30795/scijfootankle.2019.v13.1090","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1090","url":null,"abstract":"Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown. \u0000Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85842268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1043
Caio A. Araujo, E. Arie, Danilo Mizusaki, M. Peccin, Jhony De Almeida Estevam, B. Barros
Objective: Given the epidemiological importance of malleolar fractures and differences in treatment choices, this study provides an update on the multiprofessional treatment of these fractures by mapping systematic reviews available in the scientific literature. Methods: The search was performed in the electronic databases Cochrane Database of Systematic Reviews (CDSR), Medline and Lilacs and in the PROSPERO international prospective register of systematic reviews, with no language or publication date restriction. The most recent search was performed on June 1, 2018. The term “ankle fracture” was used in those databases. Pubmed was also searched, using the [Mesh] term. The inclusion criteria were systematic reviews on the treatment of malleolar ankle fractures in adults. Results: Twenty-two systematic reviews were identified in the searched databases. Systematic reviews on the multiprofessional treatment of patients with malleolar fractures addressed the selection of metallic syndesmotic screw rather than absorbable screw without indicating its removal in the absence of symptoms. Furthermore, the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm was established for the diagnosis and treatment of diabetic patients. There is still no evidence that arthroscopically assisted open reduction and internal fixation (ORIF) is the best therapeutic method, nor is there biomechanical evidence that the locking plate is better than the conventional plate for treating lateral malleolar fracture in elderly people. There is strong evidence that mobility and early weight-bearing directly affect the functional prognosis of patients. Conclusion: This study was extremely important for identifying and selecting the most recent systematic reviews on the topic, thereby guiding practices regarding the best therapeutic regimen for patients with malleolar fractures.
目的:考虑到外踝骨折的流行病学重要性和治疗选择的差异，本研究通过对现有科学文献的系统回顾，为外踝骨折的多专业治疗提供了最新信息。方法:检索电子数据库Cochrane系统评价数据库(CDSR)、Medline和Lilacs以及PROSPERO国际前瞻性系统评价注册库，无语言和发表日期限制。最近一次搜索是在2018年6月1日进行的。这些数据库中使用的术语是“踝关节骨折”。我们也搜索了Pubmed，使用了[Mesh]这个词。纳入标准是对成人踝部骨折治疗的系统评价。结果:在检索的数据库中确定了22篇系统评价。对外踝骨折患者的多专业治疗的系统回顾指出了金属联合螺钉的选择而不是可吸收螺钉，而没有说明在没有症状的情况下将其取出。建立了糖尿病踝关节阿德莱德骨折(Adelaide Fracture in the Diabetic Ankle, AFDA)算法，用于糖尿病患者的诊断和治疗。目前仍没有证据表明关节镜下辅助切开复位内固定(ORIF)是最好的治疗方法，也没有生物力学证据表明锁定钢板优于传统钢板治疗老年人外踝骨折。有强有力的证据表明，活动能力和早期负重直接影响患者的功能预后。结论:本研究对于识别和选择有关该主题的最新系统综述非常重要，从而指导外踝骨折患者最佳治疗方案的实践。
{"title":"PO 18219 - Treatment of malleolar ankle fractures","authors":"Caio A. Araujo, E. Arie, Danilo Mizusaki, M. Peccin, Jhony De Almeida Estevam, B. Barros","doi":"10.30795/scijfootankle.2019.v13.1043","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1043","url":null,"abstract":"Objective: Given the epidemiological importance of malleolar fractures and differences in treatment choices, this study provides an update on the multiprofessional treatment of these fractures by mapping systematic reviews available in the scientific literature. Methods: The search was performed in the electronic databases Cochrane Database of Systematic Reviews (CDSR), Medline and Lilacs and in the PROSPERO international prospective register of systematic reviews, with no language or publication date restriction. The most recent search was performed on June 1, 2018. The term “ankle fracture” was used in those databases. Pubmed was also searched, using the [Mesh] term. The inclusion criteria were systematic reviews on the treatment of malleolar ankle fractures in adults. Results: Twenty-two systematic reviews were identified in the searched databases. Systematic reviews on the multiprofessional treatment of patients with malleolar fractures addressed the selection of metallic syndesmotic screw rather than absorbable screw without indicating its removal in the absence of symptoms. Furthermore, the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm was established for the diagnosis and treatment of diabetic patients. There is still no evidence that arthroscopically assisted open reduction and internal fixation (ORIF) is the best therapeutic method, nor is there biomechanical evidence that the locking plate is better than the conventional plate for treating lateral malleolar fracture in elderly people. There is strong evidence that mobility and early weight-bearing directly affect the functional prognosis of patients. Conclusion: This study was extremely important for identifying and selecting the most recent systematic reviews on the topic, thereby guiding practices regarding the best therapeutic regimen for patients with malleolar fractures.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85847292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1012
Luis Paulo Vilela Lemos, T. Baumfeld, Jorge Batista, C. Nery, D. Baumfeld
Introduction: Fifth metatarsal fractures are among the most common forefoot injuries, especially in young athletes. The purpose of this paper is to evaluate the functional outcome of professional soccer players undergoing surgical treatment of Dameron’s zones II and III fifth metatarsal fractures with an intramedullary screw with or without bone graft. Methods: Thirty-four professional soccer players underwent operations from July 2001 to June 2016. All of them underwent an evaluation based on AOFAS and VAS scores before and after surgery, with a mean follow-up of 24 months. The need for grafting was evaluated in relation to the time for surgery. Additionally, the influence of time to surgery, fracture union, Torg’s classification and grafting were related to the time to return to sports. In addition, the player's position, age, complications and side of the lesion were also described. Results: There were 10 forwards, 07 center forwards, 06 full-backs, 05 midfielders, 03 defenders, 02 goalkeepers and 01 central defender, with an average of 19 years; the right side was affected in 44% of cases. The AOFAS average pre and postoperatively was 42 and 99, respectively, while the EVA was 6 and 0. The longer delay to operate, the greater was the need for grafting (p = 1.11%), each day increasing by 1,015 times the need for grafting. The return to activities was not influenced by the time to operate, time to union, Torg’s classification or graft use. Conclusion: Surgical treatment of a proximal fifth metatarsal fracture in professional soccer player presents good clinical outcomes and can be performed safely in these cases, with a low rate of complications.
{"title":"TL 18073 - Medium-term follow-up after surgically treated fifth metatarsal fractures in professional soccer players","authors":"Luis Paulo Vilela Lemos, T. Baumfeld, Jorge Batista, C. Nery, D. Baumfeld","doi":"10.30795/scijfootankle.2019.v13.1012","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1012","url":null,"abstract":"Introduction: Fifth metatarsal fractures are among the most common forefoot injuries, especially in young athletes. The purpose of this paper is to evaluate the functional outcome of professional soccer players undergoing surgical treatment of Dameron’s zones II and III fifth metatarsal fractures with an intramedullary screw with or without bone graft. Methods: Thirty-four professional soccer players underwent operations from July 2001 to June 2016. All of them underwent an evaluation based on AOFAS and VAS scores before and after surgery, with a mean follow-up of 24 months. The need for grafting was evaluated in relation to the time for surgery. Additionally, the influence of time to surgery, fracture union, Torg’s classification and grafting were related to the time to return to sports. In addition, the player's position, age, complications and side of the lesion were also described. Results: There were 10 forwards, 07 center forwards, 06 full-backs, 05 midfielders, 03 defenders, 02 goalkeepers and 01 central defender, with an average of 19 years; the right side was affected in 44% of cases. The AOFAS average pre and postoperatively was 42 and 99, respectively, while the EVA was 6 and 0. The longer delay to operate, the greater was the need for grafting (p = 1.11%), each day increasing by 1,015 times the need for grafting. The return to activities was not influenced by the time to operate, time to union, Torg’s classification or graft use. Conclusion: Surgical treatment of a proximal fifth metatarsal fracture in professional soccer player presents good clinical outcomes and can be performed safely in these cases, with a low rate of complications.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85989307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1088
M. P. Filho, K. Stéfani, M. Nogueira
Introduction: Insufficiency fractures occur in bones with decreased elastic strength. In contrast to fatigue or stress fractures, which affect normal bones and have been extensively studied in the literature, foot and ankle insufficiency fractures have been poorly researched to date. The objective of this study was to identify behavioral, biomechanical and metabolic factors associated with the development of foot and ankle insufficiency fractures. Methods: In total, 53 sedentary postmenopausal female patients who had foot and ankle insufficiency fractures and who were treated at the São Paulo State Civil Servant Hospital (Hospital do Servidor Público do Estado de São Paulo) were included in the treatment group, and 53 individuals were included in the control group. Data were collected on fracture site, body mass index (BMI), corticoid use, femoral and lumbar T-score measured by bone densitometry, and serum 25-hydroxyvitamin D level. The calcaneal angle, the angle between the first metatarsal and the talus and the metatarsus adductus angle were measured in radiographs. Results: The fractures affected the metatarsal bones in 47 patients. Other fracture sites included the lateral malleolus, lateral cuneiform bone, cuboid bone, tibia and calcaneus. All metatarsal bones were affected, most frequently the 5th. The most common fracture was a 5th metatarsal base fracture in zone II. There was no significant difference in mean BMI, serum 25-hydroxyvitamin D levels, alcohol consumption or smoking between the groups. The development of fractures was significantly associated with corticoid use (p<0.0001), low femur (p=0.028) and lumbar spine (p=0.002) bone mineral density and metatarsus adductus angle (p=0.02). When analyzed separately, 4th and 5th metatarsal fractures were associated with smaller angles between the talus and the first metatarsal (p=0.01). Conclusion: Foot and ankle insufficiency fractures among sedentary postmenopausal women are associated with corticoid use, low bone mineral density and biomechanical characteristics, such as pes cavus and metatarsus adductus. The presence of such fractures may be the first sign of bone fragility and should be used as criteria for initiating adequate treatment to prevent other fractures.
不完全性骨折发生在弹性强度降低的骨骼中。疲劳性或应力性骨折影响正常骨骼，文献中对其进行了广泛的研究，而足部和踝关节不全性骨折迄今为止的研究很少。本研究的目的是确定行为、生物力学和代谢因素与足部和踝关节不全性骨折的发生有关。方法:选取在圣保罗州公务员医院(Hospital do Servidor Público do Estado de s o Paulo)接受治疗的绝经后久坐女性足、踝关节不全性骨折患者53例作为治疗组，53例作为对照组。收集骨折部位、体重指数(BMI)、皮质激素使用情况、骨密度测量股骨和腰椎t评分以及血清25-羟基维生素D水平。x线片测量跟骨角、第一跖骨与距骨夹角和跖内收角。结果:骨折累及跖骨47例。其他骨折部位包括外踝、外侧楔形骨、长方体骨、胫骨和跟骨。所有跖骨均受影响，最常见的是第5跖骨。最常见的骨折是II区第5跖骨基底骨折。两组之间的平均BMI、血清25-羟基维生素D水平、饮酒量或吸烟量均无显著差异。骨折的发生与皮质激素使用(p<0.0001)、股骨低位(p=0.028)和腰椎(p=0.002)骨密度和跖内收角(p=0.02)显著相关。当单独分析时，第4和第5跖骨骨折与距骨与第1跖骨之间的角度较小相关(p=0.01)。结论:久坐绝经后妇女足、踝关节不全骨折与皮质激素使用、低骨密度和生物力学特征(如足弓和跖内收)有关。此类骨折的出现可能是骨脆性的第一个迹象，应作为开始适当治疗以预防其他骨折的标准。
{"title":"TL 18206 - Foot and ankle insufficiency fractures among postmenopausal sedentary women","authors":"M. P. Filho, K. Stéfani, M. Nogueira","doi":"10.30795/scijfootankle.2019.v13.1088","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1088","url":null,"abstract":"Introduction: Insufficiency fractures occur in bones with decreased elastic strength. In contrast to fatigue or stress fractures, which affect normal bones and have been extensively studied in the literature, foot and ankle insufficiency fractures have been poorly researched to date. The objective of this study was to identify behavioral, biomechanical and metabolic factors associated with the development of foot and ankle insufficiency fractures. Methods: In total, 53 sedentary postmenopausal female patients who had foot and ankle insufficiency fractures and who were treated at the São Paulo State Civil Servant Hospital (Hospital do Servidor Público do Estado de São Paulo) were included in the treatment group, and 53 individuals were included in the control group. Data were collected on fracture site, body mass index (BMI), corticoid use, femoral and lumbar T-score measured by bone densitometry, and serum 25-hydroxyvitamin D level. The calcaneal angle, the angle between the first metatarsal and the talus and the metatarsus adductus angle were measured in radiographs. Results: The fractures affected the metatarsal bones in 47 patients. Other fracture sites included the lateral malleolus, lateral cuneiform bone, cuboid bone, tibia and calcaneus. All metatarsal bones were affected, most frequently the 5th. The most common fracture was a 5th metatarsal base fracture in zone II. There was no significant difference in mean BMI, serum 25-hydroxyvitamin D levels, alcohol consumption or smoking between the groups. The development of fractures was significantly associated with corticoid use (p<0.0001), low femur (p=0.028) and lumbar spine (p=0.002) bone mineral density and metatarsus adductus angle (p=0.02). When analyzed separately, 4th and 5th metatarsal fractures were associated with smaller angles between the talus and the first metatarsal (p=0.01). Conclusion: Foot and ankle insufficiency fractures among sedentary postmenopausal women are associated with corticoid use, low bone mineral density and biomechanical characteristics, such as pes cavus and metatarsus adductus. The presence of such fractures may be the first sign of bone fragility and should be used as criteria for initiating adequate treatment to prevent other fractures.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85219932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1059
A. Godoy-Santos, Ibukunoluwa B. Araoye, Osama Elattar, Sameer Naranje, C. Netto, Ashish B. Shah
Introduction: Subtalar joint (STJ) arthrodesis is a well-established operative procedure in the treatment of subtalar arthritis and hindfoot deformities. Nonunion remains an important complication, with an incidence and role of risk factors varying in the literature. Recent reports have highlighted a decrease in overall union rates between 96% and 100% to 84%, further strengthening the need for an understanding of risk factors that may be implicated in nonunion rates. Some possible factors have been identified, including smoking, revision surgery, the presence and extent of devascularized bone, and previous ankle joint fusion. Current practice suggests that using bone grafts or bone graft substitutes decreases the risk of its occurrence. Objective: To compare union rates of isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all operations. Graft materials included β-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft and an 83% (78/93) union rate with bone graft use. The odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the nongraft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.
{"title":"TL 18097 - Role of bone graft and bone graft substitutes in isolated subtalar joint arthrodesis","authors":"A. Godoy-Santos, Ibukunoluwa B. Araoye, Osama Elattar, Sameer Naranje, C. Netto, Ashish B. Shah","doi":"10.30795/scijfootankle.2019.v13.1059","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1059","url":null,"abstract":"Introduction: Subtalar joint (STJ) arthrodesis is a well-established operative procedure in the treatment of subtalar arthritis and hindfoot deformities. Nonunion remains an important complication, with an incidence and role of risk factors varying in the literature. Recent reports have highlighted a decrease in overall union rates between 96% and 100% to 84%, further strengthening the need for an understanding of risk factors that may be implicated in nonunion rates. Some possible factors have been identified, including smoking, revision surgery, the presence and extent of devascularized bone, and previous ankle joint fusion. Current practice suggests that using bone grafts or bone graft substitutes decreases the risk of its occurrence. Objective: To compare union rates of isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all operations. Graft materials included β-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft and an 83% (78/93) union rate with bone graft use. The odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the nongraft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83398578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1006
G. Saito, A. Sanders, C. Netto, M. O'Malley, S. Ellis, Constantine A. Demetracopoulos
Introduction: With the increasing use of total ankle arthroplasty (TAA), new implants with varied configurations are being developed every year. This study aimed to assess the early complications, reoperations, and radiographic and clinical outcomes of this novel implant. Methods: A retrospective analysis of 64 consecutive ankles that underwent a primary Infinity® TAA was performed. Patients had an average follow-up of 24.5 (range, 18-39) months. Medical records were reviewed to determine the incidence of complications, reoperations, and revisions. Additionally, patient-reported outcomes were analyzed with the Foot and Ankle Outcome Score (FAOS). Results: Survivorship of the implant was 95.3%. Fourteen ankles (21.8%) presented a total of 17 complications. A total of 12 reoperations were necessary in 11 ankles (17.1%). Revision surgery was indicated for 3 ankles (4.7%) as a result of subsidence of the implant. Tibiotalar coronal deformity was significantly improved after surgery (P < .0001) and maintained at the latest follow-up (P = .81). Periprosthetic radiolucent lines were observed around the tibial component in 20 ankles (31%) and around the talar component in 2 ankles (3.1%). A tibial cyst was observed in 1 ankle (1.5%). Outcome scores were significantly improved for all FAOS components analyzed (P < .0001). Conclusion: Most complications observed in the study were minor and successfully treated with a single reoperation procedure or nonoperatively. Failures and radiographic abnormalities were most commonly related to the tibial implant. Further studies with longer follow-ups are needed to evaluate the survivorship of the tibial implant over the long term.
{"title":"TL 18050 - Short-term complications, reoperations, and radiographic outcomes of Infinity® total ankle arthroplasty","authors":"G. Saito, A. Sanders, C. Netto, M. O'Malley, S. Ellis, Constantine A. Demetracopoulos","doi":"10.30795/scijfootankle.2019.v13.1006","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1006","url":null,"abstract":"Introduction: With the increasing use of total ankle arthroplasty (TAA), new implants with varied configurations are being developed every year. This study aimed to assess the early complications, reoperations, and radiographic and clinical outcomes of this novel implant. Methods: A retrospective analysis of 64 consecutive ankles that underwent a primary Infinity® TAA was performed. Patients had an average follow-up of 24.5 (range, 18-39) months. Medical records were reviewed to determine the incidence of complications, reoperations, and revisions. Additionally, patient-reported outcomes were analyzed with the Foot and Ankle Outcome Score (FAOS). Results: Survivorship of the implant was 95.3%. Fourteen ankles (21.8%) presented a total of 17 complications. A total of 12 reoperations were necessary in 11 ankles (17.1%). Revision surgery was indicated for 3 ankles (4.7%) as a result of subsidence of the implant. Tibiotalar coronal deformity was significantly improved after surgery (P < .0001) and maintained at the latest follow-up (P = .81). Periprosthetic radiolucent lines were observed around the tibial component in 20 ankles (31%) and around the talar component in 2 ankles (3.1%). A tibial cyst was observed in 1 ankle (1.5%). Outcome scores were significantly improved for all FAOS components analyzed (P < .0001). Conclusion: Most complications observed in the study were minor and successfully treated with a single reoperation procedure or nonoperatively. Failures and radiographic abnormalities were most commonly related to the tibial implant. Further studies with longer follow-ups are needed to evaluate the survivorship of the tibial implant over the long term.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87962712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.995
E. Ribeiro, S. Prata, M. Rizzo
Introduction: Ankle fractures account for 10% of all fractures and rank second in frequency among lower limb fractures, behind only hip fractures. The lack of studies on the epidemiology of ankle fractures available in the Brazilian literature motivated a more in-depth study to better describe these fractures. The objective of this study was to analyze the epidemiological characteristics of ankle fractures. Methods: An epidemiological, prospective, descriptive, observational study of ankle fractures in a convenience sample taken from the study hospital. In total, 150 patients were evaluated from March 2016 to March 2017. A questionnaire was prepared to collect patient data and variables for subsequent analysis. The following parameters were analyzed: age, occupation, sex, ethnicity, marital status, education, emergency transport, time of trauma, day of the week of trauma, trauma mechanism, fracture type, affected limb, classification, treatment, associated injury and length of hospital stay. Results: Among the patients with ankle fractures, 33.66% of the fractures occurred in the afternoon. A total of 61.34% of the ankle fracture patients were men, and the right was the most commonly affected side. The mean age was 40.48 years. The most frequent trauma mechanism was fall from height, which accounted for 51.42% of fractures. Weber type B fractures were the most frequent type. Conclusion: Ankle fractures treated at the Department of Orthopedics and Traumatology during the study period primarily affected married, Caucasian patients aged between 40 and 50 years with up to a primary education level; fractures were most frequently on the right side and primarily occurred in the afternoon and on Sundays. Sprain due to fall from height was the most common trauma mechanism, and exposed fracture occurred in 28% of the cases.
{"title":"PO 18118 - Epidemiological study of ankle fractures","authors":"E. Ribeiro, S. Prata, M. Rizzo","doi":"10.30795/scijfootankle.2019.v13.995","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.995","url":null,"abstract":"Introduction: Ankle fractures account for 10% of all fractures and rank second in frequency among lower limb fractures, behind only hip fractures. The lack of studies on the epidemiology of ankle fractures available in the Brazilian literature motivated a more in-depth study to better describe these fractures. The objective of this study was to analyze the epidemiological characteristics of ankle fractures. Methods: An epidemiological, prospective, descriptive, observational study of ankle fractures in a convenience sample taken from the study hospital. In total, 150 patients were evaluated from March 2016 to March 2017. A questionnaire was prepared to collect patient data and variables for subsequent analysis. The following parameters were analyzed: age, occupation, sex, ethnicity, marital status, education, emergency transport, time of trauma, day of the week of trauma, trauma mechanism, fracture type, affected limb, classification, treatment, associated injury and length of hospital stay. Results: Among the patients with ankle fractures, 33.66% of the fractures occurred in the afternoon. A total of 61.34% of the ankle fracture patients were men, and the right was the most commonly affected side. The mean age was 40.48 years. The most frequent trauma mechanism was fall from height, which accounted for 51.42% of fractures. Weber type B fractures were the most frequent type. Conclusion: Ankle fractures treated at the Department of Orthopedics and Traumatology during the study period primarily affected married, Caucasian patients aged between 40 and 50 years with up to a primary education level; fractures were most frequently on the right side and primarily occurred in the afternoon and on Sundays. Sprain due to fall from height was the most common trauma mechanism, and exposed fracture occurred in 28% of the cases.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"8 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77884841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.990
N. Mansur, A. Lemos, L. Fonseca, T. Baumfeld, D. Baumfeld, C. Nery
Introduction: The extremely high prevalence of sprains in the population has led to a large number of patients with lateral ankle instability. The persistence of this condition can lead to progressive loosening of the medial containment structures, generating multidirectional rotational instability. Treatment of the deltoid complex through ligamentoplasty of its components has been proposed as a solution for these patients, and the arthroscopic technique is a currently described alternative. Methods: This is a retrospective study of 10 patients (11 ankles) diagnosed with multidirectional instability who underwent ankle arthroscopy with medial and lateral ligament reconstruction (arthroscopic Brostrom technique) from January 2017 to January 2019. All patients filled out an epidemiological questionnaire and were assessed for ankle pain and function using the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale at the last follow-up evaluation, at a mean of 12 months (6-24 months). Results: All patients showed signs of associated medial instability during the arthroscopy. Four ankles had associated osteochondral injuries. One ankle also had associated syndesmotic instability. The mean AOFAS score was 82.6 at the last follow-up evaluation, and the mean VAS score was 2.1. No patient had complications related to surgery or loss of ankle mobility greater than 5 degrees (ankle or subtalar joint). Eight patients described the outcome as excellent, and 2 described it as good. All patients returned to sports after 6 months of follow-up. No complaints of instability or positive ligament tests were observed. Conclusion: Combined medial and lateral arthroscopic ankle ligamentoplasty is an effective and safe alternative for the treatment of multidirectional instability refractory to conservative treatment. The inclusion of the deltoid complex and the reduced invasiveness of this technique may improve the clinical outcomes of these patients.
{"title":"PO 18079 - Arthroscopic medial and lateral ligament repair for multidirectional ankle instability","authors":"N. Mansur, A. Lemos, L. Fonseca, T. Baumfeld, D. Baumfeld, C. Nery","doi":"10.30795/scijfootankle.2019.v13.990","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.990","url":null,"abstract":"Introduction: The extremely high prevalence of sprains in the population has led to a large number of patients with lateral ankle instability. The persistence of this condition can lead to progressive loosening of the medial containment structures, generating multidirectional rotational instability. Treatment of the deltoid complex through ligamentoplasty of its components has been proposed as a solution for these patients, and the arthroscopic technique is a currently described alternative. Methods: This is a retrospective study of 10 patients (11 ankles) diagnosed with multidirectional instability who underwent ankle arthroscopy with medial and lateral ligament reconstruction (arthroscopic Brostrom technique) from January 2017 to January 2019. All patients filled out an epidemiological questionnaire and were assessed for ankle pain and function using the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale at the last follow-up evaluation, at a mean of 12 months (6-24 months). Results: All patients showed signs of associated medial instability during the arthroscopy. Four ankles had associated osteochondral injuries. One ankle also had associated syndesmotic instability. The mean AOFAS score was 82.6 at the last follow-up evaluation, and the mean VAS score was 2.1. No patient had complications related to surgery or loss of ankle mobility greater than 5 degrees (ankle or subtalar joint). Eight patients described the outcome as excellent, and 2 described it as good. All patients returned to sports after 6 months of follow-up. No complaints of instability or positive ligament tests were observed. Conclusion: Combined medial and lateral arthroscopic ankle ligamentoplasty is an effective and safe alternative for the treatment of multidirectional instability refractory to conservative treatment. The inclusion of the deltoid complex and the reduced invasiveness of this technique may improve the clinical outcomes of these patients.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"155 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77122636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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