Pub Date : 2019-11-11DOI: 10.30795/scijfootankle.2019.v13.1073
N. S. Mansur, R. M. Azevedo, L. Fonseca, Juliana Doering Xavier da Silveira, F. Raduan, C. Nery
Introduction: Ledderhose's disease (plantar fibromatosis) is an uncommon condition that usually affecting men older than 40 years of age and causes major discomfort and disability. The low response to conservative treatment and the progression of surgical techniques have motivated some professionals to resume considering surgical resolution for this disease. Our study describes the outcomes of a series of cases treated with resection of the affected band. Methods: This is a retrospective study with 14 patients (17 feet) diagnosed with plantar fibromatosis of the medial fascia that was refractory to conservative treatment and was treated surgically from December 2016 to November 2018. All patients were evaluated for improvement in symptoms, for major and minor complications and for relapse during the study period. Results: Our sample consisted of 9 men and 5 women with a mean age of 40.6 years (15-63 years). All patients showed medial fibromatosis and underwent subtotal fasciotomy of the medial fascial band with margins of at least 2 cm. Of the 17 feet, 5 showed relapse (29%) and only 2 required reintervention. Three patients (17%) developed surgical wound dehiscence, although all patients progressed to surgical wound closure with no need for surgical intervention. Two feet showed signs of medial plantar nerve injury, although the branch of the nerve was wrapped in fibromatosis and was also resected in those cases. Conclusion: Partial plantar fasciotomy is an alternative for the treatment of Ledderhose's disease. Our series showed outcomes in line with those reported in the literature in terms of relapse and postoperative complications. The moderate relapse and reoperation rates should be considered when this procedure is indicated.
{"title":"TL - 18148 - Partial plantar fasciotomy for the treatment of plantar fibromatosis","authors":"N. S. Mansur, R. M. Azevedo, L. Fonseca, Juliana Doering Xavier da Silveira, F. Raduan, C. Nery","doi":"10.30795/scijfootankle.2019.v13.1073","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1073","url":null,"abstract":"Introduction: Ledderhose's disease (plantar fibromatosis) is an uncommon condition that usually affecting men older than 40 years of age and causes major discomfort and disability. The low response to conservative treatment and the progression of surgical techniques have motivated some professionals to resume considering surgical resolution for this disease. Our study describes the outcomes of a series of cases treated with resection of the affected band. Methods: This is a retrospective study with 14 patients (17 feet) diagnosed with plantar fibromatosis of the medial fascia that was refractory to conservative treatment and was treated surgically from December 2016 to November 2018. All patients were evaluated for improvement in symptoms, for major and minor complications and for relapse during the study period. Results: Our sample consisted of 9 men and 5 women with a mean age of 40.6 years (15-63 years). All patients showed medial fibromatosis and underwent subtotal fasciotomy of the medial fascial band with margins of at least 2 cm. Of the 17 feet, 5 showed relapse (29%) and only 2 required reintervention. Three patients (17%) developed surgical wound dehiscence, although all patients progressed to surgical wound closure with no need for surgical intervention. Two feet showed signs of medial plantar nerve injury, although the branch of the nerve was wrapped in fibromatosis and was also resected in those cases. Conclusion: Partial plantar fasciotomy is an alternative for the treatment of Ledderhose's disease. Our series showed outcomes in line with those reported in the literature in terms of relapse and postoperative complications. The moderate relapse and reoperation rates should be considered when this procedure is indicated.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83832258","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.v13.1031
G. Saito, M. Prado, A. Mendes, D. R. Nishikawa, B. Devito, L. Devito
Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.
{"title":"PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button","authors":"G. Saito, M. Prado, A. Mendes, D. R. Nishikawa, B. Devito, L. Devito","doi":"10.30795/scijfootankle.2019.v13.1031","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1031","url":null,"abstract":"Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81416522","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.v13.992
Fábio Lemos Rodrigues, L. Lara, J. Grajales, Lucio Carlos Torres
Objective: To analyze the outcomes of percutaneous hallux valgus correction using the Reverdin-Isham osteotomy through clinical and radiographic studies. Methods: We retrospectively evaluated 43 feet in 38 patients with mild or moderate hallux valgus from June 2009 to July 2018. The mean age at surgery was 59 years; the mean postoperative follow-up time was 79 months. All patients treated with the Reverdin technique modified by Isham were evaluated in the pre- and postoperative periods using the American Association Orthopedic Foot and Ankle Society (AOFAS) score; we radiographically measured the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the first distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by an average of 55 points. On average, the HVA decreased by 14°, the IMA by 3° and the DMAA by 9°. The mean reduction in the length of the first metatarsal bone was 0.3 cm. Conclusion: This surgical technique was effective for hallux valgus correction, demonstrating good angle correction and a marked increase in the AOFAS score.
{"title":"PO 18115 - Percutaneous hallux valgus correction using the Reverdin-Isham osteotomy","authors":"Fábio Lemos Rodrigues, L. Lara, J. Grajales, Lucio Carlos Torres","doi":"10.30795/scijfootankle.2019.v13.992","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.992","url":null,"abstract":"Objective: To analyze the outcomes of percutaneous hallux valgus correction using the Reverdin-Isham osteotomy through clinical and radiographic studies. Methods: We retrospectively evaluated 43 feet in 38 patients with mild or moderate hallux valgus from June 2009 to July 2018. The mean age at surgery was 59 years; the mean postoperative follow-up time was 79 months. All patients treated with the Reverdin technique modified by Isham were evaluated in the pre- and postoperative periods using the American Association Orthopedic Foot and Ankle Society (AOFAS) score; we radiographically measured the hallux valgus angle (HVA), the intermetatarsal angle (IMA) and the first distal metatarsal articular angle (DMAA). Results: The AOFAS score increased by an average of 55 points. On average, the HVA decreased by 14°, the IMA by 3° and the DMAA by 9°. The mean reduction in the length of the first metatarsal bone was 0.3 cm. Conclusion: This surgical technique was effective for hallux valgus correction, demonstrating good angle correction and a marked increase in the AOFAS score.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82456890","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.v13.1089
Henrique Mansur, Felipe Almeida Rocha, Isnar Castro Júnior
Introduction: The relationship between knee and hindfoot alignment is intuitive, but the number of studies on associated deformities remains limited. The objective of this study is to assess the correlation between the femorotibial joint axis and the hindfoot axis in patients with advanced gonarthrosis. Methods: The knee and hindfoot axes were assessed in 72 patients with indications for total knee replacement. Knee radiographs and long axial view radiographs of the hindfoot were acquired from all patients. The hindfoot/ankle function of the patients was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Statistical analysis was performed at a maximum significance level of 5%. Results: The sample included 24 (33.3%) men and 48 (66.7%) women with a mean age of 58.7 years. The results showed that 79.2% subjects had genu varum (mean: 15º±7.69), and 20.8% had genu valgum (mean: 15.9º) (p>0.05); 46 (63.89%) patients had hindfoot varus (mean: 8.5º±6.07), and 26 (36.11%) had hindfoot valgus (mean: 3.9º±3.92). We observed a significant association between the knee and hindfoot axes (p<0.05). There was no significant correlation only between genu valgum–hindfoot varus (p<0.05). The mean AOFAS score was 74.26 points, with significantly higher scores among patients with hindfoot varus. The AOFAS score was correlated with the hindfoot and knee axes (P<0.05). Conclusion: The knee and hindfoot axes were associated in patients with advanced gonarthrosis. In addition, the patients with hindfoot varus showed better ankle function according to the AOFAS score.
{"title":"TL 18209 - Relationship between the knee and hindfoot axes among patients with advanced gonarthrosis","authors":"Henrique Mansur, Felipe Almeida Rocha, Isnar Castro Júnior","doi":"10.30795/scijfootankle.2019.v13.1089","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1089","url":null,"abstract":"Introduction: The relationship between knee and hindfoot alignment is intuitive, but the number of studies on associated deformities remains limited. The objective of this study is to assess the correlation between the femorotibial joint axis and the hindfoot axis in patients with advanced gonarthrosis. Methods: The knee and hindfoot axes were assessed in 72 patients with indications for total knee replacement. Knee radiographs and long axial view radiographs of the hindfoot were acquired from all patients. The hindfoot/ankle function of the patients was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Statistical analysis was performed at a maximum significance level of 5%. Results: The sample included 24 (33.3%) men and 48 (66.7%) women with a mean age of 58.7 years. The results showed that 79.2% subjects had genu varum (mean: 15º±7.69), and 20.8% had genu valgum (mean: 15.9º) (p>0.05); 46 (63.89%) patients had hindfoot varus (mean: 8.5º±6.07), and 26 (36.11%) had hindfoot valgus (mean: 3.9º±3.92). We observed a significant association between the knee and hindfoot axes (p<0.05). There was no significant correlation only between genu valgum–hindfoot varus (p<0.05). The mean AOFAS score was 74.26 points, with significantly higher scores among patients with hindfoot varus. The AOFAS score was correlated with the hindfoot and knee axes (P<0.05). Conclusion: The knee and hindfoot axes were associated in patients with advanced gonarthrosis. In addition, the patients with hindfoot varus showed better ankle function according to the AOFAS score.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82480870","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.v13.1061
A. Godoy-Santos, Kandir Genesio Innocenti Dinhane, A. Fabro, M. Moretto, I. Deprá, W. Yoshida
Introduction: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Objective: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group - in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group - in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, the animals were euthanized and the tendons harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load 3 elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group showed a significant reduction in MMP2 expression compared with the control groups (P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased follow-up durations, various doses, and multiple injections and in tendinopathic models.
{"title":"TL 18099 - Short-term changes after corticosteroid injections into the normal tendons of rabbits","authors":"A. Godoy-Santos, Kandir Genesio Innocenti Dinhane, A. Fabro, M. Moretto, I. Deprá, W. Yoshida","doi":"10.30795/scijfootankle.2019.v13.1061","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1061","url":null,"abstract":"Introduction: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Objective: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group - in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group - in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, the animals were euthanized and the tendons harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load 3 elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group showed a significant reduction in MMP2 expression compared with the control groups (P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased follow-up durations, various doses, and multiple injections and in tendinopathic models.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82575756","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.v13.982
José Antônio Veiga Sanhudo, Luíza Barbosa Horta Barbosa
Introduction: Hallux valgus is the most common deformity of the adult foot and is often highly debilitating, especially when severe. First metatarsophalangeal arthrodesis (FMTPA) is a reliable method of hallux valgus correction, with a high success rate and a low relapse rate. This study assesses the union rate and degree of satisfaction and compares the pre- and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scale scores of patients subjected to FMTPA for hallux valgus treatment. This study is a retrospective review of 29 feet that underwent FMTPA fixed with crossed 1.5-mm Kirschner wires, with or without cerclage. Union was assessed radiologically and clinically. Methods: From March 2011 to April 2018, 23 patients diagnosed with hallux valgus underwent surgery using the FMTPA technique fixed with crossed Kirschner wires. One patient died of unrelated causes, and another was not located for the review, leaving a total of 21 patients for the analysis (29 feet). Eight patients were operated on bilaterally, 6 underwent operation of the right foot, and 7 underwent surgery of the left foot. The mean follow-up was 32 months (7-94 months), and the mean age at the time of surgery was 69 years (45-88). Results: The AOFAS score improved from a mean of 26.8 points before the surgery (10-55) to a mean of 77.6 points after (57-90). The patients were fully satisfied with 17 of the 29 procedures and satisfied with reservations in 12 cases. No patient was dissatisfied with the outcome. Clinical and radiological union was observed in all cases. The orthopedic hardware was removed due to pain or local discomfort in 18 feet (62% of cases). Conclusion: FMTPA fixed with crossed Kirschner wires for hallux valgus treatment is highly effective, with a high union rate and a high degree of patient satisfaction.
{"title":"PO 18035 - Metatarsophalangeal arthrodesis for hallux valgus treatment","authors":"José Antônio Veiga Sanhudo, Luíza Barbosa Horta Barbosa","doi":"10.30795/scijfootankle.2019.v13.982","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.982","url":null,"abstract":"Introduction: Hallux valgus is the most common deformity of the adult foot and is often highly debilitating, especially when severe. First metatarsophalangeal arthrodesis (FMTPA) is a reliable method of hallux valgus correction, with a high success rate and a low relapse rate. This study assesses the union rate and degree of satisfaction and compares the pre- and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scale scores of patients subjected to FMTPA for hallux valgus treatment. This study is a retrospective review of 29 feet that underwent FMTPA fixed with crossed 1.5-mm Kirschner wires, with or without cerclage. Union was assessed radiologically and clinically. Methods: From March 2011 to April 2018, 23 patients diagnosed with hallux valgus underwent surgery using the FMTPA technique fixed with crossed Kirschner wires. One patient died of unrelated causes, and another was not located for the review, leaving a total of 21 patients for the analysis (29 feet). Eight patients were operated on bilaterally, 6 underwent operation of the right foot, and 7 underwent surgery of the left foot. The mean follow-up was 32 months (7-94 months), and the mean age at the time of surgery was 69 years (45-88). Results: The AOFAS score improved from a mean of 26.8 points before the surgery (10-55) to a mean of 77.6 points after (57-90). The patients were fully satisfied with 17 of the 29 procedures and satisfied with reservations in 12 cases. No patient was dissatisfied with the outcome. Clinical and radiological union was observed in all cases. The orthopedic hardware was removed due to pain or local discomfort in 18 feet (62% of cases). Conclusion: FMTPA fixed with crossed Kirschner wires for hallux valgus treatment is highly effective, with a high union rate and a high degree of patient satisfaction.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78713008","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.v13.1028
Wrgelles Godinho Bordone Pires, R. Pinto, Philipe Eduardo Carvalho Maia, Rodrigo Castilho, Felipe Daniel Vasconcelos de Carvalho, F. Lopes
Objective: The objective of this study is to perform a functional and quality of life assessment of patients subjected to debridement of ulcers in the posterior region of the ankle, which progressed to complete Achilles tendon resection without any type of tendon reconstruction or transfer. Methods: This is a case series of 4 patients, mostly diabetic, who underwent complete resection of an exposed and degenerated Achilles tendon due to ulcer in the posterior region of the ankle that precluded preservation given the need to control the infectious process considering the diagnosis of calcaneal osteomyelitis. This diagnosis was compatible with changes observed in the magnetic resonance imaging evaluation and was confirmed in cultures of bone tissue removed during debridement. The patients filled out the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) and 36-Item Short Form Survey (SF-36) during the postoperative period, and follow-up ranged from 6 to 24 months. The ATRS score ranges from 0 to 100, and the higher the scores are, the fewer symptoms and limitations the patients have. The SF-36 consists of 36 questions covering 8 domains: physical role functioning, physical functioning, bodily pain, general health perceptions, social role functioning, vitality, mental health and emotional role functioning. The items are independently assessed, and the total possible score is 100 points, which is indicative of the best health status. Results: All 4 Achilles tendons were approached. The mean age of the patients was 69.8 years. The mean score on the physical functioning section of the SF-36 was 63.8 points. When comparing the outcome with literature data, we observed that when patients with ulcers were compared with individuals of a similar age group, our study showed better results than previous studies. The mean score of the ATRS-BR was 46.3 points, which suggests a poor outcome. However, the patients had few complaints about their physical functioning, as shown in the SF-36 analysis. The decision not to perform Achilles tendon reconstruction was made jointly by the medical team and the patients and their families. Conclusion: Not reconstructing the Achilles tendon in patients, mostly elderly diabetic patients with posterior ankle ulcers, led to encouraging functional scores. The present study suggests that this type of ulcer treatment is a viable option for such populations.
{"title":"PO 18194 - Functional and quality of life assessment of patients with ankle ulcers treated with complete Achilles tendon resection","authors":"Wrgelles Godinho Bordone Pires, R. Pinto, Philipe Eduardo Carvalho Maia, Rodrigo Castilho, Felipe Daniel Vasconcelos de Carvalho, F. Lopes","doi":"10.30795/scijfootankle.2019.v13.1028","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1028","url":null,"abstract":"Objective: The objective of this study is to perform a functional and quality of life assessment of patients subjected to debridement of ulcers in the posterior region of the ankle, which progressed to complete Achilles tendon resection without any type of tendon reconstruction or transfer. Methods: This is a case series of 4 patients, mostly diabetic, who underwent complete resection of an exposed and degenerated Achilles tendon due to ulcer in the posterior region of the ankle that precluded preservation given the need to control the infectious process considering the diagnosis of calcaneal osteomyelitis. This diagnosis was compatible with changes observed in the magnetic resonance imaging evaluation and was confirmed in cultures of bone tissue removed during debridement. The patients filled out the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) and 36-Item Short Form Survey (SF-36) during the postoperative period, and follow-up ranged from 6 to 24 months. The ATRS score ranges from 0 to 100, and the higher the scores are, the fewer symptoms and limitations the patients have. The SF-36 consists of 36 questions covering 8 domains: physical role functioning, physical functioning, bodily pain, general health perceptions, social role functioning, vitality, mental health and emotional role functioning. The items are independently assessed, and the total possible score is 100 points, which is indicative of the best health status. Results: All 4 Achilles tendons were approached. The mean age of the patients was 69.8 years. The mean score on the physical functioning section of the SF-36 was 63.8 points. When comparing the outcome with literature data, we observed that when patients with ulcers were compared with individuals of a similar age group, our study showed better results than previous studies. The mean score of the ATRS-BR was 46.3 points, which suggests a poor outcome. However, the patients had few complaints about their physical functioning, as shown in the SF-36 analysis. The decision not to perform Achilles tendon reconstruction was made jointly by the medical team and the patients and their families. Conclusion: Not reconstructing the Achilles tendon in patients, mostly elderly diabetic patients with posterior ankle ulcers, led to encouraging functional scores. The present study suggests that this type of ulcer treatment is a viable option for such populations.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89650718","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.v13.1044
Jorge Eduardo de Schoucair Jambeiro, Tavares Cordeiro Neto, Fernando Delmonte Moreira, J. A. Oliveira, Felipe Fernande Leão
Introduction: Primary osteoarthritis, post-traumatic lesions, Charcot arthropathy and rheumatoid arthritis are some of the causes of ankle and hind foot osteoarthritis that result in pain and sometimes functional limitations in patients affected by such pathology. The therapeutic options vary from conservative treatment (painkillers, bracing and nonsteroidal anti-inflammatory drugs) and surgical treatment. The objective of this present study is to report three cases of patients with ankle osteoarthritis who had undergone minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis with an intramedullary nail, with the use of a retrograde blocked intramedullary nail and screws as fixation. Methods: Clinical and radiographic evaluations were conducted of three cases treated using this technique at our institution in 2017, who were allowed full weight bearing postoperatively The AOFAS questionnaire and radiographic evaluation were employed in two orthogonal incidences of the ankle, evaluated after one year postoperatively. Results: We obtained AOFAS scores between 68 and 86 after one year postoperatively with this study technique, and the radiographic consolidation index was observed in 100% of cases (between 6 and 12 weeks) postoperatively. There were no complications. Conclusion: We obtained good results with minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis, with satisfactory consolidation presenting no complications. However, there are an insufficient number of studies in the literature demonstrating superiority of the percutaneous tibio-talocalcaneal arthrodesis technique over the open technique. We believe that the percutaneous technique is a recent method fir study that may be added to the therapeutic arsenal.
{"title":"PO 18220 - Talocalcaneal tibio arthrodesis with percutaneous retrograde intramedullary nail","authors":"Jorge Eduardo de Schoucair Jambeiro, Tavares Cordeiro Neto, Fernando Delmonte Moreira, J. A. Oliveira, Felipe Fernande Leão","doi":"10.30795/scijfootankle.2019.v13.1044","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1044","url":null,"abstract":"Introduction: Primary osteoarthritis, post-traumatic lesions, Charcot arthropathy and rheumatoid arthritis are some of the causes of ankle and hind foot osteoarthritis that result in pain and sometimes functional limitations in patients affected by such pathology. The therapeutic options vary from conservative treatment (painkillers, bracing and nonsteroidal anti-inflammatory drugs) and surgical treatment. The objective of this present study is to report three cases of patients with ankle osteoarthritis who had undergone minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis with an intramedullary nail, with the use of a retrograde blocked intramedullary nail and screws as fixation. Methods: Clinical and radiographic evaluations were conducted of three cases treated using this technique at our institution in 2017, who were allowed full weight bearing postoperatively The AOFAS questionnaire and radiographic evaluation were employed in two orthogonal incidences of the ankle, evaluated after one year postoperatively. Results: We obtained AOFAS scores between 68 and 86 after one year postoperatively with this study technique, and the radiographic consolidation index was observed in 100% of cases (between 6 and 12 weeks) postoperatively. There were no complications. \u0000Conclusion: We obtained good results with minimally invasive surgery (MIS) for tibio-talocalcaneal arthrodesis, with satisfactory consolidation presenting no complications. However, there are an insufficient number of studies in the literature demonstrating superiority of the percutaneous tibio-talocalcaneal arthrodesis technique over the open technique. We believe that the percutaneous technique is a recent method fir study that may be added to the therapeutic arsenal.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89475495","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.v13.1092
A. Lemos, M. Cohen, N. Mansur
Introduction: Clinical data collection is an essential stage in the development of any scientific research study. The recruitment of patients to research centers for data collection may be considerably difficult in some situations. There are few studies examining the use of distance evaluations conducted with digital and online tools. The use of information technology and the Internet to collect clinical data for scientific studies in orthopedics in Brazil remains somewhat limited; nonetheless, such approaches may provide several benefits to and facilitate data collection for Brazilian researchers. Methods: We performed a descriptive, observational study with printed or online (using an electronic device, such as computer, tablet or cell phone) self-administered questionnaires. Data from 40 patients (22 women; 18 men) with a mean age of 36.9 years (min: 15 years; max: 65 years) who were undergoing orthopedic follow-up for acute ankle sprain were collected using the Foot Function Index (FFI), Physical Function, Cumberland Ankle Instability Tool (CAIT), and visual analog scale (VAS) questionnaires. The questionnaires were administered at 4 different times: at the initial evaluation and at 3 weeks, 6 weeks and 12 weeks. Results: A comparative group analysis (digital, online data collection vs physical data collection) showed a higher level of collection of all data for each patient when the online questionnaires were used (87.5% vs 45% p<0.005), along with a higher accuracy of data collection (standard deviation (SD): 1.26; 2.3318; 1.6393 vs SD: 2.948; 3.807; 8.1189 p<0.005). Conclusion: Data collection using a remote approach through digital online forms (Internet) was highly effective in increasing the rate of response to long-term orthopedic follow-up questionnaires and showed improved data quality (decreased variability in collection dates), thus rendering online data more reliable for intergroup comparison.
临床数据收集是任何科学研究发展的重要阶段。在某些情况下，招募患者到研究中心收集数据可能相当困难。很少有研究调查使用数字和在线工具进行的远程评估的使用情况。在巴西，利用信息技术和互联网收集骨科科学研究的临床数据的情况仍然有限;尽管如此，这些方法可能为巴西研究人员提供一些好处并促进数据收集。方法:我们进行了一项描述性的观察性研究，采用印刷或在线(使用电子设备，如电脑、平板电脑或手机)自我管理的问卷。数据来自40例患者(22例女性;18名男性)，平均年龄36.9岁(最小15岁;使用足功能指数(FFI)、物理功能、Cumberland踝关节不稳定工具(CAIT)和视觉模拟量表(VAS)问卷收集急性踝关节扭伤接受骨科随访的患者。问卷在4个不同的时间进行:初始评估和3周、6周和12周。结果:比较组分析(数字、在线数据收集与物理数据收集)显示，使用在线问卷时，每位患者的所有数据收集水平更高(87.5% vs 45% p<0.005)，数据收集的准确性更高(标准差(SD): 1.26;2.3318;1.6393 vs SD: 2.948;3.807;8.1189 p < 0.005)。结论:通过数字在线表格(Internet)远程收集数据在提高骨科长期随访问卷的回复率和提高数据质量(减少收集日期的可变性)方面非常有效，从而使在线数据更可靠地用于组间比较。
{"title":"TL 18245 - Analysis of the efficacy of clinical data collection in orthopedic patients using online questionnaires","authors":"A. Lemos, M. Cohen, N. Mansur","doi":"10.30795/scijfootankle.2019.v13.1092","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1092","url":null,"abstract":"Introduction: Clinical data collection is an essential stage in the development of any scientific research study. The recruitment of patients to research centers for data collection may be considerably difficult in some situations. There are few studies examining the use of distance evaluations conducted with digital and online tools. The use of information technology and the Internet to collect clinical data for scientific studies in orthopedics in Brazil remains somewhat limited; nonetheless, such approaches may provide several benefits to and facilitate data collection for Brazilian researchers. Methods: We performed a descriptive, observational study with printed or online (using an electronic device, such as computer, tablet or cell phone) self-administered questionnaires. Data from 40 patients (22 women; 18 men) with a mean age of 36.9 years (min: 15 years; max: 65 years) who were undergoing orthopedic follow-up for acute ankle sprain were collected using the Foot Function Index (FFI), Physical Function, Cumberland Ankle Instability Tool (CAIT), and visual analog scale (VAS) questionnaires. The questionnaires were administered at 4 different times: at the initial evaluation and at 3 weeks, 6 weeks and 12 weeks. Results: A comparative group analysis (digital, online data collection vs physical data collection) showed a higher level of collection of all data for each patient when the online questionnaires were used (87.5% vs 45% p<0.005), along with a higher accuracy of data collection (standard deviation (SD): 1.26; 2.3318; 1.6393 vs SD: 2.948; 3.807; 8.1189 p<0.005). Conclusion: Data collection using a remote approach through digital online forms (Internet) was highly effective in increasing the rate of response to long-term orthopedic follow-up questionnaires and showed improved data quality (decreased variability in collection dates), thus rendering online data more reliable for intergroup comparison.","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":"87354433","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.v13.1081
J. Guimarães, Fabio Luciano Arcanjo de Jesus, Gustavo Leporace De Oliveira Lomelino So, L. Metsavaht, M. Moreno, M. Neto
Introduction: Fascite Plantar é a causa mais comum de dor no calcanhar e muitas vezes responde a uma ampla gama de terapias. Atualmente existem muitas opções de tratamento, sendo que algumas, como plasma rico em plaquetas e injeção de corticosteroides, apresentam grande sucesso no alívio da dor. Entretanto, não há consenso sobre o melhor método de tratamento. O objetivo desta revisão sistemática e meta-análise foi investigar os efeitos do plasma rico em plaquetas versus injeção de corticosteróides em desfechos de dor e incapacidade no paciente com fascite plantar. Métodos: Os estudos foram amplamente pesquisados em PubmedMEDLINE, na base de dados PEDro, na biblioteca eletrônica científica online (SciELO) e no registro central de ensaios controlados da Cochrane, desde a data mais antiga disponível até janeiro de 2019. Foram incluídos ensaios clínicos controlados randomizados que compararam os efeitos do plasma rico em plaquetas versus injeção de corticosteróides para paciente com fascite plantar. Foram calculados as diferenças médias (DM) e intervalos de confiança (ICs) de 95%, e a heterogeneidade foi avaliada usando o teste I2. Os cálculos foram feitos usando um modelo de efeito aleatório. Resultados: Dez artigos preencheram os critérios do estudo, incluindo 475 pacientes com fascite plantar. Os principais resultados incluíram alterações da linha de base no Escore da Escala Visual Analógica (dor) e no Escore da Sociedade Ortopédica Americana do Pé e Tornozelo (incapacidade). A terapia com plasma rico em plaquetas resultou em melhora na dor (DM -1,01 IC95%: -1,8 a -0,3, N=375) em comparação com a injeção de corticosteróides. Não foi encontrada nenhuma diferença significativa na incapacidade (DM 6,5 IC95%: -15,8 a 29,0, N=156) em participantes do grupo de terapia com plasma rico em plaquetas em comparação com o grupo de injeção de corticosteróides. Além disso, nenhum evento adverso grave foi relatado. Conclusão: O plasma rico em plaquetas foi mais eficaz do que a injeção de corticosteróides e tem o potencial de reduzir a dor do paciente com fascite plantar.
{"title":"TL 18176 - Platelet-rich plasma versus corticosteroid injection in pain and disability outcomes in patients with plantar fasciitis","authors":"J. Guimarães, Fabio Luciano Arcanjo de Jesus, Gustavo Leporace De Oliveira Lomelino So, L. Metsavaht, M. Moreno, M. Neto","doi":"10.30795/scijfootankle.2019.v13.1081","DOIUrl":"https://doi.org/10.30795/scijfootankle.2019.v13.1081","url":null,"abstract":"Introduction: Fascite Plantar é a causa mais comum de dor no calcanhar e muitas vezes responde a uma ampla gama de terapias. Atualmente existem muitas opções de tratamento, sendo que algumas, como plasma rico em plaquetas e injeção de corticosteroides, apresentam grande sucesso no alívio da dor. Entretanto, não há consenso sobre o melhor método de tratamento. O objetivo desta revisão sistemática e meta-análise foi investigar os efeitos do plasma rico em plaquetas versus injeção de corticosteróides em desfechos de dor e incapacidade no paciente com fascite plantar. Métodos: Os estudos foram amplamente pesquisados em PubmedMEDLINE, na base de dados PEDro, na biblioteca eletrônica científica online (SciELO) e no registro central de ensaios controlados da Cochrane, desde a data mais antiga disponível até janeiro de 2019. Foram incluídos ensaios clínicos controlados randomizados que compararam os efeitos do plasma rico em plaquetas versus injeção de corticosteróides para paciente com fascite plantar. Foram calculados as diferenças médias (DM) e intervalos de confiança (ICs) de 95%, e a heterogeneidade foi avaliada usando o teste I2. Os cálculos foram feitos usando um modelo de efeito aleatório. Resultados: Dez artigos preencheram os critérios do estudo, incluindo 475 pacientes com fascite plantar. Os principais resultados incluíram alterações da linha de base no Escore da Escala Visual Analógica (dor) e no Escore da Sociedade Ortopédica Americana do Pé e Tornozelo (incapacidade). A terapia com plasma rico em plaquetas resultou em melhora na dor (DM -1,01 IC95%: -1,8 a -0,3, N=375) em comparação com a injeção de corticosteróides. Não foi encontrada nenhuma diferença significativa na incapacidade (DM 6,5 IC95%: -15,8 a 29,0, N=156) em participantes do grupo de terapia com plasma rico em plaquetas em comparação com o grupo de injeção de corticosteróides. Além disso, nenhum evento adverso grave foi relatado. Conclusão: O plasma rico em plaquetas foi mais eficaz do que a injeção de corticosteróides e tem o potencial de reduzir a dor do paciente com fascite plantar.","PeriodicalId":21602,"journal":{"name":"Scientific Journal of the Foot & Ankle","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576078","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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