Fuss und Sprunggelenk最新文献

The modified Lapidus arthrodesis is a well-established procedure to adress pathologies of the first metatarso-cuneiform joint, i.e. metatarsus primus varus with concomitant hallux valgus deformity. Despite a standardized surgical technique complications like pseudarthrosis or metatarsalgia may occur.

This article includes measures to avoid these complications and gives strategies to manage postoperative adverse effects.

Septic non-union of a tibial pilon or plafond fracture is a serious complication. Only a consistent procedure with multiple interventions and a long process promises a sustainable success. In the following, a current and practicable therapeutical concept of a septic non-union of the tibial pilon is presented, which is carried out in an established manner in our clinic and which, if carried out consistently, many of these complex patients can be healed with a good clinical result. The key points of the concept are radical bone and soft-tissue resection followed by local and systemic anti-infective therapy, and reconstruction of bone and soft tissue loss. Depending on the degree of bone loss, the authors describe local defect filling, if necessary, in combination with osteosynthetic treatment or primary arthrodesis. In the case of long-distance bone loss, there is the possibility of bone segment transport. Therefore, different techniques are presented, followed by docking-procedure or secondary arthrodesis depending on the condition of the joint.

Minimally invasive procedures have gained enormous popularity in recent years. Like any surgical procedure, these techniques have particular challenges and complications. In the meantime, a large amount of literature supports minimally invasive procedures so that today they can no longer be classified as outsider procedures.

The article considers minimally invasive hallux valgus correction (MICA), distal minimally invasive metatarsal osteotomies (DMMO), minimally invasive calcaneal osteotomy (MICO), and lesser toe corrections as the most common procedures.

This article aims to present the typical complications and to show possible solutions to avoid them or to deal with the problem should it materialize.

Background

For many decades now, the ankle arthrodesis is still considered and widely accepted by many surgeon as a gold-standard treatment for either an end stage osteoarthritis or posttraumatic osteoarthritis of the Tibiotalar joint because if it’s significant improvement of clinical and functional outcomes. Despite the availability of advanced surgical techniques to fuse the ankle, non-union remains a common complication due to several risk factors. Risk factors associated with failed arthrodesis can be categorised as either patient related or surgical approach related.

Material and Methods

We present an analysis of the aetiology of malunion following surgical fusion of the tibiotalar joint, based on a retrospective review of the literature over the past 20 years. In addition, we present possible solutions based on our own clinical experience, which are comparable to those suggested in previous literature.

Conclusion

Risk factors such as nicotine abuse, diabetes mellitus, Charcot neuroarthropathy, history of open fractures and infections, avascular osteonecrosis, talar malalignment and vitamin D deficiency should be considered by surgeons when planning tibiotalar arthrodesis. Non-compliance also plays an important role in follow-up to achieve a good outcome. It is important to tailor the surgical approach and fixation method to the patient's needs in both primary and revision arthrodesis.