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Bilateral calcaneal stress fracture, after a enthesopaty achilles surgery: A case report
112
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
phone Hallux Valgus Angle: SP-HVA) (Smartphone Method), with hallux valgus angles determined using conventional radiography in a standing posture during weight-bearing (X-ray HVA: XR-HVA). We evaluated 37 feet of 25 patients (5 men and 25 women) who visited our hospital. The mean age at the time of the visit was 73.9 years. In the Smartphone Method, subjects stood upright and the examiner used a smartphone to take photos of both feet from above while holding the phone at the level of the anterior knee. Results: The mean value was 36.2◦ for SP-HVA and 36.7◦ for XRHVA; the two methods showed a statistically significant correlation (correlation coefficient of 0.86). Conclusion: Our smartphone-assisted screening method for hallux valgus was possible to make a diagnosis equivalent to conventional radiography method without radiation exposure. http://dx.doi.org/10.1016/j.fas.2017.07.427
339 Zadek osteotomy for the treatment of insertional Achilles tendinopathy L. Lopez-Capdevila ∗ , A. Sanataria, E. Pich-Aguilera, A. Dominguez, J. Manuel Rios, E. Gil Gil, J. Roman, M. Sales Consorci Sanitari Integral, Spain Introduction: The calcaneal dorsal closing wedge osteotomy was described by Zadek for the treatment of Haglund disease and bursitis retrocalcaneal. However, the literature reporting their outcomes in Achilles tendinopathy is poor. This osteotomy aims to reduce the length of calcaneus and elevate the insertion of the Achilles and therefore, to reduce the tension of Achilles in its insertion. The objective of this study is to assess the clinical outcomes of the Zadek osteotomy in Achilles tendinopathy. Methods: This is a prospective study of twelve patients, mean age 49 years. They were diagnosed with calcific insertional Achilles tendinopathy and had already been treated conservatively. A dorsal wedge osteotomy was performed; whose apex was plantar and base 1 cm dorsal. It was fixed with two 6.5 mm cannulated screws. The patients were scored preoperatively and postoperatively at 6 and 12 months with Aofas, VAS, ROM and patient satisfaction. Radiological parameters such as Calcaneal inclination angle and Fowler-Phillips angles were analysed. The results were analysed statistically (t-student). Mean follow-up was 18 months. Results: All the patients clinically improved. VAS scale improved from 8 to 2 points, as well as Aofas from 41 to 86 points (p < 0,05). Postoperative activity and daily pain were the parameters of Aofas that most improved. Radiographic calcifications did not correlate with clinical pain. Conclusion: The Zadek osteotomy can be considered a standard procedure for insertional Achilles tendinopathy as it has been demonstrated to have good results. http://dx.doi.org/10.1016/j.fas.2017.07.428
340 Tibialis anterior tendon rupture treated with a peroneus tendon allograft. A case report A. Arias ∗ , E. Gaviria, D. Berlanga, L. Lobo, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: Rupture of the tibialis anterior tendon is a rare event. Chronic ruptures of the tibialis anterior tendon are often associated with tendon retraction and poor-quality tissue, resulting in a large segmental defect that make end-to-end repair impossible. A patient with a traumatic chronic rupture of the tibial tendon treaded with intercalary allograft reconstruction will be presented. Methods: A 36 years old male who consulted for ankle dorsiflexion and difficulty walking. The patient mentioned a trauma incident with a saw that occurred 6 months earlier. On physical examination, the tibias anterior tendon was not palpable, it had an active deficit of dorsiflexion in the ankle. A reconstruction of the anterior tibial tendon was performed by intercalary allograft of peroneal tendons. Results: In the postoperative period, the patient was immobilized with a cast, partial progressive loading was authorized at 6 postoperative weeks. At 5 months postoperative, the patient presented an active ankle mobility comparable to the contralateral side an he returned to work after 6 months postoperative. Conclusion: Like the primary dorsiflexor of the ankle, the anterior tibial tendon plays an important role in normal gait. Chronic tibial tendon insufficiency after rupture is associated with functional disability and poses a surgical challenge. When the endto-end repair is not possible the use of tendon grafts is a good treatment option. Reconstruction of the tibialis anterior tendon with peroneal allograft provides a safe and reliable alternative without the morbidity of the donor site associated with the autograft technique. http://dx.doi.org/10.1016/j.fas.2017.07.429
341 Bilateral calcaneal stress fracture, after a enthesopaty achilles surgery: A case report A. Arias ∗ , E. Gaviria, L. Lobo, D. Chaverri, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. In the literature, calcaneal stress fractures are mostly reported in soldiers or athletes, but our case is one of a 43-year-old man with bilateral heel pain after an Achilles tendinitis surgery. Objectives: The aim of this paper is to describe an unusual complication of the Achilles enthesopathy’s surgery. Study design and methods: A 43-year-old male, with a previous history of fibromyalgia and pyramidal syndrome undergoing surgery without complications, and Haglunds disease diagnosed. After the failure of conservative treatment, a bilateral calcaneoplasty is performed in a single surgical time. At 4 months after surgery, the patient came to our clinic because of persistent pain in both heels; the patient reported that he had made an early rehabilitation after bilateral calcaneoplasty. After requesting a study of MRI, he was diagnosed with bilateral stress calcaneous fracture.
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Results: The patient was treated with 2 orthopedic boots with wedges for 2 months and progressive weightbearing. At the 5 months of our visit he was asymptomatic with MRI normalized. Conclusion: The usual treatment for Achilles enthesopathy surgical technique is resection of the degenerated tendon, excision of the calcification and bursa and resection of the posterior calcaneal bony prominence. Partial load is recommended postoperatively and depending on the technique with boot protection or cast. Excessive or early loading can help us in a recurrence of the disease or stress fracture associated as here. http://dx.doi.org/10.1016/j.fas.2017.07.430
342 Treatment of calcaneal fractures with minimally invasive plate osteosynthesis. Our first cases A. Arias ∗ , E. Gaviria, D. Berlanga, L. Lobo, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: The treatment of articular calcaneal fractures remains a challenge for the orthopaedic surgeon. One of the most common complications in calcaneal fractures are skin problems, in part to the lateral standard surgical approach. Delays in healing and necrosis of the wound can become expose the osteosynthesis material. The postsurgical infection rate rises to between 3 and 5% of cases. By the sinus tarsi approach we can decrease the number of this complications and allows performing reduction and osteosynthesis with calcaneal plates. Objectives: In this study we describe the treatment of the calcaneal fractures with minimally invasive plate osteosynthesis. Study design and methods: In the last year we have operated 10 patients with intraarticular calcaneal fracture, using a minimally invasive approach and synthesis with a specific plate. This technique is based on a posterior-lateral approach to the subtalar joint through which perform a reduction stable direct joint allowing synthesis using specific plates. Results: We haven’t had any skin or infectious complications. We have had to remove a plate for a commitment to the peroneal tendons and one case has ended in subtalar arthrodesis. 9 of the 10 patients have returned to their work. Conclusion: This technique is not applicable to all types of calcaneal fractures but should be a technique to consider especially for calcaneal fractures Sanders type II, which allows us to prevent or decrease the rate of skin problems associated with extended lateral usual approach. http://dx.doi.org/10.1016/j.fas.2017.07.431
113
343 Cuboid fracture: Epidemiology and treatment algorithm on 28 patients F. Vargas ∗ , C. Bastias, M. Parra, C. Urbina, F. Chaparro Hospital Clinico Mutual de Seguridad, Chile Objective: To describe the epidemiology of cuboid fracture in patients treated surgically, the injury mechanisms and associated lesions, proposing an algorithm for operative management. Patients and method: Retrospective and descriptive study of 28 patients with cuboid fracture, operated on between 2009 and 2014. We analyzed variables such as age, gender, mechanism of injury, associated fractures, fracture classification, osteoarthritis changes among others. Results: 28 cases were identified: 20 men and 8 women. The age mean was 42 years. The average follow-up was 1.3 years. The mechanisms of injury were motor vehicle accident (MVA), fall from height and sprain. 12 cases correspond to Chopart fracture. The most common associated injuries were Lisfranc fracture. 48% of cases had shortening of the lateral column. 88% of patients had involvement of some articular surfaces. Cuboid locking plate was used in 15 cases, single screw fixation was used in 4 patients. Degenerative changes are observed in calcaneocuboid and cuboidmetatarsal articulations. Conclusion: Cuboid fracture is an uncommon lesion. It is frequently associated with others midfoot injuries. In general, the lesions are caused by high-energy accidents. It is necessary to assess the presence or absence of lesion to the medial column. In our study, 69% of patients had injury of the medial column. We recommend the use of cuboid locking plate for comminuted fractures. For simple fractures, screw fixation is indicated. Bridge plate or external fixation be considered for most complex cases. The use of graft should be evaluated in cases of bone stock loss. http://dx.doi.org/10.1016/j.fas.2017.07.432
344 Etiology of ankle osteoarthritis in an Asian population Y. Tochigi ∗ , M. Ogawa, M. Kakihana, Y. Masuda, S. Ozeki Dokkyo Medical University Koshigaya Hospital, Japan Introduction: Previous Caucasian studies reported that vast majority (>70%) of ankle osteoarthritis (OA) was post-traumatic, while primary OA was relatively rare (<10%). It has been believed that primary ankle OA is more common in Asians. The present study aimed to document etiological features of ankle OA in Asians. Methods: Clinical records and preoperative radiographs of 86 consecutive ankle OA surgical cases were retrospectively reviewed to identify preceding pathology of the involved joint, preoperative radiographic grading, and OA-related radiographic changes in the contralateral ankle. Results: Thirty-nine individuals (45%) were classified into posttraumatic, 18 (21%) secondary, and 29 (34%) primary. In the post-traumatic group, 18/39 cases had relatively mild preceding injury (e.g., recurrent sprains). This subgroup exhibited the remarkably higher female-to-male ratio compared to the severe injury group (15/3 vs.10/11), and this characteristic was consistent with the primary group (25/4). In the contralateral ankle radiographs,
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
phone Hallux Valgus Angle: SP-HVA) (Smartphone Method), with hallux valgus angles determined using conventional radiography in a standing posture during weight-bearing (X-ray HVA: XR-HVA). We evaluated 37 feet of 25 patients (5 men and 25 women) who visited our hospital. The mean age at the time of the visit was 73.9 years. In the Smartphone Method, subjects stood upright and the examiner used a smartphone to take photos of both feet from above while holding the phone at the level of the anterior knee. Results: The mean value was 36.2◦ for SP-HVA and 36.7◦ for XRHVA; the two methods showed a statistically significant correlation (correlation coefficient of 0.86). Conclusion: Our smartphone-assisted screening method for hallux valgus was possible to make a diagnosis equivalent to conventional radiography method without radiation exposure. http://dx.doi.org/10.1016/j.fas.2017.07.427
339 Zadek osteotomy for the treatment of insertional Achilles tendinopathy L. Lopez-Capdevila ∗ , A. Sanataria, E. Pich-Aguilera, A. Dominguez, J. Manuel Rios, E. Gil Gil, J. Roman, M. Sales Consorci Sanitari Integral, Spain Introduction: The calcaneal dorsal closing wedge osteotomy was described by Zadek for the treatment of Haglund disease and bursitis retrocalcaneal. However, the literature reporting their outcomes in Achilles tendinopathy is poor. This osteotomy aims to reduce the length of calcaneus and elevate the insertion of the Achilles and therefore, to reduce the tension of Achilles in its insertion. The objective of this study is to assess the clinical outcomes of the Zadek osteotomy in Achilles tendinopathy. Methods: This is a prospective study of twelve patients, mean age 49 years. They were diagnosed with calcific insertional Achilles tendinopathy and had already been treated conservatively. A dorsal wedge osteotomy was performed; whose apex was plantar and base 1 cm dorsal. It was fixed with two 6.5 mm cannulated screws. The patients were scored preoperatively and postoperatively at 6 and 12 months with Aofas, VAS, ROM and patient satisfaction. Radiological parameters such as Calcaneal inclination angle and Fowler-Phillips angles were analysed. The results were analysed statistically (t-student). Mean follow-up was 18 months. Results: All the patients clinically improved. VAS scale improved from 8 to 2 points, as well as Aofas from 41 to 86 points (p < 0,05). Postoperative activity and daily pain were the parameters of Aofas that most improved. Radiographic calcifications did not correlate with clinical pain. Conclusion: The Zadek osteotomy can be considered a standard procedure for insertional Achilles tendinopathy as it has been demonstrated to have good results. http://dx.doi.org/10.1016/j.fas.2017.07.428
340 Tibialis anterior tendon rupture treated with a peroneus tendon allograft. A case report A. Arias ∗ , E. Gaviria, D. Berlanga, L. Lobo, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: Rupture of the tibialis anterior tendon is a rare event. Chronic ruptures of the tibialis anterior tendon are often associated with tendon retraction and poor-quality tissue, resulting in a large segmental defect that make end-to-end repair impossible. A patient with a traumatic chronic rupture of the tibial tendon treaded with intercalary allograft reconstruction will be presented. Methods: A 36 years old male who consulted for ankle dorsiflexion and difficulty walking. The patient mentioned a trauma incident with a saw that occurred 6 months earlier. On physical examination, the tibias anterior tendon was not palpable, it had an active deficit of dorsiflexion in the ankle. A reconstruction of the anterior tibial tendon was performed by intercalary allograft of peroneal tendons. Results: In the postoperative period, the patient was immobilized with a cast, partial progressive loading was authorized at 6 postoperative weeks. At 5 months postoperative, the patient presented an active ankle mobility comparable to the contralateral side an he returned to work after 6 months postoperative. Conclusion: Like the primary dorsiflexor of the ankle, the anterior tibial tendon plays an important role in normal gait. Chronic tibial tendon insufficiency after rupture is associated with functional disability and poses a surgical challenge. When the endto-end repair is not possible the use of tendon grafts is a good treatment option. Reconstruction of the tibialis anterior tendon with peroneal allograft provides a safe and reliable alternative without the morbidity of the donor site associated with the autograft technique. http://dx.doi.org/10.1016/j.fas.2017.07.429
341 Bilateral calcaneal stress fracture, after a enthesopaty achilles surgery: A case report A. Arias ∗ , E. Gaviria, L. Lobo, D. Chaverri, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. In the literature, calcaneal stress fractures are mostly reported in soldiers or athletes, but our case is one of a 43-year-old man with bilateral heel pain after an Achilles tendinitis surgery. Objectives: The aim of this paper is to describe an unusual complication of the Achilles enthesopathy’s surgery. Study design and methods: A 43-year-old male, with a previous history of fibromyalgia and pyramidal syndrome undergoing surgery without complications, and Haglunds disease diagnosed. After the failure of conservative treatment, a bilateral calcaneoplasty is performed in a single surgical time. At 4 months after surgery, the patient came to our clinic because of persistent pain in both heels; the patient reported that he had made an early rehabilitation after bilateral calcaneoplasty. After requesting a study of MRI, he was diagnosed with bilateral stress calcaneous fracture.
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Results: The patient was treated with 2 orthopedic boots with wedges for 2 months and progressive weightbearing. At the 5 months of our visit he was asymptomatic with MRI normalized. Conclusion: The usual treatment for Achilles enthesopathy surgical technique is resection of the degenerated tendon, excision of the calcification and bursa and resection of the posterior calcaneal bony prominence. Partial load is recommended postoperatively and depending on the technique with boot protection or cast. Excessive or early loading can help us in a recurrence of the disease or stress fracture associated as here. http://dx.doi.org/10.1016/j.fas.2017.07.430
342 Treatment of calcaneal fractures with minimally invasive plate osteosynthesis. Our first cases A. Arias ∗ , E. Gaviria, D. Berlanga, L. Lobo, A. Dalmau Hospital Asepeyo Sant Cugat, Spain Background: The treatment of articular calcaneal fractures remains a challenge for the orthopaedic surgeon. One of the most common complications in calcaneal fractures are skin problems, in part to the lateral standard surgical approach. Delays in healing and necrosis of the wound can become expose the osteosynthesis material. The postsurgical infection rate rises to between 3 and 5% of cases. By the sinus tarsi approach we can decrease the number of this complications and allows performing reduction and osteosynthesis with calcaneal plates. Objectives: In this study we describe the treatment of the calcaneal fractures with minimally invasive plate osteosynthesis. Study design and methods: In the last year we have operated 10 patients with intraarticular calcaneal fracture, using a minimally invasive approach and synthesis with a specific plate. This technique is based on a posterior-lateral approach to the subtalar joint through which perform a reduction stable direct joint allowing synthesis using specific plates. Results: We haven’t had any skin or infectious complications. We have had to remove a plate for a commitment to the peroneal tendons and one case has ended in subtalar arthrodesis. 9 of the 10 patients have returned to their work. Conclusion: This technique is not applicable to all types of calcaneal fractures but should be a technique to consider especially for calcaneal fractures Sanders type II, which allows us to prevent or decrease the rate of skin problems associated with extended lateral usual approach. http://dx.doi.org/10.1016/j.fas.2017.07.431
113
343 Cuboid fracture: Epidemiology and treatment algorithm on 28 patients F. Vargas ∗ , C. Bastias, M. Parra, C. Urbina, F. Chaparro Hospital Clinico Mutual de Seguridad, Chile Objective: To describe the epidemiology of cuboid fracture in patients treated surgically, the injury mechanisms and associated lesions, proposing an algorithm for operative management. Patients and method: Retrospective and descriptive study of 28 patients with cuboid fracture, operated on between 2009 and 2014. We analyzed variables such as age, gender, mechanism of injury, associated fractures, fracture classification, osteoarthritis changes among others. Results: 28 cases were identified: 20 men and 8 women. The age mean was 42 years. The average follow-up was 1.3 years. The mechanisms of injury were motor vehicle accident (MVA), fall from height and sprain. 12 cases correspond to Chopart fracture. The most common associated injuries were Lisfranc fracture. 48% of cases had shortening of the lateral column. 88% of patients had involvement of some articular surfaces. Cuboid locking plate was used in 15 cases, single screw fixation was used in 4 patients. Degenerative changes are observed in calcaneocuboid and cuboidmetatarsal articulations. Conclusion: Cuboid fracture is an uncommon lesion. It is frequently associated with others midfoot injuries. In general, the lesions are caused by high-energy accidents. It is necessary to assess the presence or absence of lesion to the medial column. In our study, 69% of patients had injury of the medial column. We recommend the use of cuboid locking plate for comminuted fractures. For simple fractures, screw fixation is indicated. Bridge plate or external fixation be considered for most complex cases. The use of graft should be evaluated in cases of bone stock loss. http://dx.doi.org/10.1016/j.fas.2017.07.432
344 Etiology of ankle osteoarthritis in an Asian population Y. Tochigi ∗ , M. Ogawa, M. Kakihana, Y. Masuda, S. Ozeki Dokkyo Medical University Koshigaya Hospital, Japan Introduction: Previous Caucasian studies reported that vast majority (>70%) of ankle osteoarthritis (OA) was post-traumatic, while primary OA was relatively rare (<10%). It has been believed that primary ankle OA is more common in Asians. The present study aimed to document etiological features of ankle OA in Asians. Methods: Clinical records and preoperative radiographs of 86 consecutive ankle OA surgical cases were retrospectively reviewed to identify preceding pathology of the involved joint, preoperative radiographic grading, and OA-related radiographic changes in the contralateral ankle. Results: Thirty-nine individuals (45%) were classified into posttraumatic, 18 (21%) secondary, and 29 (34%) primary. In the post-traumatic group, 18/39 cases had relatively mild preceding injury (e.g., recurrent sprains). This subgroup exhibited the remarkably higher female-to-male ratio compared to the severe injury group (15/3 vs.10/11), and this characteristic was consistent with the primary group (25/4). In the contralateral ankle radiographs,