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CT evaluation of the syndesmosis treated with suture button
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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
202
D. Tantigate ∗ , G. Ho, J. Kirschenbaum, C. Freibott, B. Ascherman, J. Greisberg, T. Vosseller
and 1st TMT joint injury. In 11 patients (13%), the injury extended into the navicular-first cuneiform joint. Conclusion: Our study demonstrated that subtle Lisfranc injuries constitute a wide spectrum of injury to the mid-foot joints. These findings can help to guide orthopaedic surgeons on effective methods of internal fixation and provide prognosis of this injury.
Columbia University Medical Center, Columbia
http://dx.doi.org/10.1016/j.fas.2017.07.292
Background: Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of operatively treated ankle fracture-dislocations. The purpose of this study is to compare functional outcome after operative treatment in ankle fractures with and without dislocation. Methods: A retrospective chart review of operatively treated ankle fractures over a three-year period was performed. Sixtytwo ankle fracture patients older than 18 years with a minimum follow-up of 12 months were included. Demographic variables, complications, and functional outcome determined by Foot and Ankle Outcome Score (FAOS) were recorded. Comparison of demographic variables and FAOS were performed between these two groups. Results: The mean follow-up time was 40 months. Twenty patients (32.3%) were fracture-dislocations. The fracturedislocation cohort demonstrated worse FAOS than the nondislocation cohort (symptoms 73 vs 79, pain 75 vs 85, ADL 80 vs 88, Sport 63 vs 76 and QOL 54 vs 60, respectively), although none of these differences were statistically significant. Patients with ankle fracture-dislocation had bi- and trimalleolar fractures (p = .007). There was no statistically significant difference in patient demographics or the rate of complications. Conclusion: Fracture-dislocations of the ankle presented with more bimalleolar and trimalleolar fractures, although there was no statistically significant difference in terms of functional outcome. Although our data showed no difference in outcome, there was a trend towards worse outcomes in the dislocation cohort.
204
Functional outcomes after fracture-dislocation of the ankles
http://dx.doi.org/10.1016/j.fas.2017.07.291
203 Pathoanatomy of subtle Lisfranc injury
CT evaluation of the syndesmosis treated with suture button S. Isefuku ∗ , M. Abe Sendai Medical Center, Japan Background: Suture button stabilization has been widely used to treat tibiofibular syndesmosis disruption, however, the ability to maintain reduction has not been evaluated precisely in clinical setting. We observed the syndesmosis treated with suture button on CT images. Patients and methods: Acute syndesmosis disruptions with ankle malleolar fractures were stabilized with this method in 8 patients with the mean age of 44 years, 4 men and 4 women. The mean postoperative observation period was 10.1 months (3–15). The distances between tibia and fibula were measured on the axial CT images 1 cm proximal to the tibia plafond. The distances were also measured in the uninjured ankles. The angles between the tibia and the fibula were measured on the same images. Results: The mean distances were 2.9 mm (1.8–3.6) in the uninjured sides, 2.7 mm (2.1–4.2) after the operations, 3.8 mm (2.7–5.3) just before metal removal, respectively. In 4 ankles, the suture buttons were removed. The mean distance after removal was 3.9 mm (2.6–5.4). Comparing to the uninjured side, the fibular was externally rotated in 3 ankles with the mean angle of 4.3◦ and internally rotated in 5 ankles with the mean angle of 5.2◦ just before metal removal. The mean clinical score based on Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was 95 points (87–100) at the final observation. Conclusion: The disrupted syndesmoses became loose even after suture button stabilization, however, the loosening was considered within the acceptable level in clinical practice.
N. Haraguchi ∗ , K. Ota, T. Ozeki, N. Nishida Tokyo Metropolitan Police Hospital, Japan
http://dx.doi.org/10.1016/j.fas.2017.07.293
205 Introduction: Although thorough knowledge of the pathologic anatomy of the subtle Lisfranc injuries is essential for the development of improved operative techniques and outcomes, data on the pattern of Lisfranc complex disruption are scarce. Methods: We identified specific injured joints by intraoperative direct visualization as well as weight bearing radiograph and computed tomography in 87 patients with a subtle Lisfranc injury diagnosed by the criteria of Faciszewski et al. We used Karr’s criteria as a broad category; transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and the M2) and longitudinal type (instability between the C1 and the M2 and between the C1 and C2). Results: The injury was classified as longitudinal type in 33 patients (38%) and transverse type in 26 patients (30%). 17 patients (20%) had transverse type injury combined with 1st tarsometatarsal (TMT) joint injury. 6 patients (7%) had a combination of longitudinal and transverse type injury. 3 patients (3%) had longitudinal type injury combined with 1st TMT joint injury. 2 patients (2%) had a combination of longitudinal type injury, transverse type injury,
Management of the ankle evolved osteochondritis by mosaicoplasty H. Kefi ∗ , K. Amri, A. Abdnadher Tunis’s Main Military Training Hospital, Tunisia Introduction: Mosaicoplasty is a technique used to repair articular cartilage developed during the 1990s. It was introduced to clinical practice in 1992. This article aims to evaluate the mediumterm functional outcome of this technique through a series of 7 patients. Methods: The study included 7 patients with 4 men and 3 women aged 35–52 with grade 3 and 4 ankle osteochondritis. Patients were evaluated according to the IKDC score and the EVA scale Results: The mean IKDC score was 80% and an EVA < 4.
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
202
D. Tantigate ∗ , G. Ho, J. Kirschenbaum, C. Freibott, B. Ascherman, J. Greisberg, T. Vosseller
and 1st TMT joint injury. In 11 patients (13%), the injury extended into the navicular-first cuneiform joint. Conclusion: Our study demonstrated that subtle Lisfranc injuries constitute a wide spectrum of injury to the mid-foot joints. These findings can help to guide orthopaedic surgeons on effective methods of internal fixation and provide prognosis of this injury.
Columbia University Medical Center, Columbia
http://dx.doi.org/10.1016/j.fas.2017.07.292
Background: Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of operatively treated ankle fracture-dislocations. The purpose of this study is to compare functional outcome after operative treatment in ankle fractures with and without dislocation. Methods: A retrospective chart review of operatively treated ankle fractures over a three-year period was performed. Sixtytwo ankle fracture patients older than 18 years with a minimum follow-up of 12 months were included. Demographic variables, complications, and functional outcome determined by Foot and Ankle Outcome Score (FAOS) were recorded. Comparison of demographic variables and FAOS were performed between these two groups. Results: The mean follow-up time was 40 months. Twenty patients (32.3%) were fracture-dislocations. The fracturedislocation cohort demonstrated worse FAOS than the nondislocation cohort (symptoms 73 vs 79, pain 75 vs 85, ADL 80 vs 88, Sport 63 vs 76 and QOL 54 vs 60, respectively), although none of these differences were statistically significant. Patients with ankle fracture-dislocation had bi- and trimalleolar fractures (p = .007). There was no statistically significant difference in patient demographics or the rate of complications. Conclusion: Fracture-dislocations of the ankle presented with more bimalleolar and trimalleolar fractures, although there was no statistically significant difference in terms of functional outcome. Although our data showed no difference in outcome, there was a trend towards worse outcomes in the dislocation cohort.
204
Functional outcomes after fracture-dislocation of the ankles
http://dx.doi.org/10.1016/j.fas.2017.07.291
203 Pathoanatomy of subtle Lisfranc injury
CT evaluation of the syndesmosis treated with suture button S. Isefuku ∗ , M. Abe Sendai Medical Center, Japan Background: Suture button stabilization has been widely used to treat tibiofibular syndesmosis disruption, however, the ability to maintain reduction has not been evaluated precisely in clinical setting. We observed the syndesmosis treated with suture button on CT images. Patients and methods: Acute syndesmosis disruptions with ankle malleolar fractures were stabilized with this method in 8 patients with the mean age of 44 years, 4 men and 4 women. The mean postoperative observation period was 10.1 months (3–15). The distances between tibia and fibula were measured on the axial CT images 1 cm proximal to the tibia plafond. The distances were also measured in the uninjured ankles. The angles between the tibia and the fibula were measured on the same images. Results: The mean distances were 2.9 mm (1.8–3.6) in the uninjured sides, 2.7 mm (2.1–4.2) after the operations, 3.8 mm (2.7–5.3) just before metal removal, respectively. In 4 ankles, the suture buttons were removed. The mean distance after removal was 3.9 mm (2.6–5.4). Comparing to the uninjured side, the fibular was externally rotated in 3 ankles with the mean angle of 4.3◦ and internally rotated in 5 ankles with the mean angle of 5.2◦ just before metal removal. The mean clinical score based on Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was 95 points (87–100) at the final observation. Conclusion: The disrupted syndesmoses became loose even after suture button stabilization, however, the loosening was considered within the acceptable level in clinical practice.
N. Haraguchi ∗ , K. Ota, T. Ozeki, N. Nishida Tokyo Metropolitan Police Hospital, Japan
http://dx.doi.org/10.1016/j.fas.2017.07.293
205 Introduction: Although thorough knowledge of the pathologic anatomy of the subtle Lisfranc injuries is essential for the development of improved operative techniques and outcomes, data on the pattern of Lisfranc complex disruption are scarce. Methods: We identified specific injured joints by intraoperative direct visualization as well as weight bearing radiograph and computed tomography in 87 patients with a subtle Lisfranc injury diagnosed by the criteria of Faciszewski et al. We used Karr’s criteria as a broad category; transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and the M2) and longitudinal type (instability between the C1 and the M2 and between the C1 and C2). Results: The injury was classified as longitudinal type in 33 patients (38%) and transverse type in 26 patients (30%). 17 patients (20%) had transverse type injury combined with 1st tarsometatarsal (TMT) joint injury. 6 patients (7%) had a combination of longitudinal and transverse type injury. 3 patients (3%) had longitudinal type injury combined with 1st TMT joint injury. 2 patients (2%) had a combination of longitudinal type injury, transverse type injury,
Management of the ankle evolved osteochondritis by mosaicoplasty H. Kefi ∗ , K. Amri, A. Abdnadher Tunis’s Main Military Training Hospital, Tunisia Introduction: Mosaicoplasty is a technique used to repair articular cartilage developed during the 1990s. It was introduced to clinical practice in 1992. This article aims to evaluate the mediumterm functional outcome of this technique through a series of 7 patients. Methods: The study included 7 patients with 4 men and 3 women aged 35–52 with grade 3 and 4 ankle osteochondritis. Patients were evaluated according to the IKDC score and the EVA scale Results: The mean IKDC score was 80% and an EVA < 4.