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Comparing weight bearing radiographs and weight bearing cone beam CT for flatfoot assessment
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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Results: The mean age of the donors was 80.8 years. Eight left and six right feet were prepared. After Hintermann osteotomy there was no damage of the peroneus longus tendon, after evansosteotomy in one case (14.3%). The peroneus brevis tendon was once totally damaged after Hintermann osteotomy and once partially damaged after Evans osteotomy. In one cadaver the suralis nerve was partially damaged after Hintermann osteotomy, in no case after Evans osteotomy. After Hintermann osteotomy the calcaneal anterior and medial articular surface were 100% and 85.7% intact, whereas after Evans osteotomy only 42.9% and 71.4% were not damaged. The posterior articular surface was affected in no cadaver. Conclusion: After both osteotomies anatomical structures can be damaged. Besides biomechanical advantages, with the Hintermann osteotomy the calcaneal anterior and medial articular surface can be protected in a higher percentage than with the Evans osteotomy. Further studies should be performed, if these findings correlate with the clinical outcome. http://dx.doi.org/10.1016/j.fas.2017.07.259
171 Use of absorbable suture placed using a horizontal mattress technique in elective forefoot surgery R.R. Gorman III Bronson Medical Group, Western Michigan University School of Medicine, United States Introduction: Use of absorbable suture for surgical wound closure has been well described in the orthopaedic literature. Running subcuticular and continuous horizontal mattress techniques have been identified for use in major joint arthroplasty and trauma, but not for surgery of the foot where alternative techniques are typically employed. This study sought to evaluate the viability of using absorbable suture placed in an interrupted horizontal mattress pattern in elective forefoot surgery. Methods: The electronic medical record was queried for a retrospective review of patients having undergone defined elective forefoot reconstructive procedures, performed by the author, from August 2014 through August 2016. Isolated reconstructions for hallux valgus and lesser toe deformities were included. Patients with skin closure using an interrupted horizontal mattress technique ® and poliglecaprone 25 (Monocryl ) were identified. Sutures were not removed post-operatively. Follow-up records were analyzed for complications including superficial infection, deep infection, delayed wound healing and wound dehiscence. Results: 69 surgeries in 62 patients were identified. 4 patients showed superficial skin necrolysis that resolved with wound care alone. One patient developed a cellulitis that resolved with antibiotic treatment. There were no deep infections or wound dehiscences. No patients required formal suture removal. Conclusion: Use of absorbable suture placed using a horizontal mattress technique is a viable option for elective forefoot surgery. Potential benefits include decreased patient discomfort and increased clinical staff efficiency in the outpatient clinical setting. http://dx.doi.org/10.1016/j.fas.2017.07.260
172 Comparing weight bearing radiographs and weight bearing cone beam CT for flatfoot assessment C. de Cesar Netto 1,∗ , S. Demehri 2 , Y. Chodaba 1 , G. Thawait 2 , L. Fonseca 3 , A. Chinanuvathana 3 , A. Mousavian 3 , D. Shakoor 2 , L. Schon 3 1 University of Alabama at Birmingham (UAB), United States 2 Johns Hopkins University, United States 3 Medstar Union Memorial Hospital, United States
Introduction: We compared validated adult acquired flatfoot deformity (AAFD) measurements between WB conventional radiographs and WB CBCT images. Methods: Prospective study, 20 patients (20 ft) with clinical diagnosis of flexible AAFD were included, 12 males and 8 females, mean age of 52.2 years (20–88), and average BMI of 30.35 kg/m2 (19.00–46.09). Involved feet underwent standing anteroposterior (AP) and lateral radiographs, and WB CBCTs. Images were assessed with traditional AAFD measurements obtained at sagittal (lateral) and axial (anteroposterior) planes using predefined anatomical landmarks, by two independent and blinded observers. Intra- and Inter-observer reliabilities were calculated. WB radiograph and WB CBCT measurements were compared by Students t-test. pValues < 0.05 were considered significant. Results: There was good to excellent intra and inter-observer agreements for most of the measurements on both radiographs and WB CBCT images, with slightly better results favoring WBCT measurements. When comparing both imaging modalities we found significant differences in measuring: talus-first metatarsal angle in the sagittal plane (11.34◦ × 21.73◦ ), navicularmedial cuneiform angle (13.19◦ × 7.63◦ ), medial cuneiform to floor distance (6.70 mm × 5.50 mm) and navicular to floor distance (31.34 mm × 23.22 mm). No differences were found for talus-first metatarsal angle (axial plane), talar uncoverage angle, cuboid to floor distance and calcaneal inclination angle. Conclusion: Measurements performed on WB CBCT have similar intra-observer and overall higher inter-observer reliability when compared to WB radiographs. The differences found in some of the AAFD measurements might be related to a better characterization of this three-dimensional deformity on WB CBCT images. http://dx.doi.org/10.1016/j.fas.2017.07.261
173 Comparison between ankle arthroplasty and ankle arthrodesis in end-stage ankle osteoarthritis K. Mikhaylov ∗ , A. Bulatov, V. Emelyanov, D. Pliev, M. Guatsaev, A. Savchuk Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Russia Background: Current aim is to develop approach to the choice of surgical treatment for end-stage ankle arthritis and to estimate the efficacy between ankle arthroplasty and arthrodesis on basis of performed operations. Materials and methods: 134 patients between 22 and 82 years old, comparable by gender and osteoarthritis stages underwent surgical treatments at Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden from 2003
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Results: The mean age of the donors was 80.8 years. Eight left and six right feet were prepared. After Hintermann osteotomy there was no damage of the peroneus longus tendon, after evansosteotomy in one case (14.3%). The peroneus brevis tendon was once totally damaged after Hintermann osteotomy and once partially damaged after Evans osteotomy. In one cadaver the suralis nerve was partially damaged after Hintermann osteotomy, in no case after Evans osteotomy. After Hintermann osteotomy the calcaneal anterior and medial articular surface were 100% and 85.7% intact, whereas after Evans osteotomy only 42.9% and 71.4% were not damaged. The posterior articular surface was affected in no cadaver. Conclusion: After both osteotomies anatomical structures can be damaged. Besides biomechanical advantages, with the Hintermann osteotomy the calcaneal anterior and medial articular surface can be protected in a higher percentage than with the Evans osteotomy. Further studies should be performed, if these findings correlate with the clinical outcome. http://dx.doi.org/10.1016/j.fas.2017.07.259
171 Use of absorbable suture placed using a horizontal mattress technique in elective forefoot surgery R.R. Gorman III Bronson Medical Group, Western Michigan University School of Medicine, United States Introduction: Use of absorbable suture for surgical wound closure has been well described in the orthopaedic literature. Running subcuticular and continuous horizontal mattress techniques have been identified for use in major joint arthroplasty and trauma, but not for surgery of the foot where alternative techniques are typically employed. This study sought to evaluate the viability of using absorbable suture placed in an interrupted horizontal mattress pattern in elective forefoot surgery. Methods: The electronic medical record was queried for a retrospective review of patients having undergone defined elective forefoot reconstructive procedures, performed by the author, from August 2014 through August 2016. Isolated reconstructions for hallux valgus and lesser toe deformities were included. Patients with skin closure using an interrupted horizontal mattress technique ® and poliglecaprone 25 (Monocryl ) were identified. Sutures were not removed post-operatively. Follow-up records were analyzed for complications including superficial infection, deep infection, delayed wound healing and wound dehiscence. Results: 69 surgeries in 62 patients were identified. 4 patients showed superficial skin necrolysis that resolved with wound care alone. One patient developed a cellulitis that resolved with antibiotic treatment. There were no deep infections or wound dehiscences. No patients required formal suture removal. Conclusion: Use of absorbable suture placed using a horizontal mattress technique is a viable option for elective forefoot surgery. Potential benefits include decreased patient discomfort and increased clinical staff efficiency in the outpatient clinical setting. http://dx.doi.org/10.1016/j.fas.2017.07.260
172 Comparing weight bearing radiographs and weight bearing cone beam CT for flatfoot assessment C. de Cesar Netto 1,∗ , S. Demehri 2 , Y. Chodaba 1 , G. Thawait 2 , L. Fonseca 3 , A. Chinanuvathana 3 , A. Mousavian 3 , D. Shakoor 2 , L. Schon 3 1 University of Alabama at Birmingham (UAB), United States 2 Johns Hopkins University, United States 3 Medstar Union Memorial Hospital, United States
Introduction: We compared validated adult acquired flatfoot deformity (AAFD) measurements between WB conventional radiographs and WB CBCT images. Methods: Prospective study, 20 patients (20 ft) with clinical diagnosis of flexible AAFD were included, 12 males and 8 females, mean age of 52.2 years (20–88), and average BMI of 30.35 kg/m2 (19.00–46.09). Involved feet underwent standing anteroposterior (AP) and lateral radiographs, and WB CBCTs. Images were assessed with traditional AAFD measurements obtained at sagittal (lateral) and axial (anteroposterior) planes using predefined anatomical landmarks, by two independent and blinded observers. Intra- and Inter-observer reliabilities were calculated. WB radiograph and WB CBCT measurements were compared by Students t-test. pValues < 0.05 were considered significant. Results: There was good to excellent intra and inter-observer agreements for most of the measurements on both radiographs and WB CBCT images, with slightly better results favoring WBCT measurements. When comparing both imaging modalities we found significant differences in measuring: talus-first metatarsal angle in the sagittal plane (11.34◦ × 21.73◦ ), navicularmedial cuneiform angle (13.19◦ × 7.63◦ ), medial cuneiform to floor distance (6.70 mm × 5.50 mm) and navicular to floor distance (31.34 mm × 23.22 mm). No differences were found for talus-first metatarsal angle (axial plane), talar uncoverage angle, cuboid to floor distance and calcaneal inclination angle. Conclusion: Measurements performed on WB CBCT have similar intra-observer and overall higher inter-observer reliability when compared to WB radiographs. The differences found in some of the AAFD measurements might be related to a better characterization of this three-dimensional deformity on WB CBCT images. http://dx.doi.org/10.1016/j.fas.2017.07.261
173 Comparison between ankle arthroplasty and ankle arthrodesis in end-stage ankle osteoarthritis K. Mikhaylov ∗ , A. Bulatov, V. Emelyanov, D. Pliev, M. Guatsaev, A. Savchuk Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Russia Background: Current aim is to develop approach to the choice of surgical treatment for end-stage ankle arthritis and to estimate the efficacy between ankle arthroplasty and arthrodesis on basis of performed operations. Materials and methods: 134 patients between 22 and 82 years old, comparable by gender and osteoarthritis stages underwent surgical treatments at Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden from 2003