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Early weight bearing on a fixed syndesmosis. Does it matter?
E-Poster / Foot and Ankle Surgery 22S (2016) 80–104
Conclusions: This is the first large cohort retrieval study of TAR explants. Damage modes indicative of high levels of wear and deformation were evident. Pitting caused by third body debris was abundant and suggested fixation surface wear. http://dx.doi.org/10.1016/j.fas.2016.05.226
205 FI2016_E-Poster_28 A prospective continuous study of first MTPJ arthrodesis using dorsal plate at 7 year minimal FU J.L. Grisard * Clinique du Parc Lyon, France *Corresponding author. Background/Aims: The aim of this prospective study was to evaluate the long-term results of patients treated with hallux MTP joint arthrodesis using a dorsal titanium plate and lag screw. Methods: Out of a prospective continuous study of 122 feet in 117 patients who underwent surgery from 2006 to 2007, 69 feet (65 patients) were available for a minimum 7 year folllow up. The technique used cup-shaped reamers, non-locked dorsal titanium plate and lag screw (one operator). Patients were evaluated clinically, by standing radiographs, and with a questionnaire considering risk factors and indications for first MTPJoint arthrodesis, VAS rate, AOFAS score, indications and rate of subsequent surgery. Results: 22/69 feet (31.9%) had associated lesser toe techniques. Average AOFAS score raised from 38.9 to 83.8 (one year FU) and to 78.7 (7 year FU). VAS pain/function/satisfaction (6.7/6.6/4.4 preoperatively) shifted to 1.4/9.2/8.1 at maximum follow-up. Causes of subsequent surgery were 1 nonunion, 7 hardware problems in fused group (3 screw migrations and 4 phalanx dorsal migrations who lead to 4 malunions), 2 excessive valgus, 2 patients with symptomatic inter-phalangeal osteoarthritis and 2 patients with late metatarsalgias. Summary/Conclusion: First MTPJ arthrodesis using dorsal titanium plate and plantar lag screw allows a very high rate of fusion (68/69 feet). Nevertheless, a solid first MTPJ fusion does not guarantee a good result. The main source of complications was malunion: 4 patients with excessive dorsiflexion and 2 excessive valgus lead to subsequent surgery. Further, late metatarsalgias and stifness of lesser toes reduced satisfaction. http://dx.doi.org/10.1016/j.fas.2016.05.227
206 FI2016_E-Poster_29 Adult flexible flatfoot due to insufficiency of posterior tibial tendon: Calcaneo-stop and tensioni P. Ceccarini *, G. Rinonapoli, G. Gambaracci, M. Bisaccia, A. Ceccarini, A. Caraffa SM Misericordia Hospital, University of Perugia, Italy *Corresponding author. Aim: We postulated that in a flexible adult flatfoot, calcaneostop procedure combined with medial tensioning of posterior tibial tendon allowed the resolution of symptoms by correcting the pattern of the gait and avoiding the evolution to a subsequent stage. The purpose of this study was to determine functional,
89
biomechanic, and radiographic results in patients who underwent surgery for flexible flatfoot without osteotomies or arthrodesis. Methods: We evaluated clinically and radiographically 29 patients surgically treated for adult flatfoot grade IIa according to Myerson, with a mean age of 46.4 years. Mean follow-up was 34.15 months. For clinical evaluation the AOFAS hindfoot and VAS-FA scores were used. In 10 patients, pre and post-operatively gait analisys was performed. Results: Postoperative results showed a significant increase of AOFAS and VAS-FA scores, from 54.7 (range 34–78) to 83.1 (range 66–100) and 60.5 (range 35–86) 85 (range 64–100) points, respectively. For the X-ray parameters, in the AP projection, we observed a significant variation of Kites angle, from 24.28 in the pre-op to 19.28 in the post-op. In lateral view Costa-Bertani angle showed changes from 146.88 to 140.58. The Mearys angle, showed an average at the post-op of 4.38. Postoperative satisfaction was excellent-good for 25 patients (86.2%). Postoperative gait analysis showed an improved pattern of the gait. Conclusions: The technique of arthroereisis with medial tensioning of PTT is a valid technique for the young adult, up to 50 years and with no signs of osteoarthritis of the midfoot and hindfoot. http://dx.doi.org/10.1016/j.fas.2016.05.228
207 FI2016_E-Poster_30 Early weight bearing on a fixed syndesmosis. Does it matter? P. Mococain 1,*, A. Keller 1, E. Wagner 1, P. Wagner 1, C. Ortiz 1, D. Zanolli 1, J.J. Valderrama 2, D. Paccot 1 1
Clı´nica Alemana de Santiago, Chile Hospital Mutual de Seguridad de Santiago, Chile *Corresponding author. 2
Introduction: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation, of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged. The aim of this study was to evaluate the radiographic parameters of the syndesmosis over time in patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). We measure medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS) and talar shift (TS). Results: At final follow up, 66.6% of the screws were broken, 30.9% showed significant loosening and only 1 patient (4.7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2.94 mm; 3.3 mm; 3.02, respectively. OL was 6.76 mm; 6.78 mm; 6.83 and CS was 4.26 mm; 4.66 mm; 4.6 mm. No TS was detected. There was no difference in measurements along time (p > 0.05). Also no difference was found in measurements within patients with intact versus broken screws (p > 0.05). Conclusions: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographics consequences regarding ankle joint parameters. Despite screw breakage or loosening on X-rays, loss of reduction is seldom observed. http://dx.doi.org/10.1016/j.fas.2016.05.229
Conclusions: This is the first large cohort retrieval study of TAR explants. Damage modes indicative of high levels of wear and deformation were evident. Pitting caused by third body debris was abundant and suggested fixation surface wear. http://dx.doi.org/10.1016/j.fas.2016.05.226
205 FI2016_E-Poster_28 A prospective continuous study of first MTPJ arthrodesis using dorsal plate at 7 year minimal FU J.L. Grisard * Clinique du Parc Lyon, France *Corresponding author. Background/Aims: The aim of this prospective study was to evaluate the long-term results of patients treated with hallux MTP joint arthrodesis using a dorsal titanium plate and lag screw. Methods: Out of a prospective continuous study of 122 feet in 117 patients who underwent surgery from 2006 to 2007, 69 feet (65 patients) were available for a minimum 7 year folllow up. The technique used cup-shaped reamers, non-locked dorsal titanium plate and lag screw (one operator). Patients were evaluated clinically, by standing radiographs, and with a questionnaire considering risk factors and indications for first MTPJoint arthrodesis, VAS rate, AOFAS score, indications and rate of subsequent surgery. Results: 22/69 feet (31.9%) had associated lesser toe techniques. Average AOFAS score raised from 38.9 to 83.8 (one year FU) and to 78.7 (7 year FU). VAS pain/function/satisfaction (6.7/6.6/4.4 preoperatively) shifted to 1.4/9.2/8.1 at maximum follow-up. Causes of subsequent surgery were 1 nonunion, 7 hardware problems in fused group (3 screw migrations and 4 phalanx dorsal migrations who lead to 4 malunions), 2 excessive valgus, 2 patients with symptomatic inter-phalangeal osteoarthritis and 2 patients with late metatarsalgias. Summary/Conclusion: First MTPJ arthrodesis using dorsal titanium plate and plantar lag screw allows a very high rate of fusion (68/69 feet). Nevertheless, a solid first MTPJ fusion does not guarantee a good result. The main source of complications was malunion: 4 patients with excessive dorsiflexion and 2 excessive valgus lead to subsequent surgery. Further, late metatarsalgias and stifness of lesser toes reduced satisfaction. http://dx.doi.org/10.1016/j.fas.2016.05.227
206 FI2016_E-Poster_29 Adult flexible flatfoot due to insufficiency of posterior tibial tendon: Calcaneo-stop and tensioni P. Ceccarini *, G. Rinonapoli, G. Gambaracci, M. Bisaccia, A. Ceccarini, A. Caraffa SM Misericordia Hospital, University of Perugia, Italy *Corresponding author. Aim: We postulated that in a flexible adult flatfoot, calcaneostop procedure combined with medial tensioning of posterior tibial tendon allowed the resolution of symptoms by correcting the pattern of the gait and avoiding the evolution to a subsequent stage. The purpose of this study was to determine functional,
89
biomechanic, and radiographic results in patients who underwent surgery for flexible flatfoot without osteotomies or arthrodesis. Methods: We evaluated clinically and radiographically 29 patients surgically treated for adult flatfoot grade IIa according to Myerson, with a mean age of 46.4 years. Mean follow-up was 34.15 months. For clinical evaluation the AOFAS hindfoot and VAS-FA scores were used. In 10 patients, pre and post-operatively gait analisys was performed. Results: Postoperative results showed a significant increase of AOFAS and VAS-FA scores, from 54.7 (range 34–78) to 83.1 (range 66–100) and 60.5 (range 35–86) 85 (range 64–100) points, respectively. For the X-ray parameters, in the AP projection, we observed a significant variation of Kites angle, from 24.28 in the pre-op to 19.28 in the post-op. In lateral view Costa-Bertani angle showed changes from 146.88 to 140.58. The Mearys angle, showed an average at the post-op of 4.38. Postoperative satisfaction was excellent-good for 25 patients (86.2%). Postoperative gait analysis showed an improved pattern of the gait. Conclusions: The technique of arthroereisis with medial tensioning of PTT is a valid technique for the young adult, up to 50 years and with no signs of osteoarthritis of the midfoot and hindfoot. http://dx.doi.org/10.1016/j.fas.2016.05.228
207 FI2016_E-Poster_30 Early weight bearing on a fixed syndesmosis. Does it matter? P. Mococain 1,*, A. Keller 1, E. Wagner 1, P. Wagner 1, C. Ortiz 1, D. Zanolli 1, J.J. Valderrama 2, D. Paccot 1 1
Clı´nica Alemana de Santiago, Chile Hospital Mutual de Seguridad de Santiago, Chile *Corresponding author. 2
Introduction: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation, of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged. The aim of this study was to evaluate the radiographic parameters of the syndesmosis over time in patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). We measure medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS) and talar shift (TS). Results: At final follow up, 66.6% of the screws were broken, 30.9% showed significant loosening and only 1 patient (4.7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2.94 mm; 3.3 mm; 3.02, respectively. OL was 6.76 mm; 6.78 mm; 6.83 and CS was 4.26 mm; 4.66 mm; 4.6 mm. No TS was detected. There was no difference in measurements along time (p > 0.05). Also no difference was found in measurements within patients with intact versus broken screws (p > 0.05). Conclusions: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographics consequences regarding ankle joint parameters. Despite screw breakage or loosening on X-rays, loss of reduction is seldom observed. http://dx.doi.org/10.1016/j.fas.2016.05.229