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Management of neglected Lisfranc Injury of foot -a tertiary referral centre experience
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
months, respectively. AOFAS ankle-hindfoot scores, Visual Analogue Scale (VAS) and the degree of range of motion (ROM) were used to compare the clinical outcomes. Radiographic outcomes was evaluated by measuring width of medial clear space and tibiofibular overlap on plain radiograph. Results: The difference of AOFAS, VAS and ROM was not significant between two groups at final follow-up. In radiographic evaluation, both groups showed significantly improved width of medial clear space and distal tibiofibular overlap without statistically significant intergroup difference. Eight cases of cartilage injury and three cases of anterior talofibular ligament injury of intraarticular portion were observed during arthroscopic-assisted syndesmotic screw fixation. Conclusions: Arthroscopic-assisted syndesmotic screw fixation is more appropriate treatment strategy which is capable of evaluation of intraarticular injury and reduction of lateral malleolus in its anatomic position. http://dx.doi.org/10.1016/j.fas.2017.07.368
280 PIP resection arthroplasty vs PIP arthrodesis for fixed hammertoe deformity correction. A review M.C.H.W. Fuchs ∗ , M. Reijman, M.C. Steen, J.G.E. Hendriks Maxima Medical Centre, The Netherlands Introduction: Hammertoe deformity is a common foot problem in clinical practice. There is much difference of opinion in relation to treatment and general consensus does not exist. The aim of this review was to summarize the results of resection and arthrodesis of the PIP joint regarding patient satisfaction, pain and function, toe alignment and complications. Therefore we looked to four different fixation methods, non invasive method, temporarily k-wire fixation or use of an implant. Methods: In October 2014, EMBASE, MEDLINE, Cochrane, Web of Science, Scopus, Pubmed publisher, and Google scholar databases were searched for clinical studies reporting included hammer toe, hammertoe, hallux malleus, surgery, surgical, osteotomy, arthrodesis, operation, operative, resection, correction, repair, fixation, phalangectomy. Two researchers independently screened titles and abstracts for eligibility and assessed risk of bias. Results: Thirteen studies were included and separate in for groups: PIP resection with non invasive fixation (group 1), PIP resection with temporarily k-wire fixation (group 2), PIP arthrodesis with temporarily k-wire fixation (group 3) and PIP arthrodesis with an implant (group 4). Regarding to patient satisfaction, pain and function no big differences were found. Radiological alignment was in favour of group 4. Complication rates tend to be smaller in the resection groups, recurrence rates were low in all groups. Conclusion: PIP resection or arthrodesis show both good results in patient satisfaction, pain en function. Better results in postoperative alignment were found in the arthrodesis with implant group. Lesser complications due to no implant related complications were found in the resection group. http://dx.doi.org/10.1016/j.fas.2017.07.369
93
281 Indications for supramalleolar osteotomy based on arthroscopic findings for varus ankle arthritis N. Hio 1,∗ , A. Hasegawa 2 , S. Monden 3 , H. Noguchi 4 , M. Taki 5 , K. Tsunoda 3 1
Higashimaebashi Orthopaedic Hospital, Japan Agatsumahigashi Orthopaedic Clinic, Japan 3 Kiryu Orthopaedic Hospital, Japan 4 Ishii Clinic, Japan 5 Seirei Hamamatsu General Hospital, Japan 2
Introduction: The purpose of this study is to assess the indications for supramalleolar osteotomy on the basis of the arthroscopic findings. Methods: The study evaluated 66 ankles of 64 patients. Among these were 5 male and 61 females, with a mean age of 58.9 years, and a mean observation period of two years and seven months. Preoperative arthroscopy were performed and the proportion of the surface area of the ankle that had become hardened into an eburnation was classified according to a five-grade scale on the basis of arthroscopic findings: Grade 1, fibrillation of the articular cartilage alone; Grade 2, eburnation was limited to the medial malleolar articular surface; Grade 3, eburnation extended across the medial shoulder of the talus, but covered < 25% of the talocrural joint; Grade 4, eburnation covered ≥ 25% but < 50% of the talocrural joint; and Grade 5, eburnation covered ≥ 50% of the talocrural joint. The operative method was lateral closing wedge osteotomy, and the clinical assessment was carried out using Takakura et al. clinical score. Results: Clinical scores showed an improvement from 62.0 ± 12.7 points preoperatively to 88.0 ± 10.0 points postoperatively of Grade 1, 66.0 ± 11.3 points to 88.6 ± 10.5 points of Grade 2, 65.7 ± 9.3 points to 83.3 ± 10.0 points of Grade 3, 62.9 ± 10.9 points to 78.0 ± 13.2 points of Grade 4, 58.8 ± 16.5 points to 72.5 ± 8.7 points of Grade 5. Conclusions: The preoperative assessment of patients of Grade 3 or below tended to be good postoperative outcome. Preoperative arthroscopy should be done before the supramalleolar osteotomy. http://dx.doi.org/10.1016/j.fas.2017.07.370
282 Management of neglected Lisfranc Injury of foot -a tertiary referral centre experience J. Dhaliwal ∗ , K. Vemulapalli Queens Hospital, Romford, UK Background: Delayed presentation and subsequent complications of lisfranc injury of foot remain a worldwide challenge in orthopaedics. Lisfranc injury comprise a spectrum including a mild sprain to fracture dislocation of tarso-metatarsal joint. Misdiagnosis and delayed presentation of neglected injuries can have devastating long-term consequences of secondary osteoarthritis and mid foot collapse often occurring in young patients. We reviewed our operative experience over eight years and developed guidelines to aid early diagnosis of lisfranc injury. Aims: Identify patients treated for delayed presentation of lisfranc injury over a period between 2008 and 2016. Identify whether patients had open reduction internal fixation or primary fusion and outcome.
94
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Methods: Patients were identified using surgeon’s logbook. This was followed by review of patients medical notes and imaging. AOFAS score was used to assess outcome. Results: There were 18 cases of neglected lisfranc injury referred to our tertiary referral center between 2008 and 2016. Sixteen had open reduction and internal fixation and two had primary fusion. Patients were followed up on average for 16 months post operatively. In two cases metal work was removed after eighteen months. There was no difference in AOFAS score between two groups. Summary: Neglected lisfranc injury presents significant challenges for clinicians. The outcome is often poor hence early diagnosis is vital. We propose a modification of Ottawa foot and ankle rules to include palpation of midfoot as a key component to supplement clinical assessment. http://dx.doi.org/10.1016/j.fas.2017.07.371
283 Calcaneal lengthening osteotomy in talocalcanel tarsal coalition
Results: The prevalence rate of surgical treatment in ankle arthrodesis patients significantly increased by 15.4% from 1.3 per 100,000 persons in 1997 to 1.5 per 100,000 persons in 2013 (p < 0.001). The percentage of ankle arthrodesis patients aged < 65 years old significantly decreased from 79.8% to 70.2%, but that of patients aged 65–74 years old and >75 years old significantly increased from 16.4% to 22.1% and from and 3.8% to 7.6%, respectively. The percentage of patients treated in high-volume hospitals and by high-volume surgeons significantly increased simultaneously. Age, gender, Deyo-Charlson co-morbidity index score, social economic level, urbanization, hospital level, hospital volume and surgeon volume were significantly associated with ankle arthrodesis surgical outcomes (p < 0.05). Conclusions: These population-based data reveal that the prevalence of ankle arthrodesis has increased, especially in older patients. Additionally, hospital treatment costs for ankle arthrodesis have increased despite decreases in LOS. These analytical results should be applicable to most countries with relatively small populations. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.
M. Napiontek Ortop Poliklinika, Poznan, Poland
http://dx.doi.org/10.1016/j.fas.2017.07.373
285 Introduction: The role of calcaneal lengthening osteotomy in the treatment of plano-valgus deformity in tarsal coalition was described by Mosca and Bevan in 2012. The goal of this study is to present patients treated on the same way in our centre in the period 2007–2016. Materials and methods: Five patients (6 feet) were operated due to talocalcaneal coalition and painful plano-valgus foot. One patient was operated bilaterally at the same time. Age at operation ranged from 12 to 18 years (mean 15.2). In all feet opening wedge osteotomy of the anterior part of calcaneus and gastrocnemius lengthening without coalition resection was done. Follow up ranged from 1 to 10 years (mean 6). Results: In all patients this technique dedicated for valgus deformity corrected deformity and as well disestablished the pain. http://dx.doi.org/10.1016/j.fas.2017.07.372
284 Trends and predictions of outcomes after ankle arthrodesis: A nationwide population-based study C.H. Lee 1,∗ , P.J. Huang 2 , S.J. Chen 2 , H.Y. Shi 3 , C.Y. Kuo 4 , Y.M. Cheng 1 1 Pingtung Hospital,Ministry of Health and Welfare, Taiwan, ROC 2 Kaohsiung Medical University, Tzyou 1st Road, Kaohsiung, Taiwan, ROC 3 Department of Healthcare Administration and Medical Informatrics Kaohsiung Medical University, Kaoh, Taiwan, ROC 4 Department of Management, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, ROC
Purpose: To analyze trends and predictions of hospital total costs and lengths of stay (LOS) in a population of patients who had received ankle arthrodesis surgery. Patients and materials: This population-based patient cohort study retrospectively analyzed 5071 patients who had received surgical treatment for ankle arthrodesis from 1997 to 2013.
Is mechanical correction of the foot and ankle important for healing the diabetic foot ulcer? H. El-Mowafi ∗ , Y. Kandil, A. El-hawary Mansoura Faculty of Medicine, Egypt Background: Diabetic ulcers are either in weight-bearing or non weight-bearing area. Both types of ulcers result from mechanical failure of the underlying insensitive neuropathic joints leading to progressive pressure necrosis and eventually ulceration. Skin fragility and poor vascularity add to this problem especially in non weight-bearing area. Aim: To define the role of orthopaedic surgery in managing diabetic foot and ankle ulcers and to evaluate the result of diabetic foot ulcers healing in weight-bearing and in non weight-bearing areas. Material and methods: Total of 20 patient, 8 ulcers on the tip of the lateral malleolus, 2 ulcers on the medial border of the foot and 10 planter ulcers. Ulcers were grade II Wagner in the weightbearing area and grade III in non weight-bearing area. All patients underwent correction of the deformity. The follow up period ranged from 7 to 19 months. All patients wear diabetic walker with offloading sole pad. Results: All the excised ulcers in non weight-bearing area healed in the average time 2 weeks. All the ulcers in the weight-bearing area healed in an average time of 5 weeks. Conclusion: Analysis of the foot deformity biomechanically and correcting or improving the foot mechanics is the corner stone in treatment of diabetic foot ulcers. If the ulcer is in non weightbearing area it should be excised completely. If the ulcer is in weight-bearing area, offloading after mechanical correction will allow for spontaneous healing without the need for extensive debridement or excision. http://dx.doi.org/10.1016/j.fas.2017.07.374
months, respectively. AOFAS ankle-hindfoot scores, Visual Analogue Scale (VAS) and the degree of range of motion (ROM) were used to compare the clinical outcomes. Radiographic outcomes was evaluated by measuring width of medial clear space and tibiofibular overlap on plain radiograph. Results: The difference of AOFAS, VAS and ROM was not significant between two groups at final follow-up. In radiographic evaluation, both groups showed significantly improved width of medial clear space and distal tibiofibular overlap without statistically significant intergroup difference. Eight cases of cartilage injury and three cases of anterior talofibular ligament injury of intraarticular portion were observed during arthroscopic-assisted syndesmotic screw fixation. Conclusions: Arthroscopic-assisted syndesmotic screw fixation is more appropriate treatment strategy which is capable of evaluation of intraarticular injury and reduction of lateral malleolus in its anatomic position. http://dx.doi.org/10.1016/j.fas.2017.07.368
280 PIP resection arthroplasty vs PIP arthrodesis for fixed hammertoe deformity correction. A review M.C.H.W. Fuchs ∗ , M. Reijman, M.C. Steen, J.G.E. Hendriks Maxima Medical Centre, The Netherlands Introduction: Hammertoe deformity is a common foot problem in clinical practice. There is much difference of opinion in relation to treatment and general consensus does not exist. The aim of this review was to summarize the results of resection and arthrodesis of the PIP joint regarding patient satisfaction, pain and function, toe alignment and complications. Therefore we looked to four different fixation methods, non invasive method, temporarily k-wire fixation or use of an implant. Methods: In October 2014, EMBASE, MEDLINE, Cochrane, Web of Science, Scopus, Pubmed publisher, and Google scholar databases were searched for clinical studies reporting included hammer toe, hammertoe, hallux malleus, surgery, surgical, osteotomy, arthrodesis, operation, operative, resection, correction, repair, fixation, phalangectomy. Two researchers independently screened titles and abstracts for eligibility and assessed risk of bias. Results: Thirteen studies were included and separate in for groups: PIP resection with non invasive fixation (group 1), PIP resection with temporarily k-wire fixation (group 2), PIP arthrodesis with temporarily k-wire fixation (group 3) and PIP arthrodesis with an implant (group 4). Regarding to patient satisfaction, pain and function no big differences were found. Radiological alignment was in favour of group 4. Complication rates tend to be smaller in the resection groups, recurrence rates were low in all groups. Conclusion: PIP resection or arthrodesis show both good results in patient satisfaction, pain en function. Better results in postoperative alignment were found in the arthrodesis with implant group. Lesser complications due to no implant related complications were found in the resection group. http://dx.doi.org/10.1016/j.fas.2017.07.369
93
281 Indications for supramalleolar osteotomy based on arthroscopic findings for varus ankle arthritis N. Hio 1,∗ , A. Hasegawa 2 , S. Monden 3 , H. Noguchi 4 , M. Taki 5 , K. Tsunoda 3 1
Higashimaebashi Orthopaedic Hospital, Japan Agatsumahigashi Orthopaedic Clinic, Japan 3 Kiryu Orthopaedic Hospital, Japan 4 Ishii Clinic, Japan 5 Seirei Hamamatsu General Hospital, Japan 2
Introduction: The purpose of this study is to assess the indications for supramalleolar osteotomy on the basis of the arthroscopic findings. Methods: The study evaluated 66 ankles of 64 patients. Among these were 5 male and 61 females, with a mean age of 58.9 years, and a mean observation period of two years and seven months. Preoperative arthroscopy were performed and the proportion of the surface area of the ankle that had become hardened into an eburnation was classified according to a five-grade scale on the basis of arthroscopic findings: Grade 1, fibrillation of the articular cartilage alone; Grade 2, eburnation was limited to the medial malleolar articular surface; Grade 3, eburnation extended across the medial shoulder of the talus, but covered < 25% of the talocrural joint; Grade 4, eburnation covered ≥ 25% but < 50% of the talocrural joint; and Grade 5, eburnation covered ≥ 50% of the talocrural joint. The operative method was lateral closing wedge osteotomy, and the clinical assessment was carried out using Takakura et al. clinical score. Results: Clinical scores showed an improvement from 62.0 ± 12.7 points preoperatively to 88.0 ± 10.0 points postoperatively of Grade 1, 66.0 ± 11.3 points to 88.6 ± 10.5 points of Grade 2, 65.7 ± 9.3 points to 83.3 ± 10.0 points of Grade 3, 62.9 ± 10.9 points to 78.0 ± 13.2 points of Grade 4, 58.8 ± 16.5 points to 72.5 ± 8.7 points of Grade 5. Conclusions: The preoperative assessment of patients of Grade 3 or below tended to be good postoperative outcome. Preoperative arthroscopy should be done before the supramalleolar osteotomy. http://dx.doi.org/10.1016/j.fas.2017.07.370
282 Management of neglected Lisfranc Injury of foot -a tertiary referral centre experience J. Dhaliwal ∗ , K. Vemulapalli Queens Hospital, Romford, UK Background: Delayed presentation and subsequent complications of lisfranc injury of foot remain a worldwide challenge in orthopaedics. Lisfranc injury comprise a spectrum including a mild sprain to fracture dislocation of tarso-metatarsal joint. Misdiagnosis and delayed presentation of neglected injuries can have devastating long-term consequences of secondary osteoarthritis and mid foot collapse often occurring in young patients. We reviewed our operative experience over eight years and developed guidelines to aid early diagnosis of lisfranc injury. Aims: Identify patients treated for delayed presentation of lisfranc injury over a period between 2008 and 2016. Identify whether patients had open reduction internal fixation or primary fusion and outcome.
94
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Methods: Patients were identified using surgeon’s logbook. This was followed by review of patients medical notes and imaging. AOFAS score was used to assess outcome. Results: There were 18 cases of neglected lisfranc injury referred to our tertiary referral center between 2008 and 2016. Sixteen had open reduction and internal fixation and two had primary fusion. Patients were followed up on average for 16 months post operatively. In two cases metal work was removed after eighteen months. There was no difference in AOFAS score between two groups. Summary: Neglected lisfranc injury presents significant challenges for clinicians. The outcome is often poor hence early diagnosis is vital. We propose a modification of Ottawa foot and ankle rules to include palpation of midfoot as a key component to supplement clinical assessment. http://dx.doi.org/10.1016/j.fas.2017.07.371
283 Calcaneal lengthening osteotomy in talocalcanel tarsal coalition
Results: The prevalence rate of surgical treatment in ankle arthrodesis patients significantly increased by 15.4% from 1.3 per 100,000 persons in 1997 to 1.5 per 100,000 persons in 2013 (p < 0.001). The percentage of ankle arthrodesis patients aged < 65 years old significantly decreased from 79.8% to 70.2%, but that of patients aged 65–74 years old and >75 years old significantly increased from 16.4% to 22.1% and from and 3.8% to 7.6%, respectively. The percentage of patients treated in high-volume hospitals and by high-volume surgeons significantly increased simultaneously. Age, gender, Deyo-Charlson co-morbidity index score, social economic level, urbanization, hospital level, hospital volume and surgeon volume were significantly associated with ankle arthrodesis surgical outcomes (p < 0.05). Conclusions: These population-based data reveal that the prevalence of ankle arthrodesis has increased, especially in older patients. Additionally, hospital treatment costs for ankle arthrodesis have increased despite decreases in LOS. These analytical results should be applicable to most countries with relatively small populations. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.
M. Napiontek Ortop Poliklinika, Poznan, Poland
http://dx.doi.org/10.1016/j.fas.2017.07.373
285 Introduction: The role of calcaneal lengthening osteotomy in the treatment of plano-valgus deformity in tarsal coalition was described by Mosca and Bevan in 2012. The goal of this study is to present patients treated on the same way in our centre in the period 2007–2016. Materials and methods: Five patients (6 feet) were operated due to talocalcaneal coalition and painful plano-valgus foot. One patient was operated bilaterally at the same time. Age at operation ranged from 12 to 18 years (mean 15.2). In all feet opening wedge osteotomy of the anterior part of calcaneus and gastrocnemius lengthening without coalition resection was done. Follow up ranged from 1 to 10 years (mean 6). Results: In all patients this technique dedicated for valgus deformity corrected deformity and as well disestablished the pain. http://dx.doi.org/10.1016/j.fas.2017.07.372
284 Trends and predictions of outcomes after ankle arthrodesis: A nationwide population-based study C.H. Lee 1,∗ , P.J. Huang 2 , S.J. Chen 2 , H.Y. Shi 3 , C.Y. Kuo 4 , Y.M. Cheng 1 1 Pingtung Hospital,Ministry of Health and Welfare, Taiwan, ROC 2 Kaohsiung Medical University, Tzyou 1st Road, Kaohsiung, Taiwan, ROC 3 Department of Healthcare Administration and Medical Informatrics Kaohsiung Medical University, Kaoh, Taiwan, ROC 4 Department of Management, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan, ROC
Purpose: To analyze trends and predictions of hospital total costs and lengths of stay (LOS) in a population of patients who had received ankle arthrodesis surgery. Patients and materials: This population-based patient cohort study retrospectively analyzed 5071 patients who had received surgical treatment for ankle arthrodesis from 1997 to 2013.
Is mechanical correction of the foot and ankle important for healing the diabetic foot ulcer? H. El-Mowafi ∗ , Y. Kandil, A. El-hawary Mansoura Faculty of Medicine, Egypt Background: Diabetic ulcers are either in weight-bearing or non weight-bearing area. Both types of ulcers result from mechanical failure of the underlying insensitive neuropathic joints leading to progressive pressure necrosis and eventually ulceration. Skin fragility and poor vascularity add to this problem especially in non weight-bearing area. Aim: To define the role of orthopaedic surgery in managing diabetic foot and ankle ulcers and to evaluate the result of diabetic foot ulcers healing in weight-bearing and in non weight-bearing areas. Material and methods: Total of 20 patient, 8 ulcers on the tip of the lateral malleolus, 2 ulcers on the medial border of the foot and 10 planter ulcers. Ulcers were grade II Wagner in the weightbearing area and grade III in non weight-bearing area. All patients underwent correction of the deformity. The follow up period ranged from 7 to 19 months. All patients wear diabetic walker with offloading sole pad. Results: All the excised ulcers in non weight-bearing area healed in the average time 2 weeks. All the ulcers in the weight-bearing area healed in an average time of 5 weeks. Conclusion: Analysis of the foot deformity biomechanically and correcting or improving the foot mechanics is the corner stone in treatment of diabetic foot ulcers. If the ulcer is in non weightbearing area it should be excised completely. If the ulcer is in weight-bearing area, offloading after mechanical correction will allow for spontaneous healing without the need for extensive debridement or excision. http://dx.doi.org/10.1016/j.fas.2017.07.374