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Tibialis posterior transfer in rebalancing of rigid cavovarus foot in Charcot-Marie-Tooth disease
66
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
195 The features and short term results of total ankle arthroplasty using total talar prosthesis N. Kanzaki 1,∗ , Y. Takakura 2 , Y.Y. Takakura 2 , K. Ibaraki 1 , N. Miyaji 1 , T. Tanaka 1 , K. Nishida 1 , D. Araki 1 , T. Matsusita 1 , R. Kuroda 1
Helal (1987) reported about cancellous bone transplantation, but the methods did not spread afterwards. This procedure produced good results in the early stages that the cartilaginous damage is slight, and it may shorten the treatment period. http://dx.doi.org/10.1016/j.fas.2017.07.285
197
1
Kobe University Graduate School of Medicine, Japan 2 Takakura Orthopaedic and Sports Clinic, Japan
Aim of study: Total talar prosthesis (TTP) was invented for the treatment of osteonecrosis of talus. We have taken to performing total ankle arthroplasty (TAA) using TTP in case of both ankle and subtalar joint osteoarthritis, or sever collapse of talus. The aim of this study is to introduce the features and short term results of TAA using TTP. Materials and methods: The number of the case was 18, the mean follow-up terms was 15 months, and the mean age was 74.2 years old. The classification of OA stage was 3 cases in stage 3a, 3 cases in stage 3b, and 12 cases in stage 4. The TNK ankle (KYOCERA Medical, Osaka, Japan) was used in all patient, and TTP (KYOCERA Medical) was made from alumina ceramic and designed with computed tomography of healthy side. We examined the postoperative results such as ankle ranges of motion, Japanese Society for Surgery of the Foot (JSSF) scale and complications. Results: The mean range of motion was improved up to 10.0◦ from 3.2◦ in dorsiflexion and 28.0◦ from 23.9◦ in plantarflexion respectively. JSSF scale was improved up to 84 points from 39 points. Complications were 3 cases of prolonged wound healing, 2 case of screw breakage for tibial component, and one case of deep infection. Conclusion: TAA using TTP could be a reliable procedure for the treatment for both ankle and subtalar joint osteoarthritis, or sever collapse of talus. http://dx.doi.org/10.1016/j.fas.2017.07.284
Severe hallux valgus with coalition of the hallux sesamoids: A case report T. Kurashige Chiba Aiyukai Memorial Hospital, Japan Introduction: Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only one case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. Methods: The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart-shaped on anteroposterior radiographs and dumbbellshaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heartshaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Results and conclusion: Although delayed union occurred, successful correction of the deformity was achieved. http://dx.doi.org/10.1016/j.fas.2017.07.286
198
196
Tibialis posterior transfer in rebalancing of rigid cavovarus foot in Charcot-Marie-Tooth disease
Cancellous bone transplantation for the early-stage of Freiberg’s disease
E. Irha ∗ , D. Perkovic
M. Kubota ∗ , K. Hattori, K. Minagawa, T. Kimura, H. Inoue, K. Marumo Jikei University School of Medicine, Japan Introduction: The gold-standard surgical treatment for Freiberg’s disease is the osteotomy procedure and it is suitable for the advanced stage. Recently we tried cancellous bone transplantation for relatively early-stage of Freiberg’s disease. A retrospective study was carried out to examine the results of this method. Methods: This study involved four cases, and stage 2 was one, stage 3 were three according to Smillie’s classification. The average age at operation was 42 years, and average follow-up after surgery was 16 months. At the operations we approached to the nonunion portion from dorsal part of the neck of the metatarsal, and reposition the articular surface. Next we harvested cancellous bone into a gap and inserted a bone nail from a cartilage surface to fix it. Results: Bone union was obtained in all patients. Mean JSSF scale was improved from 71 points to 95 points postoperatively. In three cases dorsiflexion of the MTP joint was kept more than 70◦ at the final follow-up. Conclusion: Generally conservative treatment is performed for early stage of Freiberg’s disease, but it takes a long term, and sometimes it was difficult to treat satisfactorily. Smillie (1957) and
Special Orthopedic Hospital Dr. Nemec, Croatia Introduction: Charcot-Marie-Tooth disease is the most common cause for the development of cavovarus foot. Plantar flexion of the first ray caused by relatively stronger peroneus longus induces hindfoot varus. Tibialis posterior opposed to weak peroneus brevis further enhances hindfoot varus. We believe that tibialis posterior blocks the talonavicular joint movement, causing rigidity of the hindfoot varus. Methods: Between 2011 and 2015, we operated 22 ft of 11 patients (7 male, 4 female) with CMT disease. Inclusion criteria were cavovarus foot with negative Coleman block test. Mean age at surgery was 35.9 years (range 14–58 years; S.D. ± 18.38; median 41). Operative technique was the same for all feet and consisted of gastrocnemius aponeurosis lengthening, lateral sliding calcaneal osteotomy, plantar fascia release, peroneus longus to brevis transfer, posterior tibial tendon transfer through the interosseus membrane to the cuboid bone, dorsiflexion first metatarsal osteotomy. Results: AOFAS ankle hindfoot score was used for the clinical and functional assessment. The mean score preoperatively was 40 (S.D. ± 5.25) and postoperatively 88.63 (S.D. ± 6.31). The Foot Function Indeks (FFI) score was used to measure pain and impairment. The pain score improved from 51.45% to 18.36%; impairment
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
score improved from 40.24% to 24.24%. Both questionnaires were filled prior to surgery of the 1st, and 1 year after the surgery of the 2nd foot. Mean follow up was 27.63 months (range 12–50 months, S.D. ± 13.63; median = 27). Conclusion: Our results show that it is possible to achieve good functional results by rebalancing rigid cavovarus foot through tendon transfers and joint sparing approach. http://dx.doi.org/10.1016/j.fas.2017.07.287
199 Long-term radiographic outcome of resection arthroplasty for rheumatoid foot N. Otani ∗ , K. Yano, M. Shimazaki, K. Ikari Institute of Rheumatology, Tokyo Women’s Medical University, Japan Introduction: The aim of this study is to compare the long-term radiographic results of resection arthroplasty for rheumatoid forefoot deformities with and without a smooth curve of the excised metatarsals. Methods: From 1999 to 2010, a total of 100 ft in 67 rheumatoid arthritis patients were treated with pan resection arthroplasty. The mean duration of follow-up was 9.9 years. The 100 ft were divided into two groups according to the quality of the smooth curve of the radiograph immediately after surgery: Group W (65 ft) had a well-made smooth curve, and Group P (35 ft) had a poorlymade smooth curve. The radiographs at the most recent follow-up were reviewed to assess dorsal dislocations at excised sites and the recurrence of deformities using the hallux valgus angle (HVA), the intermetatarsal angle between the first and second metatarsals (M1M2A) and the first and fifth metatarsals (M1M5A). Results: The dorsal dislocations at excised sites at the most recent follow-up were 31/65 (47.7%) for Group W and 12/35 (34.3%) for Group P (Fisher’s exact test, p = 0.21). The average HVA, M1M2A and M1M5A at the most recent follow-up were 19.3◦ , 13.5◦ , and 33.3◦ respectively for Group W and 26.4◦ , 14.8◦ , and 32.7◦ respectively for Group P (unpaired t-test, p = 0.03, p = 0.18, p = 0.74, respectively). Conclusion: HVA of Group P was more significantly increased than Group W at the most recent follow-up. Reconstitution of the metatarsal parabola into a smooth curve prevents recurrence of deformity. http://dx.doi.org/10.1016/j.fas.2017.07.288
200 Series of lateral collateral ankle ligament all-inside arthroscopic repair S. Catalán Amigo ∗ , M.O. Moncusí, J.R. García Medina Hospital Fremap Barcelona, Spain Introduction: After an ankle sprain, between 10 and 48% of the patients present persistent instability or symptomatology that interfere their daily activities. The anatomical reconstruction techniques such as modified Brostrom, have been the gold standard for a long time. With improve of the arthroscopic techniques, we can find all-inside arthroscopic lateral ligament repair techniques described in the literature. We present our experience with the all-inside arthroscopic ATFL repair in the chronic instability.
67
Materials and methods: A total of 34 patients have been treated from 2014 until 2016. Same surgeons have used the same technique, all-inside arthroscopic repair, and same postoperative protocol. The average follow up is 15.9 months. The results have been evaluated clinically (drawer test, talar tilt) and with the AOFAS score, Visual Analogic Scale and Overall Satisfaction Score. Results: Average age was 36 years, with an equal male to female ratio, 17:17. We have operated 17 right and 7 left ankles. 7 patients had additional procedures during the arthroscopy ATFL repair, including osteochondral talar injury debridement in 3 and anterolateral soft tissue impingement debridement in 4 patients. Only one patient had a complication, superficial peroneal nerve injury. We had no re-operations. The mean AOFAS score increased from 53.6 to 81.9. The VAS decreased from 7.61 to 3.5. The overall satisfaction was good and the results were good-excellent in 80%. Conclusion: Our results are good and similar to those previously reported in the literature. With this technique we can avoid the open surgery morbidity with good functional results. http://dx.doi.org/10.1016/j.fas.2017.07.289
201 Timing of open reduction and internal fixation of ankle fractures D. Tantigate ∗ , G. Ho, J. Kirschenbaum, C. Freibott, B. Ascherman, J. Greisberg, T. Vosseller Columbia University Medical Center, Columbia Background: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) in order to prevent posttraumatic arthritis. It is not uncommon for operative treatment to be performed in an ambulatory setting several days after injury. The purpose of this study is to compare the functional outcomes based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 119 surgically treated acute, closed ankle fracture patients over a three-year period was performed. Sixty-one patients older than 18 years with a minimum of 24 months of follow-up were included. Demographic variables, duration from injury to surgery, complications, and Foot and Ankle Outcome Score (FAOS) were recorded. Comparison of each variable was performed between patients that underwent ORIF <14 days after injury and ≥14 days. Results: Fifty-eight patients were included. The mean age was 48 years. The mean follow-up time was 41 months. The average duration between injury and surgery was 7 and 18 days, respectively in the two groups. There was no statistically significant difference in demographic variables, length of operation, complication and FAOS between these two groups. Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: ORIF of ankle fracture more than 14 days does not significantly diminish functional outcome. Delay of operative treatment does not play a significant role in the functional outcome. http://dx.doi.org/10.1016/j.fas.2017.07.290
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
195 The features and short term results of total ankle arthroplasty using total talar prosthesis N. Kanzaki 1,∗ , Y. Takakura 2 , Y.Y. Takakura 2 , K. Ibaraki 1 , N. Miyaji 1 , T. Tanaka 1 , K. Nishida 1 , D. Araki 1 , T. Matsusita 1 , R. Kuroda 1
Helal (1987) reported about cancellous bone transplantation, but the methods did not spread afterwards. This procedure produced good results in the early stages that the cartilaginous damage is slight, and it may shorten the treatment period. http://dx.doi.org/10.1016/j.fas.2017.07.285
197
1
Kobe University Graduate School of Medicine, Japan 2 Takakura Orthopaedic and Sports Clinic, Japan
Aim of study: Total talar prosthesis (TTP) was invented for the treatment of osteonecrosis of talus. We have taken to performing total ankle arthroplasty (TAA) using TTP in case of both ankle and subtalar joint osteoarthritis, or sever collapse of talus. The aim of this study is to introduce the features and short term results of TAA using TTP. Materials and methods: The number of the case was 18, the mean follow-up terms was 15 months, and the mean age was 74.2 years old. The classification of OA stage was 3 cases in stage 3a, 3 cases in stage 3b, and 12 cases in stage 4. The TNK ankle (KYOCERA Medical, Osaka, Japan) was used in all patient, and TTP (KYOCERA Medical) was made from alumina ceramic and designed with computed tomography of healthy side. We examined the postoperative results such as ankle ranges of motion, Japanese Society for Surgery of the Foot (JSSF) scale and complications. Results: The mean range of motion was improved up to 10.0◦ from 3.2◦ in dorsiflexion and 28.0◦ from 23.9◦ in plantarflexion respectively. JSSF scale was improved up to 84 points from 39 points. Complications were 3 cases of prolonged wound healing, 2 case of screw breakage for tibial component, and one case of deep infection. Conclusion: TAA using TTP could be a reliable procedure for the treatment for both ankle and subtalar joint osteoarthritis, or sever collapse of talus. http://dx.doi.org/10.1016/j.fas.2017.07.284
Severe hallux valgus with coalition of the hallux sesamoids: A case report T. Kurashige Chiba Aiyukai Memorial Hospital, Japan Introduction: Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only one case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. Methods: The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart-shaped on anteroposterior radiographs and dumbbellshaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heartshaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Results and conclusion: Although delayed union occurred, successful correction of the deformity was achieved. http://dx.doi.org/10.1016/j.fas.2017.07.286
198
196
Tibialis posterior transfer in rebalancing of rigid cavovarus foot in Charcot-Marie-Tooth disease
Cancellous bone transplantation for the early-stage of Freiberg’s disease
E. Irha ∗ , D. Perkovic
M. Kubota ∗ , K. Hattori, K. Minagawa, T. Kimura, H. Inoue, K. Marumo Jikei University School of Medicine, Japan Introduction: The gold-standard surgical treatment for Freiberg’s disease is the osteotomy procedure and it is suitable for the advanced stage. Recently we tried cancellous bone transplantation for relatively early-stage of Freiberg’s disease. A retrospective study was carried out to examine the results of this method. Methods: This study involved four cases, and stage 2 was one, stage 3 were three according to Smillie’s classification. The average age at operation was 42 years, and average follow-up after surgery was 16 months. At the operations we approached to the nonunion portion from dorsal part of the neck of the metatarsal, and reposition the articular surface. Next we harvested cancellous bone into a gap and inserted a bone nail from a cartilage surface to fix it. Results: Bone union was obtained in all patients. Mean JSSF scale was improved from 71 points to 95 points postoperatively. In three cases dorsiflexion of the MTP joint was kept more than 70◦ at the final follow-up. Conclusion: Generally conservative treatment is performed for early stage of Freiberg’s disease, but it takes a long term, and sometimes it was difficult to treat satisfactorily. Smillie (1957) and
Special Orthopedic Hospital Dr. Nemec, Croatia Introduction: Charcot-Marie-Tooth disease is the most common cause for the development of cavovarus foot. Plantar flexion of the first ray caused by relatively stronger peroneus longus induces hindfoot varus. Tibialis posterior opposed to weak peroneus brevis further enhances hindfoot varus. We believe that tibialis posterior blocks the talonavicular joint movement, causing rigidity of the hindfoot varus. Methods: Between 2011 and 2015, we operated 22 ft of 11 patients (7 male, 4 female) with CMT disease. Inclusion criteria were cavovarus foot with negative Coleman block test. Mean age at surgery was 35.9 years (range 14–58 years; S.D. ± 18.38; median 41). Operative technique was the same for all feet and consisted of gastrocnemius aponeurosis lengthening, lateral sliding calcaneal osteotomy, plantar fascia release, peroneus longus to brevis transfer, posterior tibial tendon transfer through the interosseus membrane to the cuboid bone, dorsiflexion first metatarsal osteotomy. Results: AOFAS ankle hindfoot score was used for the clinical and functional assessment. The mean score preoperatively was 40 (S.D. ± 5.25) and postoperatively 88.63 (S.D. ± 6.31). The Foot Function Indeks (FFI) score was used to measure pain and impairment. The pain score improved from 51.45% to 18.36%; impairment
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
score improved from 40.24% to 24.24%. Both questionnaires were filled prior to surgery of the 1st, and 1 year after the surgery of the 2nd foot. Mean follow up was 27.63 months (range 12–50 months, S.D. ± 13.63; median = 27). Conclusion: Our results show that it is possible to achieve good functional results by rebalancing rigid cavovarus foot through tendon transfers and joint sparing approach. http://dx.doi.org/10.1016/j.fas.2017.07.287
199 Long-term radiographic outcome of resection arthroplasty for rheumatoid foot N. Otani ∗ , K. Yano, M. Shimazaki, K. Ikari Institute of Rheumatology, Tokyo Women’s Medical University, Japan Introduction: The aim of this study is to compare the long-term radiographic results of resection arthroplasty for rheumatoid forefoot deformities with and without a smooth curve of the excised metatarsals. Methods: From 1999 to 2010, a total of 100 ft in 67 rheumatoid arthritis patients were treated with pan resection arthroplasty. The mean duration of follow-up was 9.9 years. The 100 ft were divided into two groups according to the quality of the smooth curve of the radiograph immediately after surgery: Group W (65 ft) had a well-made smooth curve, and Group P (35 ft) had a poorlymade smooth curve. The radiographs at the most recent follow-up were reviewed to assess dorsal dislocations at excised sites and the recurrence of deformities using the hallux valgus angle (HVA), the intermetatarsal angle between the first and second metatarsals (M1M2A) and the first and fifth metatarsals (M1M5A). Results: The dorsal dislocations at excised sites at the most recent follow-up were 31/65 (47.7%) for Group W and 12/35 (34.3%) for Group P (Fisher’s exact test, p = 0.21). The average HVA, M1M2A and M1M5A at the most recent follow-up were 19.3◦ , 13.5◦ , and 33.3◦ respectively for Group W and 26.4◦ , 14.8◦ , and 32.7◦ respectively for Group P (unpaired t-test, p = 0.03, p = 0.18, p = 0.74, respectively). Conclusion: HVA of Group P was more significantly increased than Group W at the most recent follow-up. Reconstitution of the metatarsal parabola into a smooth curve prevents recurrence of deformity. http://dx.doi.org/10.1016/j.fas.2017.07.288
200 Series of lateral collateral ankle ligament all-inside arthroscopic repair S. Catalán Amigo ∗ , M.O. Moncusí, J.R. García Medina Hospital Fremap Barcelona, Spain Introduction: After an ankle sprain, between 10 and 48% of the patients present persistent instability or symptomatology that interfere their daily activities. The anatomical reconstruction techniques such as modified Brostrom, have been the gold standard for a long time. With improve of the arthroscopic techniques, we can find all-inside arthroscopic lateral ligament repair techniques described in the literature. We present our experience with the all-inside arthroscopic ATFL repair in the chronic instability.
67
Materials and methods: A total of 34 patients have been treated from 2014 until 2016. Same surgeons have used the same technique, all-inside arthroscopic repair, and same postoperative protocol. The average follow up is 15.9 months. The results have been evaluated clinically (drawer test, talar tilt) and with the AOFAS score, Visual Analogic Scale and Overall Satisfaction Score. Results: Average age was 36 years, with an equal male to female ratio, 17:17. We have operated 17 right and 7 left ankles. 7 patients had additional procedures during the arthroscopy ATFL repair, including osteochondral talar injury debridement in 3 and anterolateral soft tissue impingement debridement in 4 patients. Only one patient had a complication, superficial peroneal nerve injury. We had no re-operations. The mean AOFAS score increased from 53.6 to 81.9. The VAS decreased from 7.61 to 3.5. The overall satisfaction was good and the results were good-excellent in 80%. Conclusion: Our results are good and similar to those previously reported in the literature. With this technique we can avoid the open surgery morbidity with good functional results. http://dx.doi.org/10.1016/j.fas.2017.07.289
201 Timing of open reduction and internal fixation of ankle fractures D. Tantigate ∗ , G. Ho, J. Kirschenbaum, C. Freibott, B. Ascherman, J. Greisberg, T. Vosseller Columbia University Medical Center, Columbia Background: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) in order to prevent posttraumatic arthritis. It is not uncommon for operative treatment to be performed in an ambulatory setting several days after injury. The purpose of this study is to compare the functional outcomes based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 119 surgically treated acute, closed ankle fracture patients over a three-year period was performed. Sixty-one patients older than 18 years with a minimum of 24 months of follow-up were included. Demographic variables, duration from injury to surgery, complications, and Foot and Ankle Outcome Score (FAOS) were recorded. Comparison of each variable was performed between patients that underwent ORIF <14 days after injury and ≥14 days. Results: Fifty-eight patients were included. The mean age was 48 years. The mean follow-up time was 41 months. The average duration between injury and surgery was 7 and 18 days, respectively in the two groups. There was no statistically significant difference in demographic variables, length of operation, complication and FAOS between these two groups. Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: ORIF of ankle fracture more than 14 days does not significantly diminish functional outcome. Delay of operative treatment does not play a significant role in the functional outcome. http://dx.doi.org/10.1016/j.fas.2017.07.290