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Tourne's technique (modified) for ankle lateral ligament reconstruction
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
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163
Isolated talonavicular fusion for arthritis
Radiological and immunohistochemical study of osteoid osteoma in the foot and ankle
H. Kurup Pilgrim Hospital, United Kingdom Talonavicular joint fusion in isolation is not recommended in most textbooks due to the fact that it locks subtalar motion anyway and there is a higher quoted risk of non-union. There are very few reports of isolated talonavicular fusion due to this reason. We report a consecutive series of 11 cases of isolated talonavicular fusion with a minimum follow up of 12 months. All patients had pre-operative MRI scans to rule out arthritis in adjacent joints especially subtalar. All but one patient had a pre-operative image guided steroid injection for diagnostic/therapeutic purpose. There were no patients with inflammatory arthritis. 75% patients had a bony or fibrous calcaneonavicular coalition which was presumed be the primary aetiology and predisposing factor. All patients had double fixation with a 4 mm cannulated screw medially and a small 4 holed locking foot compression plate (DePuy Synthes ALPS) dorsally. Only one patients developed non-union which was confirmed on CT, however he did not want any further surgery. Another patient had removal of painful metalwork but the fusion was noted to be complete at revision surgery. We conclude that isolated talonavicular fusion is a successful procedure in selected patients whose arthritic symptoms are limited to the joint. http://dx.doi.org/10.1016/j.fas.2017.07.250
162 Tourne’s technique (modified) for ankle lateral ligament reconstruction H. Kurup Pilgrim Hospital, United Kingdom There are many described techniques for lateral ligament reconstruction of ankle from simple Brostrom repair to augmenting it with synthetic suture braces. Yves Tourne’s well documented technique involves transferring a flap of extensor retinaculum to a tunnel in distal fibula and later adapted to securing it with a biotenodesis screw. This provides a neoligament which supplements both ATFL & CFL. Our modified technique involves using absorbable anchors to secure the fixation and avoid drilling three adjacent tunnels in fibula. All patients in this series had failed conservative treatment with rehabilitation and diagnosis confirmed with MRI scan. There were 24 patients with a minimum follow up of 6 months. Patients were protected in weight bearing plaster or boot for 6 weeks. No patients had a failure requiring revision surgery. There was one patient with a wound hematoma which required evacuation but the repair was preserved. All patients returned to their pre-injury level of activity. http://dx.doi.org/10.1016/j.fas.2017.07.251
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M. Hatori ∗ , O. Dohi, S. Kotajima, K. Kishimoto Department of Orthopaedic Surgery, Tohoku Kosai Hospital, Japan Purpose: Osteoid osteoma (OO) is a benign bone tumor with a nidus causing spontaneous pain. We report radiological features of OO in the foot and ankle with the related immunohistochemical characters. Patients and methods: The radiological findings of five patients (five men and two women, two in the calcaneus, two in the talus, two in the distal phalanx and one in the distal tibia) were investigated by plain radiography, computed tomography, bone scan and MRI. The surgical specimens were immunohistochemically studied by using cyclooxygenase-2 (COX-2) and bradykinin antibodies in five. Results: Nidus was unclear on plain radiograms. CT demonstrated a nidus with bone sclerosis, central mineralization and/or articular irregularities. One nidus was observed as an extraosseous small ossicle. MRI revealed a nidus with high signal intensities on T2 weighted images, ring like Gd-enhancement and intra and extraarticular signal changes suggestive of arthritis and synovitis. Bone scan showed increased uptake. Immunohistochemical examination revealed expression of COX-2 and bradykinin in the nidus. Discussion: There have been few reports on comprehensive radiological and immunohistochemical studies of OO in the foot and ankle. It is difficult to detect a nidus by plain radiography only. Combined radiological examinations including bone scan for screening, and CT and MRI to reveal a nidus are necessary to arrive at the correct diagnosis. Inflammatory changes adjacent to a nidus probably related to COX-2 and bradykinin are another important signs to suspect OO in the foot and ankle. http://dx.doi.org/10.1016/j.fas.2017.07.252
164 Interpositional arthroplasty of the first MTP joint for the treatment of severe hallux rigidus A. Bulatov ∗ , V. Emelyanov, K. Mikhaylov, D. Pliev, M. Guatsaev, A. Savchuk Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Russia Background: Hallux rigidus is a common, painful, condition of the 1 MTP joint. Arthrodesis is an excellent treatment choice for patients with severe deformity (Coughlin grade 3–4). But in our opinion the interpositional arthroplasty is almost always an alternative to the fusion especially for active patients. The purpose of our study is to report the follow-up of a joint preservation, using allogenic Dura Mater. Materials and methods: We used human allogenic Dura Mater (from Tissue Bank of our Institute) in 12 patients (14 ft) from 2012 to 2015 as an interpositional graft. There were 2 male, 10 female, aged from 34 to 68 years (mean age 55.4). Analysis included clinical evaluation with the AOFAS Hallux Score and radiographic assessment. The average follow-up was 3.7 years (range, 12–52 months). Results: Of the 12 patients 11 were available for follow-up. The average preoperative AOFAS score was 34 (range, 30–41). The most recent AOFAS was 65.8 (range, 58–68). Preoperatively dorsiflexion was 8–10◦ and 30◦ – postoperatively. Plantar flexion – 9◦ preoper-
161
163
Isolated talonavicular fusion for arthritis
Radiological and immunohistochemical study of osteoid osteoma in the foot and ankle
H. Kurup Pilgrim Hospital, United Kingdom Talonavicular joint fusion in isolation is not recommended in most textbooks due to the fact that it locks subtalar motion anyway and there is a higher quoted risk of non-union. There are very few reports of isolated talonavicular fusion due to this reason. We report a consecutive series of 11 cases of isolated talonavicular fusion with a minimum follow up of 12 months. All patients had pre-operative MRI scans to rule out arthritis in adjacent joints especially subtalar. All but one patient had a pre-operative image guided steroid injection for diagnostic/therapeutic purpose. There were no patients with inflammatory arthritis. 75% patients had a bony or fibrous calcaneonavicular coalition which was presumed be the primary aetiology and predisposing factor. All patients had double fixation with a 4 mm cannulated screw medially and a small 4 holed locking foot compression plate (DePuy Synthes ALPS) dorsally. Only one patients developed non-union which was confirmed on CT, however he did not want any further surgery. Another patient had removal of painful metalwork but the fusion was noted to be complete at revision surgery. We conclude that isolated talonavicular fusion is a successful procedure in selected patients whose arthritic symptoms are limited to the joint. http://dx.doi.org/10.1016/j.fas.2017.07.250
162 Tourne’s technique (modified) for ankle lateral ligament reconstruction H. Kurup Pilgrim Hospital, United Kingdom There are many described techniques for lateral ligament reconstruction of ankle from simple Brostrom repair to augmenting it with synthetic suture braces. Yves Tourne’s well documented technique involves transferring a flap of extensor retinaculum to a tunnel in distal fibula and later adapted to securing it with a biotenodesis screw. This provides a neoligament which supplements both ATFL & CFL. Our modified technique involves using absorbable anchors to secure the fixation and avoid drilling three adjacent tunnels in fibula. All patients in this series had failed conservative treatment with rehabilitation and diagnosis confirmed with MRI scan. There were 24 patients with a minimum follow up of 6 months. Patients were protected in weight bearing plaster or boot for 6 weeks. No patients had a failure requiring revision surgery. There was one patient with a wound hematoma which required evacuation but the repair was preserved. All patients returned to their pre-injury level of activity. http://dx.doi.org/10.1016/j.fas.2017.07.251
55
M. Hatori ∗ , O. Dohi, S. Kotajima, K. Kishimoto Department of Orthopaedic Surgery, Tohoku Kosai Hospital, Japan Purpose: Osteoid osteoma (OO) is a benign bone tumor with a nidus causing spontaneous pain. We report radiological features of OO in the foot and ankle with the related immunohistochemical characters. Patients and methods: The radiological findings of five patients (five men and two women, two in the calcaneus, two in the talus, two in the distal phalanx and one in the distal tibia) were investigated by plain radiography, computed tomography, bone scan and MRI. The surgical specimens were immunohistochemically studied by using cyclooxygenase-2 (COX-2) and bradykinin antibodies in five. Results: Nidus was unclear on plain radiograms. CT demonstrated a nidus with bone sclerosis, central mineralization and/or articular irregularities. One nidus was observed as an extraosseous small ossicle. MRI revealed a nidus with high signal intensities on T2 weighted images, ring like Gd-enhancement and intra and extraarticular signal changes suggestive of arthritis and synovitis. Bone scan showed increased uptake. Immunohistochemical examination revealed expression of COX-2 and bradykinin in the nidus. Discussion: There have been few reports on comprehensive radiological and immunohistochemical studies of OO in the foot and ankle. It is difficult to detect a nidus by plain radiography only. Combined radiological examinations including bone scan for screening, and CT and MRI to reveal a nidus are necessary to arrive at the correct diagnosis. Inflammatory changes adjacent to a nidus probably related to COX-2 and bradykinin are another important signs to suspect OO in the foot and ankle. http://dx.doi.org/10.1016/j.fas.2017.07.252
164 Interpositional arthroplasty of the first MTP joint for the treatment of severe hallux rigidus A. Bulatov ∗ , V. Emelyanov, K. Mikhaylov, D. Pliev, M. Guatsaev, A. Savchuk Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Russia Background: Hallux rigidus is a common, painful, condition of the 1 MTP joint. Arthrodesis is an excellent treatment choice for patients with severe deformity (Coughlin grade 3–4). But in our opinion the interpositional arthroplasty is almost always an alternative to the fusion especially for active patients. The purpose of our study is to report the follow-up of a joint preservation, using allogenic Dura Mater. Materials and methods: We used human allogenic Dura Mater (from Tissue Bank of our Institute) in 12 patients (14 ft) from 2012 to 2015 as an interpositional graft. There were 2 male, 10 female, aged from 34 to 68 years (mean age 55.4). Analysis included clinical evaluation with the AOFAS Hallux Score and radiographic assessment. The average follow-up was 3.7 years (range, 12–52 months). Results: Of the 12 patients 11 were available for follow-up. The average preoperative AOFAS score was 34 (range, 30–41). The most recent AOFAS was 65.8 (range, 58–68). Preoperatively dorsiflexion was 8–10◦ and 30◦ – postoperatively. Plantar flexion – 9◦ preoper-