RESUMEN
The authors analyze the randomized use of three ankle arthrodesis techniques. Indications for this procedure, which are pain, instability, deformity and articular degeneration, are common to the three groups. In group I the Gatellier-Adams technique was used by transfibular approach. In group II the Kenneth-Johnson technique was adopted, using Calandruccio external fixator. The same surgical procedure was adopted in group III, using crossed canulated screws as fixation device. The specific advantages and disadvantages of each method are discussed. The criteria for evaluation of the results are the final roentgenographic position of the foot and the achievement of union. The critical analysis conclude that the major indications for group I technique are cases of "in situ" arthrodesis, for group II infected cases and for group III cases with severe malalignment.
Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis/métodos , Adolescente , Adulto , Anciano , Articulación del Tobillo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios RetrospectivosRESUMEN
In a retrospective review of 77 patients with arthrogryposis multiplex congenita, 21 showed involvement of the hip (28%). The authors studied 18 cases with hip dislocation (11 bilateral and seven unilateral) and three with hip contracture. There were 12 female and nine male patients ranging their age from one month to 14 years. The follow-up in this series lasted from two to 23 years. The treatment was conservative or surgical. The contractures were treated by manipulation and abduction orthosis in one patient and surgically by multiple hip tenotomy in two. The dislocation was treated by abduction orthosis (two cases), closed reduction (two cases) and open reduction (one case) in the 11 cases with bilateral involvement; for the seven unilateral dislocations the treatment was: closed reduction and abduction orthosis (one case), closed reduction with abductor tenotomy and hip spica cast (four cases) and open reduction followed by hip spica and abduction orthosis (one case); one case remained without treatment of the hip involvement because of severity of deformities in knee and foot. Ten patients of this groups were not treated because they were confined to wheelchairs. The overall result was good in six patients, regular in four and poor in two in the dislocation group; for the three cases of hip contracture the result of treatment was good. In conclusion the authors recommend such treatment for the independent ambulatory patients and emphasize the necessity of treatment of patients with unilateral hip involvement.