RESUMEN
BACKGROUND: The purpose of this study was to analyze bony fusion and functional outcomes after talonavicular arthrodesis (TNA) using an original minimally invasive surgery (MIS). METHODS: There was a total of 11 feet in 11 patients who underwent TNA and were followed up for 47 months (range 40.8-53.1). Functional outcomes were measured by AOFAS and quality of life by eight sections of SF-36. RESULTS: Radiographic and clinical consolidation was achieved in 10 of 11 cases. In the AOFAS score, physical function improved a mean of 34.4 points (95% CI: 23.2-45.6; p<.0001) and pain improved a mean of 23.6 points (95% CI: 17.4-29.8; p<.0001). One osteoporotic and rheumatic patient had a non-union. No cases of early complications, such as wound infections, neurovascular damage or delayed wound healing, occurred. CONCLUSION: Isolated TNA by MIS could be an option for the treatment of TN arthritis, especially for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Artritis/cirugía , Artrodesis/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Calidad de Vida , Articulación Talocalcánea/cirugía , Anciano , Anciano de 80 o más Años , Artritis/diagnóstico por imagen , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Articulación Talocalcánea/diagnóstico por imagen , Resultado del TratamientoAsunto(s)
Traumatismos del Tobillo/cirugía , Artrodesis/métodos , Fracturas Óseas/cirugía , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure for severe diseases involving ankle and subtalar joints. However, this procedure is often associated with postoperative complications related to preoperative comorbidities. The purpose of this study was to present the clinical and functional outcomes of a consecutive series of TTCA using an original operative approach based on minimal incision surgery (MIS). METHODS: Forty patients were followed prospectively for a mean (SD) of 31 (12.5) months. Clinical data, which included x-rays, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, SF-36 scores, and a patient satisfaction survey, were collected. A further 25 patients were examined retrospectively. RESULTS: In the prospective group (n = 40), the mean AOFAS score improved by 44.8 points 1 year after the intervention (95% confidence interval [CI], 40.6-48.9), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the mental component summary (MCS) score and 11.5 points (95% CI, 8.3-14.7) in the physical component summary (PCS) score. In the prospective group, postsurgical pain correlated with MCS score (r = 0.47, P < .001). In the entire group, bony union (defined as radiographic consolidation and absence of clinical symptoms) was observed in 86% of cases. Two deep infections, 2 nonunions in patients with preoperative persistent ulcers, and 7 delayed unions were the major complications observed in the entire group. One patient required amputation. No cases of superficial infection, wound dehiscence, or deep venous thrombosis were recorded. CONCLUSION: To our knowledge, the present series represents the largest study on TTCA using MIS. The data obtained in the present study showed clinical and functional improvement after surgery and similar bony union rates as previously reported in the literature but with fewer complications related to the surgical wounds. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Traumatismos del Tobillo/cirugía , Artrodesis/métodos , Fracturas Óseas/cirugía , Adolescente , Adulto , Anciano , Artritis/cirugía , Artropatía Neurógena/cirugía , Neuropatías Diabéticas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Satisfacción del Paciente , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: In recent years there has been an increase in the use of minimally invasive techniques, such as arthroscopy, percutaneous, and minimally invasive incisions, for foot and ankle surgery. The purpose of this study was to analyze the fusion rate and clinical results of isolated subtalar arthrodesis (ISA) using the novel and original technique of minimal incision surgery (MIS). METHODS: There were a total of 77 feet in 76 patients who underwent ISA and were followed for 50 months on average (range, 15-108). The first 30 cases were evaluated retrospectively, and 47 cases were evaluated prospectively. MIS without tourniquet was used in all cases and fusion was assessed radiographically and clinically. Clinical outcome measures used were the Angus and Cowell Scoring System, AOFAS Ankle-Hindfoot, the SF-36, and a patient satisfaction questionnaire 12 months after the intervention. RESULTS: Radiographic and clinical consolidation was achieved in 92% of cases. Main outcomes were "good" in 57 patients as determined by the Angus and Cowell criteria, with 13 "fair" and 7 "poor" results. In the prospective group, AOFAS scores improved by 47.6 points (95% CI: 50.7-42.5) 12 months after surgical intervention. SF-36 outcomes improved by 14.5 points (95% CI: 11.58-17.31) in the mental summary component and 4.2 points (95% CI: 2.2-6.1) in the physical summary component. We recorded no cases of early complications such as wound infections, neurovascular damage, or delayed wound healing. CONCLUSIONS: To our knowledge, the present series represents the largest study on subtalar arthrodesis using minimally invasive surgery. The data obtained showed a similar rate of bony union and clinical outcomes compared with the literature, but without early wound complications. ISA using the MIS technique was a good option for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Artrodesis/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Articulación Talocalcánea/cirugía , Artrodesis/estadística & datos numéricos , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Osteoartritis/cirugía , Dolor , Satisfacción del Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Calidad de Vida , Radiografía , Estudios Retrospectivos , Articulación Talocalcánea/diagnóstico por imagen , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
The ankle soft tissue pathology represents a very painful disorder for patients who, often times, are not precisely diagnosed. Anterolateral ankle impingement is a condition that occurs in young people and athletes due to a plantar flexion-inversion mechanism. We report a case of anterolateral ankle impingement describing the arthroscopic technique and making the differential diagnosis considering other conditions.
Asunto(s)
Síndrome del Túnel Tarsiano/diagnóstico , Adulto , Tobillo , Artroscopía , Diagnóstico Diferencial , Humanos , Masculino , Dolor/etiología , Síndrome del Túnel Tarsiano/complicaciones , Síndrome del Túnel Tarsiano/cirugíaRESUMEN
La patología de partes blandas del tobillo supone trastornos muy dolorosos para los pacientes que en muchas ocasiones carecen de diagnóstico preciso. El pinzamiento anterolateral de tobillo es una patología que aparece en gente joven y deportistas por mecanismo de flexión plantar-inversión. Se presenta un caso de pinzamiento anterolateral de tobillo, describiendo la técnica artroscópica y planteando el diagnóstico diferencial con otras patologías (AU)
Diseases of the ankle soft tissues are very painful disorders for patients for whom many times there is no accurate diagnosis. Anterolateral ankle impingement is a condition occurring in young people and athletes for plantar-inversion flexion mechanism. We report the case of anterolateral ankle impingement with a description of the arthroscopic technique and considering the differential diagnosis with other diseases (AU)