RESUMO
Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.
Assuntos
Osteoartrite , Articulação Talocalcânea , Artrodese/métodos , Parafusos Ósseos , Humanos , Estudos Retrospectivos , Articulação Talocalcânea/diagnóstico por imagem , Articulação Talocalcânea/cirurgiaRESUMO
BACKGROUND: Hindfoot arthrodesis is used in patients with advanced-stage acquired flatfoot, usually associated with degenerative joint disease. The objective of the present study was to evaluate the clinical and radiographic results of hindfoot arthrodesis using the single-incision medial approach. METHODS: A case series of 18 consecutive patients undergoing surgical correction between 2015 and 2018 with hindfoot arthrodesis using the medial approach was evaluated. The clinical assessment used the visual analog pain scale, AOFAS hindfoot score, SF-36, and foot function index. Radiographs and personal satisfaction criteria were also analyzed. RESULTS: All radiographic parameters evaluated showed a significant improvement (p < .05), except the calcaneal pitch. Pain decreased by 5.1 points (p < .001), and the mean final AOFAS score was 72.6. In three feet, a new surgery was required. Two feet developed talar necrosis. None of the cases presented surgical wound dehiscence, and two presented with superficial infection, which was resolved with the use of oral antibiotics. CONCLUSION: Double arthrodesis (subtalar and talonavicular) to correct adult-acquired valgus flatfoot using a medial approach has a low risk of soft tissue complications and presents satisfactory functional results. Avascular necrosis is a serious complication that was present in 11% of cases.
Assuntos
Artrodese/métodos , Calcâneo , Pé Chato , Adulto , Pé Chato/diagnóstico por imagem , Pé Chato/cirurgia , Pé , Humanos , OsteotomiaRESUMO
Como resultado de la insuficiencia del tendón tibial posterior (TTP), el arco longitudinal medial se derrumba en forma progresiva. Los intentos de restaurar la función del TTP mediante reparación directa no han sido satisfactorios. Por lo tanto, se ha recomendado la sustitución del TTP por medio de la transferencia de tendones aunque eso no corrige la deformidad. Debido a esto es necesario agregar una osteotomía. La osteotomía por preferencia es la medialización de la tuberosidad posterior del calcáneo. Respecto al método de fijación de la osteotomía existen diferentes alternativas de fijación. El objetivo del trabajo es presentar los resultados radiográficos y clínicos del tratamiento de la insuficiencia del TTP Grado II y sus deformidades resultantes mediante osteotomía de desplazamiento medial del calcáneo fijada con placa escalonada y otros procedimientos. (AU)
As a result of posterior tibial tendon insufficiency (PTT), the medial longitudinal arch collapses progressively. Attempts to restore the TTP function through direct repair have not been satisfactory.2 Therefore, TTP replacement has been recommended by means of tendon transfer although this does not correct the deformity. Because of this it is necessary to add an osteotomy. The osteotomy by preference is the medialization of the posterior tuberosity of the calcaneus. Regarding the fixation method of the osteotomy, there are different fixation alternatives. The objective of this study was to present the radiographic and clinical results of the treatment of TTP grade II insufficiency and its resulting deformities by osteotomy of the medial displacement of the calcaneus fixed with stepped plaque and other procedures. (AU)