Comparison of Single and Double Fusions in Transverse Tarsal Joint / 대한족부족관절학회지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of single and double fusions in the transverse tarsal joint. MATERIALS AND METHODS: Between December 2000 and April 2009, 16 patients (16 feet) who had been treated by fusion of transverse tarsal joint were included in this study. In 8 patients, only talonavicular joint was fused and in the other 8 patients, both talonavicular and calcaneocuboid joints were fused simultaneously. We have measured talo-first metatarsal angle, calcaneal pitch angle, talonavicular coverage angle and presence of adjacent joint arthritis for radiological assessment at both preoperative and last visit. Furthermore, we have evaluated Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction. RESULTS: In a single fusion group, VAS was improved from 6.4+/-1.4 to 0.8+/-1.0 (p=0.0011) and AOFAS score was improved from 63.8+/-6.2 to 89.4+/-9.8 (p=0.0012). In a double fusion group, VAS was improved from 8.0+/-0.75 to 2.0+/-1.8 (p=0.0011) and AOFAS score was improved from 60.5+/-11.2 to 89.5+/-6.0 (p=0.0012). In the difference of talo-first metatarsal angle between two groups, a single fused group was more improved than a double fused group (p=0.04). CONCLUSION: Both single and double fusions are useful and attractive treatment for the transverse tarsal joint arthritis. Furthermore, a single fusion has advantages of less invasiveness and preserving some degree of hindfoot motion and could be an effective alternative to a double fusion if patient meets appropriate criteria through careful preoperative evaluation.

Comparison of Clinical Outcome of Excision versus Osteosynthesis in Type II Accessory Navicular / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the clinical outcome of excision versus osteosynthesis of type II accessory navicular performed by a single surgeon. MATERIALS AND METHODS: Cases of 14 feet treated with excision and 13 feet by osteosynthesis for type II accessory navicular of 25 patients from 2002 to 2009 were included in this study. Radiological measurements and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale was evaluated. RESULTS: AOFAS midfoot scale of both excision and osteosynthesis groups at last follow-up showed improvement from pre-operation. However, there was no statistical difference in AOFAS midfoot scale and subjective satisfaction between the two groups at last follow-up. In detail of AOFAS midfoot scale, pain and footwear requirements showed statistically favorable results for the excision group, while activity limitation and support showed statistically favorable results for the osteosynthesis group. Subjective recovery time returning to daily activities and starting rehabilitation exercise were 14.6 weeks in the excision group and 13.7 weeks in the osteosynthesis group (p=0.025, Mann-Whitney). Suture anchor loosening was observed in one case in the excision group and non-union in two cases in the osteosynthesis group. CONCLUSION: Both excision and osteosynthesis are favorable surgical methods, but each method has advantages and possible complications such as suture anchor loosening or non-union. Surgeon's preference, patient's chief complaint, specific needs of patient after the operation and consideration of the size of accessory navicular can be a criteria to consider when selecting a surgical method.