Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability / Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo

Abstract Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Resumo Objetivo O presente estudo avalia os resultados de uma técnica cirúrgica minimamente invasiva para o manejo da instabilidade aguda e crônica do tornozelo. Métodos O presente estudo de uma série de casos avaliou retrospectivamente 40 pacientes submetidos à reconstrução percutânea assistida por artroscopia do ligamento do tornozelo entre 2013 e 2019. Resultados O estudo incluiu 17 homens e 23 mulheres com idade média de 38,3 anos. O acompanhamento pós-intervenção utilizou a pontuação American Orthopaedic Foot and Ankle Society (AOFAS, na sigla em inglês). As pontuações do tornozelo-retropé identificaram melhora > 30 pontos na função e no controle da dor. As lesões associadas mais frequentes foram as osteocondrais (35%). Nenhum paciente precisou de reintervenção ou teve infecção durante o acompanhamento. Conclusão A técnica do presente estudo é fácil e consegue resultados satisfatórios para a função e o controle da dor. Nível de Evidência IV.

Controversy of subtalar arthroereisis in symptomatic flatfoot / 中国骨伤

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Tratamiento artroscópico en lesión osteocondral subtalar / Arthroscopic treatment of subtalar osteochondral lesion

Las lesiones osteocondrales de la articulación subtalar es una patología infrecuente y de incidencia variable, dado su reporte principalmente como hallazgo en el estudio de dolor crónico de tobillo y ya con cambios degenerativos articulares. La sospecha clínica y el estudio imagenológico dirigido, permiten investigar esas lesiones en estadios iniciales, evitando así el uso de técnicas que no preservan la articulación para su manejo. La artroscopía subtalar es una excelente herramienta tanto diagnóstica como terapéutica para la resolución de dichas lesiones. Dadas las características anatómicas y biomecánicas de la articulación, en estadios iniciales, el manejo mediante sinovectomía y microfracturas es una alternativa con excelentes resultados funcionales. Este trabajo incluye dos casos de lesiones osteocondrales de la faceta posterior de la articulación subtalar manejadas vía artroscópica mediante sinovectomía y microfracturas y su posterior evolución.

Osteochondral lesions in the subtalar joint are an uncommon pathology with a variable incidence, being mainly reported as a finding in chronic ankle pain studies and with already visible degenerative joint changes at time of diagnosis. Clinical suspicion and directed imaging study, allows to investigate these lesions during early stages, thus avoiding the use of invasive techniques with scarce joint preservation. Subtalar arthroscopy is an excellent diagnostic and therapeutic tool for the resolution of these lesions. Given the anatomical and biomechanical characteristics of the joint, in the early stages the management by synovectomy and microfractures is an alternative with excellent functional results. This study includes two cases of osteochondral lesions of the posterior facet of the subtalar joint managed through arthroscopically synovectomy and microfractures and their subsequent evolution.

Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis / Comparação biomecânica da força de fixação de parafuso com orientação de plantar para dorsal e vice-versa para artrodese subtalar

ABSTRACT Objective To compare screw fixation strength for subtalar arthrodesis. Methods Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. Results Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.

RESUMO Objetivo Comparar a força de fixação dos parafusos para artrodese subtalar. Métodos Oito pares de pés de cadáveres frescos foram submetidos à artrodese da articulação subtalar com dois parafusos canulados de 7,3mm. A randomização foi usada para atribuir a orientação do parafuso, de modo que um pé em cada par foi designado com orientação de dorsal para plantar (Grupo DP), e o outro pé com orientação de plantar para dorsal (Grupo PD). Técnica cirúrgica padrão com radioscopia foi usada para os procedimentos. Após a fixação, cada amostra foi testada até a falha com um dispositivo Bionix®858 MTS, aplicando força axial descendente a uma distância para criar torque. O torque de falha foi comparado entre os Grupos DP e PD, usando o teste t de Student, com p=0,05 usado para determinar significância estatística. Resultados A análise estatística demonstrou que a média do torque até a falha favoreceu ligeiramente o Grupo DP (37,3Nm) em relação ao PD (32,2Nm). No entanto, a diferença entre os dois grupos não foi estatisticamente significativa (p=0,55). Conclusão Na artrodese subtalar, não há diferença significativa na força de compressão entre as orientações dos parafusos dorsal-plantar e plantar-dorsal. A abordagem escolhida pelo cirurgião deve ser baseada em outros fatores, sem preocupação com a força biomecânica da orientação dos parafusos.

Treatment of closed subtalar joint dislocation: A case report and literature review / 中华创伤杂志(英文版)

Subtalar dislocation is defined as a separation of the talocalcaneal and talonavicular articulations, commonly caused by high-energy mechanisms, which include falls from height, motor vehicle crashes, and twisting leg injuries. The dislocations are divided into medial, lateral, anterior, and posterior types on the basis of the direction in which the distal part of the foot has shifted in relation to the talus. The most common type is medial dislocation resulted from inversion injury. Subtalar dislocation may accompany with other fractures. Physical examination must be performed carefully to assess for neurovascular compromise. Most of the subtalar dislocations can be treated with closed reduction under sedation. If this is not possible, open reduction without further delay should be conducted. After primary treatment, X-ray and computed tomography scan should be performed to evaluate the alignment and the fractures. We report a 37-year-old male patient sustained a subtalar dislocation without any bony injury when he was playing football. The patient was successfully treated by closed reduction, and a good alignment was observed at the last follow-up. The pathogenesis and treatment method of this case were analyzed, and the related literature were reviewed, which provided a reference for future clinical treatment.

Factores pronósticos asociados a los resultados de la artrodesis subastragalina / Pronostic factors associated with the results of subtalar arthrodesis

Resumen: Introducción: La artrodesis subastragalina o astrágalo calcánea, es un procedimiento de estabilización quirúrgica en la patología aislada de la articulación subastragalina que no responde a tratamiento conservador, su objetivo es obtener una fusión sólida de la articulación para eliminar o aminorar el dolor y mejorar la función, normalizando la distribución de cargas del pie y su alineación. Existen variables estudiadas que interfieren en el resultado quirúrgico de los pacientes tratados con artrodesis subastragalina como son: el tabaquismo, edad, sexo, artrosis, IMC, rehabilitación, material de osteosíntesis y la técnica quirúrgica. Objetivo: Conocer los factores pronósticos asociados a los resultados de la artrodesis subastragalina. Material y métodos: Estudio retrospectivo, longitudinal, descriptivo con revisión de expedientes y elaboración de estadística descriptiva de casos tratados de Agosto de 2012 a Enero de 2016 con artrodesis subastragalina para identificar factores pronósticos que afecten el resultado. Resultados: Se analizaron 29 pies, reportándose una artrodesis exitosa en 21 casos (72.4%), en 82.8% la técnica quirúrgica fue adecuada. La tasa de complicaciones fue de 20.7%. En la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) 55.2% se reportaron como resultado muy bueno, 27.6% bueno y sólo 17.2% regular, se encontraron como factores asociados el sexo y la rehabilitación postoperatoria al buen resultado. Discusión: La artrodesis subastragalina brinda alivio en cuanto al dolor y mejoría en alineación, en nuestro servicio este procedimiento presenta una tasa de éxito de 72.4%, entre los factores asociados con significancia estadística fue la rehabilitación y el sexo.

Abstract: Introduction: Subtalar arthrodesis is a surgical stabilization procedure in the isolated pathology of the subastragaline joint that does not respond to conservative treatment, its goal is to obtain a solid fusion of the joint to eliminate or improve pain and function, normalizing the distribution of foot loads and alignment of the foot. There are studied variables that interfere with the surgical outcome of patients treated with subtalar arthrodesis such as: smoking, age, sex, osteoarthritis, BMI, rehabilitation, osteosynthesis material and surgical technique. Objective: To know the prognostic factors associated with the results of subastragaline arthrodesis. Material and methods: Retrospective, longitudinal, descriptive study with review of files and conducting descriptive statistics of treated cases of August 2012- Jan 2016 with subtalar arthrodesis to identify predictive factors affecting the outcome. Results: 29 feet were analyzed, reporting a successful arthrodesis in 21 cases (72.4%), in 82.8% the surgical technique was adequate. The complication rate was 20.7% On the AOFAS scale 55.2% were reported as a very good result, 27.6% good and only 17.2% regular. The factors associated with good outcome were sex and postoperative rehabilitation. Discussion: The subtalar arthrodesis provides improvement in pain and alignment, at our service this procedure presents a success rate of 72.4%, among the factors associated with statistical significance was rehabilitation and sex.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Clinical Outcomes of Minimally Invasive Surgery in Sanders Type IV Intra-Articular Calcaneal Fractures

PURPOSE: This study evaluated the radiologic and clinical results in patients who underwent minimal invasive surgery using sinus tarsi approach in Sanders type IV calcaneal fracture. MATERIALS AND METHODS: This retrospective study evaluated 13 cases of Sanders type IV calcaneus fractures that were treated by minimal invasive surgery using the sinus tarsi approach from July 2012 to April 2017. Further, these cases could be followed up for more than 12 months. Bone union, radiologic parameters such as Böhler's angle, Gissane's angle, calcaneal height, length, and width, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the postoperative complications were evaluated. RESULTS: Bony union was achieved in all the cases at the final follow up, and the mean union time was 5.5 months. One patient underwent reoperation for a surgical site infection, six patients had post traumatic arthritis, and two of them underwent subtalar joint fusion. The mean AOFAS ankle-hindfoot score was 81.2. At the final follow-up, the mean values of Böhler's angle and Gissane's angle were 20° and 119.8°, respectively, and the mean values of the calcaneus height, length, and width were 46.8 mm, 81.8 mm, and 45.6 mm, respectively. CONCLUSION: Minimal invasive surgery using the sinus tarsi approach for Sanders type IV calcaneal fracture resulted in satisfactory anatomic reduction and stable fixation, and satisfactory clinical and radiologic results were obtained in most of the patients. Minimal invasive surgery is thought to reduce the soft tissue-related complications as compared to surgery using the extensile lateral approach.

Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

PURPOSE: The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography. MATERIALS AND METHODS: The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017. RESULTS: An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%). CONCLUSION: Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.

Subtalar Dislocations: Case Series Inclusive of the Rare Anterior Subtalar Dislocation and Review of the Literature / Dislocaciones subtalares: serie de casos con inclusión de la rara dislocación subtalar anterior y revisión de la literatura

ABSTRACT Subtalar dislocations were first described by Judey and Dufaurest in 1811. These dislocations represent only 1-2% of all joint dislocations, making them a rare injury. In this rare injury, there are four variations with differing clinical presentations. The clinical picture may vary from a dramatic deformity (as in medial and lateral dislocations) to a more subtle presentation (as in anterior and posterior dislocations). This case series highlights the variations in clinical presentations and the management difficulties associated with each subtype.

RESUMEN Las dislocaciones subtalares fueron por primera vez descritas por Judey y Dufaurest en 1811. Estas dislocaciones representan solamente el 1-2% de todas las dislocaciones de las articulaciones, por lo que constituye una lesión poco frecuente. Esta rara lesión se caracteriza por cuatro variaciones con presentaciones clínicas que difieren. El cuadro clínico puede variar desde una deformidad dramática (tal cual ocurre en las dislocaciones intermedias y laterales) hasta una presentación más sutil (como en el caso de las dislocaciones anteriores y posteriores). Esta serie de casos destaca las variaciones en las presentaciones clínicas y las dificultades en el tratamiento asociado con cada subtipo.

Synovial Osteochondromatosis of the Subtalar Joint in an Adolescent Baseball Player / 대한스포츠의학회지

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. Smaller joints are rarely affected and it may be progressed to osteochondromatosis after ossification or calcification of metaplastic cartilage. It is commonly presented in the third to fourth decade of life, but rarely presented in adolescence. We report a unique case of synovial osteochondromatosis of the subtalar joint in 14-year-old baseball player. Arthroscopic removal of loose body and complete excision of the osteochondral mass with concomitant synovectomy resulted in satisfactory outcome without recurrence at final follow-up.

Subtalar Arthroscopy and Posterior Endoscopy / 대한정형외과학회잡지

The application of arthroscopy is becoming increasingly widespread due to the development of surgical instruments and techniques. Subtalar pathology can cause chronic pain in the hindfoot, but it is often misdiagnosed as a lesion of the adjacent ankle joint, which can lead to delayed diagnosis and treatment. Subtalar arthroscopy and posterior endoscopy are good methods to confirm and treat the posterior pathology of the subtalar joint and posterior ankle joint.

Arthroscopy Techniques in Foot and Ankle Field: Arthroscopic Ankle and Subtalar Fusion / 대한정형외과학회잡지

For the arthroscopic fusion procedure, the development of arthroscopic techniques of joint preparation for fusion have made arthroscopic ankle arthrodesis popular, and foot and ankle surgeons also have gained considerable experience in arthroscopic techniques. Arthroscopic techniques offer minimized soft tissue disruption, lower morbidity and mortality, faster recovery, and shorter hospital stay and time to fusion. In addition, they may reduce the risk of wound complications for patients with a poor soft tissue envelope or relevant co-morbidities.

Outcomes of Arthroscopic Assisted Reduction and Percutaneous Fixation for Tongue-Type Sanders Type II Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures. MATERIALS AND METHODS: Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Böhler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review. RESULTS: The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The Böhler's angle was increased significantly from 2° (−14°~18°) preoperatively to 21.8° (20°~28°) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion. CONCLUSION: Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

Morphometric measurement and types of articular facets on the talus and calcaneus in an Anatolian population / Mediciones morfométricas y tipos de facetas articulares en el talus y calcáneo de una población Anatolia

Anatomical variations in terms of ligamentous attachments, articulations and bony morphology are common in the subtalar region. The shape of the articular facets of the talus and calcaneus and their relationship to each other are important for joint function and surgical procedures. In this study an assessment of the morphology of the articular facets of the talus and calcaneus, in an Anatolian population, was undertaken. 49 tali and 57 calcanei from Anatolian adults of unknown gender were examined. The types of articular facets on the talus and calcaneus were determined using the following classification: Type A1, the distance between the anterior and middle facets was less than 2 mm; Type A2, the distance between the anterior and middle facets was 2-5 mm; Type A3, the distance between the anterior and middle facets was more than 5 mm; Type A4, there was only one articular facet; Type B1, the separation between the anterior and middle facets was not complete; Type B2, separation of the anterior and middle facets was present; Type C, no separation between the anterior, middle and posterior facets was present, i.e. there was one articular facet. In addition, the anteroposterior length and width of the talus and calcaneus, together with the width, length and depth of sulcus tali and sulcus calcanei were determined. Left and right tali, respectively, displayed the folowing types of articular facet: A1, 0 %, 0 %; A2, 0 %, 3,4 %; A3, 0 %, 0 %; A4, 0 %, 0 %; B1, 60 %, 51,8 %; and B2, 40 %, 44.8 %. Articular facets on left and right calcanei, respectively, were: A1, 10 %, 7.4 %; A2, 10 %, 14.8 %; A3, 16.7 %, 11.1 %; A4, 3.3 %, 3.7 %; B1, 30 %, 22.2 %; B2, 30 %, 40.8 %. The length and width of left and right tali were 50.5±3.81 mm and 39.5±2.97 mm, and 53.1±4.38 mm and 39.3±3.66 mm, respectively. The width, length and depth of left and right sulcus tali were: 5.2±1.09 mm, 21.7±2.73 mm and 5.7±0.84 mm, and 6.1±2.05 mm, 21.1±3.66 mm and 5.7±1.52 mm, respectively. For left and right calcanei length and width were; 76.1±5.44 mm 44.0±3.97 mm, and 75.7±6.76 mm and 45.9±4.21 mm, respectively. The width, length and depth of left and right sulcus calcanei were: 6.4±1.19 mm, 31.9±2.76 mm and 4.0±0.81 mm, and 5.5±1.00 mm, 32.4±3.23 mm and 4.4±1.05 mm, respectively. The articular facets on both the talus and calcaneus in the Anatolian population studied was predominantly type B. This observations is similar to previous reports conducted in America, India and Africa, but differ from those undertaken in Europe. A knowledge of variations of the articular facets of the talus and calcaneus provides a valuable road map for orthopaedic surgeons, as well as others involved in foot rehabilitation.

Las variaciones anatómicas de ligamentos, articulaciones y morfología ósea son comunes en la región subtalar. La forma de las facetas articulares del talus y calcáneo y su relación mutua son importantes para la función articular y los procedimientos quirúrgicos. En este estudio se realizó una evaluación de la morfología de las facetas articulares del talus y del calcáneo en una población de Anatolia. Se examinaron 49 talus y 57 calcáneos de individuos adultos anatolios de sexo no conocido. Se clasificaron las facetas articulares del talus y el calcáneo de la siguiente manera: Tipo A1, la distancia entre las facetas anterior y media fue inferior a 2 mm; Tipo A2, la distancia entre las facetas anterior y media fue de 2-5 mm; Tipo A3, la distancia entre las facetas anterior y media fue de más de 5 mm; Tipo A4, sólo había una faceta articular; Tipo B1, la separación entre las facetas anterior y media no fue completa; Tipo B2, la separación de las facetas anterior y media estaba presente; Tipo C, no existía separación entre las facetas anterior, media y posterior, es decir, había una faceta articular. Además, se determinó la longitud anteroposterior y el ancho del talus y del calcáneo, junto con el ancho, la longitud y la profundidad del surco talar y del surco del calcáneo. Los talus izquierdo y derecho, respectivamente, mostraron los siguientes tipos de faceta articular: A1, 0 %, 0 %; A2, 0 %, 3,4 %; A3, 0 %, 0 %; A4, 0 %, 0 %; B1, 60 %, 51,8 %; B2, 40 %, 44,8 %. Las facetas articulares de los calcáneos izquierdo y derecho, respectivamente, fueron: A1, 10 %, 7,4 %; A2, 10 %, 14,8 %; A3, 16,7 %, 11,1 %; A4, 3,3 %, 3,7 %; B1, 30 %, 22,2 %; B2, 30 %, 40,8 %. La longitud y el ancho de talus izquierdo y derecho fueron 50,5±3,81 mm y 39,5±2,97 mm, y 53,1±4,38 mm y 39,3±3,66 mm, respectivamente. El ancho, la longitud y la profundidad del surco talar izquierdo y derecho fueron: 5,2±1,09 mm, 21,7 ± 2,73 mm y 5,7±0,84 mm, y 6,1±2,05 mm, 21,1±3,66 mm y 5,7±1,52 mm, respectivamente. Para el calcáneo izquierdo y derecho, la longitud y ancho fueron: 76,1±5,44 mm 44,0±3,97 mm y 75,7±6,76 mm y 45,9±4,21 mm, respectivamente. El ancho, longitud y profundidad del surco del calcáneo izquierdo y derecho fueron: 6,4±1,19 mm, 31,9±2,76 mm y 4,0±0,81 mm, y 5,5±1,00 mm, 32,4±3,23 mm y 4,4±1,05 mm, respectivamente. Las facetas articulares, tanto en el talus como en el calcáneo en la población de Anatolia estudiada, eran predominantemente de tipo B. Estas observaciones son similares a reportes previos realizados en América, India y África, pero difieren de los realizados en Europa. Un conocimiento de las variaciones de las facetas articulares del talus y del calcáneo proporciona una valiosa hoja de ruta para los cirujanos ortopédicos, así como otros involucrados en la rehabilitación de los pies.

Pigmented Villonodular Synovitis of the Ankle and Subtalar Joint Treated by Surgical Excision and Ligament Reconstructions: A Case Report / 대한족부족관절학회지

Diffuse pigmented villonodular synovitis (PVNS) involving ankle joint needs complete mass excision and total synovectomy to reduce recurrence rate, while surrounding ligaments can be easily damaged. So the concurrent ligament reconstruction should be considered for post-excisional instability in subtalar joint as well as lateral ankle joint. We describe our experience in the management of a diffuse type PVNS, invades lateral talocrural joint extended to subtalar joint and introduce a new technique of all-in-one reconstruction for anterior talofibular,calcaneofibular and cervical ligament. Our new reconstruction technique applying modified Chrisman and Snook technique is useful in stabilization for deficiencies of the ligament complexafter PVNS excisionat lateral ankle and subtalar joint.

Virtual movement of the ankle and subtalar joints using cadaver surface models / Movimiento virtual de las articulaciones talocrural y subtalar utilizando modelos de superficie de cadáveres

Medical students in the dissection room do not fully understand the ankle joint for dorsiflexion and plantar flexion as well as the subtalar joint for inversion and eversion. Thus, a three-dimensional simulation of the movements would be beneficial as a complementary pedagogic tool. The bones and five muscles (tibialis anterior, tibialis posterior, fibularis longus, fibularis brevis, and fibularis tertius) of the left ankle and foot were outlined in serially sectioned cadaver images from the Visible Korean project. The outlines were verified and revised; and were stacked to build surface models using Mimics software. Dorsiflexion and plantar flexion were simulated using the models on Maya to determine the mediolateral axis. Then, inversion and eversion were done to determine the anteroposterior axis. The topographic relationship of the two axes with the five affecting muscles was examined to demonstrate correctness. The models were placed in a PDF file, with which users were capable of mixed display of structures. The stereoscopic image data, developed in this investigation, clearly explain ankle movement. These graphic contents, accompanied by the sectioned images, are expected to facilitate the development of simulation for the medical students' learning and the orthopedic surgeons' clinical trial.

Los estudiantes de medicina en la sala de disección no entienden completamente la dorsiflexión y flexión plantar de la articulación talocrural, así como la inversión y eversión de la articulación subtalar. Por tanto, la simulación 3D de estos movimientos resultaría beneficiosa como herramienta pedagógica complementaria. Los huesos y cinco músculos (tibial anterior, tibial posterior, fibular largo, fibular corto y fibular tercero), se describen en imágenes del proyecto "Visible Korean", de cadáveres seccionados en serie. Los contornos fueron verificados, revisados, y agrupados para construir modelos de superficie utilizando el programa Mimics. Los movimientos de dorsiflexión y flexión plantar fueron simulados utilizando los modelos generados en el programa Maya, para determinar el eje mediolateral. La inversión y eversión se realizó para determinar el eje anteroposterior. Se examinó la relación topográfica de los dos ejes con los cinco músculos estudiados para demostrar la exactitud de movimientos. Los modelos fueron colocados en un archivo PDF, mediante el cual los usuarios fueron capaces de obtener una visualización combinada de las estructuras. Los datos procedentes de imágenes estereoscópicas, obtenidos en esta investigación, permiten explicar claramente el movimiento de las articualciones talocrural y subtalar. Estos contenidos gráficos, acompañados de las imágenes seccionadas, facilitarán el desarrollo de la simulación en el aprendizaje de los estudiantes y su uso en ensayos clínicos por parte de cirujanos ortopédicos.

Treatment of Calcaneal Fracture Malunion Using Lateral Exostectomy and Corrective Osteotomy: A Report of Three Cases / 대한족부족관절학회지

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.

The Surgical Outcome of Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail / 대한족부족관절학회지

PURPOSE: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. MATERIALS AND METHODS: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (> or =5degrees), negative value of 5th metatarsal-tibial angle. CONCLUSION: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.

Intraosseous Calcaneal Lipoma with Subtalar Perforation through Cystic Degeneration: A Case Report / 대한족부족관절학회지

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.