[Translated article] Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw.

BACKGROUND AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIALS AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into two groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSION: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw. / Mejores resultados en la consolidación de la artrodesis metatarsofalángica del hallux con placa dorsal y tornillo de compresión interfragmentario.

INTRODUCTION AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIAL AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into 2 groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSIONS: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Estudio de la relación de la fractura del maléolo posterior y el desarrollo de artrosis / Study of the relation between the posterior malleolus fracture and the development of osteoarthritis

ANTECEDENTES Y OBJETIVOS: Al menos el 10% de las fracturas de tobillo presentan afectación del maléolo posterior de la tibia, lo cual se ha relacionado con peor pronóstico a largo plazo. Nuestro objetivo ha sido analizar los resultados clínico-funcionales de las fracturas de tobillo con afectación del canto posterior, tratadas de forma quirúrgica sin reducción directa del tercer maléolo. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo sobre 45 pacientes menores de 60años que hemos clasificado en tres grupos atendiendo al porcentaje de afectación articular del fragmento posterior (<10%, 10-25% y >25%), valorando los resultados funcionales mediante la escala visual analógica del dolor (EVA), la escala American Orthopaedic Foot and Ankle Society (AOFAS) de tobillo y retropié, y el cuestionario de salud global SF-36; también hemos analizado el grado de artrosis con radiografía en carga, al menos un año tras la lesión. RESULTADOS: La puntuación media del dolor EVA de la muestra fue de 1,1 (0-5) en reposo y de 3 (0-8) en ejercicio; en la escala AOFAS fue de 88,4+/-10,1 y en la de SF-36, de 68,5+/-19,3 puntos. Hasta el 18% de los pacientes desarrollaron artrosis radiográficamente significativa a corto y a medio plazo (entre 12 y 73 meses, con una media de 33 meses). El 55,6% presentaban una afectación entre el 10 y el 25% de la superficie articular. Comprobamos que un mayor tamaño del fragmento posterior se relacionaba con mayor grado de artrosis precoz (p < 0,03) y peores puntuaciones en la escala AOFAS (p < 0,01). CONCLUSIÓN: Las fracturas de tobillo con afectación del maléolo posterior parecen contribuir al desarrollo de artrosis precoz con limitación funcional en adultos jóvenes

Background and aims: At least 10% of ankle fractures involve the posterior malleolus of the tibia, which has been related to poorer long-term prognosis. Our aim was to analyse the clinical and functional outcomes of ankle fractures involving the posterior edge, treated surgically without direct reduction of the third malleolus. MATERIAL AND METHODS: We performed a retrospective study of 45 patients aged under 60, who we classified into three groups in terms of the percentage of joint involvement of the posterior fragment (<10%, 10%-25% and >25%) assessing the functional outcomes using the visual analogue pain scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Society) of the ankle and hindfoot and the global health questionnaire SF-36; we also analysed the degree of osteoarthritis with weight-bearing radiography, at least one year following the injury. RESULTS: The mean VAS pain score of the sample was 1.1 (0-5) at rest and 3 (0-8) on exercise; 88.4+/-10.1 on the AOFAS scale, and 68.5+/-19.3 points on the SF-36. Up to 18% of the patients developed radiographically significant osteoarthritis in the short and medium term (between 12 and 73 months, with a mean of 33 months). Of the patients, 55.6% had involvement of between 19% and 25% of the joint surface. We found that a larger posterior fragment size related to a greater degree of early-onset osteoarthritis (P<.03) and poorer AOFAS scores (P<.01). CONCLUSION: Ankle fractures involving the posterior malleolus seem to contribute to the development of early-onset osteoarthritis with functional limitation in young adults

Study of the relation between the posterior malleolus fracture and the development of osteoarthritis. / Estudio de la relación de la fractura del maléolo posterior y el desarrollo de artrosis.

BACKGROUND AND AIMS: At least 10% of ankle fractures involve the posterior malleolus of the tibia, which has been related to poorer long-term prognosis. Our aim was to analyse the clinical and functional outcomes of ankle fractures involving the posterior edge, treated surgically without direct reduction of the third malleolus. MATERIAL AND METHODS: We performed a retrospective study of 45 patients aged under 60, who we classified into three groups in terms of the percentage of joint involvement of the posterior fragment (<10%, 10%-25% and >25%) assessing the functional outcomes using the visual analogue pain scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Society) of the ankle and hindfoot and the global health questionnaire SF-36; we also analysed the degree of osteoarthritis with weight-bearing radiography, at least one year following the injury. RESULTS: The mean VAS pain score of the sample was 1.1 (0-5) at rest and 3 (0-8) on exercise; 88.4±10.1 on the AOFAS scale, and 68.5±19.3 points on the SF-36. Up to 18% of the patients developed radiographically significant osteoarthritis in the short and medium term (between 12 and 73months, with a mean of 33months). Of the patients, 55.6% had involvement of between 19% and 25% of the joint surface. We found that a larger posterior fragment size related to a greater degree of early-onset osteoarthritis (P<.03) and poorer AOFAS scores (P<.01). CONCLUSION: Ankle fractures involving the posterior malleolus seem to contribute to the development of early-onset osteoarthritis with functional limitation in young adults.