Use of a Ponseti-hex Assisted Triple Arthrodesis: A Case Study of Bilateral Neglected Adult Clubfoot.

INTRODUCTION: Management of neglected clubfoot presents a challenging problem. Treatments traditionally involve extensive posteromedial soft tissue releases, bony procedures, and the Ilizarov technique of differential distraction. CASE REPORT: We present a case of bilateral neglected clubfoot in a 34-year-old female. Management involved the novel combination of the gradual distraction of prepared triple arthrodesis surfaces and the Ponseti regimen which was achieved using the three-dimensional corrective power of hexapod-type circular fixators. Both feet were corrected to achieve plantigrade painless feet. CONCLUSION: Combining the Ponseti regimen with a hexapod fixator has presented an excellent management strategy for neglected clubfeet in an adult. We further propose the use of a generic name, the Ponseti-hex technique, to cover for the use of all makes of hexapod external fixators.

Use of locking barbed sutures in foot and ankle surgery. A case series.

BACKGROUND: Barbed sutures represent a novel technique for wound closure. By distributing tension forces across the length of a wound, it results in better wound healing. A recent article from Chowdhry et al. cautioned against the use of barbed sutures in foot and ankle surgery. Our experience with the Quill® (Angiotech, Vancouver, BC) barbed suture, showed a more positive outcome. MATERIALS AND METHODS: 123 surgical wounds were prospectively followed up after closure with a bidirectional barbed suture. The cohort represented a large range of patient ages and co-morbidities, as well as incision length and locations. RESULTS: Complication rates were low in this large cohort. The total complication rate was 6.5% (8 wounds). One wound (0.8%) had a major infection that needed further surgery, and 2 wounds (1.6%) showed inflammatory related complications. The remaining 5 wounds (4%) had minor wound complications, which resolved without any further surgical intervention. Patient satisfaction rates were high, with 78% of incisions scoring at maximum on the visual analogue cosmesis score. CONCLUSIONS: Use of the Quill® (Angiotech, Vancouver, BC) suture is a safe and effective alternative for wound closure in foot and ankle surgery.

Peroneal tendon dislocation/subluxation - Case series and review of the literature.

BACKGROUND: Dislocating or subluxing peroneal tendons is a relatively infrequent injury. Although infrequent it is very debilitating for the athlete. This retrospective study addresses primarily the surgical technique. METHODS: Twenty-three patients between 2005 and 2014 were operated on for symptomatic dislocating or subluxing peroneal tendons. Five patients presented in the acute phase and 18 patients were late cases. Twenty patients were available for follow-up at a mean of 53.1 months. Three patients were classified as Stage III and 17 as Stage I/II. The procedures varied from pure repair of the superior peroneal retinaculum (SPR), reattachment of the SPR, groove-deepening or a combination of the above. No one procedure was favoured over the other. The choice of procedure was decided intraoperatively depending on the findings. RESULTS: The mean postoperative VAS score was 1.5 with a mean AOFAS score of 85. Sixteen patients rated their results as excellent, one as good, one uncertain and two poor. The results showed no one procedure superior to another with respect to chronicity, stage or satisfaction score. CONCLUSIONS: Several procedures have been described for this condition. Most published studies however, comprise of a small cohort of patients with good results following surgery. The surgical techniques vary and depend largely on the surgeon's clinical experience and preference. The authors conclude that the surgical technique described in this article is largely successful with a low complication rate and a high satisfaction rate.