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BACKGROUND: This study compares outcomes of patients with severe, multiplanar, fixed, pantalar deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA). METHODS: Fifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17-72 years) and median follow-up duration was 49.9 months (24.0-253.7 months). Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgery and whether they would have the same surgery again. RESULTS: There was no statistically significant difference in functional outcomes, satisfaction, or complications between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p = 0.414). There was no difference in the proportion of patients who would opt for the same procedure again (p = 0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p = 0.692). CONCLUSION: This study concludes that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative pantalar deformities. This data may be useful in counselling patients when considering salvage versus amputation in such cases. LEVEL OF EVIDENCE: Level 3(Original) Clinical Research Article.
Subject(s)
Amputation, Surgical , Limb Salvage , Adult , Humans , Lower Extremity , Retrospective Studies , Treatment OutcomeABSTRACT
AIM: This study evaluated and compared two impression techniques in terms of their dimensional accuracies to reproduce implant positions on working casts. MATERIALS AND METHODS: A master model was designed to simulate a clinical situation. Impressions were made using four techniques: (1) Stock open tray (SOT) technique; (2) stock closed tray (SCT) technique; (3) custom open tray (COT) technique; and (3) custom closed tray (CCT) technique. Reference points on the hexagonal silhouette of the implant on master model and onto the analogs of the obtained master casts were compared after using the four impression techniques. Measurements were made using an optical microscope, capable of recording under 50x magnifications. The means and standard deviations of all the groups and subgroups were calculated and statically analyzed using analysis of variance (ANOVA) and Tukey's test. RESULTS: The open tray impressions showed significantly less variation from the master model and all the techniques studied were comparable. CONCLUSION: All the techniques studied shown some distortion. COT showed the most accurate results of all the techniques.
ABSTRACT
INTRODUCTION: Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, tophi can also occur as first sign of the disorder. CASE REPORT: We report the case of a 60 year female with tophaceous involvement of the pubis bone which is an unusual location for this type of pathology without any prior manifestation of gouty arthritis. CONCLUSION: Tophi can present in unexpected locations, even as the first sign of gout, often mimicking infection and neoplasia and vigilance is required when unusual symptoms or signs occur in a patient with gout.
