A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction.

Charcot foot syndrome (Charcot neuroarthropathy affecting the foot), particularly in its latter stages, may pose a significant technical challenge to the surgeon. Because of the lack of anatomic consistency, preoperative planning with virtual and physical models of the foot could improve the chances of achieving a predictable intraoperative result. In this report, we describe the use of a novel, inexpensive, 3-dimensional template printing technique that can provide, with just a normal printer, multiple "copies" of the foot to be repaired. Although we depict this method as it pertains to repair of the Charcot foot, it could also be used to plan and practice, or revise, 3-dimensional surgical manipulations of other complex foot deformities.

The tripod fixation technique for ankle arthrodesis.

Fixation for ankle arthrodesis often consists of compression screws. A technique using a mechanically sound configuration for stable fixation is presented. The spatial orientation of the screws is in the form of a tripod that provides circumferential compression across the fusion mass. The sequence of delivery of the hardware minimizes the likelihood of intraosseous screw collision. The strategic placement of the screws also prevents stress concentration that may lead to stress risers in the distal tibia.

Radiographic analysis of transverse plane digital alignment after surgical repair of the second metatarsophalangeal joint.

We undertook a retrospective cohort study of 51 feet in 49 patients with surgically managed second metatarsophalangeal joint instability, including repair of the crossover second toe deformity. The fundamental intervention consisted of proximal interphalangeal joint arthrodesis combined with second metatarsophalangeal joint relocation and Kirschner-wire transfixation, and this was performed alone or in combination with one of the following additional surgical maneuvers: flexor tendon transfer or flexor set release, flexor plate repair, placement of a plantar-lateral retention suture, extensor tendon transfer, metatarsophalangeal arthroplasty, metatarsal osteotomy, or second-to-third syndactyly. The outcome of interest was the presence of a transverse plane second metatarsophalangeal joint angle of 0 degrees to 15 degrees measured on the late postoperative follow-up radiograph. Overall, the median angular correction for all second metatarsophalangeal joint interventions was 8 degrees , and second-to-third syndactyly yielded the most long-term correction followed by, in descending order of the amount of angular correction, use of the fundamental intervention in combination with metatarsophalangeal joint arthroplasty, placement of a plantar-lateral anchor suture in the flexor plate, metatarsal osteotomy, flexor tendon transfer, flexor plate repair, extensor tendon transfer, and the fundamental intervention as a solitary procedure. A sensitivity analysis indicated that our results were resistant to the influence that an unmeasured variable would impart on the data. The results of this investigation should aid surgeons treating patients with unstable second metatarsophalangeal joints, and can be used in the development of future clinical trials and observational studies that focus on the management of this common deformity.