RESUMEN
The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction's consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system.
Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , Pandemias/prevención & control , Salud Pública , Vigilancia de Guardia , Difusión de la InformaciónRESUMEN
Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These 2 treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular postoperative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) postoperatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury.
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Artrodesis , Fracturas no Consolidadas , Humanos , Artrodesis/métodos , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Masculino , Femenino , Anciano , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Adulto Joven , Fijación Interna de Fracturas/métodos , Huesos Metatarsianos/lesiones , Huesos Metatarsianos/cirugía , Articulaciones Tarsianas/cirugía , Articulaciones Tarsianas/lesiones , Resultado del Tratamiento , Traumatismos de los Pies/cirugía , Traumatismos de los Pies/diagnóstico por imagen , Estudios de Seguimiento , Articulaciones del Pie/cirugía , Articulaciones del Pie/lesiones , Articulaciones del Pie/diagnóstico por imagen , RadiografíaRESUMEN
Moderate to severe hallux valgus deformity often requires a Lapidus procedure (first-tarsometatarsal arthrodesis). Traditional methods include a dorsal approach with dorsal or medial fixation. However, studies demonstrate plantar/tension-side fixation, provides superior load to failure and fixation strength. This could improve outcomes, address comorbidities, and accelerate postoperative protocols; however, a paucity exists for patient outcomes in the literature regarding tension-side-fixation. The purpose of this study is to report the outcomes for tension-side Lapidus fixation. A retrospective analysis was performed of 81 patients who underwent tension-side-fixation Lapidus. Data collection consisted of: time to weight-bear, time to return to regular shoegear, hardware removal rate, revision rate, recurrence rate, relative metatarsal shortening, and nonunion rates. Mean patient age was 44 years old (range: 16-82). There were 65 females, and 16 males. The average time to weightbearing was 10.4 days. Time to return to regular shoegear was a mean of 6 weeks (ranging 2-10 weeks). Hardware removal rate was 1.2%. The recurrence rate was 8.6% (7 of 81 patients) and 5 of those 7 patients experienced recurrence before frontal-plane-correction was adopted by the surgeon. The revision rate was 0% and despite 8.6% recurrence, no patients were dissatisfied or requested a revisional procedure. The first-metatarsal shortening was a mean of 0.42 mm. The complications were as follows: 7% superficial dehiscence, 1.2% superficial wound infection, 0% deep infection, and 1.2% asymptomatic nonunion. This study suggests tension-side-fixation for Lapidus arthrodesis may allow for safe early return to weightbearing, early return to regular shoegear, low hardware removal rate, low revision rate, low metatarsal shortening, and low nonunion rate.
Asunto(s)
Artrodesis , Hallux Valgus , Humanos , Artrodesis/métodos , Artrodesis/instrumentación , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Hallux Valgus/cirugía , Anciano , Adolescente , Adulto Joven , Anciano de 80 o más Años , Soporte de Peso , Huesos Metatarsianos/cirugía , Resultado del Tratamiento , Reoperación , RecurrenciaRESUMEN
The deltoid ligament is vitally important in the stability of the ankle and preventing excessive medial ankle movement. Historically, the impact of medial ankle instability has not been well understood in the setting of chronic ankle instability. A retrospective review of 226 patients treated for ankle instability between 2017 and 2022 identified 40 patients who required both medial and lateral repair. Decision for medial deltoid repair was based upon patient presentation, MRI findings, intraoperative fluoroscopy and final confirmation via arthroscopic positive "drive-through sign". Preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores, Patient-Recorded Outcomes Measurement Information System (PROMIS) scores, and Karlsson-Peterson Ankle Function (K&P) scores were obtained and compared. There were statistically significant improvements found in all 3 scoring systems at a mean follow-up time of 11.7 months postoperatively. In the setting of chronic ankle instability, consideration should be given to the evaluation and potential repair of the deltoid ligament in order to provide sufficient stability to the medial ankle.
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Inestabilidad de la Articulación , Ligamentos Laterales del Tobillo , Humanos , Tobillo , Incidencia , Resultado del Tratamiento , Artroscopía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Ligamentos , Estudios Retrospectivos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/cirugía , Ligamentos Laterales del Tobillo/cirugíaRESUMEN
Posterior heel pain secondary to insertional Achilles tendinopathy is a common condition that often times requires surgical management. Typically, this involves reflecting a portion of the Achilles tendon from its insertion to adequately debride devitalized or thickened tendon as well as any osseous prominence and then reattached into the calcaneus via suture anchors. Oftentimes, it is suggested that patients with an increased body mass index (BMI) have a higher risk of complications. However, there is no published evidence to support this claim. The present study is a retrospective review of 78 patients who underwent detachment/reattachment of the Achilles tendon for chronic insertional Achilles tendinopathy. Patients were separated into three groups based on BMI: normal, obese, and morbidly obese. The mean BMI of all patients included was 35.6 kg/m2 (range: 21.8-54.9, SD: 6.9). We compared complication rates between the groups and found no significant difference (p = .541). Patients in all groups also demonstrated statistically significant improvements in both American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores (Normal BMI: p = .002; Obese: p = <.001; Morbidly obese: p = <.001) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores (Normal BMI: p = .003; Obese: p = <.001; Morbidly obese: p = .001). In conclusion, the results of our study demonstrate that detachment/reattachment of the Achilles insertion in the management of insertional Achilles tendinopathy in obese and morbidly obese patients may be safe and effective without the risk of increased complications.
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Tendón Calcáneo , Índice de Masa Corporal , Tendinopatía , Humanos , Tendón Calcáneo/cirugía , Tendinopatía/cirugía , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Enfermedad Crónica , Resultado del Tratamiento , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Obesidad/complicaciones , AncianoRESUMEN
Primary repair of the deltoid ligament is a common surgical option for unstable ankle fracture. However, controversy exists regarding whether such repair is necessary or provides any benefit to patient outcomes. A retrospective study was performed following acute deltoid repairs using all-suture bone anchors. Patients at 2 surgical centers were included when they were over 18 years old at surgery, had a medial clear space (MCS) greater than 4 mm preoperatively, and had at least 6 months of follow-up. Subjective outcomes were measured with PROMIS, FAAM, and numeric rating scale. Preoperative and follow-up scores were compared with t tests (p < .05). For the 47 patients identified, age at time of surgery was 30.6 ± 14.9 years (range 15.4-65.0 years). Follow-up data were captured for 36 (73%) of the patients at 75 ± 37 weeks (range 18-169 weeks) after surgery. Mean time to weightbearing was 4 ± 1 weeks (range 1-7 weeks). Patients returned to sport 14 ± 5 weeks after surgery (range 8-41 weeks). Various complications consisted of wound infection, superficial dehiscence, and complex regional pain syndrome (CRPS). The PROMIS, FAAM, and NRS patient outcome scores improved significantly from preoperative to postoperative follow-up. Significant reduction in the radiographic MCS postoperatively occurred in all patients. These findings suggest primary deltoid repair when associated with ankle fracture to be a safe procedure and has the potential of allowing early weightbearing and return to sports.
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Fracturas de Tobillo , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Anclas para Sutura , Estudios Retrospectivos , Ligamentos Articulares/cirugía , Fijación Interna de Fracturas/métodos , Articulación del Tobillo/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB. METHODS: Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm. RESULTS: Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST (P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL (P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group (P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group (P = .144). CONCLUSION: Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity. LEVEL OF EVIDENCE: Level II, prospective comparative study.
Asunto(s)
Inestabilidad de la Articulación , Ligamentos Laterales del Tobillo , Adulto , Articulación del Tobillo , Humanos , Inestabilidad de la Articulación/cirugía , Estudios Prospectivos , SuturasRESUMEN
The most common injury sustained to the ankle ligaments is a result of inversion of the foot. This mechanism results in injury to the anterior talofibular ligament alone or in conjunction with the calcaneofibular ligament and posterior talofibular ligament. Patients experiencing recurrent ankle sprains despite nonoperative measures often require surgical management. Recent focus has been on augmentation procedures to improve the stability of a lateral ankle ligament repair by protecting it during the healing phase and supporting early mobilization. This article describes, with video illustration, anterior talofibular ligament repair with suture tape augmentation.
RESUMEN
BACKGROUND: The open Broström-Gould lateral ankle stabilization procedure has been the gold standard for primary lateral ankle stabilization. A new minimally invasive all-inside arthroscopic technique has been described for the correction of lateral ankle instability. METHODS: We performed a review of patients who underwent lateral ankle stabilization by either the traditional open Broström-Gould (BG) or the All-Inside Bröstrom (AIB) technique to compare and identify any discrepancies between functional and/or patient satisfaction outcomes. A total of 62 patients underwent a lateral ankle stabilization. Of those 62 patients, 32 received a traditional open Broström-Gould procedure and 30 patients underwent an All-Inside Bröstrom type procedure. The two groups were compared preoperatively with AOFAS ankle-hindfoot scoring system and Visual Analog Score (VAS) for pain. Postoperatively, AOFAS, Karlsson Peterson and VAS scores were compared. RESULTS: The mean preoperative VAS pain score for the open Broström-Gould was 7.28, the All-Inside Broström was 8.18. The mean postoperative VAS pain score for the open Broström-Gould was 1.2, the All-Inside Broström was 1.5. The mean preoperative AOFAS score for the Broström-Gould was 35.44, the All-Inside Broström was 35.07. The mean postoperative AOFAS score for the open Broström-Gould was 93.53, the All-Inside Broström was 95.33. The mean postoperative Karlsson Peterson score for the open Broström-Gould was 93.41, the All-Inside Broström was 91.80. The mean time to weight bearing for the Broström-Gould was 22 days, the All-Inside Broström was 12 days. CONCLUSION: There were no statistically significant differences identified in any of the functional or patient satisfaction outcome scores using either technique. This review suggests the minimally invasive arthroscopic technique using bone anchors for lateral ankle stabilization may be comparable to the traditional open Broström-Gould with the added advantage of earlier time to weight bearing.
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Articulación del Tobillo/cirugía , Artrodesis/métodos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Ligamentos Laterales del Tobillo/cirugía , Anclas para Sutura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/diagnóstico por imagen , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/fisiopatología , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Soporte de Peso , Adulto JovenRESUMEN
Acute deltoid injuries may occur with ankle fractures. They are often left to heal without repair, possibly leading to chronic medial ankle instability. Stress radiographs identify the need for surgical repair of fractures or soft tissue damage. Gravity stress views have benefits over manually stressing the ankle. MRI can explore the extent of medial soft tissue injuries. Arthroscopy can evaluate and potentially treat deltoid injuries. Interposition of the deltoid may preclude adequate fracture reduction. Except with deltoid tear, fractures should be reduced and fixated, then the deltoid assessed. With persistent instability, primary repair may prevent long-term sequelae.
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Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Inestabilidad de la Articulación/cirugía , Ligamentos Articulares/cirugía , Fracturas de Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/diagnóstico por imagen , Articulación del Tobillo/diagnóstico por imagen , Humanos , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesionesRESUMEN
Arthrodesis of the ankle or foot is a common procedure for chronic pain and disability. Nonunion remains a prevalent complication among arthrodesis procedures. Some patients present with an inherent risk of developing a nonunion. Allograft biologics have gained popularity in an effort to reduce complications such as nonunion. Various biologics bring unique properties while maintaining a singular purpose. Platelet-derived growth factor (PDGF) may be introduced into a fusion site to facilitate healthy bony consolidation. The purpose of this article is to review the benefits and modalities of PDGF and how it can improve patient outcomes in ankle and hindfoot fusions.
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Articulación del Tobillo/cirugía , Artrodesis/métodos , Articulaciones del Pie/cirugía , Fracturas no Consolidadas/terapia , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Adulto , Anciano , Aloinjertos , Materiales Biocompatibles , Productos Biológicos/uso terapéutico , Trasplante Óseo , Fosfatos de Calcio/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factor de Crecimiento Derivado de Plaquetas/fisiología , Andamios del TejidoRESUMEN
Surgical intervention for hallux rigidus could be necessitated when conservative attempts fail to alleviate pain and dysfunction. Controversy exists as to which procedure is ideal and will provide lasting relief of hallux rigidus pain. Many arguments have been made for and against hemi-implant arthroplasty. We advocate the use of a low-profile hemimetallic endoprosthesis (Metasurg(®)) and present our technique of using a reamer to sculpt the articular surface of the metatarsal head when necessary. We further advocate for minimal resection of the phalangeal base when using a low-profile device to maintain the soft tissue periarticular intrinsics. We present a 2- to 3-position reamer decompression of the metatarsal and discuss the benefits of maintaining range of motion at the first metatarsophalangeal joint.
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Hallux Rigidus/cirugía , Hemiartroplastia/métodos , Articulación Metatarsofalángica/cirugía , Rango del Movimiento Articular/fisiología , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hallux Rigidus/fisiopatología , Humanos , Prótesis Articulares , Masculino , Articulación Metatarsofalángica/fisiopatología , Persona de Mediana Edad , Osteotomía/métodos , Dimensión del Dolor , Satisfacción del Paciente/estadística & datos numéricos , Medición de Riesgo , Resultado del TratamientoRESUMEN
Injury to the lateral ankle ligaments is very common among both athletes and nonathletes alike. Although anterior talofibular ligament injuries and combination anterior talofibular ligament and calcaneofibular ligament injuries are considerably common, an isolated injury to the calcaneofibular ligament has rarely been reported. We present the case reports of 2 patients, both of whom had sustained an isolated calcaneofibular ligament injury. In both patients, the diagnosis was obtained from the clinical examination and magnetic resonance imaging. Also, in 1 patient, formal open surgical inspection was performed. We advocate conservative treatment initially using the same protocols used for common lateral ankle ligament injuries and, if necessary, surgical intervention to address this unique and rare pathologic entity.
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Traumatismos del Tobillo/diagnóstico , Traumatismos del Tobillo/cirugía , Ligamentos Laterales del Tobillo/lesiones , Adulto , Anciano , Femenino , HumanosRESUMEN
Squamous cell carcinoma is the second most common type of skin cancer and may present in the distal extremities including the foot. We present a case in which a primary squamous cell carcinoma of the foot, which presented as a granulomatous ulcerating lesion, was diagnosed and successfully treated with a radical resection. Our case shows an atypical presentation of a very common malignancy and, it is therefore essential for health-care providers to consider malignancy in all suspicious lesions of the foot.
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Carcinoma de Células Escamosas/patología , Pie/patología , Neoplasias Cutáneas/patología , Carcinoma de Células Escamosas/cirugía , Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/cirugíaRESUMEN
Syndesmotic diastasis can occur as an isolated injury or with concomitant fractures. A review of 37 patients with 64 TightRopes® for syndesmotic repair was performed, with a mean follow-up of 23.6 ± 4.3 months, from 2007 to 2011. The patients' mean age was 40.67 (range 14 to 87) years. The mean initial measurements were as follows: tibiofibular clear space (TFCS) = 4.1 ± 1.1 mm, tibiofibular overlap (TFO) = 7.2 ± 2.7 mm, and medial clear space (MCS) = 2.9 ± 0.5 mm. The mean final measurements were as follows: TFCS = 4.2 ± 1.3 mm, TFO = 7.4 2.8 mm, and MCS = 3.0 0.5 mm. The calculated measurable difference from the initial to final TFCS, TFO, and MCS was significantly less than the maximum threshold for allowable widening of the syndesmosis: TFCS, p < .001; TFO, p < .002; and MCS, p < .001. Complications occurred in 10 patients; 7 (19%) experienced knot irritation and 3 (8%) developed an infection. The mean interval to weightbearing was 33.2 ± 12.7 days. The mean postoperative American Orthopaedic Foot and Ankle Society score was 97 (range 90 to 100). Of 64 suture endobuttons, 4 (6.25%) required removal. The fracture types were as follows: 3 (8%) isolated syndesmotic injuries, 9 (24%) trimalleolar fractures, 10 (27%) bimalleolar fractures, 7 (18%) Weber B fractures, 3 (8%) Weber C fractures, 1 (3%) Salter Harris type 3 fracture, and 4 (11%) Maisonneuve fractures. TightRope® fixation was advantageous because it rarely required removal, allowed for physiologic motion of the syndesmosis, and resulted in an early return to weightbearing. In addition, we have concluded that the TightRope® provides long-term stability of the ankle mortise, which was confirmed by the radiographic criteria and excellent American Orthopaedic Foot and Ankle Society scores.
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Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Dispositivos de Fijación Ortopédica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos del Tobillo/diagnóstico por imagen , Articulación del Tobillo/diagnóstico por imagen , Antibacterianos/uso terapéutico , Femenino , Estudios de Seguimiento , Fracturas Óseas/clasificación , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Dispositivos de Fijación Ortopédica/efectos adversos , Radiografía , Infección de la Herida Quirúrgica/tratamiento farmacológico , Soporte de Peso , Adulto JovenRESUMEN
Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the surgical treatment of insertional Achilles tendinosis.
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Tendón Calcáneo/cirugía , Anclas para Sutura , Técnicas de Sutura , Tendinopatía/cirugía , Soporte de Peso , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Escala Visual AnalógicaRESUMEN
Lateral ankle sprains are the most common injury in sports. Nonoperative therapy is recommended initially, including functional rehabilitation. Surgery might be an option for those patients in whom nonoperative attempts fail. Various surgical approaches have been described in published studies for treating chronic lateral ankle instability. The procedures are typically grouped into 2 main categories: anatomic and nonanatomic repair of the lateral ligament complex. The open modified Broström-Gould anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. In the present study, we used an arthroscopic approach to treat chronic anterior talofibular ligament tears without the extensive open incisions common in the traditional modified Broström-Gould procedure. Our hypothesis was that the use of an all-inside arthroscopic Broström procedure would provide a minimally invasive technique with acceptable patient outcomes. We also wished to explore the complication rates and interval to return to weightbearing activity. A total of 40 ankles in 40 consecutive patients were included in the cohort.
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Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Esguinces y Distensiones/cirugía , Implantes Absorbibles , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Anclas para Sutura , Escala Visual Analógica , Adulto JovenRESUMEN
Lapidus arthrodesis (first metatarsal cuneiform arthrodesis) has become an accepted procedure for hallux abducto valgus. Several variations of fixation have been described. Earlier weightbearing postoperatively has been one reported benefit of using locking plates for fixation. Additionally, studies have demonstrated that fixation placed on the plantar or tension side of the arthrodesis increases the biomechanical advantage. We performed a biomechanical cadaveric study of the Lapidus procedure, comparing a previously reported technique using a low profile locking plate with an intraplate compression screw versus the same locking plate with a plantar interfragmentary screw (PIFS) placed on the tension side of the arthrodesis in 10 fresh, paired, cadaver limbs. The mean ultimate load of the plate with a PIFS was 383.2 ± 211.5 N, and the mean ultimate load of the plate with an intraplate compression screw was 205.5 ± 97.2 N. The mean ultimate load of the LPS Lapidus plate with a PIFS was statistically greater (p = .027) than that with the plate intraplate compression screw. Our results indicated that changing the orientation of the compression screw to a PIFS significantly increased the stability of the Lapidus arthrodesis fixation construct. The modified construct with the PIFS might decrease the incidence of nonunion and, ultimately, allow patients to bear weight faster postoperatively.
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Artrodesis/instrumentación , Articulaciones del Pie/cirugía , Hallux Valgus/cirugía , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Placas Óseas , Tornillos Óseos , Cadáver , Femenino , Articulaciones del Pie/fisiopatología , Hallux Valgus/fisiopatología , Humanos , Masculino , Huesos Metatarsianos , Persona de Mediana Edad , Huesos TarsianosRESUMEN
Femoral head allograft is an accepted alternative for significant bone loss in severe hindfoot reconstruction. This is primarily because the size and shape of the graft provides not only structural support but additionally prevents significant loss of limb length. We present a case using a technique from a directly lateral approach and simultaneous preparation of the tibia and calcaneus for tibiocalcaneal arthrodesis. Acetabular resurfacing reamers were used to prepare the joint for grafting as well as sculpt the graft itself for near press fit between the tibia and calcaneus. Fixation with a lateral locking plate avoids the unnecessary decompression reaming of the graft core itself, ultimately sparing the valuable poles of the graft for increased likelihood of incorporation.