Radiographic analysis of the impact of internal fixation and dressing choice of distal chevron osteotomy: randomized control trial.

BACKGROUND: The aim of this study was to perform prospective, randomized comparison of two surgical techniques (fixation versus no fixation) and two postoperative regimens (soft cast versus elastic band) to determine if the head fragment displaces more or less with either technique. METHODS: One hundred consecutive patients were included in the study. The osteotomy was fixed with an absorbable pin in 50 cases and no fixation in the other 50. Half of each group used a soft cast for 6 weeks postoperatively and half had a traditional elastic bandage. Weightbearing radiographs at 6 weeks, 6 months, 1 year, and mean of 7.9 years were evaluated. RESULTS: A larger shift was found when fixation was used 3.9 (SD, 0.8) mm at 6 weeks versus 3.1 (SD, 0.9) mm in the no fixation group (p < 0.001). The two bandage types had no significant effect to the mean shift. Correction of the mean hallux valgus angle was worse overall when preoperative angles were over 30 degrees (p < 0.001). CONCLUSION: There was a statistically higher shift in the fixation group, but the clinical significance of 0.7 mm difference and the type of postoperative bandaging did not influence outcome is questionable. The risk for recurrence of hallux valgus was higher when preoperative angles were over 30 degrees.

Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail: a report of 34 consecutive patients.

BACKGROUND: Tibiotalocalcaneal arthrodesis is a treatment modality for severe arthrosis and malalignment of the hindfoot. Complications, such as delayed union and nonunion, are well-known risks of the procedure. Arthrodesis can be done with a plate, screws, an external fixator, or an intramedullary nail. Compression with an intramedullary nail was the focus of this report. METHODS: Thirty-four consecutive patients (23 men and 11 women) with an average age range of 57 (range 25-77) years had tibiotalocalcaneal arthrodesis using retrograde intramedullary compression nail fixation. Mean followup was 24 (range 6 to 43) months. One patient died of an unrelated cause, but 30 (91%) of the remaining 33 patients answered the questionnaire. RESULTS: Bony consolidation was achieved in 26 (76%) patients, the mean time to fusion being 16 weeks. Five patients (15%) had complications and seven (20%) had repeat surgery. Of the 30 patients who responded to the questionnaire, three patients (10%) evaluated the overall result subjectively as being of no benefit and 27 (90%) as improved. The visual analog scale (VAS) score for preoperative pain was 66 at rest and 83 when walking, and the mean postoperative scores were 19 and 32, respectively (p<0.001). CONCLUSIONS: Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail is an effective and safe procedure for patients with severe malalignment or arthrosis of the hindfoot. It is essentially a salvage procedure, and most patients benefit from it, but excellent results are rare.