Rigidity comparison of locking plate and intramedullary fixation for tibiotalocalcaneal arthrodesis.

BACKGROUND: Obtaining adequate fixation during tibiotalocalcaneal (TTC) arthrodesis may be challenging. Various fixation constructs have been tested biomechanically, but the use of a locking plate has not been reported. We hypothesized that the locking plate with a TTC augmentation screw would provide structural rigidity comparable to that of the intramedullary (IM) nail with a TTC augmentation screw during dorsiflexion testing. MATERIALS AND METHODS: Six matched pairs of fresh frozen cadavers underwent TTC arthrodesis. Specimens in each pair were randomized to receive a locking plate or an intramedullary nail. Each specimen had an additional TTC augmentation screw through the calcaneus, talus, and medial tibia. All samples underwent dorsiflexion testing with determination of structural rigidity at the first cycle (initial rigidity) and last cycle (final rigidity) and the torque required to achieve a failure of 10 degrees of dorsiflexion. Statistical analysis was performed using a paired t-test to determine whether any differences were significant (p < 0.05). RESULTS: The locking plate construct showed higher final rigidity (mean +/- standard error of the mean) (27.7 +/- 2.6 N-m/degree versus 17.6 +/- 2.1 N-m/degree, p = 0.01) than the IM nail construct. There were no other differences measured. CONCLUSION: Rigidity with the the IM nail was inferior to that with locking plate fixation for TTC arthrodesis in one of the four parameters tested. CLINICAL RELEVANCE: Screw augmented IM nail fixation and augmented locking plate fixation may offer similar rigidity clinically for TTC arthrodesis.

The use of suture anchors to repair the ruptured quadriceps tendon.

Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.

Calcaneocuboid distraction arthrodesis and first metatarsocuneiform arthrodesis for correction of acquired flatfoot deformity in a cadaver model.

BACKGROUND: Lateral column lengthening has been associated with residual forefoot supination and symptomatic lateral overload in treatment of acquired flatfoot. A medial column procedure may be useful to redistribute load to the medial column. We evaluated radiographic and pressure changes in a severe flatfoot model with lateral column lengthening and investigated the effect of an added first metatarsocuneiform arthrodesis. METHODS: Ten cadaver specimens were loaded in simulated double-legged stance, and radiographic and pressure data were collected for all tested states. Calcaneocuboid arthrodesis was done with a 10-mm foam wedge. Residual forefoot varus was corrected through the first metatarsocuneiform joint. RESULTS: Differences in the mean lateral talar-first metatarsal angle, talonavicular angle, talocalcaneal angle, and calcaneal pitch were significant between the intact foot and the flatfoot. After calcaneocuboid distraction arthrodesis and tendon transfer, the lateral talar-first metatarsal angle, talonavicular angle, and calcaneal pitch were significantly different from the flatfoot. After added first metatarsocuneiform arthrodesis, the talonavicular angle was not significantly different from the intact foot. Lateral forefoot pressure increased in the flatfoot after lateral column lengthening but was not significantly different from the intact foot after first metarsocuneiform arthrodesis was added. CONCLUSIONS: Adding first metatarsocuneiform arthrodesis to calcaneocuboid distraction arthrodesis for treatment of flatfoot deformity provided improvement in radiographic and pedobarographic parameters of a severe model of stage II posterior tibial tendon dysfunction.