Proximal metatarsal osteotomies are inherently unstable and difficult to fix. The purpose of this study was to compare the mechanical stiffness in sawbone models of medially versus dorsally placed plates and then to compare semilocked versus nonlocked plates in different osteotomy configurations. Thirty sawbone models were constructed, fixed either with titanium self-locking or steel mini-fragment plates. They were divided in groups and their stiffness was measured. The stiffness of any model fixed with medial titanium or steel plates was on average 158% and 228% greater, respectively, compared to dorsal plates. Adding a dorsal shelf of bone to a proximal closing wedge osteotomy increases its stiffness. Using locked plates increased the mechanical stiffness in only one configuration. The article suggests that models fixed with medial plates have greater resistance to failure than models fixed with dorsal plates. Using locked plates does not increase the mechanical stiffness of the construct.
Category: Ankle, Ankle Arthritis Introduction/Purpose: The supramalleolar osteotomy (SMO) serves as a means to alter joint load transmission and shield damaged areas of cartilage within the tibiotalar joint. The aim of this study was to directly measure the changes in pressure attributed to varying degrees of SMOs (varus and valgus); with and without an osteochondral (OCD) pseudolesion, and in multiple ankle alignments (Dorsiflexion, neutral, and plantarflexion). We hypothesize measurement metrics to be reduced with increasing degrees of SMO. Methods: 6 cadaver specimens were in included in the biomechanical study (sectioned at the mid-tibia). A pressure sensor was used to measure load, load area, and peak pressure within the tibiotalar joint. SMOs of 3,6,9, and 12 degrees in varus or valgus were performed. A servohydraulic machine was used to transmit 400 and 800 N through the specimens; in 10 degrees of dorsiflexion, neutral, or in 10 degrees of plantarflexion during load transmission. Measurements were performed in undisturbed joints, followed by re-measurement in the presence of a created 9 mm diameter pseudolesion. Results: Load was not changed (only significant changes reported) in the presence of a lesion. For the load, it was more influenceable at 800 N, changes were observed in higher degree SMOs, and changes were only observed in neutral and dorsiflexion. Changes in area were only observed when 12 degrees of varus or valgus SMOs were used. Peak Pressure was the only modifiable metric in the presence of a pseudo-lesion, reductions were more common at 800 N, and in the absence of a pseudolesion there was an incremental reduction in medial peak pressure when increasing varus SMOs were performed (dorsiflexion). Conclusion: Medial peak pressure tended to decrease with varus SMOs in neutral and dorsiflexion. Medial load tended to decrease with varus osteotomies in 10 degrees of dorsiflexion. A 12 degree varus SMO was the only SMO to influence a pseudolesion.
Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc fractures are rare, but with a high degree of morbidity. Post-traumatic degenerative changes that result in pain and deformity, are common; with arthrodesis being a treatment option. There are several implants for midfoot arthrodesis, but with little literature regarding the best method for achieve bone fusion. We analice the fusion rates, comparing different joint stabilization techniques. Methods: A retrospective descriptive study of 20 patients with post traumatic osteoarthritis of the midfoot was performed, who underwent midfoot arthrodesis, between January 2016 - January 2018. The comparison between arthrodesis techniques with compression plate (CP) vs plates and / or screws (PS) was made. Data analysis was performed with SPSS software. Results: The fusion times were compared between the 2 groups, CP 18.7 (+- 8.01) vs PT 16.86 (+- 11.5) weeks, without significant differences. There were also no significant differences when comparing the discharge times between the 2 groups, CP 8 (+- 1.84) vs PS 9 weeks (+- 2.36) (p = 0.312). However, when comparing the proportion of complications between both groups, the CP group has lesser than the PS group (42.8% vs 83.3%). This difference was not statistically significant (p = 0.95) although there is a tendency for CP to have fewer complications. In addition, the proportion of complications in primary vs. secondary arthrodesis, 25% vs. 75% respectively, was compared, finding statistically significant differences (p = 0.028) Conclusion: At the moment, there is a lack of evidence to recommend the exclusive use of implants. However, when comparing complications between both groups, there would be a tendency that the use of compression plates would have fewer complications. In addition, it could be inferred that in patients with lesions with greater joint destruction, primary arthrodesis is valid as an option.
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