Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.
Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.
Introduction: Surgical techniques for hallux valgus correction are constantly evolving. However, there is little data in the literature comparing the different techniques and methods of fixation. The aim of this study was to compare two variations of the Lapidus procedure with respect to the rate of complications, radiographic and functional outcomes. Methods: A retrospective review of 94 consecutive patients treated with a Lapidus fusion for hallux valgus correction between 2006 and 2017 was performed. In the first group, 33 patients underwent modeling arthrodesis between the first metatarsal base and the medial cuneiform, and between the base of the first and second metatarsals. In the second group, 61 patients underwent a fusion between the base of the first metatarsal and the medial cuneiform only. Results: In group 1, the rate of complications was 18% compared with 13% in group 2; of these, 10,5% required a revision procedure in group 1 versus 7,5% in group 2. The most common complications were nonhealing, partial recurrence of the deformity and loosened screws. In group 1, the first intermetatarsal angle and the hallux valgus angle were improved from an average of 18,3 degrees to 14 degrees and from 29 to 9,7 degrees, respectively. In group 2, the angles were improved from 16,1 to 9,1 degrees and from 31,1 to 9,1 degrees, respectively. The AOFAS score was improved from 44,5 to 94,9 in group 1 and from 35,8 to 91,32 in group 2. Conclusion: The Lapidus procedure with fusion of only the first metatarsal base and the medial cuneiform is safe, with a low rate of complications. In this modified procedure, the surgeon is required to optimize the congruency between the base of the first metatarsal and the medial cuneiform prior to fixation, which may conceivably explain the good results observed in this group.
Introduction: Acute syndesmotic sprain is rarely associated with instability in the absence of fracture. The surgical treatment of these injuries is usually performed as an open procedure with direct visualization of the anatomical reduction of the joint. However, direct visualization of the reduction can be achieved by arthroscopy with minor incisions avoiding damage to the soft tissues. The aim of this study is to present the short-term outcomes of a series of patients with acute unstable syndesmotic injuries who were surgically treated through an arthroscopic reduction and percutaneous fixation with a suture button. Methods: We report a series of 8 patients with a mean age of 25,62 years with acute instability of the syndesmosis without fracture who were treated through arthroscopic reduction of the syndesmosis followed by percutaneous fixation using a suture button, between October 2014 and May 2018. Medical records, the visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pre and postoperative radiological results (stress radiographs, computed tomography and magnetic resonance imaging) and complications were retrospectively reviewed. Results: After a mean follow-up of 13,4 months, the mean VAS was 0 and the mean AOFAS was 100. All patients were able to return to their preinjury activities and were completely satisfied with the treatment outcomes. Two patients had an associated deltoid ligament rupture and were treated by open repair at the same time. Two complications were observed. One patient developed an aseptic cyst over the distal knot, and one evolved with complex regional pain syndrome. The last one required a reoperation to remove the anterior button. Conclusion: Arthroscopic treatment represents an effective approach for acute syndesmotic instability. In the short-term, it provides satisfactory clinical and functional results, allowing patients to return to their previous activities. It is reliable regarding anatomic reduction of the syndesmotic joint and percutaneous fixation with a suture button without aggression toward the soft tissue of the ankle.
Idiopathic thrombocytopenic purpura in a patient with situs inversus totalis: case report and literature review Púrpura trombocitopênica idiopática em paciente com situs inversus totalis: relato de caso e revisão da literatura
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