Aims We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602.
Lateral swivel dislocation, a subtype pattern of dislocations occurring at mid tarsal joint is a rare type of injury. A medially or laterally directed force applied to the forefoot causes dislocation of the talonavicular joint but not subtalar joint. The calcaneum alongwith the remaining foot swivels on the intact interosseous talocalcaneal ligament. The present case report is a more rare lateral swivel type of dislocation of talonavicular joint in a 25-year-old male. The article also presents a comprehensive review of literature and management of such type of injuries of the hindfoot . How to cite this article Kapila R, Verka Ps, Garg Rs, Ahmed M. Lateral Swivel Dislocation of the Hindfoot: A Case Report and Literature Review. J Foot Ankle Surg (Asia-Pacific) 2015;2(1): 41-43.
Avulsion fractures of the tibial eminence, although generally a rare injury pattern, are more common in children and adolescents than in adults. Many open and arthroscopic techniques are available with variable degrees of satisfying results and incidence of complications and adverse effects. Arthroscopic fixation appeared to improve the functional outcomes with fewer complications than the open fixation. New techniques were reported using commercially available suspension sling devices for the acromioclavicular joint that offers an easy and rapid method of fixation. However, this technique has the disadvantages of the presence of hardware (button) over the tibial anterior cruciate ligament attachment inside the joint and the need to drill a relatively large tunnel through the center of the avulsed fragment that may increase the chance of fracture. So small-diameter tunnels need to be drilled that will decrease bone loss and growth plate injury in children and adolescents. We describe here a technique that offers a better 4-point fixation through the anterior cruciate ligament with fewer complications by avoiding drilling through the avulsed fragment, absence of hardware inside the joint, and decreasing bone loss in adolescents by drilling only smaller transosseous tunnels and allowing for correction of the fixation using a special configuration of knots and cortical button.
The crossing internal suture augmentation technique is an all-inside technique of anterior cruciate ligament reconstruction with augmentation of the hamstring tendon autograft with a braided ultrahigh-molecular-weight polyester–polyethylene suture tape resting on the adjustable cortical buttons on both the femoral and tibial sides. The internal suture augmentation acts as a backbone supporting and protecting the graft until the process of healing and ligamentization of the graft is completed. The ends of the suture tape are tied on the tibial button and additionally fixed to the tibia with a knotless anchor as a backup fixation with the knee in full extension. The technique has the advantages of being minimally invasive with small incisions and allowing preservation of the bone stock through the use of sockets. It also allows early return to activity thanks to the more secure rehabilitation and prevents early failure and stretching of the graft.
Aim The modern trend in the management of fractures is fast changing in favor of rigid fixation and early mobilization with minimal period of plaster immobilization. We present a prospective cohort study of fixation of distal tibial fractures with distal tibial locking plate and its evaluation in terms of maintenance of accurate anatomical reduction, stable fixation, with early restoration of functions. Materials and methods A total of 25 patients with median age 38.04 years, age range 19 to 70, with distal tibial fracture were treated by using distal tibial locking plate. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The majority of fractures in this study were extraarticular (64%), while 20% were partial articular fractures and 16% were complete articular fractures. Out of 25 patients, 6 patients had superficial infection and 1 patient had deep infection. Out of 25 cases, 5 cases had union by 16 weeks, 11 cases by 20 weeks, 7 cases had union by 30 weeks, and 2 cases had nonunion. According to AOFAS score at 6 months, 4 cases had score of 31 to 70 and 21 cases had score of 71 to 100. Conclusion The results of our study corroborate with the contemporary literature relevant to distal tibial fracture fixation performed with various locking plates. Therefore, locking compression plate is a good device to stabilize the fracture of the distal tibial. Clinical significance Locking plates are a good device to stabilize the fractures of the distal tibial, especially when used in conjunction with meticulous intraoperative handling of soft tissue and active participation of patients in rehabilitation program. Studying this alternative method expands the present knowledge for the management of distal tibial fractures. How to cite this article Ahmed M, Jindal S, Bansal V, Kapila R, Garg RS. Evaluation of Outcome of Management of Distal Tibial Fractures using Distal Tibial Locking Plate. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):5-9.
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