Search

Category: Hindfoot Introduction/Purpose: Tarsal tunnel volume is affected by position of the foot and the alignment of the ankle. Although medial displacement calcaneal osteotomy (MDCO) significantly alters the alignment of the hindfoot, the change of tarsal tunnel volume after this procedure has not yet been well documented. Therefore, authors investigated the volumetric change of tarsal tunnel after MDCO using Computed Tomography (CT) scan. Methods: This retrospective study involved 101 feet of 91 patients who underwent a MDCO at our institution from March 2016 to December 2018. We compared the tarsal tunnel volume from the preoperative and postoperative CT scan images under following protocols. On a sagittal scout image, the oblique axial plane was drawn parallel to the long axis of the calcaneus using talonavicular joint as a landmark. Serial oblique axial images were displayed using PACS (PathSpeed, GE Healthcare, Chicago, IL, USA) with both the soft tissue and the bone window settings. The volume of tarsal tunnel was evaluated from just distal to the tip of medial malleolus anterior colliculus to distance of 3 cm distal using 10 consecutive images by drawing the border of tarsal tunnel. The volume was calculated by adding 10 cross-sectional areas and then multiplying by 3 mm corresponding to slice thickness. Results: The mean preoperative and postoperative tarsal tunnel volume were 12229 mm3 (SD, 1842 mm3) and 12762 mm3 (SD, 1803 mm3), respectively. There was 4.6% (SD, 3.4%) of volume increase after MDCO (p

Category: Ankle Introduction/Purpose: Rupture of the contralateral Achilles tendon following Achilles tendon rupture can lead to devastating outcomes. However, despite the clinical importance, the risk factors and incidence of contralateral Achilles tendon rupture have not been well-studied. This study aimed to determine the incidence of contralateral tendon rupture after Achilles tendon rupture and to identify associated patient characteristics. Methods: Medical records for 226 consecutive patients with Achilles tendon rupture were retrospectively reviewed. The occurrence of contralateral Achilles tendon rupture and patient characteristics were determined through review of medical records and telephone surveys. Results: The cumulative incidences of contralateral Achilles tendon rupture at one, three, five, and seven years after Achilles tendon rupture were 0.4%, 1.8%, 3.4%, and 5.1%, respectively. The only statistically significant risk factor was age between 30 and 39 years at the time of initial Achilles tendon rupture (hazard ratio = 4.9). Conclusion: Patients who sustain Achilles tendon rupture in their 30 s have significantly increased risk for contralateral tendon rupture.

Category: Trauma Introduction/Purpose: Suture-button fixation device (TightRope, Arthrex, Naples, Florida) is devised to obviate the need for second operation for removal in the treatment of syndesmosis diastasis, but considerable removal rate has been reported. Nevertheless, functional and radiographic outcomes after suture-button fixation device removal has not yet been well documented. Therefore, the purpose of this study is to investigate the functional and radiographic outcomes of syndesmosis fixation treated with suture-button device before and after device removal. Methods: The records of 30 patients with syndesmosis injury who underwent suture-button fixation and later device removal between August 2009 and September 2017 were investigated. The mean postoperative time to device removal was 11.9 months (range, 7-19). In plain radiograph, tibiofibula clear space (TFCS), tibiofibula overlap (TFO), and medial clear space (MCS) were measured at three specific follow-up period; immediate postoperative (F1), just before device removal (F2), and at least three months after device removal (F3). For subgroup of 18 patients with CT scans, the Anterior to posterior (A/P) ratio (Normal range: 0.8 -1.2) was measured to investigate malreduction of syndesmosis and they were divided into two groups according to their accuracy of reduction. Additionally, functional outcomes were recorded and compared using American Orthopedic Foot and Ankle (AOFAS) score. Repeated measurement analysis of variance was performed to statistically compare the data and statistical significance was set at P < 0.05. Results: In plain radiographs, TFCS, TFO, MCS at three specific follow-up period showed no significant differences. In CT analysis at immediate postoperative period, 6 cases (30%) revealed malreduction, but 5 of them showed spontaneous reduction at follow- up just before device removal. Malreduced patients (n = 6) had a mean A/P ratio of 1.28 (range, 0.78 -1.52) at F1, 1.08 (range, 0.81- 1.21) at F2, and 1.08 (range, 0.83 -1.22) at F3 (F1, F2: p = 0.021, F1, F3: p = 0.032, F2, F3: p > 0.05). Patients with initial adequate reduction (n = 12) continued to have a reduced syndesmosis during the follow-up period and after the device removal. The AOFAS score did not change significantly before and after removal. Conclusion: Our investigation showed that the removal of suture-button device for syndesmosis fixation at average 1-year postoperative time does not bring out reduction loss or functional changes. Thus, removal is advisable for the patients with irritation or discomfort related to device. Furthermore, malreduced syndesmosis after tightrope fixation may have possibility of spontaneous reduction during the follow-up period.

Abstract. Rationale:. A few cases of intercalary staphyloma have been reported in patients with Marfan syndrome, but we believe that this is the first case of intercalary staphyloma in Marfan syndrome developing after strabismus surgery. Patient concerns:. A 9-year-old girl diagnosed with Marfan syndrome visited a strabismus clinic for treatment of esotropia. Both eyes were aphakic and had 60 prism diopter esotropia at distance and 55 prism diopter esotropia at near. There were no corneal, conjunctival, or scleral abnormalities. Six millimeters of recession was performed on both medial rectus muscles via an inferonasal fornix approach under general anesthesia. 5 days after surgery, a dark gray protruding lesion was observed on the upper nasal side of the left eye. Diagnoses:. Intraocular ultrasonography showed no bleeding, retinal detachment, or other abnormal findings. Computed tomography showed a conical protrusion of the scleral wall which was diagnosed as intercalary staphyloma. Interventions:. To reduce risk of progression of the staphyloma in the left eye and to reduce risk of development of a new staphyloma, intraocular pressure lowering eye drops were administered. Outcomes:. We just observed it without any intervention except the intraocular pressures lowering eye drops. It remained stable for 12 months. Lessons:. Clinicians need to be alert to the possibility of this serious complication in Marfan syndrome patients after minor surgical trauma, which can occur during uneventful strabismus surgery.

Abstract. Bipolar hemiarthroplasty (BHA) is one of the common procedures done for the treatment of femur neck fracture. One of the frequently encountered complication with this surgery is erosion of the acetabular cartilage. This study was conducted to investigate acetabular erosion after BHA according to the difference in diameter between femoral head and implanted cup at minimum 10-year follow-up. We retrospectively reviewed 117 patients (117 hips) undergoing BHA with fracture of neck of the femur. Their mean age was 77.8 years (range, 65–96 years) and male: female ratio was 32:85. Patients were divided into 3 groups; Group A – bipolar cup size > actual head size, Group B – cup size

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsophalangeal (MTP) joint osteoarthritis (OA) was newly introduced at 2013. However, treatment of second MTP joint OA was not reported yet. The purpose of this study was to investigate the difference in clinical and radiographic outcomes between a chilectomy and an Weil osteotomy for treatment of second MTP joint OA. Methods: From August 2007 to January 2015, 61 feet of 51 patients who had been operated for second MTP joint OA by were retrospectively reviewed. The cheilectomy involved removal of bone spur on the second MTP joint. And the Weil osteotomy involved shortening of second metatarsal bone and removal of the bone spur (Fig.1). The average age was 60 years (95% CI: 57-62 years), the mean duration of follow up was 15 months (95% CI: 12-17months). The 61 feet were divided into two groups, the cheilectomy-group (36 feet) and the Weil-osteotomy-group(25 feet). The preoperative and the last follow-up radiological values and clinical values were measured. Length of the second metatarsal relative to the fourth (2-4 MT length ratio), second MTP joint OA grade, and Visual Analogue Scale (VAS) of pain were measured to evaluate clinical and radiological outcomes. Further, prevalence of second MTP joint disturbance at the time of last follow-up was measured. Results: There were no significant differences of age (P=0.83), gender (P=0.08), BMI (P=0.09), the preoperative 2-4 MT length ratio (P=0.68) and the second MTP joint OA grade (P=0.21) between the chilectomy-group and the Weil-osteotomy-group. In the cheilectomy-group, the last follow-up 2-4 MT length ratio and second MTP joint OA grade were not statistically different from the preoperative values. In the Weil-osteotomy-group, there was a significant decreasing of the 2-4 MT length ratio and a significant improvement of the second MTP joint OA grade between the preoperative values and the last follow-up values. For both the cheilectomy-group and the Weil-osteotomy-group, there was a significant improvement of the VAS of pain after treatment. However, the cheilectomy-group showed the statistically higher prevalence of second MTP joint disturbance than the Weil- osteotomy-group (Table.1). Conclusion: The Weil-osteotomy group showed superior result than the cheilectomy group clinically and radiologically in this study. Because shortening of second metatarsal bone could reduce a pressure of second MTP joint, joint space widening and joint disturbance decreasing could be achieved after the Weil osteotomy. We therefore recommend the Weil osteotomy as a treatment of second MTP joint OA.

Category: Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) has been recognized as a most effective surgical treatment for flexible flatfoot. But the LCL is known to be associated with many complications, which are lateral foot pain or calcaneocuboid arthrosis. In order to correct flexible flatfoot without these complications, we have developed a novel technique-dynamic medial column stabilization (dynamic-MCS). The dynamic-MCS consists of flexor hallucis longus transfer to the medial cuneiform, arthrodesis of first tarsometatarsal joint and medial displacement calcaneal osteotomy. The dynamic-MCS had different mechanism from the LCL. The dynamic-MCS directly restores longitudinal arch of flexible flatfoot, while the LCL indirectly restores the longitudinal arch. The purpose of this study is to investigate difference of radiographic outcomes between the dynamic-MCS and the LCL. Methods: Dynamic-MCS group included 16 flexible flatfeet of 16 patients which were treated with the dynamic-MCS from January 2014 to February 2015. The LCL group included 23 flexible flatfeet of 21 patients which were treated with the LCL from January 2011 to January 2014. A single surgeon performed the dynamic-MCS and the LCL in our clinic. We retrospectively evaluated radiological outcomes of the dynamic-MCS group and the LCL group. The preoperative and postoperative radiographic parameters were measured. Talonavicular coverage angle was measured on plain weight-bearing anteroposterior radiograph. Calcaneal pitch, talocalcaneal angle, talar angle, meary angle and 1st metatarsal declination angle were measured on plain weight- bearing lateral radiograph. Hindfoot alignment angle was measured on hindfoot alignment view. We compared postoperative improvements of the dynamic-MCS group with those of the LCL group in each radiographic parameters. All the postoperative values were obtained at the last follow-up. Results: The average age in the dynamic-MCS group was 41 years (95% CI: 33.5-47.9) and mean follow-up period was 12.9 months (minimum 10months). The average age in the LCL group was 36 years (95% CI: 27.9-43.1) and mean follow-up period was 22.2 months (minimum 12 months). The talonavicular coverage angle (P=0.002) and calcaneal pitch (P=0.002) of the LCL group showed significant higher improvement than that of the dynamic-MCS group. The talocalcaneal angle (P=0.030) and hindfoot alignment angle (P=0.005) of the dynamic-MCS group showed significant higher improvement than that of the LCL group. The improvement of the other radiographic parameters showed no significant difference between the dynamic-MCS group and the LCL group (Fig 1-B). Conclusion: Radiographic outcomes between the dynamic-MCS and the LCL were different for flatfoot correction in this study. The LCL showed higher correction of forefoot abduction than the dynamic-MCS. The dynamic-MCS showed higher correction of heel valgus than the LCL. Correction of flat longitudinal arch was not different between the dynamic-MCS and the LCL. To restore the flat longitudinal arch,the dynamic-MCS corrected the plantar-flexed talus and the LCL corrected the low calcaneal pitch. Lateral plantar pain and calcaneocuboid arthrosis did not occurred after the dynamic-MCS in our experience. We concluded that the dynamic-MCS could be a good treatment option for flexible flatfoot.