Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. The study group consisted of 19 men who were subjected to intramedullary and intraosseous arthrodesis using an intramedullary nail. The average age of patients was 46 (range 19-68) years. The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group, clinical condition was assessed using the American Orthopedic Foot and Ankle Score (AOFAS) classification, quality of life using the SF-12 scale, and assessment of pain intensity using the visual-analog scale (VAS) scale. The above parameters were evaluated before surgery (under 2 years), intermediate (from 2 to 5 years), and late (over 5 years) postoperative period. The clinical condition on the AOFAS scale improved from an average of 20.6 points before tibiotalocalcaneal arthrodesis to 63.5 after the procedure. The result was statistically significant (p < .0001). Analyzing the results using the SF-12 scale, a statistically significant increase was found. In the physical sphere of Physical Health Component Score-12 (p = .0004) and in the mental sphere of Mental Health Component Score-12 (p = .030). The intensity of pain assessed in the VAS scale, decreased in all three periods-p < .05. The strongest analgesic effect was observed in the early postoperative follow-up period. Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement quality of life assessed in the SF-12 scale and a significant reduction of pain ailments assessed in the VAS scale, especially in the early postoperative period.
- MeSH
- artrodéza MeSH
- dospělí MeSH
- hlezenní kloub diagnostické zobrazování chirurgie MeSH
- kostní hřeby MeSH
- kotník MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteoartróza * diagnostické zobrazování chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- subtalární kloub * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVE: To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA). METHODS: Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS: Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively. CONCLUSION: Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
- MeSH
- delfská metoda MeSH
- dospělí MeSH
- incidence MeSH
- konsensus MeSH
- lidé středního věku MeSH
- lidé MeSH
- reprodukovatelnost výsledků MeSH
- revmatoidní artritida patologie MeSH
- subtalární kloub diagnostické zobrazování patologie MeSH
- synovitida diagnostické zobrazování epidemiologie MeSH
- ultrasonografie dopplerovská metody normy MeSH
- výzkumný projekt MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
The subtalar joint is divided into the talocalcaneonavicular and the talocalcaneal joint, separated by a conical interosseous tunnel (canalis and sinus tarsi). The talocalcaneonavicular joint is a ball-and-socket articulation (coxa pedis). An important part of the coxa pedis is the spring ligament. The canalis and sinus tarsi are occupied by the roots of the inferior extensor retinaculum, cervical ligament, interosseous talocalcaneal ligament, and anterior talocalcaneal ligament. Three-dimensional motion in the subtalar joint complex (eversion/inversion) is guided by the axial alignment of the talus, calcaneus, and navicular; the ligaments; and the shape of the articular surfaces.
- MeSH
- kloubní ligamenta anatomie a histologie fyziologie MeSH
- lidé MeSH
- subtalární kloub anatomie a histologie fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE OF THE STUDY Currently, operative treatment is preferred in dislocated calcaneal fractures. Most frequently used is the extended lateral approach, the disadvantage of which is the risk of early complications. Therefore, less invasive operative techniques are sought that would reduce the risk of such complications. The presented study aimed to compare the two different surgical approaches with respect to the restoration of gait stereotype using the objective pedobarography. We assume that the limited operative approach in osteosynthesis of intra-articular calcaneal fractures results in comparable or earlier restoration of gait stereotype with regard to temporal and dynamic parameters compared to the extended lateral approach. MATERIAL AND METHODS The research study comprised a total of 22 patients who underwent the surgical treatment of intra-articular calcaneal fractures, divided into two groups by the applied operative approach. The first group consisted of 10 patients treated with less invasive sinus tarsi operative approach (ST). For osteosynthesis a calcaneal nail (C-nail, Medin, CR) was used. The second group consisted of 12 patients, to whom extended lateral approach (EXT) was applied. For osteosynthesis a calcaneal plate 3.5 mm (DePuy Synthes, Switzerland) was used. Pedobarographic measurement using a tensometric platform was performed in all the patients, always six months post-operatively. Temporal and dynamic variables of the gait cycle during the interaction of the foot with the ground were monitored. RESULTS In the EXT group, significant differences between the injured and healthy foot were found in walking 6 months after the surgery in most of temporal and dynamic variables. The ST group, however, showed no significant differences between the values for the injured and healthy foot in most of temporal and dynamic variables. DISCUSSION Six months after the surgery, the patients continue to carefully load the heel, regardless of the selected surgical approach, due to which the pressure at this place is significantly reduced and tends to be transferred to the midfoot or forefoot. This finding corresponds with previous studies. The patients undergoing a less invasive surgical approach load both the operated and healthy feet. Also, with regards to temporal parameters, as early as 6 months after the surgery correct gait stereotype is restored under the heel in these patients. We believe this is achieved thanks to less pain due to a limited extent of the surgical approach. On the very contrary, the extended lateral approach can cause deterioration of conditions for the restoration of gait stereotype due to the presence of extensive scarring on the heel side with a limited mobility of talocalcaneal joint or also an impaired mobility of peroneal tendons outside the ankle bone. CONCLUSIONS Six months after the surgical treatment of calcaneal fractures changes still persist in gait stereotype. The analysis of temporal and dynamic gait parameters in the followed-up group of patients reveals that the limited sinus tarsisurgical approach results in an earlier restoration of gait stereotype compared to the extended lateral approach. A higher number of patients in the respective groups is necessary in order to obtain more general results. Key words:sinus tarsi; extended lateral approach; plantar pressure; force; contact time.
- MeSH
- chůze (způsob) * MeSH
- dospělí MeSH
- fraktury kostí diagnóza chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- intraartikulární fraktury diagnóza chirurgie MeSH
- kostní destičky MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- patní kost * diagnostické zobrazování zranění chirurgie MeSH
- pooperační období MeSH
- subtalární kloub * patofyziologie chirurgie MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Traumatic injury to the subtalar joint occurs during subtalar dislocations, talar and calcaneal fractures, and fracture-dislocations. After closed reduction of subtalar dislocations, peripheral talar or calcaneal fractures need to be ruled out by computed tomography scanning. In fractures and fracture-dislocations of the talus and calcaneus involving the subtalar joint, anatomic reconstruction of joint congruity is essential for functional rehabilitation. Failure to anatomically reduce the subtalar joint potentially leads to chronic instability, subtalar arthritis and posttraumatic hindfoot deformity. Despite adequate management, subtalar arthritis may develop as a result of primary cartilage damage at the time of injury.
- MeSH
- artritida etiologie MeSH
- dislokace kloubu komplikace diagnóza terapie MeSH
- dislokovaná fraktura komplikace diagnóza terapie MeSH
- fraktury kostí komplikace diagnóza terapie MeSH
- intraartikulární fraktury komplikace diagnóza terapie MeSH
- lidé MeSH
- patní kost zranění MeSH
- subtalární kloub zranění patofyziologie chirurgie MeSH
- talus zranění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
UNLABELLED: PURPOSE OF THE STUDY The aim of the study was to evaluate, on the basis of radiographic findings and AOFAS scores, the results of the Grice extra-articular subtalar arthrodesis for treatment of planovalgus foot deformity in cerebral palsy patients. MATERIAL AND METHODS A total of 38 patients (50 feet) with cerebral palsy indicated to the Grice procedure for planovalgus foot deformity between 2006 and 2010 were assessed. The group comprised 18 girls and 20 boys, of whom 10 had spastic quadriparesis (four undergoing bilateral surgery), three had triparesis, four had hemiparesis and 21 had diparesis (treated on both sides in eight). The average age at surgery was 12 years (range, 7 years and 2 months to 17 years and 8 months). All patients were evaluated based on the AOFAS scoring system and radiographic findings before and after surgery. RESULTS The average follow-up was 4.5 years. The average AOFAS score increased from 54.9 points pre-operatively to 76.6 points post-operatively. The pre- and post-operative average values for the talocalcaneal angle were 49.8° and 25°, respectively; for the calcaneal inclination angle they were 8.6° and 13.4°, respectively. DISCUSSION The Grice procedure has long been considered a primary surgical treatment for planovalgus foot deformity in patients with cerebral palsy. Recently, calcaneal osteotomy has been used more frequently, but with no evidence of provably better results. CONSLUSIONS The mid-term results of the Grice extra-articular arthrodesis in our group of cerebral palsy children were very good in terms of both radiographic and AOFAS score evaluation; the latter includes objective assessment as well as the patient's subjective evaluation. KEY WORDS: Grice procedure, extra-articular subtalar arthrodesis, cerebral palsy, planovalgus foot deformity.
- MeSH
- artrodéza metody MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna komplikace MeSH
- patní kost chirurgie MeSH
- subtalární kloub diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- Chopartova amputace,
- MeSH
- amputace * metody mortalita statistika a číselné údaje MeSH
- diabetická noha * chirurgie MeSH
- dospělí MeSH
- hlezenní kloub MeSH
- lidé středního věku MeSH
- lidé MeSH
- protézy a implantáty statistika a číselné údaje MeSH
- reoperace statistika a číselné údaje MeSH
- retence protézy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- subtalární kloub * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE OF THE STUDY: When the talus and the talocalcaneal joint are both affected, their fusion is the method of treatment. Ankle arthrodesis is carried out using various osteosynthetic materials such as external fixators, screws and plates. One of the options is retrograde nailing. Tibio-talo-calcaneal arthrodesis is frequently indicated in patients with rheumatoid arthritis (RA) in whom both the talus and the subtalar joint are often affected. MATERIAL AND METHODS: A retrograde nail for tibio-talo-calcaneal arthrodesis was developed at our department in cooperation with MEDIN Company. This is a titanium double-curved nail, with the distal part bent at 8 degrees ventrally and 10 degrees laterally. It is inserted from the transfibular approach. RESULTS: Sixty-two patients, 35 women and 27 men, were treated at our department from 2005. Since one patient had bilateral surgery, 63 ankles were included. The indications for arthrodesis involved rheumatoid arthritis in 42, post-traumatic arthritis in 10, failed ankle arthrodesis in two and failed total ankle arthroplasty in five ankles; tibial stress fractures close above the ankle in two RA patients, one patient with dermatomyositis and one with lupus erythematodes. The average age at the time of surgery was 64.2 years (range, 30 to 80). The average follow-up was 4.5 years (range, 1 to 9 years), Satisfaction with the treatment outcome and willingness to undergo surgery on the other side were reported by 82% of the patients. The AOFAS score improved from 35 to 74 points. Three (4.8%) patients complained of painful feet due to the fact that exact correction of the calcaneus was not achieved and the heel after arthrodesis remained in a slightly varus position. Of them, two had a failed total ankle arthroplasty. Post-operative complications included early infection managed by antibiotic treatment and early surgical revision with irrigation.in two (3.2%) RA patients, who were undergoing biological therapy. Late infection developed at 2 to 3 years after surgery in three (4.3%) patients (two had RA). The infection was managed by revision surgery with nail removal and irrigation. All patients healed well. Necrosis of the talus and development of a pseudoarthrosis were recorded in four (6.4%) patients, who subsequently underwent nail removal and repeat fusion using an external fixator. DISCUSSION: Retrograde nailing for tibio-talo-calcaneal arthrodesis is used by many authors. Its complication rate is comparable with the other methods of arthrodesis. CONCLUSIONS: The use of tibio-talo-calcaneal arthrodesis aims at a painless and stable joint. Arthrodesis of the talus and the subtalar joint using a retrograde nail is an effective surgical treatment of the joints affected. It is especially recommended for RA patients who have severe deviations. Retrograde nailing provides a stable osteosynthesis which does not require plaster cast immobilisation. The double-curved nail allows for its insertion in the solid part of the calcaneus and helps avoiding injury to the neurovascular bundle.
- MeSH
- antibakteriální látky aplikace a dávkování MeSH
- artrodéza * škodlivé účinky přístrojové vybavení metody MeSH
- hlezenní kloub patologie chirurgie MeSH
- infekce chirurgické rány * diagnóza farmakoterapie chirurgie MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- odstranění implantátu metody MeSH
- patní kost radiografie chirurgie MeSH
- poranění kotníku * diagnóza etiologie chirurgie MeSH
- reoperace metody MeSH
- retrospektivní studie MeSH
- revmatoidní artritida chirurgie MeSH
- subtalární kloub * zranění patologie chirurgie MeSH
- talus radiografie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
PURPOSE OF THE STUDY Based on a retrospective analysis, the authors present their experience with treatment of subtalar dislocation of the foot. MATERIAL AND METHODS Between 1999 and 2011 six patients, all of them men, with the average age of 31 years were treated for subtalar fractures. Five patients were diagnosed with medial dislocation and one with lateral dislocation. In one patient with medial subtalar dislocation it was an open injury. The clinical and radiographic results of the patients followed up for 1 to 12 years (average, 7.8 years) were retrospectively evaluated. RESULTS The achieved average score, based on the AOFAS ankle and hindfoot scale, was 91.3 points (? 9.77; minimum, 73; maximum, 100). Excellent results were recorded in four patients, good in one and satisfactory in the patient with lateral dislocation. Radiographic signs of subtalar joint osteoarthritis were found in one patient. No neurological or circulation disorders, skin necrosis, signs of reflex sympathetic dystrophy, aseptic bone necrosis of the talus, infection or joint instability were recorded. DISCUSSION A subtalar dislocation of the foot involves simultaneous dislocation of the talocalcaneal and talonavicular joints. It is a rare injury accounting for about 1 to 2% of all traumatic dislocations. It may occur as medial, lateral, anterior or posterior subtalar dislocation. The results of treatment depend on several factors, such as the type of dislocation (medial and open dislocations are at higher risk), associated injuries, or damage to deep skin layers, and also on an exact diagnosis, early and accurate reduction and sufficiently long foot immobilisation.
- Klíčová slova
- subtalární luxace,
- MeSH
- dislokace kloubu * etiologie chirurgie terapie MeSH
- dospělí MeSH
- imobilizace metody MeSH
- klouby nohy (od hlezna dolů) chirurgie zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortopedické výkony metody MeSH
- retrospektivní studie MeSH
- subtalární kloub * chirurgie zranění MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
