Distal tibial oblique osteotomy for reconstruction of ankle joint congruity and stability

Teramoto distal tibial oblique osteotomy (DTOO) is a joint-preserving surgery for ankle osteoarthritis (AOA). However, there are few articles on the radiological assessment of DTOO. The purpose of this study was to report the clinical outcomes and radiological evaluations of weight-bearing radiographs before and after DTOO.We retrospectively reviewed 52 patients who underwent DTOO between 2007 and 2018. We recorded the Tanaka–Takakura classification, fixation methods, Japanese Society for Surgery of the Foot Ankle/Hindfoot Scale (JSSF scale), and complications. The tibial articular surface angle (TAS), medial malleolar angle (MMA), tibial lateral surface angle (TLS), talar tilt angle (TTA), and tibiotalar surface angle (TTS) were evaluated using weight-bearing ankle radiographs.The median patient age was 66 years, and the mean follow-up duration was 46 ± 23 months. Two stage 2, 9 stage 3a, 30 stage 3b, and 11 stage 4 according to the Tanaka–Takakura classification were performed using DTOO. The JSSF scale improved significantly from 39.9 ± 13.8 before surgery to 87.2 ± 7.5 after surgery. Seven cases were fixed using a locking plate, and 45 cases were fixed using a circular external fixator. The TAS, MMA, TLS, TTA, and TTS significantly changed before and after DTOO.Radiological evaluation indicated that DTOO influences talar behavior during weight-bearing, and improves the clinical outcomes of AOA.     

Changes in the subtalar joint alignment after supramalleolar osteotomy for varus ankle arthritis

BackgroundThe subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint.MethodsThirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT).ResultsThe foot and ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), and subtalar vertical angle (SVA) were significantly corrected (P＜0.05). The subtalar inclination angle (SIA) decreased in 19 patients and increased in the other 12 cases after the SMOT (P＜0.001). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P＜0.001, r = −0.621).ConclusionsThe shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity.Level of evidenceLevel IV, case series.     

Outcomes of oblique supramalleolar osteotomy without fibular osteotomy for congruent- and incongruent-type medial ankle arthritis

BackgroundAlthough high talar tilt and ankle mortise incongruence are risk factors for supramalleolar osteotomy (SMO), no study on lateral talofibular joint congruence exists. We aimed to evaluate the outcomes of oblique SMO without fibular osteotomy for medial ankle arthritis and compare them according to the lateral talofibular joint congruity.MethodsForty-eight ankles were retrospectively reviewed and divided according to preoperative talofibular joint congruity (congruent, 22 [45.8%] vs. incongruent, 26 [54.2%]).ResultsThe mean VAS score, AOFAS score, and modified Takakura stage were significantly improved. No significant differences were noted in clinical outcomes, but the mean postoperative tibiotalar angle and difference between the upper and lower talofibular gaps were significantly different in both groups (p = 0.004 and p = 0.009, respectively). The mean Takakura stage at 1 and 2 years after surgery was higher in the incongruent group (p = 0.013, p = 0.012).ConclusionThis procedure was effective against early- to mid-stage medial ankle arthritis. Radiographic arthritic grade changed according to the talofibular joint congruity.     

踝关节周围截骨术治疗踝关节炎

 目的 探讨和评价踝关节周围截骨矫正术治疗踝关节炎的指征、方法和疗效。 方法 2005 年2 月至2011 年5 月, 采用踝关节周围截骨手术治疗65 例踝关节炎患者。女43 例, 男22 例;年 龄35~74 岁, 平均55.5 岁。Takakura 踝关节炎分级:2 级29 例, 3 级32 例, 4 级4 例。接受单纯踝上胫骨 截骨20 例, 踝上胫腓骨截骨12 例, 踝上胫骨截骨合并跟骨截骨30 例, 踝上胫腓骨截骨合并跟骨截骨3 例。合并行三关节融合术者3 例, 距舟关节融合术者2 例, 第一跖骨基底截骨术者4 例。对43 例患者施 行踝关节内外侧软组织松解和韧带重建手术。比较患者手术前后正、侧位X 线片上胫骨前面角(tibial anterior surface angle, TAS)和胫骨侧面角(tibial lateral surface angle, TLS)差异。应用美国足踝医师协会 后足与踝关节评分(AOFAS-HA评分)对患者手术前后功能情况进行评价。 结果 59 例患者获得平均 35.7 个月(7~94 个月)随访。所有患者均达到骨性愈合, 平均骨愈合时间为7~8 周。AOFAS 评分自术前 平均49.7 分提高到术后12 个月时的平均78.6 分。TAS 术前平均86.1°, 术后6 个月平均93.9°。TLS 不 正常者5 例, 术前平均70.0°, 术后6 个月时平均81.5°。5 例患者术后发生切口延迟愈合, 经伤口护理后 愈合。42 例患者对手术效果表示非常满意, 15 例患者比较满意, 2 例患者满意度一般。 结论 踝关节周 围截骨术治疗非对称性踝关节炎有效, 选择合适指征的患者, 能够减轻病变处关节软骨的负荷, 延长自 身关节的使用时间。     

Long-term follow-up of first metacarpal extension osteotomy for early CMC arthritis

Background

The purpose of this study was to evaluate long-term outcomes of first metacarpal extension osteotomy for early trapeziometacarpal arthritis.

Methods

We retrospectively reviewed 13 patients who underwent first metacarpal extension osteotomy at our institution between 1996 and 2005 and obtained subjective and objective outcome data.

Results

Mean follow-up was 9.9 years (range 6 to 14 years). Ten of the 13 patients (77 %) were either satisfied or very satisfied with their results. Mean pain level was 2.00 on a scale of 1 (nonexistent) to 7 (unbearable). Mean QuickDASH score was 24.17, with a median score of 9.09. Mean pinch strength was 13.1 lbs compared to 12.8 lbs in the nonoperative extremity. Mean radial abduction of the thumb was 45.5° which was equal to the nonoperative extremity. Of the eight patients who agreed to repeat radiographs, five had no progression of degenerative changes compared to pre-op radiographs.

Conclusions

Based on subjective and objective follow-up data, first metacarpal extension osteotomy can provide good long-term results in terms of patient satisfaction, pain relief, and upper extremity function. It is a reasonable alternative to ligament reconstruction in patients with early-stage trapeziometacarpal arthritis.     

踝上截骨术治疗踝关节二期创伤性关节炎的疗效观察

目的 观察踝上截骨术治疗踝关节2期创伤性关节炎的疗效.方法 自2005年10月至2008年5月对47例踝火节2期创伤性关节炎行踝上截骨术治疗,31例获得完整随访.12例行开放性楔形截骨术,其中10例胫骨内侧开放件楔形截骨术即时矫正踝关节内翻,此间有3例在即时矫正内翻的同时行跗管松解术,2例因踝关节严重内翻畸形愈合,截骨同时在Ilizarov治疗器下缓慢牵张矫正原始畸形愈合;19例行腓骨退旋延长术.采用美国骨科足踝外科协会(AOFAS)踝关节功能评分系统进行评分.结果 31例获得12～43个月(平均27.3个月)随访.骨折全部愈合,临床愈合时间平均为13.3周(11～17周),完全负重时间平均为14.1周(12～19周).术后12个月踝火节AOFAS评分为63～92分,平均84.3分,其中优14例,良11例,一般6例,优良率80.6%.术后2例出现内侧切口裂开,1例发生内侧切口皮缘部分坏死,均经换药保守治疗痊愈.3例术后出现足外侧皮肤感觉麻木,2例患者在最近随访时X线片示关节炎有轻微进展,予以关节腔注射施沛特保守治疗后而无需手术即获得了满意的临床效果.无螺钉松动、断裂及内固定失效等其他并发症.结论 采用踝上截骨术治疗踝关节2期创伤性关节炎,近期可获得满意效果.     

踝关节融合术与全踝关节置换术治疗终末期踝关节炎临床疗效的Meta分析

目的:系统评价全踝关节置换术(total ankle arthroplasty,TAA)和踝关节融合术(ankle arthrodesis,AA)在治疗终末期踝关节炎的临床疗效。方法:文献检索PubMed、EMBASE和Cochrane图书馆数据库发表的TAA或AA治疗终末期踝关节炎的文献,检索日期从建库至2021年6月。采用偏倚风险工具进行文献质量评价。采用RevMan 5.3软件美国足对两组踝外科协会踝与后足评分(American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale,AOFAS)、视觉模拟评分(visual analog scale,VAS)、踝关节骨关节炎评分(ankle osteoarthritis scale,AOS),步态分析(步速、步频、步幅)、活动范围(range of motion,ROM),满意度、并发症和再次手术率进行Meta分析。结果:共纳入12篇文献,其中AA组1 050例,TAA组3 760例,共计4 810例患者。Meta分析结果显示两组的AOFAS总分[MD=-3.12,95%C...     

Low tibial osteotomy for varus-type osteoarthritis of the ankle

In this retrospective study we have assessed the results of low tibial valgus osteotomy for varus-type osteoarthritis of the ankle and its indications. We performed an opening wedge osteotomy in 25 women (26 ankles). The mean follow-up was for eight years and three months (2 years 3 months to 17 years 11 months). Of the 26 ankles, 19 showed excellent or good clinical results. Their mean scores for pain, walking, and activities of daily living were significantly improved but there was no change in the range of movement. In the ankles which were classified radiologically as stage 2 according to our own grading system, with narrowing of the medial joint space, and in 11 as stage 3a, with obliteration of the joint space at the medial malleolus only, the joint space recovered. In contrast, such recovery was seen in only two of 12 ankles classified as stage 3b, with obliteration of the joint space advancing to the upper surface of the dome of the talus. Low tibial osteotomy is indicated for varus-type osteoarthritis of stage 2 or stage 3a.     

踝关节融合术对足踝创伤性关节炎的治疗研究

目的：观察关节镜下微创踝关节融合术与开放式踝关节融合术治疗创伤性关节炎的疗效。方法：回顾性分析26例创伤性踝关节炎患者的临床资料,按治疗方法不同分为微创组和开放式组,对比两组骨性融合率及术后美国足踝外科协会踝-后足评分系统(AOFAS,Ankle Hindfoot Scale)评分。结果：术后6个月微创组骨性融合率为80.0%,高于开放式组的31.3%,两组比较差异有统计学意义(P<0.05);术后1年两组骨性融合率差异无统计学意义(P>0.05)。术后6个月两组AOFAS评分差异均无统计学意义(P>0.05),术后1年时微创组评分明显高于开放式组,差异有统计学意义(P<0.01)。结论：关节镜下踝关节融合术在提高早期骨性融合率及减轻疼痛方面较开放式踝关节融合术更具优势。     

Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles

BackgroundThe importance of deformity correction before or during total ankle replacement (TAR) has been recognized for a long time. Our results of TAR, combined with medial malleolar lengthening osteotomy, for the reconstruction of osteoarthritic ankles with varus deformity are hereby reported.MethodsAll ankles in which a medial malleolar osteotomy was performed during implantation of an ankle prosthesis during the period 1998–2018 were filtered out of our database. Preoperative coronal talar alignment was evaluated by measuring the angle between the tibial shaft and talar dome on the weightbearing mortise ankle radiograph. Patient-reported outcomes were measured with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). A Kaplan-Meier survival curve was constructed and the number of revisions per 100 observed component years was calculated for interprosthetic comparison.ResultsA total of 95 TARs were included, consisting of the Alpha Ankle Arthroplasty (n = 22); Buechel-Pappas (n = 14) and the Ceramic Coated Implant Evolution (n = 59) prostheses. The preoperative average talar angle in these ankles was 12.4 degrees varus. In 33% (31/95) corrective procedures, in addition to the medial malleolar osteotomy, were performed. A reoperation rate of 44% (42/95) was found, including 28 revisions (revision rate 29% (4% septic; 25% aseptic) at an average follow-up of 5.9 years, resulting in a survival of 0.69 for the total cohort at 10 years of follow-up.At an average follow-up of 6.6 years the average FAOS scores were: FAOS_symptoms 66, FAOS_pain 73, FAOS_function 78, FAOS_sport 45 and FAOS_{quality of life} 56 respectively. The FAAM_adl score averaged 64.ConclusionThis is the largest cohort of TAR combined with medial malleolar osteotomy to date. A 29% revision rate at 5.9 years of average follow-up compares unfavorably with regular cohort studies and with most other results in varus-deformed ankles. Scores on the FAOS and FAAM are comparable to those obtained in regular cohorts with similar length of follow-up. TAR in varus-deformed ankles necessitating medial malleolar osteotomy has an even higher failure rate than regular TAR. Obtaining a stable prosthesis with a neutrally-aligned hindfoot at the end of the procedure is of paramount importance.Level of evidenceIV.     

Dowel arthrodesis of the ankle joint in rheumatoid arthritis

Surgical Principles Dowel arthrodesis of the ankle is a simple, safe and effective form of arthrodesis for the rheumatoid ankle joint in those cases where there is no significant deformity. The basic technique of the operation is similar to that used for anterior interbody fusion of the spine and uses similar instruments [1].     

关节镜下胫骨交锁髓内钉融合术治疗类风湿踝关节炎

目的观察关节镜下胫骨交锁髓内钉融合术治疗类风湿踝关节炎的临床疗效。方法 2008年6月至2011年10月,选择30例(30踝)类风湿踝关节炎患者,在关节镜下行普通胫骨交锁髓内钉踝关节融合手术。术后平均随访20个月(6～36个月),根据美国足踝外科协会(AOFAS)踝与后足功能评分对所有患者进行评分。结果手术前后AOFAS踝与后足功能评分由术前平均54.3分(40～65分)提高到术后平均79.6分(61～89分)。术后无疼痛27例,轻度疼痛3例。未出现血管神经损伤、骨不连、骨延迟愈合和感染等并发症。所有患者踝后足对线良好,30踝均获骨性融合,融合率100%。结论关节镜下胫骨交锁髓内钉融合术可有效缓解踝关节疼痛,改善关节功能,对患侧下肢活动、负重未见不良影响,是一种治疗类风湿踝关节炎的安全有效方法。     

Outcome of ankle arthrodesis in posttraumatic arthritis

Background:

Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley''s compression device.

Materials and Methods:

Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females) who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN) talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3), medial malleoli nonunion (n=2). All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1–5.7 years).

Results:

All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities.

Conclusion:

We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.     

微创踝关节融合术治疗足踝创伤性关节炎的疗效观察

目的：观察关节镜下微创踝关节融合术治疗足踝创伤性关节炎的疗效。方法回顾性分析2009年1月至2012年12月在我院接受微创及开放式踝关节融合术的26例创伤性踝关节炎病人的临床资料,按治疗方法不同分为微创组（10例）和开放组（16例）,对比两组病人术后6个月及1年的骨性融合率和美国足踝外科医师协会（AOFAS）踝与后足功能评分。结果术后6个月时,微创组的骨性融合率为80.0%（8/10）,高于开放组的31.3%（5/16）,差异有统计学意义（χ2=5.850,P=0.016）;术后1年时两组病人全部达到骨性融合。术后6个月,两组病人的AOFAS踝与后足功能评分差异无统计学意义（P＞0.05）;术后1年时,微创组的AOFAS评分为（75.3±2.7）分,明显高于开放组的（68.8±2.5）分,差异有统计学意义（χ2=7.568,P＜0.001）。结论关节镜下踝关节融合术在提高早期骨性融合率及改善足踝功能方面较开放式踝关节融合术更具优势。     

Advancing a guide wire for intramedullary nail across an obliterated medullary canal during femoral diaphyseal osteotomy: a technical trick

The use of a reamed intramedullary nail allows the immediate correction and stabilisation of deformity in diaphysis of the femur. Passing a guide wire after a femoral diaphyseal osteotomy can prove to be difficult, particularly if the medullary canal has been narrowed or obliterated by bone re-modelling after fracture repair. We present a technique to allow safe and accurate guide-wire passage.     

Corrective osteotomy for symptomatic scaphoid malunion

A prospective study aimed at assessment of the outcome of management of symptomatic scaphoid malunion (hump-back deformity). The work included 13 scaphoid malunions in 13 patients. All patients complained of weak painful hand grip and limitation of wrist function. All cases were subjected to a corrective opening wedge scaphoid osteotomy with insertion of a trapezoid-shaped tricortical iliac bone graft.

At the final assessment, after a mean follow-up period of 42 months, the achieved results were rated excellent in seven cases, good in four and fair in two according to the scoring system used. Objectively, the mean range of wrist motion and hand grip strength improved from 48% and 47% pre-operatively to 82% and 79% at the final assessment. Radiological parameters including height to length ratio, lateral intrascaphoid angle and dorsal cortical angle were also effectively improved. The intra-operative corrected carpal alignment has almost been maintained at the final follow-up. The procedure did not have serious drawbacks such as non-union or avascular necrosis and perhaps might delay the development of degenerative arthritis of the wrist.     

全踝关节置换术治疗继发性踝关节炎的中期随访及疗效分析

目的评估全踝关节置换术（total ankle replacement,TAR）治疗继发性踝关节炎的治疗效果。方法回顾性分析1999年5月至2006年5月行TAR的18例患者,男2例,女16例;年龄52～66岁,平均61岁;病程9个月－18年。其中骨关节炎5例,创伤性关节炎9例,类风湿关节炎4例。患者均经保守治疗无效,且踝关节疼痛,活动障碍。术后患者定期随访,进行临床和影像学评估。结果患者均获随访,随访时间2～9年,平均5．4年;其中16例获得满意疗效。依据美国矫形足踝协会（American orthopaedic foot and ankle society,AOFAS）评分标准评分,由术前的27～53分,平均（41．5±6．8）分,提高至术后的60—91分,平均（74．6±9．7）分,视觉模拟评分（visual analogue scale,VAS）由术前的5～10分,平均（8．4±2．1）分改善至术后的1～4分,平均（2．3±0．9）分。无一例患者需行踝关节融合术或踩关节翻修术。影像学评估,16例假体位置稳定、无下沉迹象,2例在胫骨假体和骨质接触发生气球样骨溶解,但无任何症状。结论TAR可用于治疗踝关节炎。尽管TAR的中期随访效果比较满意,但TAR仍属较新技术,其远期临床效果有待进一步随访评估。     

关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎

 目的 探讨关节镜辅助踝关节融合术对保守治疗无效的晚期创伤性踝关节炎的治疗价值。方法 2007年7月至2010年12月,采用关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎21例,男14例,女7例;年龄21～68岁,平均(37±13)岁。均为单侧手术。首次踝关节外伤至踝关节融合术的时间为1~41年,平均12.6年。患者术前均接受保守治疗无效,疼痛明显。术中彻底清除关节面软骨,行关节端“微骨折”处理,初步复位后以克氏针临时固定;“C”型臂X线机透视确认位置,拧入空心螺钉固定。2例同期行关节镜辅助距下关节融合术。术后石膏固定6~10周,部分负重锻炼直至骨性愈合。结果 全部患者获得随访,随访时间1～4年,平均1.8年。术后10~16周骨性愈合,平均12周。步态均得到改善,无切口愈合不良和感染等早期并发症。3例单纯踝关节融合患者术后出现距下关节炎伴疼痛,2例经保守治疗后症状缓解、1例行开放距下关节融合术后症状缓解。术前疼痛视觉模拟评分平均(8.1±1.5)分,术后1年平均(2.7±1.1)分,差异有统计学意义(t=3.153,P=0.005)。结论 对晚期创伤性踝关节炎,关节镜辅助踝关节融合术创伤小、切口小、融合率高,但对设备条件要求高,掌握该技术需要一定的学习曲线。     

Modified Blair ankle fusion for ankle arthritis

Objective： To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis. Methods： Between November 2009 and June 2012, 28 patients with ankle arthritis were treated, among whom 11 had obvious foot varus deformity, and 17 were almost normal in appearance. There were 13 males and 15 females with an average age of 49.4 years （range, 23-67 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankles. The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） preoperatively and at I year follow-up. Results： Twenty-eight patients were followed up for 19.8 months on average （range, 1-2 years）. Superficial wound infection occurred in 3 cases, and was cured after debridement; the other incisions healed by first intention without complications. All ankles were fused at 1 year follow-up after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, or nonunion. The postoperative AOFAS ankle and hindfoot score was 83.13±3.76, showing significant difference when compared with the preoperative score （45.38±3.21, P〈0.01）. VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up （P〈0.05）. Conclusion： Modified Blair ankle fusion has the advantages of high feasiblity, less cost and rigid fixation. It shows high reliability in pain relief and may obtain a good clinical effectiveness.