Objective To discuss the effect of the calcaneocuboid arthrodesis on three-dimensional kinematics of talonavicular joint and its clinical significance. Methods Ten freshfrozen foot specimens, three-dimensional kinematics oftalonavicular joint were determined in the case of neutral position, dorsiflexion, plantoflexion, adduction, abduction, inversion and eversion motion by meansof threedimensional coordinate instrument（Immersion MicroScribe G2X） before and after calcaneocuboid arthrodesis under non-weight with moment of couple, bending moment, equilibrium dynamic loading. Calcaneocuboid arthrodesis was performed on these feet in neutral position and the lateral column of normal length. Results A significant decrease in the three-dimensional kinematics of talonavicular joint was observed（P＜0.01）in cadaver model following calcaneocuboid arthrodesis. Talonavicular joint motion was diminished by 31.21%±6.08％ in sagittal plane; by 51.46%±7.91％ in coronal plane; by 36.98%±4.12％ in transverse plane; and averagely by 41.25%±6.02％. Conclusion Calcaneocuboid arthrodesis could limite motion of the talonavicular joints, and the disadvantage of calcaneocuboid arthrodesis shouldn’t be neglected.
Objective To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD). Methods The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference (P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness. Results The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group (P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant (P<0.05). There was no significant difference in the change values of outcome indicators between the two groups (P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up. Conclusion In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.
Objective To evaluate the effect of triple arthrodesison treating complications of calcaneus fractures. Methods From 1990to 2001, 12 patients with the complications of calcaneus fractures underwent the triple arthrodesis(subtalar,talaronavicular and calcaneocuboid joints). Ollier incision was applied to all patients. Peroneal tenolysis was required in 2 patients and a decompression and transposition of tibialnerve in 1 patient.Of the 12 patients, 7 were males and 5 were females. Their ages ranged from 29 to 64 years. Complications, like pain and deformity, occurred 5 to 22 months after the operation(18 months on average).Preoperative score, fibulocalcaneal distance, Bohler angle, differenceof talardeclination angle and height of hind foot were 40.00±5.22, 0.41±0.03 cm, 12.00±3.40°, 17.00±3.32° and 4.12±0.35 cm respectively. Results All patients were followed up from 3 to 13 years with an average of 7 years. Postoperative score, tibulocalcaneal distance, B[AKo¨]hler angle, difference of talar declination angle and height of hind foot were 75.00±6.46，0.73±0.02 cm， 31.00±5.61°，9.00±3.15° and 6.75±0.62 cm respectively. There were significant differences in these indexes(P＜0.05). Conclusion To evaluate the complications of calcaneus fractures and to adopt proper operative procedures are necessary. To restore theheight of hind foot and the anatomical relationship between hind foot and calcaneus is the key factor to success.
Objective To evaluate the short-term effectiveness of Ilizarov technique combined with steel needle internal fixation in treating Charcot neuroarthropathy (CN) of the foot and ankle. Methods Between June 2020 and December 2023, 12 patients with Eichenholtz stage Ⅲ CN of the foot and ankle were treated with Ilizarov technique and steel needle internal fixation. There were 9 males and 3 females with an average age of 48.6 years (range, 19-66 years). The disease duration ranged from 1 to 16 months (mean, 6.8 months). Ankle joint involvement predominated in 7 cases, while midfoot involvement occurred in 5 cases; 3 cases presented with skin ulceration and soft tissue infection. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 31.2±9.0, 36-Item Short-Form Health Survey (SF-36)-Physical Component Summary (PCS) score was 32.6±6.8, and Mental Component Summary (MCS) score was 47.8±8.4. Postoperative assessments included wound healing, regular X-ray film/CT evaluations of fusion status, and effectiveness via AOFAS and SF-36-PCS, MCS scores. ResultsAll operations were successfully completed without neurovascular complication. Two patients experienced delayed wound healing requiring intervention, and the others achieved primary healing. All patients were followed up 15-43 months (mean, 23.3 months). Imaging confirmed successful joint fusion within 13-21 weeks (mean, 16.8 weeks). At last follow-up, the AOFAS score was 72.5±6.4, and the SF-36-PCS and MCS scores were 63.2±8.4 and 76.7±5.3, respectively, all of which improved compared to preoperative levels, with significant differences (P<0.05). Conclusion Ilizarov technique combined with steel needle internal fixation effectively restores walking function and achieves satisfactory short-term effectiveness in CN of the foot and ankle.
Objective To investigate the clinical efficacy of selective tarsometatarsal arthrodesis for old Lisfranc injury without significant post-traumatic osteoarthritis (PTOA). Methods The clinical data of patients with old Lisfranc injury without significant PTOA who were treated by selective tarsometatarsal arthrodesis at Chengdu Pidu District People’s Hospital between June 2013 and June 2021 were analyzed retrospectively. The improvement of patients’ Visual Analogue Scale (VAS) score, American Orthopedic Foot Ankle Society (AOFAS) midfoot score and Short Form 12 (SF-12) score before surgery and at the final follow-up were compared. Results Seventeen oldLisfranc injury patients (17 feet) without significant PTOA were finally recorded, including 12 males and 5 females. All patients completed the surgery successfully, and the surgical incisions healed smoothly after surgery without complications such as poor incision healing, soft tissue ischemic necrosis, and deep and superficial infections. All patients were followed up for an average of 22.6 months (12 to 36 months). Three months after surgery, follow-up X-ray films showed bony healing of the fused ends in all patients, and the patient satisfaction was 94.1%. Compared with the preoperative scores, VAS score (6.0±0.3 vs. 0.8±0.2), AOFAS score (50.5±1.5 vs. 86.5±0.9), SF-12 physiological score (21.9±0.6 vs. 46.1±0.5) and SF-12 psychological score (31.1±0.8 vs. 47.3±0.7) at the last follow-up improved (P<0.05). Conclusion Selective tarsometatarsal arthrodesis for the old Lisfranc injuries without significant PTOA can restore the midfoot force lines and stability, avoid stiffness after full feet fusion, preserve midfoot function, and improve patient satisfaction.
ObjectiveTo evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors.MethodsBetween March 2012 and January 2018, 11 patients with distal tibial malignant and invasive tumors were treated with vascularized fibula reconstruction. There were 7 males and 4 females with an average age of 20 years (range, 16-39 years). There were 8 cases of osteosarcoma, 2 cases of invasive giant cell tumor of bone, and 1 case of hemangioendothelioma. The tumors were rated as benign stage 3 in 2 cases and malignant stageⅠA in 1 case, stageⅡA in 4 cases, and stage ⅡB in 4 cases according to the Enneking staging. The disease duration was 1-6 months (mean, 2.7 months). The limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score, and the distal and proximal union of the transplanted fibula and the diameter of the fibula were examined by imaging.ResultsAll incisions healed by first intention. All patients were followed up 16-85 months (mean, 41 months). No tumor recurrence or metastasis occurred during the follow-up. The proximal and distal grafts in the 10 cases showed osseous healing, and the healing time was 7-12 months (mean, 10.1 months) at proximal end and 7-12 months (mean, 9.3 months) at distal end. In 1 case, the proximal end did not heal at 19 months, while the distal end healed at 13 months; proximal bone grafting was performed, and the proximal end healed. Among the 4 patients with distal screw fixation, 2 had peri-internal fixation fractures after graft healing, but no skin necrosis or infection occurred. All the 7 patients with distal steel plate fixation had no peri-internal fixation fracture, but 1 patient developed anterior tibial skin necrosis. At 12 months after operation, the diameter of fibula increased 1-5 mm (mean, 2.4 mm) by compared with that before operation. The MSTS score was 17-27 (mean, 22.8).ConclusionReconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results, which is one of the feasible and worthy methods for the distal tibial malignant and invasive tumors.
Objective To summarize the research progress of scaphotrapeziotrapezoid osteoarthritis (STT OA) and its etiology and clinical treatment. Methods The domestic and foreign literature on STT OA in recent years was reviewed and the research progress was summarized. Results STT OA is a common OA, which is highly prevalent in postmenopausal women and diagnosed by wrist X-ray films. The current treatment methods include conservative treatment and surgery. Among them, the conservative treatment can relieve clinical symptoms, but the long-term effectiveness is not ideal. In surgical treatment, scaphoid arthrodesis can effectively relieve wrist pain, but it sacrifices part of the range of motion and grip strength of the wrist, and there is a risk of fusion failure. Distal scaphoid resection and trapezium resection have the advantages of short operation time, simple operation, less damage to the joint capsule and ligament, and shorter postoperative external fixation time, but they lead to changes in carpal bone alignment and dorsal intercalated segmental instability. Arthroplasty can provide pain relief while restoring grip strength and preserving wrist motion, but there is a risk of dislocation of the prosthesis. Conclusion At present, there is no gold standard for the STT OA treatment. The short-term effectiveness of arthroplasty and arthroscopic distal scaphoid resection are satisfactory, but the long-term effectiveness needs further study.