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Equinus Deformity
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Correction of equinus Serial manipulation and castingSofttissue procedures Revision of Achilles tendon lengtheningPosterior ankle releasePlantar fascia releaseGradual correction of ankle equinus With a circular external fixator with or without foot osteotomiesAnterior distal tibial hemiepiphyseodesisArthrodesis Triple arthrodesis (Lambrinudi)Ankle arthrodesis
Surgery of the Foot
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Yaser Ghani, Simon Clint, Nicholas Cullen
Once a patient has developed severe hallux rigidus, a cheilectomy is unlikely to address the problem. Although various arthroplasties are available, most either have limited long-term results or are associated with high failure rates. Arthrodesis of the joint provides a reliable solution to the pain of advanced arthritis of the joint.
Treatment of a nonunion of a thoracolumbar deformity, not at the site of a three-column osteotomy
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Randall B. Graham, Tyler R. Koski, Patrick A. Sugrue
Upon exposure, care must be taken to use the patient's existing incision as much as possible to avoid necrosis of the skin edges. Dissection is then carried through the midline down to the implants on either side. Great care must be taken to avoid dissection into areas of previous decompressions due to risk of dural breach. This is most easily done by leaving islands of scar tissue over these sites. This should be balanced, however, by the necessity of dissecting off adequate soft tissue to provide coverage of the new implants at the completion of the case. Soft tissue is dissected thoroughly all the way around the instrumentation and then carried out in such a way that the entire dorsal extent of the fusion mass is exposed down to the bone. This is critical because the existing fusion mass must serve as the main arthrodesis surface. The nonunion site should also be explored fully. Usually, a fracture in the rod, which should also be radiographically apparent, can be found. Additionally, the fusion mass may have a fracture or gap in bone formation. Graft material that failed to fuse should be removed so that the underlying bone surface can undergo repeat arthrodesis.
Disease activity affects the recurrent deformities of the lesser toes after resection arthroplasty for rheumatoid forefoot deformity
Published in Modern Rheumatology, 2021
Taro Kasai, Gen Momoyama, Yuichi Nagase, Tetsuro Yasui, Sakae Tanaka, Takumi Matsumoto
Recurrent hallux valgus deformity is one of the major complications after resection arthroplasty of the hallux, which directly leads to patient dissatisfaction after the procedure [27]. A large preoperative HVA has been well identified as a major risk factor for recurrence after joint-preserving surgery for hallux valgus deformity [29]. Similarly, the preoperative severity of hallux valgus has also been reported to be one of the risk factors of recurrent deformity after resection arthroplasty of the hallucal MTP joints [27]. Although arthrodesis is accompanied by some other specific complications including non-union, irritation by the implanted hardware, interphalangeal joint osteoarthritis, and shoe wear problem or painful callosities caused by inappropriate fixed angle at the MTP joints, arthrodesis is advantageous because it does not cause recurrent hallux valgus deformity after the procedure. Although controversy exists in the choice between resection and arthrodesis for the management of the first metatarsal in resection arthroplasty of the forefoot [30,31], the results of the present study suggest that arthrodesis of the hallux may be considered instead of resection arthroplasty of all 5 metatarsal heads from the aspect of recurrent deformity prevention, especially in cases with severe preoperative HVA regardless of the status of RA disease activity control.
Arthrodesis of the digital joint using intraosseous wiring in patients with rheumatoid arthritis
Published in Modern Rheumatology, 2021
Yumi Nomura, Hajime Ishikawa, Asami Abe, Hiroshi Otani, Satoshi Ito, Kiyoshi Nakazono, Akira Murasawa
A woman in her 50s whose job involved sewing complained of an inability to pick up a sewing machine needle due to a mutilating deformity in both thumbs. Both IP joints were dislocated radially, and severe shortening due to bone resorption had occurred (Figure 4). Arthrodesis at the IP joint using intraosseous wiring with a bone block graft was performed. A bone block was harvested from the iliac crest and interposed between the two bones. The IP joint was fixed at 15° of flexion (Figure 5). A splint for the IP joint was applied for 8 weeks. Complete bone union occurred at three months after surgery in the right thumb and at four months after surgery in the left thumb. At seven months after surgery, although there was no significant improvement in the grip power or side-pinch power, a large improvement was noted in the patient’s VAS. The preoperative appearance improved from 3 to 90 postoperatively. The ease of putting strength into the digit improved from 9 to 45, the ease of use improved from 7 to 85, and the overall satisfaction improved from 4 to 88.
Triple osteotomy for erosive first metatarsal in a patient with rheumatoid arthritis: a case report
Published in Modern Rheumatology Case Reports, 2021
Haruki Tobimatsu, Katsunori Ikari, Koichiro Yano, Ken Okazaki
Joint-sacrificing procedures such as resection arthroplasty, arthrodesis, and artificial joint replacement have been chosen as the main treatments for forefoot deformities of patients with RA. There are some advantages and disadvantages of joint-sacrificing procedures. Resection arthroplasty provides increased short-term patient satisfaction by releasing the pressure of the bone head from the callus. However, it often comes at the expense of instability of the MTP joint and the hallux valgus may recur easily. Although joint arthrodesis is superior for pain relief and can maintain alignment over a long time, range of motion is lost with a risk of non-union. Silicone implant arthroplasty functions as a spacer to provide pain relief and preserve motion and avoids shortening of the metatarsal. However, breakage or loosening might occur and silicon synovitis arises occasionally.