Poor clinical results are seen with syndesmotic injuries in the setting of ankle sprains and ankle fractures. The goal of syndesmosis repair is to restore the normal anatomic relationship of the ...distal tibiofibular joint and prevent ankle arthritis. Indications for surgical intervention for isolated syndesmotic injuries include frank syndesmosis diastasis, medial clear space widening on plain radiographs, significant radiographic syndesmosis diastasis during stress examination, or subtle syndesmotic diastasis detected by arthroscopic evaluation. Complications after syndesmosis repair include symptomatic hardware, malreduction, and arthritis. Anatomic reduction of the syndesmosis leads to better outcomes following surgery.
BACKGROUND:Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has been utilized for the treatment of ...various disorders. However, there is limited literature addressing the postoperative complications of this procedure. In this study, the postoperative complications in patients treated with posterior ankle and hindfoot arthroscopy were analyzed to determine the type, rate, and severity of complications.
METHODS:The study included 189 ankles in 186 patients (eighty-two male and 104 female; mean age, 37.1 ± 16.4 years). The minimum duration of follow-up was six months, and the mean was 17 ± 13 months. The most common preoperative intra-articular diagnoses were subtalar osteoarthritis (forty-six ankles), an osteochondral lesion of the talus (forty-two), posterior ankle impingement (thirty-four), ankle osteoarthritis (twenty), and subtalar coalition (five). The most common extra-articular diagnoses were painful os trigonum (forty-six), flexor hallucis longus tendinitis (thirty-two), and insertional Achilles tendinitis (five).
RESULTS:The most common intra-articular procedures were osteochondral lesion debridement (forty-four ankles), subtalar debridement (thirty-eight), subtalar fusion (thirty-three), ankle debridement (thirty), and partial talectomy (nine). The most common extra-articular procedures were os trigonum excision (forty-eight), tenolysis of the flexor hallucis longus tendon (thirty-eight), and endoscopic partial calcanectomy (five). Complications were noted following sixteen procedures (8.5%); four patients had plantar numbness, three had sural nerve dysesthesia, four had Achilles tendon tightness, two had complex regional pain syndrome, two had an infection, and one had a cyst at the posteromedial portal. One case of plantar numbness and one case of sural nerve dysesthesia failed to resolve.
CONCLUSIONS:Our experience demonstrated that posterior ankle and hindfoot arthroscopy can be performed with a low rate of major postoperative complications.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Purpose To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and ...postgraduate year. Methods Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r ; alpha = 0.05. Results 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee : training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = −0.92, P = .004, 95% CI = −0.96, −0.84; and camera path length, r = −0.97, P = .0004, 95% CI = −0.98, −0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = −0.54, P = .002, 95% CI = −0.75, −0.22; and camera path length, r = −0.62, P = .0003, 95% CI = −0.8, −0.33. Shoulder : training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = −0.94, P = .001, 95% CI = −0.97, −0.89; and camera path length, r = −0.89, P = .007, 95% CI = −0.95, −0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = −0.62, P = .0002, 95% CI = −0.8, −0.33; and camera path length, r = −0.37, P = .044, 95% CI = −0.64, −0.01, by training year. FAST : training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = −0.86, P = .012, 95% CI = −0.93, −0.74; and camera path lengths, r = −0.85, P = .015, 95% CI = −0.92, −0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. Conclusions We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. Clinical Relevance We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents.
Category:
Ankle Arthritis; Hindfoot
Introduction/Purpose:
Tibio-talo-calcaneal (TTC) arthrodesis is usually a salvage procedure to address several hindfoot and ankle conditions. Non-union rate after ...TTC fusion is variably reported 3.4% - 48%. The aims of this study were to describe the outcomes and complications of this procedure and to determine potential risk factors associated with non-union.
Methods:
In this IRB-approved retrospective cohort study, we used the following codes (28705,28725 and 27870) to search the medical records for all patients who underwent TTC fusion between 2006-2022. All relevant demographic data, surgical indications, surgery details (type of the graft, type of the implant, and surgical approach, associated procedures), post-operative course (complications and union rate) and follow-up duration were extracted. Descriptive statistics were performed, and continuous variables were described using median (interquartile range) and categorical variables were described using frequency (%) and mean (standard deviation, SD). Patients and surgery characteristics were compared between united and non-united cases using Wilcoxon Rank Sum Tests for continuous variables and Chi-squared or exact tests, as appropriate, for categorical variables. Analyses were performed using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC).
Results:
Fifty-one patients (53 feet) were included in the study. Long hindfoot fusion nails were used in 51 cases.Ten cases were routinely dynamized 8-10 weeks after surgery. In 24 (45.3%) patients, morselized allograft was combined with infuseTM and reamer irrigation aspiration autograft (RIA). In 20 (37.7%) patients, morselized allograft was combined with infuseTM only. There were 6 non-union cases (11.3%). When comparing patients and surgery characteristics between non-union versus union group, smoking (P = 0.0150) and routine dynamization (P= 0.0297) were higher in the non-union group. No difference in union rates between different types of graft. Frequency of other complications is listed in (Figure 1). Follow up duration was 27.2 months (range 4-108 months).
Conclusion:
TTC fusion achieves good union rate (88.68%), however it carries a relatively high risk of complications. Routine dynamization of the TTC nail at 8-10 weeks could be a risk factor for non-union. Smoking was also associated with a high non- union rate.
Abstract Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases ...including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000–2011 (+ 26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+ 2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (− 0.7% to − 0.6%). Physician reimbursements have declined on all case types (− 2.5% to − 2.1% per year), while list prices of orthopedic implants have risen (+ 4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment.
Minimally invasive treatment can offer an earlier recovery with less pain and scarring compared with traditional open surgeries. The goals of minimally invasive surgery are to debride degenerative ...tendon, stimulate healing, and, when appropriate, repair damaged tendon. Sclerotherapy and prolotherapy have been shown to reduce neovascularization and pain. Percutaneous stripping and endoscopic debridement are better options for diffuse tendinopathy. Plantaris release can be useful in diffuse disease in patients with primarily medial-sided Achilles pain. Overall, minimally invasive surgery provides similar benefits as open procedures with reduced complications and morbidity.
Background The Centers for Medicare & Medicaid Services targeted thirty-day readmissions as a quality-of-care measure. Hospitals can be penalized on unplanned readmissions. Given the frequency of ...amputation in diabetic patients and our changing health-care system, the purpose of this study was to determine the incidence, risk factors, and causes for unplanned thirty-day readmissions following primary lower-extremity amputation in diabetic patients. Methods Patients with a diagnosis of diabetes undergoing primary lower-extremity amputation between 2002 and 2013 were retrospectively identified in a single-center patient database. Chart review determined patient factors including comorbidities, hemoglobin A1c level, amputation level, and demographic characteristics. Patients were divided into groups with and without unplanned readmission within thirty days postoperatively. Univariate and multivariate logistic regression analyses were used to compare cohorts and to identify variables associated with readmission. Results Overall, forty-six (10.5%) of 439 diabetic patients undergoing primary lower-extremity amputation had an unplanned thirty-day readmission. The top reason for readmission was a major surgical event requiring reoperation (37.0%), followed by medical events (28.3%) and minor surgical events (28.3%). In the univariate analysis, discharge on antibiotics (p = 0.002), smoking (p = 0.003), chronic kidney disease (p = 0.002), peripheral vascular disease (p = 0.002), and higher Charlson Comorbidity Index (p = 0.001) were each associated with readmission. In the multivariate analysis, diagnosis of gangrene (odds ratio OR, 2.95 95% confidence interval (95% CI), 1.37 to 6.35), discharge on antibiotics (OR, 4.48 95% CI, 1.71 to 11.74), smoking (OR, 3.22 95% CI, 1.40 to 7.36), chronic kidney disease (OR, 2.82 95% CI, 1.30 to 6.15), and peripheral vascular disease (OR, 2.47 95% CI, 1.08 to 5.67) were independently associated with readmission. Conclusions Thirty-day readmission rates following primary lower-extremity amputation in patients with diabetes were high at >10%. Both medical and surgical complications, many of which were unavoidable, contributed to readmission. Quality-reporting metrics should include these risk factors to avoid undeservedly penalizing surgeons and hospitals caring for this patient population. Level of Evidence Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Background:
Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel ...minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique.
Methods:
Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach.
Results:
Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery.
Conclusions:
Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery.
Clinical Relevance:
Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.
PDF
