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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  Original Article
Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints
Govind Shivram Kulkarni, Milind Govind Kulkarni, Sunil Govind Kulkarni, Vidisha Sunil Kulkarni, Ruta Milind Kulkarni
[Year:2015] [Month:July-December] [Volume:2 ] [Number:2] [Pages:49] [Pages No:60-70] [No of Hits : 692]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1031 | FREE

ABSTRACT

Introduction: When ankle and subtalar joints are arthritic and painful they both need fusion. Principles of treatment by fusion are removal of cartilage till bleeding of subchondral bone, keeping the joint surfaces congruous, proper positioning of the foot and ankle and stable fixation.

Materials and methods: During the last 10 years, 16 cases of retrograde nailing were done. Eight cases were post-traumatic, one was tuberculosis, three for Charcot joint and three for osteoarthritis of the ankle joint, and one case of rheumatoid arthritis. All patients had severe pain instability, varying degrees of deformities and antalgic gain. Two cases were treated with supracondylar femoral interlocking nail. Nine cases were treated with antegrade tibial nail as retrograde nail. Nine cases were treated with retrograde tibial nails with posteroanterior calcaneal screws. Two cases were treated with special nails newly designed by Smith and Nephew. Initially, older the calcaneus had two latero-medial screws. Newer designs of nail have two posteroanterior screws, passing from calcaneal tuberosity through the nail-one towards cuboid and the other towards talus. These two screws have increased the stability of the construct and improved the outcome. Mann’s technique of ankle fusion was used. Fibular strut was used as bone graft and fixed by one screws into the tibia and the other into talus. Indian tibia is smaller in diameter with a narrow intramedullary canal. Indian tibia need to have a nail with a smaller diameter.

Results: When supracondylar femoral and antegrade tibial nails were used, 4 out of 5 failed. When newer design nails with posteroanterior calcaneal screws were used, outcome improved 2 out of 11 failed.

Conclusion: Newer design of retrograde tibial nails with two posteroanterior screws have greatly improved the outcome of pantalar arthrodesis.

Keywords: charcot joint, Pantalar arthrodesis, Post-traumatic arthritis, Retrograde tibial nail.

How to cite this article: Kulkarni GS, Kulkarni MG, Kulkarni SG, Kulkarni VS, Kulkarni RM. Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):60-70.

Source of support: Nil

Conflict of interest: None

 
2.  Case Report
Os Intermetatarseum Revisited: A Case Report of Rare Variant and Review of Literature
Rajesh Rachha, Anand Gorva
[Year:2015] [Month:January-June] [Volume:2 ] [Number:1] [Pages:50] [Pages No:47-50] [No of Hits : 658]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1029 | FREE

ABSTRACT

Os intermetatarseum is the rarest accessory bone of the foot. It is usually found between 1st and the 2nd metatarsal bases arising typically from the base of the 2nd metatarsal. Only a few symptomatic cases have been reported in the literature, which were either unilateral or bilateral and radiographically they were of different shapes and sizes. We present a large, bilaterally symmetrical and unusual variant of os intermetatarseum. To our knowledge, such large, bilaterally symmetrical, fully formed os intermetatarseum, fusing to both metatarsals has not been described before. The case report also describes the surgical anatomy during the excision of os intermetatarseum and review of the literature to date.

Keywords: Os intermetatarseum, Accessory bone of the foot, Metatarsal bar, Deep peroneal nerve compression.

How to cite this article: Rachha R, Gorva A. Os Intermetatarseum revisited: A Case Report of Rare Variant and Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2015;2(1): 47-50.

Source of support: Nil

Conflict of interest: None

 
3.  Original Article
Percutaneous Repair for the Treatment of Rupture of the Achilles Tendon: A Study of 20 Cases
Gautam D Salunkhe
[Year:2015] [Month:July-December] [Volume:2 ] [Number:2] [Pages:49] [Pages No:51-59] [No of Hits : 599]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1030 | FREE

ABSTRACT

Background: Despite many techniques used for repair of the ruptured Achilles tendon, uncertainty of healing of the surgical wound remains a problem. This mainly determines the success of the surgery. The long-term results generally result in healing of the rupture, but poor healing of the wound occurs repeatedly. This causes apprehension in advising surgery over a conservative approach.

Objectives: To study the outcome of 20 cases of acute rupture of the Achilles tendon treated by the percutaneous technique.

Materials and methods: From March 2004 to March 2012, 20 cases of acute Achilles tendon rupture were treated by percutaneous repair by the method of Ma and Griffith. Modifications were used in distal end and delayed repairs. Immobilization was used after surgery. Postoperative complications were observed, and results assessed using the Leppilahti score after 6 months. Follow-up was done for 2 years.

Results: Percutaneous repair had significantly good results in 95% cases. There were two cases of sural nerve hypoesthesia, which was a minor problem and in no way hampered the longterm result. There were no re-ruptures. Patient satisfaction was high in terms of final result and cosmesis.

Conclusion: Percutaneous repair is a safe and reliable method for repair of the Achilles tendon rupture. It has a minor complication rate, and is advisable over open surgery.

Keywords: Achilles tendon rupture, Percutaneous repair, Wound healing.

How to cite this article: Salunkhe GD. Percutaneous Repair for the Treatment of Rupture of the Achilles tendon: A Study of 20 Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):51-59.

Source of support: Nil

Conflict of interest: None

 
4.  Original Article
Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus
Abhay Shankar Dube, Manvender Gaur, Avinash Rastogi, Rajat Kapoor
[Year:2015] [Month:January-June] [Volume:2 ] [Number:1] [Pages:50] [Pages No:17-21] [No of Hits : 501]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1022 | FREE

ABSTRACT

The correlation of anteromedial foot bimalleolar angle with Pirani score evaluated prospectively in 120 children (204 feet) with congenital talipes equinovarus (CTEV). The patients were divided into groups I, II and III based on clinical severity before casting, having the Pirani score 0 to 2, 2.5 to 4 and 4.5 to 6 respectively. Mean foot bimalleolar angle 75.75°, 67.62° and 58.28° of groups I, II and III respectively was correlated by standard deviation with their Pirani scores to evaluate the severity difference among the groups before initiation of the casting treatment. The change in clinical severity or Pirani score was further correlated with the change in mean foot bimalleolar angle at the time of completion of casting and before bracing. The foot bimalleolar angle is an objective, quantitative and reproducible method which can be used to classify, prognosticate and to monitor the progress of the treatment.

Background: The prospective observational study on role of foot bimalleolar angle against the Pirani scoring in clinical evaluation of club foot in 120 children (204 feet) with mean age of 5.4 months treated by Ponseti technique of casting.

Keywords: Congenital talipes equinovarus, Foot bimalleolar angle, Pirani scoring and Podogram.

How to cite this article: Dube As, Gaur M, Rastogi A, Kapoor R. Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):17-21.

Source of support: Nil

Conflict of interest: None

 
5.  Original Article
Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management
Hu Mu, Xu Xiangyang, Bi Gang
[Year:2014] [Month:July-December] [Volume:1 ] [Number:2] [Pages:40] [Pages No:48-51] [No of Hits : 2903]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1011 | FREE

ABSTRACT

Isolated fractures of sustentaculum tali are rare and often missed at an initial visit. They can be difficult to manage and may have implications for future hindfoot function. This article describes sustentacular fracture patterns and characteristics, and a method of surgical treatment via a medial approach to the calcaneus. During the last 6 years, 11 recent isolated sustentacular fractures without calcaneal posterior facet involvement were surgically-treated at our hospital. Of these all underwent open reduction and internal fixation via medial approach to the calcaneus. Patient charts, X-ray radiographs and CT scans were reviewed for injury characteristics and associated musculoskeletal injures. Five patients had intra-articular middle facet involvement, and two had subtalar joint subluxation. By cannulated screws reduction was maintained through fractures rigidly fixation. Isolated fracture of the sustentaculum tali is tend to be ignored and easily misdiagnosed as acute ankle sprain. Open reduction and internal fixation of this fractures was reliable and should be procedure via medial approach.

Keywords: Sustentaculum tali, Calcaneus, Fracture, Open reduction and internal fixation, Foot injuries.

How to cite this article: Mu H, Xiangyang X, Gang B. Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):48-51.

Source of support: Nil

Conflict of interest: None

 
6.  Review Article
Displaced Intra-articular Calcaneal Fractures: Current Concepts and Modern Management
Gershon Volpin, Zvi Cohen, Genadi Kirshner, Haim Shtarker
[Year:2014] [Month:January-June] [Volume:1 ] [Number:1] [Pages:40] [Pages No:24-31] [No of Hits : 2434]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1006 | FREE

ABSTRACT

The calcaneal fractures are usually the result of high-energy injuries, falls from height and road traffic accidents and constitutes about 2% of all fractures. 60 to 75% of them are displaced intra-articular fractures and 90% of them are usually in males, mainly in industrial workers.there is still controversy regarding classification and treatment. The purpose of this review is to present the modern surgical modalities for these type of fractures.

Keywords: Calcaneus, Calcaneal fractures, Foot, Ffractures, High energy fractures, Ilizarov, ORIF.

How to cite this article: Volpin G, Cohen Z, Kirshner G, Shtarker H. Displaced Intra-articular Calcaneal Fractures: Current Concepts and Modern Management. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):24-31.

Source of support: Nil

Conflict of interest: None

 
7.  Original Article
Evaluation of Ankle Tightrope Syndesmosis Fixation
Waheeb AK Al-azzani, Tarique Sabah, Vishal Paringe, Declan O'Doherty
[Year:2014] [Month:January-June] [Volume:1 ] [Number:1] [Pages:40] [Pages No:1-4] [No of Hits : 2077]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1001 | FREE

ABSTRACT

Introduction: Ankle sprains are among the most common of bone and joint injuries. Historically, distal tibiofibular syndesmotic injuries have been treated using syndesmotic metal screws to prevent diastasis. However, the use of screws meant that physiological micro-movement between the tibia and fibula was lost which often results in loosening and breaking of the screws. Tightrope fixation was a new technique that has been developed to overcome these complications and allowed some degree of flexibility similar to that offered by natural ligaments. The aim of our study was to evaluate such injuries.

Materials and methods: We conducted a retrospective study reviewing all clinical records of cases of patients with injuries of the distal tibofibular syndesmosis treated with the ankle tightrope (Arthrex Inc) in our institution between January 2008 and January 2011.

Results: A total of 42 patients were reviewed. We encountered five cases with complications (12%). Of those: three required removals due to prominent knot, one soft-tissue irritation and one with uncomplicated wound infection.

Conclusion: Our study, one of the largest so far evaluating complications of tightrope fixation, demonstrates that one in eight patients treated with tightrope will experience complication.

Keywords: Ankle, Syndesmosis, Distal tibiofibular syndesmosis, Instability, TightRope.

How to cite this article: Al-azzani WAK, Sabah T, Paringe V, O’Doherty D. Evaluation of Ankle Tightrope Syndesmosis fixation. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):1-4.

Source of support: Nil

Conflict of interest: None

 
8.  Original Article
Nutcracker Cuboid Fractures are never Isolated Injuries
Siddhartha Sharma, Mandeep S Dhillon, Gaurav Sharma, Rakesh John
[Year:2014] [Month:January-June] [Volume:1 ] [Number:1] [Pages:40] [Pages No:9-11] [No of Hits : 1788]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1003 | FREE

ABSTRACT

Background: Cuboid fractures are rare injuries, and treatment methods are ill-defined. The term ‘nutcracker’ fracture denotes a comminuted fracture of the cuboid which can lead to significant lateral column shortening and pain if treated improperly. The published literature discusses these injures with implications of such fractures being isolated injuries, and little mention is made of the complex forefoot injuries associated. We believe that such fractures cannot occur in isolation and due attention is often not paid to associated foot instabilities/injuries which may be subtle at times. To validate our hypothesis, we present our evaluation of 12 such cases, all of which were part of a complex foot injury pattern and emphasize on appropriate treatment of associated foot injuries in such cases.

Materials and methods: From the trauma database of a level I trauma center, all cases of cuboid fracture were retrospectively identified, investigated for mechanism of injury, radiographs were reviewed, associated injuries in the foot were documented, and treatment methods applied were recorded.

Results: We identified 12 cases of cuboid fracture. There were 10 males and 2 females, mean age being 20.2 years (14-32 years). No cuboid fracture was found to be an isolated injury, and associated foot injuries included calcaneus fracture in 3 cases, Lisfranc injury in 3 cases and complex midfoot-forefoot injury in 6 cases. Eight cases (66.7%) were open and 4 (33.3%) were closed. Complications included superficial wound infection in 2 cases, deep infection in 1 case and reflex sympathetic dystrophy along with nonunion of the 1st and 2nd metatarsals in one case.

Conclusion: Our results substantiate the hypothesis that nutcracker cuboid fractures cannot occur in isolation and represent one part of a complex, high energy foot injury. In addition to maintaining length of the lateral column and fixing the cuboid, due attention must also be paid to the associated foot injuries, especially the medial column, so as to have a properly aligned, functional and painless foot.

Keywords: Cuboid fracture, nutcracker fracture, midfoot injuries.

How to cite this article: Sharma S, Dhillon MS, Sharma G, John R. Nutcracker Cuboid Fractures are never Isolated Injuries. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):9-11.

Source of support: Nil

Conflict of interest: None

 
9.  Original Article
Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer
G Raghunandan
[Year:2014] [Month:January-June] [Volume:1 ] [Number:1] [Pages:40] [Pages No:5-8] [No of Hits : 1722]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1002 | FREE

ABSTRACT

From July 2000 to July 2012, we have treated 48 cases with neglected Achilles tendon ruptures in Government General Hospital, Kurnool, India, with modified flexor hallucis longus (FHL) transfer. Thirty-three patients had achillodynia and 29 had local steroid infiltration. Thirty-six patients presented with ruptures in hypovascular zone II and, in 31, repair was after 3 weeks, graded as late (Inglis). The patients were managed based on a standardized evaluation and surgical protocol. The technique of FHL transfer was simplified by anchoring the tendon in a vertical transcalcaneal tunnel. The results were evaluated by Quigley's method, 100 point scoring system of Leppilahti, and recently updated with AOFAS hind foot score. The follow-up ranged from 2.5 to 12.2 years. The follow-up suggested that patients with FHL transfer showed significantly lower mean wound healing times and weight-bearing time and functional recovery times when compared with patients who had peroneal transfer, for neglected ruptures. The results are presented, analyzed and discussed.

Keywords: Achilles tendon, Peroneus brevis, Flexor hallucis longus, tendinosis, tendon transfer.

How to cite this article: Raghunandan G. Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):5-8.

Source of support: Nil

Conflict of interest: None

 
10.  Original Article
Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability
Qian-bo Chen, Xiao-kang Tan, Chen-song Yuan, Xu Tao, Hong-hui Cao, Jian-zhong Xu, Kang-lai Tang
[Year:2014] [Month:January-June] [Volume:1 ] [Number:1] [Pages:40] [Pages No:12-16] [No of Hits : 1647]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10040-1004 | FREE

ABSTRACT

Background: Chronic lateral ankle instability causes significant problems in physical activity and accelerates development of osteoarthritic changes. Many procedures were designed to reconstruct the anterior talo-fibular ligament (ATFL) in the treatment of chronic lateral ankle instability. Although most of them were effective, but brought big trauma and sacrifice of some tendons.

Objective: To design a minimally invasive ATFL reconstruction with partial peroneus brevis tendon and evaluate its clinical outcomes.

Study design: Nonrandomized controlled clinical trial.

Materials and methods: From 2004 to 2012, 29 patients of chronic lateral ankle instability were treated with minimally invasive ATFL reconstruction with partial peroneus brevis tendon. A 3 cm curved incision was made to explore the ATFL origin and its insertion. Half peroneus brevis tendon was taken to reconstruct the ATFL through the bone tunnel from the insertion of CFL to the insertion of ATFL in the fibular, and then fixed to ATFL insertion location on the talus. All patients were followed-up by radiology and clinical examination at least two years. Their ATFLs were always evaluated by standard stress X-ray examination and magnetic resonance imaging (MRI) prior to surgery and every 1 year after the operation. Functional results were assessed in terms of Karlsson score and the American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score.

Results: The average follow-up period was 57.9 months (24- 114 months). The majority of results (93.1%) were satisfactory. The mean Karlsson score improved from 41.7 prior to surgery to 88.6 and AOFAS from an average 47.2 preoperatively to 91.7 postoperatively at the final follow-up visit. Paired t-tests showed improvements of great significance (p < 0.01). The ligaments were proved be reconstructed well in all patients by MRI. It showed the negative talar tilt sign postoperatively by stress X-rays. There was no recurrence of lateral ankle instability.

Conclusion: The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction and excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability.

Keywords: Ankle instability, Reconstruction, Lateral collateral ligament, Chronic instability.

How to cite this article: Chen Q, Tan X, Yuan C, Tao X, Cao H, Xu J, Tang K. Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):12-16.

Source of support: Nil

Conflict of interest: None

 
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