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Scott J. Ellis - One of the best experts on this subject based on the ideXlab platform.
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Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate
HSS Journal ®, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft. Questions/Purposes Does the performance of the Lapidus procedure with rigid cross screw fixation, complete Joint Preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course? Methods We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively. Results The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic. Conclusions The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal Joint should be considered an infrequent occurrence.
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modified lapidus procedure with Joint compression meticulous surface Preparation and shear strain relieved bone graft yields low nonunion rate
HSS Journal, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft.
Sriniwasan B. Mani - One of the best experts on this subject based on the ideXlab platform.
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Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate
HSS Journal ®, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft. Questions/Purposes Does the performance of the Lapidus procedure with rigid cross screw fixation, complete Joint Preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course? Methods We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively. Results The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic. Conclusions The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal Joint should be considered an infrequent occurrence.
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modified lapidus procedure with Joint compression meticulous surface Preparation and shear strain relieved bone graft yields low nonunion rate
HSS Journal, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft.
Ashish Shah - One of the best experts on this subject based on the ideXlab platform.
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Mini-open vs. Transfibular Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study
Indian Journal of Orthopaedics, 2020Co-Authors: Karthikeyan Chinnakkannu, Haley Mckissack, Jun Kit He, Bradley Alexander, John Wilson, Gean C. Viner, Ashish ShahAbstract:Background Arthrodesis is considered the gold standard for end-stage ankle arthritis in patients who fail conservative management. Achieving union is paramount while minimizing complications. An essential item for successful union is Preparation of the articular surface. Our study aims to evaluate the difference in Joint Preparation between direct lateral and dual mini-open approaches. Materials and Methods Ten below knee fresh-frozen specimens were used for this study. Five were prepared through lateral approach, and five using dual mini-incisions. After Preparation, all ankles were dissected and images of tibial plafond and talar articular surfaces were taken. Surface areas of articulating facets and unprepared cartilage of talus, distal tibia, and distal fibula were measured and analyzed. Results A greater amount of total surface area was prepared with the mini-open approach in comparison to the transfibular approach. Percentage of prepared surface area of total articulating surface (including talus and tibia/fibula), talus, tibia, and fibula with the transfibular approach were 76.9%, 77.7%, and 75%, respectively. Percentages were 90.9%, 92.9%, and 88.6% with the mini-open approach. When excluding medial gutter, there was no significant difference between techniques (83.94% vs. 90.85%, p = 0.1412). Conclusion Joint Preparation with the mini-open approach is equally efficacious as the transfibular approach for the tibiotalar Joint. The mini-open approach does provide superior Preparation of the medial gutter and inferior tibial surface which may help to increase union rates and decreased complications. Level of Evidence V.
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Subtalar Joint Preparation Using the Two Portal Posterior Arthroscopic Technique versus the Sinus Tarsi Open Approach: A Cadaver Study
The Foot, 2020Co-Authors: Ashish Shah, Haley Mckissack, Martim Pinto, Karthikeyan Chinnakkannu, Bradley Alexander, James R. Jones, Rasesh DesaiAbstract:ABSTRACT Background Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. The procedure can be performed arthroscopically or through the open lateral sinus tarsi (LST) approach. The arthroscopic technique is less invasive and is associated with rapid recovery, but it is more technically challenging. One of the most important aspects of fusion is adequate Preparation of the Joint via denudation of articular cartilage. This study compares the efficacy of subtalar Joint Preparation between the lateral sinus tarsi approach and the posterior two-portal arthroscopic technique using cadaveric specimens. Materials and Methods Nineteen below-knee fresh-frozen cadaver specimens were used. The subtalar Joints of nine specimens were prepared through the LST approach, while ten were prepared arthroscopically. After Preparation, all ankles were dissected at the subtalar Joint and photographs were taken of the posterior facets of the calcaneus and talus. Total and prepared surface areas of the articular surfaces for both approaches were measured using ImageJ software and compared. Results The LST technique resulted in significantly greater percent Preparation of the posterior facet of the calcaneus, as well as of the subtalar Joint as a whole. Overall, 92.3% of the subtalar Joint surfaces (talus and calcaneus combined) were prepared using the LST technique, compared to 80.4% using the arthroscopic technique (p = 0.010). The posterior facet of the calcaneus was 94.0% prepared using the open technique, while only 78.6% prepared using the arthroscopic technique (p = 0.005). Conclusion The LST approach for subtalar arthrodesis provides superior articular Preparation compared to the two-portal posterior arthroscopic technique. Given that Joint Preparation is a critical component of fusion, maximizing prepared surface area is desirable and the open approach may be more efficacious for fusion. When using the arthroscopic approach, it may be advisable to use an accessory portal if there is poor visualization or limited access to the Joint space secondary to severe arthritis. Level of Evidence V
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Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study
Foot & Ankle Orthopaedics, 2019Co-Authors: Karthikeyan Chinnakannu, Eildar Abyar, Haley Mckissack, Martim Pinto, Leonardo V. M. Moraes, Sameer Naranje, Ashish ShahAbstract:Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the Joint for adequate Joint Preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate Preparation of the Joint. Aim of our study is to compare the Preparation of subtalar Joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens. Methods: We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar Joints of ten specimens were prepared through the lateral approach, while the remaining ten Joints were prepared using sinus tarsi incisions. After the completion of Preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed. Results: Open technique results in better Preparation of Joint surface in calcaneus and overall. While open technique results in Preparation of 92% Joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of Joint surface. Open technique results in better Preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the Preparation of talar articular surface. (Table 1) Conclusion: Open sinus tarsi results in more Joint Preparation compared to 2 portal posterior arthroscopic technique. The less amount of Joint Preparation in arthroscopic technique is mostly due to less Preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the Joint to aid in adequate Preparation.
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First tarsometatarsal fusion using saw Preparation vs. standard Preparation of the Joint: A cadaver study.
Foot and Ankle Surgery, 2019Co-Authors: Nicholas Dahlgren, Sameer Naranje, Karthikeyan Chinnakkannu, John L. Johnson, Samuel R. Huntley, Haley Mckissack, Ashish ShahAbstract:Abstract Background First tarsometatarsal (TMT) Joint fusion is effective for treatment of arthritis and some first ray deformities. To prepare the articular surfaces, cartilage should be carefully but completely denuded. Inadequate Preparation may result in non-union, while excessive Preparation may cause ray shortening and consequential transfer metatarsalgia. Preparation can be performed with an osteotome or a saw. The purpose of this study was to investigate whether utilization of an osteotome or saw would minimize shortening of the first ray in TMT arthrodesis. Methods Ten fresh-frozen cadaver specimens were randomly assigned to undergo Joint Preparation using either an osteotome (n = 5) or saw (n = 5). Sample size was determined by cadaver availability. Fusion was performed using a cross-screw construct through the dorsal aspect of the proximal phalanx and the medial cuneiform. Pre- and post-operative X-rays were taken with a radiopaque ruler in the field, and changes in length in the first metatarsal and first cuneiform were compared between osteotome and sawblade groups. Results The average change in metatarsal length was significantly smaller in the osteotome group (1.6 mm) as compared to the saw group (4.4 mm) (p = 0.031). The average percent change in metatarsal length was also significantly smaller in the osteotome group (3.0%) compared to the saw group (8.4%) (p = 0.025). There was no significant difference between the two groups with respect to change in cuneiform length. The osteotome group demonstrated a significantly smaller average measured change (3.0 mm vs. 6.9 mm, p = 0.001) and percent change (4.1% vs. 9.3%, p Conclusions In first TMT fusion, Joint Preparation with an osteotome may prevent over-shortening of the first ray in comparison to Preparation with a saw.
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Neurovascular structures at risk with percutaneous fixation in tarsometatarsal fusion: A cadaveric study.
The Foot, 2019Co-Authors: Eva Lehtonen, Sameer Naranje, Haley Mckissack, Harshadkumar A. Patel, John Lacorda, Ashish ShahAbstract:Abstract Introduction First tarsometatarsal (TMT) Joint fusion is routinely used for arthritis and deformities. Common fixation methods include a locking plate construct, cross-screws, or combinations of the two. Cross screws have proven effective for union and stability; however, there is a potential for harm to nearby neurovascular structures due to the nature of percutaneous insertion technique. This study assessed risk of damage to the superficial peroneal nerve with percutaneous TMT fusion. Methods Nine fresh-frozen cadaver specimens were included. A medial incision in the internervous plane was made for TMT Joint Preparation. Two crossed percutaneous wires followed by 4.0 cc screws were placed in the dorsal aspect of the proximal aspect of first metatarsal and in the medial cuneiform. Both were 10-15 mm from the TMT Joint line. The dorsal aspect of the foot was dissected and examined for neurovascular interruptions, particularly branches of the superficial peroneal nerve. Results Results showed a mean distance of 4.33 mm from the proximal pin to the medial branch of the superficial peroneal nerve. The distal pin had a mean distance of 6.44 mm from the medial branch, with one pin 9 mm from the lateral branch. One incident of direct injury to the neurovascular bundle was observed. Conclusion Preparing the Joint from the medial side using a percutaneous approach is less invasive, but presents a relative risk for neuritis. Care should be taken during insertion of the percutaneous screw after TMT Joint Preparation for fusion. Level of Evidence: Level V, Cadaver Study.
Eric W. Lloyd - One of the best experts on this subject based on the ideXlab platform.
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Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate
HSS Journal ®, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft. Questions/Purposes Does the performance of the Lapidus procedure with rigid cross screw fixation, complete Joint Preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course? Methods We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively. Results The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic. Conclusions The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal Joint should be considered an infrequent occurrence.
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modified lapidus procedure with Joint compression meticulous surface Preparation and shear strain relieved bone graft yields low nonunion rate
HSS Journal, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft.
Aoife Macmahon - One of the best experts on this subject based on the ideXlab platform.
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Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate
HSS Journal ®, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft. Questions/Purposes Does the performance of the Lapidus procedure with rigid cross screw fixation, complete Joint Preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course? Methods We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively. Results The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic. Conclusions The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal Joint should be considered an infrequent occurrence.
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modified lapidus procedure with Joint compression meticulous surface Preparation and shear strain relieved bone graft yields low nonunion rate
HSS Journal, 2015Co-Authors: Sriniwasan B. Mani, Eric W. Lloyd, Aoife Macmahon, Matthew M. Roberts, David S. Levine, Scott J. EllisAbstract:Background The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous Joint Preparation, and shear-strain-relieved calcaneal bone graft.
