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Nilesh Makwana - One of the best experts on this subject based on the ideXlab platform.
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A simultaneous Fracture of the tibia and talar body
Foot and Ankle Surgery, 2004Co-Authors: A. D. Mendonca, A. C. Maury, Nilesh MakwanaAbstract:Abstract Fractures of the talar body are rare. Most are coronal or sagittal plane Fractures. We present the case of a patient who sustained a simultaneous comminuted sagittal and coronal Fracture of the body of the talus involving the postero-Medial quadrant of the body with a Fracture of the Medial malleolus. He was treated with open reduction and internal fixation of the talus. Access was gained utilizing the Medial Malleolar Fracture. At review after 6 months, he has returned to full function with no complications.
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Case report A simultaneous Fracture of the tibia and talar body
2004Co-Authors: A. D. Mendonca, A. C. Maury, Nilesh MakwanaAbstract:Fractures of the talar body are rare. Most are coronal or sagittal plane Fractures. We present the case of a patient who sustained a simultaneous comminuted sagittal and coronal Fracture of the body of the talus involving the postero-Medial quadrant of the body with a Fracture of the Medial malleolus. He was treated with open reduction and internal fixation of the talus. Access was gained utilizing the Medial Malleolar Fracture. At review after 6 months, he has returned to full function with no complications. q 2004 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Alexej Barg - One of the best experts on this subject based on the ideXlab platform.
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Can a Three-Component Prosthesis be Used for Conversion of Painful Ankle Arthrodesis to Total Ankle Replacement?
Clinical Orthopaedics and Related Research®, 2017Co-Authors: Markus Preis, Travis Bailey, Lucas S. Marchand, Alexej BargAbstract:Background In patients with painful ankle arthrodesis, the surgical treatment is challenging, and may include takedown of ankle arthrodesis and conversion to a total ankle replacement (TAR). This procedure is technically demanding given the altered anatomy after arthrodesis. Few studies have evaluated TAR in the setting of prior arthrodesis. Questions/Purposes (1) What intraoperative and perioperative complications were observed in patients who underwent conversion of an ankle arthrodesis to a TAR? (2) Was durable fixation achieved at short term, and what was the alignment of the components? (3) What subsequent surgical procedures were performed, including revisions? (4) What improvements were observed in pain, tibiotalar range of motion (ROM), and quality of life? Methods Between January 2007 and December 2014, 18 patients with a painful ankle arthrodesis underwent conversion to TAR at our tertiary referral center. During this period, the indications for conversion of ankle arthrodesis to TAR were tibiotalar nonunion or malunion after attempted arthrodesis in patients who declined revision ankle arthrodesis. The goal of revision surgery was to help patients regain hindfoot mobility and to decrease pain. During the study period, all patients who met indications were treated with a conversion procedure. Of the 18 patients included, 14 were men and four were women. The mean age of the patients was 51 ± 7 years. The mean followup was 54 ± 27 months, with no loss to follow up observed. The initial ankle arthrodesis was performed 6 ± 3.5 years before conversion to TAR. In all patients, the conversion to TAR was performed using a nonconstrained cementless three-component prosthesis. Intraoperative and postoperative complications, revision procedures, and prosthesis component loosening were evaluated. Weightbearing radiographs were used to determine the angular alignment of the tibial and talar components using α/β/γ angles and to analyze the bone-implant interface. Osseointegration was defined as visible trabecular structures at the bone-implant interface without radiolucent lines. The criteria for radiographic loosening was defined as subsidence or migration of prosthesis components and/or a cystic lesion with a diameter at least 2 mm. Clinical assessment included pain evaluation, measurement of ankle ROM, and quality of life. Results Two of the 18 patients sustained an intraoperative Medial Malleolar Fracture. In three patients, delayed wound healing was observed. At latest followup, four patients had incomplete osseointegration (posterior quarter of the bone-prosthesis interface on the tibial side). None of the 18 patients had prosthesis loosening. In all patients, both components were neutrally aligned. Two patients had painful arthrofibrosis with reduced ROM, which we treated with an open arthrolysis and exchange of mobile-bearing inlay; one other patient is considering a revision for substantial tibial component Medial tilt with collapse of the Medial arch. At the latest followup, the mean dorsiflexion and plantar flexion were 8.5° ± 3° and 15° ± 5°, respectively. The mean visual analog scale (VAS) score decreased from 9 ± 0.8 to 1.7 ± 1.6 (p
Peter Smitham - One of the best experts on this subject based on the ideXlab platform.
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Screw fixation of Medial Malleolar Fractures: a cadaveric biomechanical study challenging the current AO philosophy.
Bone Joint J, 2013Co-Authors: Peter SmithamAbstract:The AO Foundation advocates the use of partially threaded lag screws in the fixation of Fractures of the Medial malleolus. However, their threads often bypass the radiodense physeal scar of the distal tibia, possibly failing to obtain more secure purchase and better compression of the Fracture. We therefore hypothesised that the partially threaded screws commonly used to fix a Medial Malleolar Fracture often provide suboptimal compression as a result of bypassing the physeal scar, and proposed that better compression of the Fracture may be achieved with shorter partially threaded screws or fully threaded screws whose threads engage the physeal scar. We analysed compression at the Fracture site in human cadaver Medial malleoli treated with either 30 mm or 45 mm long partially threaded screws or 45 mm fully threaded screws. The median compression at the Fracture site achieved with 30 mm partially threaded screws (0.95 kg/cm(2) (interquartile range (IQR) 0.8 to 1.2) and 45 mm fully threaded screws (1.0 kg/cm(2) (IQR 0.7 to 2.8)) was significantly higher than that achieved with 45 mm partially threaded screws (0.6 kg/cm(2) (IQR 0.2 to 0.9)) (p = 0.04 and p < 0.001, respectively). The fully threaded screws and the 30mm partially threaded screws were seen to engage the physeal scar under an image intensifier in each case. The results support the use of 30 mm partially threaded or 45 mm fully threaded screws that engage the physeal scar rather than longer partially threaded screws that do not. A 45 mm fully threaded screw may in practice offer additional benefit over 30 mm partially threaded screws in increasing the thread count in the denser paraphyseal region.
A. D. Mendonca - One of the best experts on this subject based on the ideXlab platform.
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A simultaneous Fracture of the tibia and talar body
Foot and Ankle Surgery, 2004Co-Authors: A. D. Mendonca, A. C. Maury, Nilesh MakwanaAbstract:Abstract Fractures of the talar body are rare. Most are coronal or sagittal plane Fractures. We present the case of a patient who sustained a simultaneous comminuted sagittal and coronal Fracture of the body of the talus involving the postero-Medial quadrant of the body with a Fracture of the Medial malleolus. He was treated with open reduction and internal fixation of the talus. Access was gained utilizing the Medial Malleolar Fracture. At review after 6 months, he has returned to full function with no complications.
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Case report A simultaneous Fracture of the tibia and talar body
2004Co-Authors: A. D. Mendonca, A. C. Maury, Nilesh MakwanaAbstract:Fractures of the talar body are rare. Most are coronal or sagittal plane Fractures. We present the case of a patient who sustained a simultaneous comminuted sagittal and coronal Fracture of the body of the talus involving the postero-Medial quadrant of the body with a Fracture of the Medial malleolus. He was treated with open reduction and internal fixation of the talus. Access was gained utilizing the Medial Malleolar Fracture. At review after 6 months, he has returned to full function with no complications. q 2004 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Jin Park - One of the best experts on this subject based on the ideXlab platform.
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Partial Rupture of the Tibialis Posterior Tendon Associated with a Closed Medial Malleolar FractureA Case Report.
Journal of the American Podiatric Medical Association, 2016Co-Authors: Jin ParkAbstract:Rupture of the tibialis posterior tendon associated with ankle Fracture is rare and difficult to diagnose. This rupture can be easily overlooked because the clinical examination is limited owing to acute pain related to a closed ankle Fracture. Complete rupture of the tibialis posterior tendon can be identified by a loss of tension during ankle Fracture fixation, but partial rupture is more difficult to detect because the tibialis posterior tendon can maintain its tension. A few cases of complete rupture of the tibialis posterior tendon combined with ankle Fracture have been reported. It is well-known that failure to diagnose a rupture of the tibialis posterior tendon can lead to long-term disability and a planovalgus foot. However, to our knowledge, this is the first report of partial rupture of the tibialis posterior tendon in the English literature. Herein, we describe a patient with a neglected partial rupture of the tibialis posterior tendon combined with a Medial Malleolar Fracture.