Varus ankle osteoarthritis (OA) is typically associated with peritalar instability, which may result in altered subtalar joint position. This study aimed to determine the extent to which total ankle replacement (TAR) in varus ankle OA can restore the subtalar position alignment using 3-dimensional semi-automated measurements on WBCT. Fourteen patients (15 ankles, mean age 61) who underwent TAR for varus ankle OA were retrospectively analyzed using semi- automated measurements of the hindfoot based on pre-and postoperative weightbearing WBCT (WBCT) imaging. Eight 3-dimensional angular measurements were obtained to quantify the ankle and subtalar joint alignment. Twenty healthy individuals were served as a control groups and were used for reliability assessments. All ankle and hindfoot angles improved between preoperative and a minimum of 1 year (mean 2.1 years) postoperative and were statistically significant in 6 out of 8 angles (P<0.05). Values The post-op angles were in a similar range to as those of healthy controls were achieved in all measurements and did not demonstrated statistical difference (P>0.05). Our findings indicate that talus repositioning after TAR within the ankle mortise improves restores the subtalar position joint alignment within normal values. These data inform foot and ankle surgeons on the amount of correction at the level of the subtalar joint that can be expected after TAR. This may contribute to improved biomechanics of the hindfoot complex. However, future studies are required to implement these findings in surgical algorithms for TAR in prescence of hindfoot deformity.
Distal radius fractures (DRF) are a common injury in the A&E departments, being a major cause of disability of the upper extremity. The aim of this prospective study is to assess the possible association between objective physical variables such as wrist range of movement (ROM), radiological parameters, and upper extremity disability (measured by the DASH questionnaire), after conservative treatment of DRF. 44 patients with non-operatively managed DRF were enrolled in a prospective cohort study from July 2007 till September 2009. Inclusion criteria: unilateral DRF in skeletally mature patients, treated non-operatively with closed reduction and cast. Patients who sustained a previous fracture of the wrist, or bilateral wrist fracture, or with dementia, were excluded. After the closed reduction and inmovilization of the fracture in the A&E department we asked the patients to complete the DASH questionnaire, referring to their baseline pre-fracture state. All fractures were classified according to the AO classification. After one year, 36 patients were still available for follow-up purposes. We assesed the following objective physical variables: ROM of both wrists: flexion/extension arc and pronation/supination arch. We recorded the following radiologic parameters: radial angulation, volar angulation and radial shortening. The patient-perceived results were measured by the DASH questionnaire, while pain was measured using the VAS scale. Statistical analysis was performed using the SPSS 15.0.Introduction
Patients and methods
The day at the Hospital: The first patient arrived at 08:00, when the daily clinical meeting for the trauma admissions began. During the first hour, an effort was made in order to triage victims and organize the requirements for operating room and ICU treatment. All scheduled operations were aborted and six orthopaedic trauma teams were prepared to start operations immediately. A separate area in the Hospital was established to treat minor injuries. All patients were operated within the first 8 hours. Injury characteristics: 39 patients admitted with an ISS higher than 9 presented the most severe injuries. A study group was made with these patients. Mean age were 33,6. The mean RTS were 6,87, mean ISS 21,94, and mean NISS 26,15, revealing the high frequency of multisistemic injuries. The most frequently injury in these group were pulmonary blast injury, with a mean AIS for thorax of 2,7 points.74% of patients had some type of pulmonary blast injury. Limb injuries: 12 (25%) patients had open fractures, combined in all cases with pulmonary blast. Open Gustilo IIIb and IIIc occur in seven patients. Soft tissue injuries caused by small fragments were also frequent. Two patients presented SCIWORA like injuries of the thoracic medullary cord. All patients were operated in the first six hours after the explosion. A detailed description of the injuries, treatment and functional outcome will be presented. Functional outcome were analyzed by physical and psychological scales at six and twelve months after the attack. Scales used were SF-36(short form 36), EQ-5D (Euroqol), CES-D( Center for Epidemiologic Studies Depression Scale) and AVS. Comparison with a similar general trauma group revealed poorer functional outcome at six months for the study group.