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The Bone & Joint Journal
Vol. 100-B, Issue 5 | Pages 596 - 602
1 May 2018
Bock P Pittermann M Chraim M Rois S

Aims

Various radiological parameters are used to evaluate a flatfoot deformity and their measurements may differ. The aims of this study were to answer the following questions: 1) Which of the 11 parameters have the best inter- and intraobserver reliability in a standardized radiological setting? 2) Are pre- and postoperative assessments equally reliable? 3) What are the identifiable sources of variation?

Patients and Methods

Measurements of the 11 parameters were recorded on anteroposterior and lateral weight-bearing radiographs of 38 feet before and after surgery for flatfoot, by three observers with different experience in foot surgery (A, ten years; B, three years; C, third-year orthopaedic resident). The inter- and intraobserver reliability was calculated.


The Bone & Joint Journal
Vol. 100-B, Issue 2 | Pages 190 - 196
1 Feb 2018
Chraim M Krenn S Alrabai HM Trnka H Bock P

Aims

Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up.

Patients and Methods

We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70).


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 85 - 85
1 May 2016
Trnka H Bock P Krenn S Albers S
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Spezializing in subfields of Orthopaedics is common in anglo-american countries for more than 20 years. IThe aim of this paper is to demonstrate the necessity of fellowship programms in extremity orientated subfileds of orthopaedics. Analyzing the results of ankle arthrodesis performed by general orthopaedic surgeons campared to ankle arthrodesis performed by spezialized foot and ankle surgeons the difference in results will be demonstrated.

Patients and methods

In 40 patients an ankle arthrodesis was performed between 1998 and 2012. Group A was formed by 20 consecutive patients treated by spezial trained Foot and Ankle surgeons and group B was formed by 20 patients treted by general orthopaedic surgeons. The average age in group A at the time of surgery was 59,9y (34 to79y) compared to 63,4y (41 to 80y) in group B. The average follow up was 34 months respectively 32 months after surgery. The study included a spezial questionnaire with the AOFAS score and rating of patients dissatisfaction. The successful healing of the arthrodesis was determied by using standardized radiographs, Furthermore a pedobarography, and a videoanalyzis of the walking was incuded.

Results

All procedures in group A were performed using an anterior approach. Neither pseudarthroses, equinus or other malositions were detected in this group.

In group B wurdenin 16 patients an anterior and in 4 patients a lateral approach was used. Complications included 3 pseudarthroses, 4 equinus malpositions, 4 varus malpositions, 4 valgus malpositions and 8 penetrations of the subtalar joint.

The AOFAS score on average was 78 (46–92) points in group A and 75 (34 – 94) in group B.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 82 - 82
1 May 2016
Chraim M Bock P Trnka H
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The surgical correction of hammer digits offers a variety of surgical treatments ranging from arthroplasty to arthrodesis, with many options for fixation. In the present study, we compared 2 buried implants for arthrodesis of lesser digit deformities: a Smart Toe® implant and a buried Kirschner wire. Both implants were placed in a prepared interphalangeal joint, did not violate other digital or metatarsal joints, and were not exposed percutaneously. A retrospective comparative study was performed of 117 digits with either a Smart Toe® implant or a buried Kirschner wire, performed from January 1, 2007 to December 31, 2010. Of the 117 digits, 31 were excluded because of a lack of 90-day radiographic follow-up. The average follow-up was 94 to 1130 days. The average patient age was 61.47 (range 43 to 84) years. Of the 86 included digits, 48 were left digits and 38 were right. Of the digits corrected, 54 were second digits, 24 were third digits and 8 were fourth digits. Fifty-eight Smart Toe® implants were found (15 with 19-mm straight; 2 with 19-mm angulated; 34 with 16-mm straight; and 7 with 16-mm angulated). Twenty-eight buried Kirschner wires were evaluated. No statistically significant difference was found between the Smart Toe® implants and the buried Kirschner wires, including the rate of malunion, nonunion, fracture of internal fixation, and the need for revision surgery. Of the 86 implants, 87.9% of the Smart Toe® implants and 85.7% of the buried Kirschner wires were in good position (0° to 10° of transverse angulation on radiographs). Osseous union was achieved in 68.9% of Smart Toe® implants and 82.1% of buried Kirschner wires. Fracture of internal fixation occurred in 12 of the Smart Toe® implants (20.7%) and 2 of the buried Kirschner wires (7.1%). Most of the fractured internal fixation and malunions or nonunions were asymptomatic, leading to revision surgery in only 8.6% of the Smart Toe® implants and 10.7% of the buried Kirschner wires. Both the Smart Toe® implant and the buried Kirschner wire offer a viable choice for internal fixation of an arthrodesis of the digit compared with other studies using other techniques.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_7 | Pages 46 - 46
1 May 2016
Bock P Hermann E Chraim M Trnka H
Full Access

Background

The adult acquired flat foot is caused by a complete or partial tear of the tibialis posterior tendon. We present the results of flexor digitorum longus transfer and medializing calcaneal osteotomy for recontruction of the deformity.

Material & Methods

Twenty-six patients (31 feet) with an average age of 58 years (36–75) were operated for an acquired flat foot deformity. The patients were seen before surgery, one year after surgery and an average of 85 months after surgery to assess the following parameters: AOFAS Score, VAS Score for pain (0–10). Foot x-rays in full weightbearing position (dorsoplantar and lateral) were done at every visit in order to assess the following parameters: tarsometatarsale angle on the dorsoplantar and lateral x-ray, talocalcaneal angle on the lateral x-ray, calcaneal pitch angle and medial cuneiforme height on the lateral x-ray.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 322 - 322
1 Sep 2012
Bock P Pittermann M
Full Access

Background

Acquired flatfoot deformity goes ahead with a partial or complete rupture and thus insufficiency of the tibialis posterior tendon. We present the results of flexor digitorum longus transfer and medial displacement calcaneal osteotomy to reconstruct the acquired deformity.

Material & Methods

Twenty two patients (24 feet) with an average age of 58 (36–75) years were operated on for acquired flexible flatfoot deformity. Two patients had a bilateral procedure. Patients were seen pre-and postoperatively in order to evaluate following parameters: AOFAS hindfoot score, visual analogue scale for pain (0–10), the tarsometatarsal angle on lateral and ap standing x-rays, the cuneiform heights and talocalcaneal angle on lateral standing x-rays and subjective postoperative satisfaction score (1-worst to 5-best). Average time of follow-up was 24.7 months (12–48).


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 143 - 143
1 Mar 2009
Bock P Lanz U Engel A
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Introduction: There are more than 150 different methods of surgical correction of hallux valgus deformity. In our institution there is a long tradition of SCARF osteotomy. We hereby present the longterm results of the SCARF.

Material & Methods: During the years 1995 and 1996 111 patients with 128 feet were operated on for a hallux valgus deformity by the SCARF osteotomy. Of those, 81 patients with 95 feet could be seen for follow up. The mean age at time of surgery was 50.9 (21–78) years. A clinical and radiographic examination was done.

Results: After an average time of 121.9 (107–141) months 92% of the patients were very satisfied with the result of their surgery. The VAS for pain improved from an average of 6.5 to 0.34. The AOFAS score for the forefoot improved from a preoperative average of 54.4 to a postoperative average of 91.6. The radiographic evaluation gave the following results: the preoperative HVA of 31.7° improved to an average of 16.8°; the preoperative IMA of 14.8° improved to an average of 7.6°. The preoperative average dorsal extension of the MTPI did not change very much from 48.6° to 50.6°, the preoperative plantar flexion decreased from an average of 50.6° to 15°. Two patients had to be reoperated because of a recurrent hallux valgus deformity. Five other patients had a recurrent deformity, but did not need any further surgery. We could observe 3 patients with an overcorrection where one needed another surgery. No head necrosis was seen.

Conclusion: Overall the SCARF osteotomy gave good and predictable results with a good correction of the deformity and a low potential for recurrence if applied for the right patient group.


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 5 | Pages 669 - 673
1 Jul 2004
Bock P Kristen K Kröner A Engel A

This study relates the extent of cartilage lesions within the first metatarsophalangeal joint to hallux valgus.

We prospectively examined 265 first metatarsophalangeal joints of 196 patients with a mean age of 54.2 years at operation for the existence of cartilage lesions.

Grade I lesions were found in 41 feet (15.5%), grade II in 82 (30.9%), grade III in 51 (19.3%), grade IV in 20 (7.5%). Only 71 (26.8%) showed no cartilage lesion. Cartilage lesions were found within the metatarsosesamoid and metatarsophalangeal compartments in 66 feet (34.0%), within the metatarsophalangeal compartment in 26 (13.4%) and within the metatarsosesamoid compartment in 102 (52.6%). A statistically significant correlation was found between the grade of cartilage lesion and the hallux valgus angle, both for the changes within the metatarsophalangeal and the metatarsosesamoid joints.