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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
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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.