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PubMed2004

Block distraction arthrodesis for the treatment of failed calcaneal fractures.

We had excellent results with our procedure and had only one unsatisfied patient. This patient's fusion site had an undersized graft; therefore, he had continued pain. Because he had no further intra-articular pain, he did not feel the need for further surgery. Block distraction arthrodesis is far more difficult to perform than subtalar arthrodesis without the use of bone graft. It is critical to allow more intraoperative time during the first two or three cases than required for regular arthrodesis of the subtalar joint. It also is essential to place the heel in a rectus position at the time of arthrodesis. With proper preoperative examination and planning, meticulous intraoperative treatment, and guarded postoperative care, block distraction arthrodesis is an excellent procedure for the treatment of poorly-treated or neglected calcaneal fractures.

Arthrodesis↗

PubMed2005

Arthrodesis techniques in horses.

When medical therapy and surgical treatments of an injured joint fail to return the animal to athletic performance or comfortable use of the limb, arthrodes is is a final option for some joints. Arthrodesis refers to the surgical fusion of a joint, resulting in bony ankylosis. Successful arthrodesis requires debridement of the articular cartilage through the calcified cartilage layer, exposing the subchondral bone; alignment of the joint into a weight-bearing position; and stabilization. The methods by which these steps are accomplished are variable, depending on the individual joint. There are currently accepted methods for arthrodesis of several joints in the horse; however, not all joints are amenable to arthrodesis. Case selection is an important aspect of performing arthrodesis procedures in horses.

Animals↗

PubMed2006

Arthroscopic ankle arthrodesis.

Surgical options are limited for the patient who has symptomatic severe ankle joint degeneration that is unresponsive to nonoperative treatment. Arthrodesis of the tibiotalar joint is a procedure that can produce a pain-free ankle that can withstand the rigors of daily life, even in a young, high-demand, working individual. Minimally invasive orthopedic techniques have been applied to ankle arthrodesis, and arthroscopic ankle fusion has been shown to be an effective technique to achieve tibiotalar arthrodesis, with high rates of fusion and low rates of complication. This article covers indications, contraindications, and procedural techniques for arthroscopic ankle arthrodesis. Results of arthroscopic versus open ankle arthrodesis are compared.

Ankle Joint↗

PubMed2005

Health status after total wrist arthrodesis for posttraumatic arthritis.

PURPOSE: Total wrist arthrodesis is regarded as the most predictable way to relieve the pain of posttraumatic wrist arthritis. Wrist arthrodesis also is believed to be compatible with a high level of upper-extremity function. This study evaluated the effect of total wrist arthrodesis on both general and upper-extremity-specific health status in patients treated for posttraumatic wrist arthritis. METHODS: By using an institutional review board-approved protocol 22 patients were evaluated an average of 6 years after total wrist arthrodesis for posttraumatic arthritis. Upper-extremity-specific and general health status were measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire and the Short-Form 36 (SF-36) instruments, respectively. Patient satisfaction and interest in pursuing a wrist-mobilizing procedure should one become available also were assessed. Objective assessment included grip strength, digit range of motion, and radiographic fusion. RESULTS: Grip strength averaged 79% of the uninvolved wrist. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 25. The average physical component score of the Short-Form 36 was 39 and the average mental component score was 52. Fourteen patients complained of wrist pain, including severe pain in 4 patients. Fifteen patients were satisfied or very satisfied with the result of the fusion, 5 patients were neutral, and 2 patients were mildly dissatisfied. Twenty patients would elect to have a procedure that could make their wrist move again if one were available. CONCLUSIONS: Substantial dysfunction was noted on both upper-extremity-specific and general health status measures after total wrist arthrodesis for posttraumatic conditions. Pain was improved but not eliminated.

Adult↗

PubMed2005

Trial pinning prior to wrist arthrodesis in children.

The purpose of this investigation was to assess the utility of trial wrist pinning as an assessment tool prior to wrist arthrodesis in the paediatric patient. Ten paediatric patients who were unable to decide if a wrist arthrodesis would be beneficial to them underwent a trial wrist pinning (using temporary K-wires) in neutral posture for an average of 28 days. The etiology of wrist pathology varied. The utility of the trial pining in decision-making was assessed through chart review and telephone conversation. All patients felt the trial pinning facilitated their decision. Two of the 10 patients declined wrist arthrodesis secondary to difficulty with daily activities. Eight patients who underwent wrist arthrodesis were satisfied with wrist position and function. Temporary wrist pinning is an effective informational tool for patients, families and physicians, allowing a true assessment of wrist function prior to definitive wrist arthrodesis.

Activities of Daily Living↗

PubMed2006

[Scapho-trapezio-trapezoidal arthrodesis for scapho-trapezio-trapezoidal osteoarthritis].

Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months. Pain was classified according to Alnot's classification: eight patients were classified as grade III, two as grade IV and two as grade II. The average preoperative range of motion of the wrist was 51 degrees for flexion, 39 degrees for extension, 9 degrees for radial deviation and 28 degrees for ulnar deviation. Grip strength was compared to the contralateral side. Radiographic changes were classified according to Crosby's classification, including sublevels for carpal instability. Four wrists were classified 2a and nine wrists were classified 2b. The average radio-lunate and scapho-lunate angles were 14 and 45 degrees respectively. Pain was improved in all patients (P = 0.05) all of whom were subjectively satisfied. Strength and range-of-motion did not statistically decrease after STT arthrodesis except for wrist extension (P = 0.03). Radio-lunate and scapho-lunate angles were unchanged in five patients and improved in five patients. There were four non-unions of whom two patients without pain were not re-operated. The other two were re-operated with the same technique leading to fusion. Scapho-trapezio-trapezoid arthrodesis is an efficient procedure for STT osteoarthritis with regard to pain reduction. Strength and global range-of-motion are not modified by this procedure. Moreover, as it limits carpal instability, this procedure is preferable in active patients.

Adult↗

PubMed2001

Arthrodesis after osteosynthesis and infection of the ankle joint.

Nineteen patients with a severely infected ankle joint after previous osteosynthesis were treated with arthrodesis in our institution. Their notes and X-rays were reviewed. Goals of treatment were eradication of infection by aggressive débridement of infected tissues, obtaining adequate soft-tissue coverage, preservation/restoration of bonelength, and finally consolidation of the arthrodesis. Thirteen men and six women were treated, with a median age of 46 (17-69) years. Arthrodesis took place after a median of 6 months (0.5-40) post-accident, and after one to six earlier operative procedures. Primarily there had been four bimalleolar, five trimalleolar and ten pilon tibial fractures. Fifteen fractures were open with severe soft tissue damage. Seven free muscle transfers were performed, and ten cancellous bone graftings. Finally 29 attempts at arthrodesis were performed. Ultimately we had to perform two amputations. After a mean follow up of 3.5 years, one patient has an aseptic but asymptomatic pseudarthrosis, for which no further surgery is scheduled. Sixteen extremities are free from infection while full weightbearing is possible. The limb-threatening problem of deep infection after osteosynthesis of an ankle fracture can be resolved by consistent but prolonged treatment. After successful arthrodesis a weightbearing extremity without infection remains in the majority of cases.

Adolescent↗

PubMed2004

[Arthroscopic knee arthrodesis: 4 cases].

PURPOSE OF THE STUDY: Arthroscopic arthrodesis of the knee joint is an alternative to classical surgery, which retains a few exceptional indications. We report the first four cases of our experience, describing the technical modalities and indications. MATERIAL AND METHODS: The four patients had undergone multiple operations for severe trauma. All four had persistent severe pain with a very limited walking distance. Before the procedure, the IKS score ranged from 11 to 44 and the mean function score was 20 to 45 points. Arthroscopic arthrodesis was proposed after several consultations and took into account the young age of the patient and a positive brace test. The successive arthroscopic times were: exploration and adherence release, complete extramural meniscectomy, joint surface avivement. Traction was not necessary. Careful avivement spared the anatomic curvatures of the condyles and slightly scraped out the plateaus. Finally, the arthrodesis was fixed in correct position under fluoroscopy using a single tube external fixator. The fixation was maintained until fusion (satisfactory x-ray and no pain). RESULTS: A drain was inserted only for the first patient. There were no cutaneous complications. Patients were discharged after 3 days on the average with immediate simulated weight bearing using two crutches. The external fixator was dynamized at two months (mean) and removed at five months. The functional gain was considerable in four patients, assessed at two years, with a mean IKS score of 75 and a mean function score of 80. The four patients walked without crutches and without pain. Single leg stance was stable. Final leg shortening was 1 to 2 cm. CONCLUSION: The arthroscopic approach provides several benefits: uneventful postoperative period, little bleeding, no cutaneous complications, shorter hospital stay. The time to fusion appears to be shorter than with classical techniques, but cannot be demonstrated clearly because of the diversity of the series reported in the literature. Arthroscopic arthrodesis does not require any special instruments, but does require surgical skill and a lengthy procedure. When arthrodesis is required the arthroscopic procedure is indicated for minimally deformed knees without major loss of bone stock.

Adult↗

PubMed2005

[Shoulder arthrodesis with vascularized fibular graft after tumor resection of the proximal humerus].

PURPOSE OF THE STUDY: Resection of malignant tumors of the proximal humerus often requires dissection of the rotator cuffs and the deltoid muscle. There is no consensus on the ideal method for shoulder reconstruction. We report the functional outcome in a homogeneous series of eight patients treated by arthrodesis using a vascularized free fibular flap. MATERIAL AND METHODS: Eight patients were included in this study. All had an aggressive tumor of the upper humerus. Tumor resection was associated with a rotator cuff and deltoid muscle resection in all patients. All patients then underwent shoulder arthrodesis using a free vascularized fibular flap fixed with a plate. Clinical and radiological evaluation was available for six patients at mean 28 months. The Musculoskeletal Tumor Society function score was used to assess overall function of the upper limb. The cosmetic outcome and radiographic bone healing as well as hypertrophy of the fibular graft were noted. RESULTS: Active abduction and active flexion were 82 degrees on average. All patients could bring their hand to the mouth. Circumduction was possible but limited in amplitude. The mean function score was 26.5/30 with an excellent functional outcome in all patients. The cosmetic outcome was considered poor by all patients. Radiographically, bone healing was achieved at last follow-up in all patients but there was one case of failed fusion between the fibular graft and the scapula which required secondary iliac grafting. Mean fibular graft hypertrophy was 32.8% at last follow-up. DISCUSSION AND CONCLUSION: Two reconstruction methods have been described for patients who require tumor resection of the upper humerus: reconstruction with preservation of glenohumeral joint function and shoulder arthrodesis. Many techniques have been described for each method. It is however difficult to compare the different series reported in the literature because rotator cuff and deltoid muscle resection was not systematically performed and reconstruction methods varied between patients. An analysis of the literature shows that preservation of motion of the scapular glenoid joint can give good functional results when the rotator cuff and deltoid muscle can be preserved. If they cannot, results favor shoulder arthrodesis which provides the patient with very satisfactory upper limb function. Use of a vascularized fibular flap has provided very good arthrodesis results. The patient must however be informed of the probable poor final cosmetic result.

Adolescent↗

PubMed2000

Potential of the back propagation neural network in the assessment of gait patterns in ankle arthrodesis.

OBJECTIVE: The purpose of this study was to recognize gait pattern in ankle arthrodesis by using a neural network trained with time domain input and compare the performance of the neural network with the statistical method. DESIGN: Three-layered feed-forward back propagation neural network and a statistical method were used to classify gait patterns of patients with ankle arthrodesis and normal subjects. BACKGROUND: Although backpropagation neural networks are very efficient in many pattern recognition tasks, they have not been used for gait pattern recognition of ankle arthrodesis. METHODS: A total of eighteen parameters measured by force platforms, including nine force parameters and their chronologic incidence of occurrence, were used to classify gait patterns. RESULTS: The results showed that the neural network model was able to classify subjects with recognition rates up to 95.8%. In contrast, the statistical method was only able to classify the subjects with recognition rates of 91.5%. CONCLUSIONS: The backpropagation neural network method has better accuracy than the statistical method in discriminating subjects and the time domain features carry important prognostic information. RELEVANCE: It is important to be able to quantify the changes in gait pattern after arthrodesis to understand the clinical implications of arthrodesis.

Adolescent↗

PubMed1995

Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis.

Seventeen patients were treated with scaphoid excision and four-corner arthrodesis (lunate, capitate, hamate, triquetrum) for scapholunate advanced collapse wrist and followed for a mean of 27 months. Eleven wrists in 10 patients had a proximal row carpectomy for scapholunate advanced collapse wrist and were followed for a mean of 37 months. The total arc of motion averaged 95 degrees in the four-corner arthrodesis patients and 115 degrees in the proximal row carpectomy patients, which was 47% and 64%, respectively, of the range of motion of the opposite wrist. Grip strength averaged 74% of the opposite wrist in the four-corner arthrodesis group and 94% in the proximal row carpectomy group. Three wrists in the four-corner arthrodesis group failed and were successfully converted to a total wrist fusion; two additional patients were awaiting arthrodesis. There were no failures in the proximal row carpectomy group. Proximal row carpectomy showed a high degree of patient satisfaction and is our motion-preserving procedure of choice except in those wrists with advanced capitolunate arthritis.

Adult↗

PubMedDate not supplied

Nonresection triple arthrodesis: a retrospective analysis.

This case series examines triple arthrodesis using articular cartilage excision without bone resection. Due to the technically demanding nature of triple arthrodesis, the authors present a nonresection technique with its perceived advantages over joint resection triple arthrodesis in the presence of reducible deformity, such as minimal shortening of bone, ease of execution, and better bony apposition. Fourteen patients with nonresection triple arthrodesis from two medical centers are included in this report. Postoperative follow-up ranged from 6 to 36 months. Evaluation of results was performed subjectively and radiographically. There was a low incidence of nonunion (2% of joints) and minimal to no bone shortening (0.1 cm mean talonavicular shortening and 0.1 cm mean increase in talocalcaneal height). Mean time to fusion of joints fixed with screws was 9.91 weeks (SD = 3.61, n = 31), while fusion time for staple or pin fixation was 8.96 weeks (SD = 4.15, n = 10). There were no significant differences in time to fusion between screw and nonscrew fixation (p = .26) nor when comparing procedures within each patient (p = .30). At follow-up, five patients reported no pain at any time (36%); two patients reported mild occasional pain (14%). Moderate, daily pain was reported by seven patients (50%). While no direct comparison with resection triple arthrodesis was made, the positive subjective and objective results support this procedure.

Adolescent↗

PubMedDate not supplied

Midfoot arthrodesis using a locking anterior cervical plate as adjunctive fixation: early experience with a new implant.

A retrospective review was performed on 14 patients (20 arthrodeses) who had undergone midfoot arthrodesis with a semi-constrained, locking anterior cervical plate as a form of adjunctive fixation. Fusion sites where the plate was used for the purpose of arthrodesis included the talonavicular joint, medial naviculocuneiform joints, first metatarsal cuneiform joint, and the calcaneal cuboid joint. All arthrodesis sites used one other type of fixation for the purpose of axial compression. Twenty midfoot arthrodesis sites went on to radiographic union at a mean of 9.1+/-1.5 weeks. A single complication of hardware irritation occurred in one patient that resolved after plate removal. This semi-constrained, locking anterior cervical plate appears to be a viable adjunct to fixation constructs for the purpose of midfoot arthrodesis.

Adult↗

PubMed2002

Analysis of arthroscopically assisted ankle arthrodesis.

PURPOSE: Evaluation of an arthroscopically assisted ankle arthrodesis technique for clinical and radiographic union, function, and patient satisfaction. TYPE OF STUDY: Retrospective analysis and review of the literature. METHODS: Twenty-one patients with a mean age of 52.7 years who underwent arthroscopic ankle arthrodesis were examined at an average follow-up time of 34 months. The mean duration of symptoms was 4.4 years. The most common diagnosis for patients who underwent arthrodesis was post-traumatic arthritis (19 of 21) with 1 patient having a diagnosis of avascular necrosis of the talus and the other patient having rheumatoid arthritis. All patients described severe mechanical pain as the most important reason for undergoing the procedure. RESULTS: Fusion occurred in 20 of 21 patients. The average time to clinical and radiographic union was 8.9 weeks. Nine patients were graded as excellent; no pain, limp, or occupational restriction, and a stable fusion. Eleven were graded as good; mild pain, occasional limp, or occupational restriction with a stable fusion. One was graded as poor; failed union and pain. The failure had extensive avascular necrosis involving approximately 50% of the talus as a preoperative diagnosis. CONCLUSIONS: The advantages of the arthroscopic technique include a high fusion rate, decreased time to fusion, and decreased cost. There are considerable advantages to the arthroscopic technique in appropriately selected patients with no or mild angular deformity and no avascular necrosis greater than 30% of the talus. There is a substantial reduction in time to fusion in the arthroscopic procedure compared with published reports on open procedures for ankle arthrodesis. While this procedure is not indicated in all instances, selected patients with disabling ankle arthrosis may be more appropriately treated with an arthroscopic arthrodesis than by open surgery.

Adult↗

PubMedDate not supplied

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of three 4.5-mm and two 5.5-mm cortical screws.

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of 2 parallel-screw techniques for proximal interphalangeal joint arthrodesis in horses. STUDY DESIGN: Randomized block design, blocking for horse (1-5), method of screw fixation (three 4.5-mm vs two 5.5-mm), side (left limb vs right limb), and end (front limb vs hind limb). Constructs were loaded to failure in 3-point bending in a dorsal-to-palmar (plantar) direction. SAMPLE POPULATION: Twenty limbs (10 limb pairs) from 5 equine cadavers. METHODS: A combined aiming device was used to facilitate consistent screw placement. Three parallel 4.5-mm cortical screws were placed in lag fashion in 1 limb of a pair, and 2 parallel 5.5-mm cortical screws were placed in lag fashion in the contralateral limb. Arthrodesis constructs were tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials-testing machine. Loading rate was 19 mm/s. Maximal bending moment at failure and composite stiffness were obtained from bending moment-angular deformation curves. Data were analyzed using ANOVA and chi(2) analysis. RESULTS: There were no significant differences in bending moment (P >.05, power = 0.8 @ delta = 19%) or composite stiffness (P >.05, power = 0.8 @ delta = 19%) between the 2 fixation techniques. Higher maximal bending moment was found in front limbs than hind limbs, and front limbs with two 5.5-mm screws than hind limbs with two 5.5-mm screws. In all cases, constructs completely failed. A greater number of 4.5-mm cortical screws failed than 5.5-mm cortical screws. CONCLUSIONS-In pastern arthrodesis constructs loaded in 3-point bending, end (front limb vs hind limb) affected maximal bending moment at failure of constructs. There was no significant effect of horse, treatment, or side on maximal bending moment or stiffness. Two 5.5-mm cortical screws should provide a surgically simpler pastern arthrodesis than three 4.5-mm cortical screws while maintaining similar biomechanical characteristics. CLINICAL RELEVANCE: Three 4.5-mm screws or two 5.5-mm screws will provide similar biomechanical characteristics in bending when performing equine pastern arthrodesis.

Animals↗

PubMed2000

[STT arthrodesis for treatment of stage III semilunar bone necrosis: functional outcome].

Scapho-trapezio-trapezoid arthrodesis for the treatment of Kienböck's disease is recommended as a salvage procedure for Stage III A and B in the Lichtman classification. This study reviews the results of 26 patients with stage III of Kienböck's disease treated by STT-arthrodesis. 26 patients (16 male, 10 female) were treated by STT-arthrodesis between 1993 and 1998. Fusion was established after seven weeks average. All patients were examined, the mean follow-up time was 35 (10 to 72) months. Active range of motion showed 63% of extension/flexion and 51% of radial/ulnar deviation on average, compared to the uninjured hand. Mean preoperative and postoperative pain scores were 58.4 (non-stress) vs. 82.5 (stress) and 16.4 (non-stress) vs. 33.7 (stress), eight patients claimed complete pain relief. Grip strength improved to 71% of the opposite side. Total DASH score reached 24.8. 20 of the 26 patients were satisfied with the final result and would undergo the operation again. We found a significant reduction of pain, a slightly reduced grip strength and a satisfying functional wrist mobility after STT-arthrodesis. Carpal height was unchanged and the carpal collapse did not progress. The mid-term data support that STT-arthrodesis will stand the test of time.

Adult↗

PubMedDate not supplied

[Shoulder arthrodesis. Possible causes of functionally poor results].

Due to severe articular destruction of the glenohumeral joint with corresponding soft tissue changes arthrodesis has been performed in 24 patients since 1973. After an average period of 5.4 years (2-15) years, 22 patients were reviewed. Primary bone consolidation was achieved in all cases. During the observation period in 7 cases one of the following additional operations had to be performed on the involved shoulder: subcapital osteotomy due to excessive abduction (2 cases), resection of the acromio-clavicular joint due to painful osteoarthritis (2 cases), partial resection of an ugly acromion projecting laterally (1 case), removal of the fixation plate protruding proximally (4 cases). 18 patients experienced a marked improvement after arthrodesis. No improvement in 2 cases and a deterioration in 2 cases were the result of a not optimal positioning of the arthrodesis. A position of 20 of abduction, 20 to 30 of flexion and 45 of internal rotation proved to be functionally the most beneficial. Patients will be only painless if the optimal position of the arthrodesis was achieved. Excessive abduction and flexion was generally experienced as unpleasant. Deviation in the rotational position leads to functional restriction. The remaining function after arthrodesis is often overrated.

Activities of Daily Living↗

PubMedDate not supplied

Outcome of two salvage procedures for posttraumatic osteoarthritis of the wrist: arthrodesis or proximal row carpectomy.

PURPOSE: to compare a motion preserving procedure of the wrist with the wrist arthrodesis, the so-called gold standard in patients with posttraumatic wristpain. DESIGN: non randomized retrospective SETTING: University Hospital--referral centre PATIENTS: we studied two groups of patients with posttraumatic wrist pain due to osteoarthritis of the radiocarpal joint: one group of 35 patients underwent a radiocarpometacarpal arthrodesis, the other group of 26 patients a proximal row carpectomy (PRC). There were no significant differences in age and gender or hand dominance distribution. INTERVENTION: proximal row carpectomy versus radiocarpal arthrodesis. OUTCOME MEASUREMENTS: DASH (disability of arm, shoulder and hand) gripping force, return to activity, complications and reintervention frequence. RESULTS: Disability (DASH score) and regaining professional activity was significantly better in the PRC group. There was no significant difference in gripping force between the PRC and the arthrodesis group. Complications were less numerous. CONCLUSION: A mobility saving procedure as a PRC is preferable over an arthrodesis in patients with posttraumatic wrist osteoarthritis.

Arthrodesis↗