Welcome to our sixths episode of the Ankle Surgery Update, this time on time and all about the hindfoot! The papers presented are:
Thank you very much for listening to Ankle Surgery Update – Science Guiding Treatment. We hope you enjoyed this episode and make sure to tune in for our next episodes!
Hans & Sebastian
Welcome to our sixths episode of the Ankle Surgery Update, this time on time and all about the hindfoot! The papers presented are:
Thank you very much for listening to Ankle Surgery Update – Science Guiding Treatment. We hope you enjoyed this episode and make sure to tune in for our next episodes!
Hans & Sebastian
Welcome back everybody to the second part of this month episode of ankle surgery update science guiding treatment. This time we put two papers dealing with the hindfoot after dieses the first paper investigated the effectiveness of closed author diseases in infected neuropathic ankle using Eliza rough ring fixation. The second paper had a look at the long term pain impairment following out loges bone grafting from various regions. In the first paper, we had a look at what was published in the bone and joint journal by Allah Martel. The studies entitled closed out for these infected neuropathic ankles using Eleazar freeing fixation infected and deform neuropathic feet and ankles are a serious challenge for surgery.
Unknown Speaker :Management. Furthermore, patients with these conditions must be considered a high risk population. Ankle arthrodesis is often the only way to treat the deformity for open ankle after these high complication rates have been reported. Consequently, minimally invasive techniques should be considered. In this study, the author's took the minimally invasive technique a step further, and evaluated their experience of performing ankle after disease in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement. Instead, they simply applied an Eliza free fixator to correct the deformity in arthritic neuropathic ankles with associated osteomyelitis. retrospectively, all patients who underwent closed ankle after pieces in the LSR of scientific centre from 2013 to 2018, were reviewed and compared with a similar group of patients who underwent open ankle after these options
Unknown Speaker :Patients included suffered from our simulators, and had a neuropathy, such as charcoal joint, or shark or Mary tooth disease in the close group after these were performed without drawing preparation by simply applying an ilizarov ring fixator in the Open Group and open debridement of the cartilage was performed, and thereafter the ring fixator was applied. If any soft tissue treatment was needed, it compromised of a percutaneous release of the Achilles tendon only. All patients were followed up clinically and radiographically for a minimum of 12 months to assess both the union and function. In the close group 21 patients were included with a union rate of 81%. The for patients suffering and non union all showed a recurrence of the infection and underwent revision with an open technique and then achieved union. In the Open Group 39 patients were included.
Unknown Speaker :demonstrating a union rate of 85%. Again, the reason for non union in these six patients was a recurrence of the infection and all healed after open revision surgery. mean duration in the ilizarov ring fixator was 72 days in the closed group and 69 days in the open Methodist group. The American orthopaedic foot and ankle society hindfoot score was comparable for both groups. According to the authors in the Open Group, more wound complications was observed without stating any details. The mean operating time was 40 minutes in the clothes compared to 80 minutes in the Open Group. The authors concluded the clothes and cloth or diseases using an hour of ring fixator is an effective method for ankle after dieses infected neuropathic foot and ankle cases and afforded comparable results to the open methods. They are
Unknown Speaker :convinced that the ilizarov method should always be considered for neuropathic ankles in suitable patients. Most definitely the laser of scientific centre is a highly specialised centre with great expertise of complex cases, and the use of rings fixators. The author's introduced various new concepts in this paper. First, to my knowledge at least, it is the first paper on a close technique for Arthur dieses without any joint preparation. From a traditional point of view, it is hard to imagine a joint to fuse just because it's being immobilised and compressed using external fixator. Furthermore, if this concept really leads to bone fusion, how can we ensure that only the ankle joint is fused? other joints such as the sub Taylor and the joint of the hind and midford did not fuse, although they were equally mobilised and compressed by the rain.
Unknown Speaker :fixator this technique really leads to fusion of the ankle, it must result at least in a functional aphrodisiac of the hind and midfoot. Second, it is noteworthy that only patients with an osteomyelitis were included, and apparently no operative Friedman was performed regarding the infection prior to fusion neither closed nor in the group. Still infection rates were 19 and 16% only. Unfortunately, nothing is reported regarding the use of antibiotics or any other treatment to address the osteomyelitis. Again, from a conventional point of view, most surgeons will perform various debridement prior to the birth of Jesus. It is astonishing that according to the authors, no specific treatment is necessary to fuse an infected joint. This most definitely is against
Unknown Speaker :new concept, which will require more studies before being implemented in everyday clinical practice. Third, the author stated that correction of the deformity was achieved immediately during the first operation, with in some cases additional percutaneous release of the Achilles tendon, but no other parry Taylor releases. This is even more astonishing when looking at the pictures of the severely deformed exemple attari presented in the study, other studies using external fixator required weeks to month of gradually correcting the deformity. Furthermore, most of the studies available report that a much more extensive soft tissue release is necessary in order to achieve a plantigrade foot. Last but not least, the meantime and fixators seems extremely short with 72 days in the closed and 69 days in the
Unknown Speaker :Group. Afterwards, the patient were immobilised in a cast, and progressed to full weight bearing over a short period of time. This is in contrast to many other studies reporting much longer time frame. Besides that, from my point of view, the study's servers various minor limitations, but to go into more detail would be too much for now. Okay, hands. So what did we learn for our daily practice? Well, that Sebastian is really a good question. From my point of view, the lesson learned is that there might be situations in which fusion of the ankle could be possibly achieved without preparation of the joint. In super high risk patients, we might try this one day. The second study is entitled long term autographed harvest side pain after ankle and hind foot after dieses. By Bom Howard, I'll publish in foot and ankle internet
Unknown Speaker :autoloaders bone grafting is one of the essential techniques to promote bone healing in cases of non union or arthrodesis. It is believed to be superior to allergenic or synthetic grafts, as it contains additional bone growth factors. Still the major downside to autoloaders, bone grafting or harvest side complications. The most commonly used regions for the Lotus bone harvesting are duly addressed, and it is well known that about 20% of patients suffer harbour side related complications, with pain being the most frequent. In 2014. Judith bomb Hauer investigated, amongst others, graft side complications after one year per different harvest sites in 130 patients. The site's investigated were in descending order, the proximal tibia, distal tibia calcaneus, and the iliac crest
Unknown Speaker :After one year 9% of patients had clinically significant pain at the bone harvest side, which did not differ significantly between the groups. The authors now published a follow up study with the same patient population, but a minimum follow up of five years. They reassessed harvest pain site fusion site pain and weight bearing pain using a 100 point visual analogue scale 58 patients, which equals 45% of the original cohort, were available for the current follow up at a mean of nine years after the initial surgery. The harvest sites, again in descending order were the proximal tibia iliac, crest calcaneus, and the distal tibia. Whereas round about 50% of the patients were available for follow up in the proximal tibia, iliac crest and calcaneus group only 17% of the distance
Unknown Speaker :tibia group were available for a follow up 37% of the patients were board some level of graft terrorist side pain, the actual vast scores are not stated clearly. Instead, the office chose a cutoff of 20 points, defining clinically significant pain. Based on this criterion, only three patients which equals 5% reported a clinically significant graft however side pain in two patients the graft had been harvested at the proximal tibia, which equals 7% and the proximal tibia cord in one patient. The graft had been harvested at the area crest, which equals 10% in the iliac crest court. These patients also had higher pain level at each previous follow up. Finally, no correlation could be found between graph volume and pain. The authors concluded that patients should
Unknown Speaker :Be informed that autoloaders bone graft harvesting can result in chronically and clinically significant pain. Thanks for presenting this papers of oestrogen. Despite the considerable loss of follow up. The follow up period presented by Baum, Hart and colleagues is impressive.
Unknown Speaker :Going through the paper, to me it remained a little unclear what the actual last points chords were. They might be presented in figure two, but at least the one year follow up data are hard to interpret. But more importantly, the paper does highlight the importance of one of our daily problems. bone graft harvesting the site where to harvest the bone is predominantly determined by the volume of bone needed. If only small volumes are needed, it is convenient to harvest the bone within the actual surgical field. For example, when doing a mini open a make procedure on the anterior lateral tailors the distal tibia is
Unknown Speaker :Easy to reach in case larger volumes of trabecular bone are needed. The only two sides suitable for us are the iliac crest or the proximal tibia. Previous studies were able to demonstrate that the same amount of bone can be harvested from both these locations, there is a seemingly endless discussion on which of the two locations is favourable. On the one hand, previous studies have reported considerable complications when hovering at the iliac crest. These include nerve injuries, fractures, and most importantly, long lasting pain. On the other hand, multiple colleagues favour the iliac crest because of presuming Lee favourable biological properties of the mesenchymal stromal cells contained therein. Still, this had never been proven. Therefore, we conducted a study comparing the proliferative and osteogenic differentiation capacity of the mesenchymal stromal cells
Unknown Speaker :isolated from grafts harvested at either the iliac crest or the proximal tibia. Based on almost 50 samples, we found comparable biological properties of the mesenchymal stromal cells for both of these harvesting sites. Based on these findings we choose whenever possible, the proximal tibia as bone graft harvesting site. Thank you, Hans. I think this is one of the great parts of doing research that we do see a clinical problem that everybody is talking about and not really anybody has had a look into. And the study you presented on the 50 samples, looking at the biological properties of the two harvesting sites really is amazing. But let's come back to the study. I think the study by baja and colleagues does highlight two things. First, longitudinal data collection over decades is essential and definitely worth the effort. Second, we have to pick
Unknown Speaker :close attention to not only inform patients on complication than the expectations of the dominant part of the surgery, but also on possible effects of accompanying interventions such as bone graft harvesting. Although only a minor aspect of the whole surgery, it by itself can result in a possible lifelong impairment. Thank you everybody for listening to this month episode of ankle surgery update. It again has been fun and we're very much looking forward to your feedback. Stay tuned and make sure to tune in next time.