Andres Keller

Cavovarus foot reconstruction.

This article presents a surgical protocol for surgical reconstruction from the subtle cavus foot described by Manoli to the most complicated cases. The goal is to merge together the available surgical options in a comprehensive way to guide surgical decisions.

Early Weight-Bearing After Percutaneous Reduction and Screw Fixation for Low-Energy Lisfranc Injury

Background: Anatomic restoration and postoperative rehabilitation of displaced fracture-dislocations of the tarsometatarsal junction of the foot are essential. Our objective was to report percutaneous reduction and screw fixation results in low-energy Lisfranc fracture dislocation injuries that were treated with early weight-bearing and rehabilitation. Methods: We retrospectively evaluated patients with low-energy Lisfranc injuries who underwent surgery between May 2007 and April 2011. The study reviewed 22 patients (12 men and 10 women) with an average age of 36.2 years (range, 16-50 years) and an average follow-up of 33.2 months (range, 12-50 months). We report the mechanism of trauma; quality of reduction in the postoperative digital radiographs; subjective satisfaction; AOFAS score; time required to return to work, recreational activities, and low-impact sports; and complications. Postoperatively, all of the patients were instructed to be non-weight-bearing for 3 weeks, and the stitches were removed after 2 weeks. At the third postoperative week, the patients were encouraged to bear weight as tolerated. Results: Quality of reduction was anatomic or near anatomic in 100% of cases. The subjective satisfaction reported by patients was very good, with complete satisfaction in 20 of them (90.9%). The AOFAS average was 94 points (range, 90-100 points). Average return to work was at 7 weeks (range, 6-9 weeks), recreational activities 7.2 weeks (range, 6-9 weeks), training for low-impact sports 7.6 weeks (range, 7-8 weeks), and symptom-free sport activities 12.4 weeks (range, 11-13 weeks). Conclusion: In this selected group of patients with low-energy Lisfranc fracture dislocation, anatomic or near-anatomic reduction can be achieved with percutaneous reduction and screw fixation. Early weight-bearing is possible in these patients, and early return to regular activities and low-impact sport can be expected. Level of Evidence: Level IV, retrospective case series.

Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus

Background: The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates. Materials and Methods: One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications. Results: The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%). Conclusions: The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities. Level of Evidence: Level IV, case series.

Proximal Oblique Slide Closing Wedge Metatarsal Osteotomy With Plate Fixation for Severe Hallux Valgus Deformities

Proximal metatarsal osteotomies are generally recommended for severe hallux valgus deformities. The most common problems encountered with these osteotomies are overcorrection, that is, hallux varus and dorsal malunion because of either technical errors or fixation failure. We report our first 12 cases of severe hallux valgus deformities treated with a modified proximal metatarsal osteotomy fixed with angular stable plates, with an average American Orthopaedic Foot and Ankle Society preoperative score of 50 points, average intermetatarsal angle of 15 degrees, and metatarsophalangeal angle of 36 degrees. The osteotomy was performed from the dorsal to the plantar aspect of the bone, removing a small bone wedge laterally as determined in the preoperative planning, and translating laterally the distal fragment. In this way, rotation and lateral displacement of the distal fragment was performed until intraoperative parallelism between the first and second metatarsal bone was obtained. The osteotomy was fixed with an angular stable plate, with 2 locked screws proximally and 3 distal nonlocked screws. The geometric model of the osteotomy, preoperative planning, technique, early results, and complications are shown.

Modified Diaphyseal Osteotomy With a Proximal Center of Rotation for Moderate to Severe Hallux Valgus

Abstract This study shows a modification of the scarf osteotomy, using a rotational and translational movement with a proximal center of rotation to correct moderate to severe hallux valgus deformities. The mathematical model of the osteotomy and the preoperative planning is presented, using the estimated intermetatarsal angle correction needed. A long oblique diaphyseal osteotomy is performed, with a short distal dorsal arm oriented 90 degrees to the long diaphyseal osteotomy, and a short plantar proximal arm oriented 90 degrees to the long osteotomy line. The distal fragment is rotated around a center of rotation located 15 mm proximal to the metatarsal cuneiform joint and fixed with 3 screws. The short-term results and complications are presented.

Plate position and angular stability: mechanical comparison in sawbone osteotomy models.

Proximal metatarsal osteotomies are inherently unstable and difficult to fix. The purpose of this study was to compare the mechanical stiffness in sawbone models of medially versus dorsally placed plates and then to compare semilocked versus nonlocked plates in different osteotomy configurations. Thirty sawbone models were constructed, fixed either with titanium self-locking or steel mini-fragment plates. They were divided in groups and their stiffness was measured. The stiffness of any model fixed with medial titanium or steel plates was on average 158% and 228% greater, respectively, compared to dorsal plates. Adding a dorsal shelf of bone to a proximal closing wedge osteotomy increases its stiffness. Using locked plates increased the mechanical stiffness in only one configuration. The article suggests that models fixed with medial plates have greater resistance to failure than models fixed with dorsal plates. Using locked plates does not increase the mechanical stiffness of the construct.

Cross-cultural adaptation and validation of the VISA-A questionnaire for Chilean Spanish-speaking patients

BackgroundThe purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population.MethodsAccording to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test.ResultsAll six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson’s r = 1.000) within an hour and within a week (rho c = 0.837; Pearson’s r = 0.840).ConclusionsVISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.

Case Report: Spontaneous Rupture of the Ankle Extensor Retinaculum

Spontaneous rupture of the extensor retinaculum of the ankle is a rare condition, only reported a few times in the literature. We present a case report of a spontaneous rupture of the ankle extensor retinaculum, which was reconstructed with a fascia lata autograft, along with a discussion of the literature.