Cintia Kelly Bittar

Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

Objective To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. Methods This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1) open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2) open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3) open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. Results Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. Conclusion Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeons experience with the surgical technique chosen.

Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator

Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery.

Tibiotalar Arthrodesis in Posttraumatic Arthritis Using the Tension Band Technique

Background: Although a variety of surgical techniques are available for the treatment of ankle degenerative disease, arthrodesis is a common treatment especially for unilateral posttraumatic arthritis in young patients. A clear trend toward internal fixation for ankle arthrodesis is evident, but fusion site compression is known to play an integral role in primary bone healing. Methods: Between September 2001 and October 2009, 17 adults with painful end-stage posttraumatic ankle arthritis were treated with the tension band technique to achieve tibiotalar arthrodesis. Results: Tibiotalar fusion was obtained in all patients at a mean of 16.6 (range, 13 to 28) weeks. No patient had pain at the last postoperative follow-up examination. AOFAS and Mazur scores were preoperatively 29 and 23.1, respectively, and postoperatively 71.1 and 70.7, respectively. Conclusion: Arthrodesis with a tension band was a safe and effective surgical treatment option for posttraumatic ankle arthritis in patients without infection and good bone density, as it was simple, less invasive, and inexpensive and allowed early full weight-bearing. Level of Evidence: Level IV, retrospective case series.

Functional and clinical results achieved in congenital clubfoot patients treated by Ponseti's technique

Objectives To analyze and evaluate functional and clinical results in patients with congenital clubfoot treated with Ponsetis technique. Methods This study evaluated 31 patients diagnosed with 51 congenital clubfeet, treated between April 2006 and September 2011 with Ponsetis technique. The patients who did not achieve an equinus correction with manipulation were treated with Achilles tenotomy. An anterior tibial tendon transfer was performed in patients who maintained residual adduction. All plasters were made by fellows and supervised by Ankle and Foot Chiefs. The technique was performed without the need for physical therapists, orthotics, and plaster technicians. Patients were submitted to pre- and post-treatment examination and evaluated under Piranis classification. Results Male patients had an increased incidence and the right side was more affected, while bilateral involvement was observed in 64.5% of the cases. The mean number of cast changes was 5.8, and Achilles tenotomy was necessary in 26 patients. There were significant deformity improvements in 46 of the 51 treated feet (90.2%); Piranis mean score improved from 5.5 to 3.6 after treatment. Conclusion The Ponseti method was effective in both functional and clinical evaluation of patients, with significant statistical relevance (p = 0.0001), with a success rate of 90.2% and mean improvement in the Piranis index of 65.5%.

Use of the semitendinosus tendon for foot and ankle tendon reconstructions

Objective To demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patients degree of satisfaction and complications in the graft donor and recipient areas were evaluated. Methods This was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients’ degree of satisfaction were evaluated. Results Three patients presented complications in the recipient area (skin necrosis); one patient showed complications in the donor area (pain and insensitivity); and all patients had satisfactory functional results, with complete range of motion. Conclusion The semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.