Jorge Javier del Vecchio

Minimally invasive Akin osteotomy and lateral release: Anatomical structures at risk-A cadaveric study.

BACKGROUND Among the many surgical techniques used for hallux valgus correction, different osteotomies may be performed in the proximal phalanx as well as lateral release as associated procedures. The aim of this study is to analyze the anatomical relationships and the risks for the soft tissue lessions when performing the dorsomedial minimally invasive surgery (MIS) portal for the Akin osteotomy, and the MIS dorsolateral portal for lateral release, in order to define a safety zone when conducting the procedure in order to avoid complications. MATERIALS AND METHODS The procedures were carried out on 16 fresh-frozen cadaveric feet. A MIS dorsomedial and dorsolateral portals were performed. The anatomical dissection of the cadaveric pieces was carried out and the different anatomic and surgical relationships were analyzed and measured. RESULTS No nerve injury was found. Injury of the extensor hallucis longus (EHL) paratendon were seen in 9 cases (56%). There was no injury of the flexor hallucis longus (FHL) tendon and or collateral plantar nerves. A partial injury of the FHL sheath was observed in 44% of the samples. CONCLUSIONS Although percutaneous Akin osteotomy is clinically effective, the possibility of injury of anatomic structures is high (9-55%), however injuries upon vascular or nerve structures were not seen.

Charcot neuroarthropathy in simultaneous kidney–pancreas transplantation: report of two cases

Charcot neuroarthropathy (CN) is considered a major complication in diabetes mellitus (DM), and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney–pancreas transplantation (SKPT) is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charcot-modified clinical presentation during the postoperative convalescence period after SKPT have been described. The clinical presentation may condition severe destructive lesions, and good practices include systematic follow-up. Based on the cases described, SKPT is one more entity that might lead to CN ‘foot-at-risk’. The aim of this article is to describe two cases of neuropathic arthropathy with rapid progression in the short term after SKPT.

Minimally Invasive Medial Plating of Low-Energy Lisfranc Injuries: Preliminary Experience with Five Cases

Fracture dislocations involving the Lisfranc joint are rare; they represent only 0.2% of all the fractures. There is no consensus about the surgical management of these lesions in the medical literature. However, both anatomical reduction and tarsometatarsal stabilization are essential for a good outcome. In this clinical study, five consecutive patients with a diagnosis of Lisfranc low-energy lesion were treated with a novel surgical technique characterized by minimal osteosynthesis performed through a minimally invasive approach. According to the radiological criteria established, the joint reduction was anatomical in four patients, almost anatomical in one patient (#4), and nonanatomical in none of the patients. At the final follow-up, the AOFAS score for the midfoot was 96 points (range, 95–100). The mean score according to the VAS (Visual Analog Scale) at the end of the follow-up period was 1.4 points over 10 (range, 0–3). The surgical technique described in this clinical study is characterized by the use of implants with the utilization of a novel approach to reduce joint and soft tissue damage. We performed a closed reduction and minimally invasive stabilization with a bridge plate and a screw after achieving a closed anatomical reduction.

Non-irradiated frozen structural allograft in reconstructive surgeries of the hindfoot and midfoot

BACKGROUND A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. METHODS We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between April 2004 and April 2010. The mean follow up period was 45.4 months. The results were evaluated according to AOFAS score, X-ray (allograft consolidation, alignment preservation, and allograft collapse or re-absorption), and complications. RESULTS We observed a 48-point mean improvement of AOFAS ankle and hindfoot score (17 cases), and a 53-point mean improvement of AOFAS midfoot score (3 cases). The mean bone consolidation time was 75 days. No graft fracture and no cases of non-union were seen. CONCLUSION This treatment is a good option to treat severe defects or fill sequelae deformities.

Percutaneous, intra-articular Chevron osteotomy (PICO) for the treatment of hallux valgus. A Cadaveric Study

Introduction/Purpose: Percutaneous or minimally invasive surgery (MIS) forefoot surgery has experienced a vertiginous and sustained growth especially in the last decade. This is supported by numerous studies among which can be mentioned: clinical series, comparative studies, technique reports, radiological validations. Two cadaveric studies considered percutaneous forefoot surgery safe and has reported minimal risk which is consistent with clinical studies. We can consider that MIS forefoot surgery is transiting a sustained and responsible experience based on Third generation (TG) techniques (Open Chevron like). The purpose of this cadaveric study was to investigate the risk of iatrogenic neurovascular and tendon injury in a TG technique. Particularly, this study evaluated the Percutaneous, Intraarticular, Chevron Osteotomy (PICO) for the correction of hallux valgus.

Letter Regarding: Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty

Dear Editor, We read carefully and with great interest the study “Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty” by Jung et al. They performed an interesting study on 54 ankles (52 patients) that were treated with total ankle arthroplasty (TAA) and 6 cases presented a heterotopic ossification (HO) as a complication. The authors presented a new classification, which is a modified version of the one by Brooker et al (table 1; figure 1), a bisecting line of the talar prosthesis was defined as the line horizontally dividing the talar component into halves between the uppermost margin and the lowermost margin of the talar component in the lateral ankle radiograph. The Brooker classification is used worldwide, and numerous modifications have been proposed. The authors made a great contribution to the subject and will be useful for the elaboration of new studies. However, we have some considerations to make. The Brooker classification used plain anteroposterior (AP) pelvic radiographs to grade HO after THA, and it was shown that it has imperfect interobserver reliability; however, it has many advantages, including its widespread familiarity, simplicity of use, and the ubiquity of AP pelvic radiographs after THA. This remains a widely cited and used classification system for management of and research on HO. There have been numerous reports of posterior ankle HO. In the Angthong et al series, the authors showed that 80% and 95.6% of ankles showed heterotopic ossification on anteroposterior and lateral views, respectively, and 97.8% showed evidence on either anteroposterior or lateral views, but they do not subclassify the lesions. We believe that anterior and posterior HO at the ankle can be subdivided into medial and lateral. To support this, we present unpublished data of a case that presented a talar anteromedial HO (Figures 1-8) after a Hintegra TAA and an anteromedial miniarthrotomy was done to treat it (Figures 9 and 10). We can see here that no HO is evident on the lateral and sagittal computed tomographic (CT) views, but being present in the AP view and coronal CT. 712986 FAIXXX10.1177/1071100717712986Foot & Ankle International letter2017