Juan Manuel Yañez Arauz

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.

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.

Osteochondral Lesions of the Talus Treatment With Fresh Frozen Allograft

INTRODUCTION Symptomatic talar osteochondral lesions are about 50% refractory to conservative treatment requiring a surgical solution. In the case of large chronic lesions, the use of bone graft taken from tissue bank is an alternative that enables to fill the defect without causing donor site morbidity. MATERIAL AND METHODS Eight patients treated with talar osteochondral allograft in lesions greater than 20mm in diameter were analyzed - 4 males and 4 females aging 39.5 years old on average. Evaluation was performed according to AOFAS scale and VAS as well as incorporation and continuation evaluations according to CT and MRI studies. A follow-up of 46.8 months on average was done. RESULTS A 34.6-point improvement on average according to AOFAS. A 6.7-point pain improvement on average according to VAS. Incorporation in 100% of the cases. Two cases showed partial resorption and one case showed peri-graft lysis less than 30%. There was no collapse. CONCLUSIONS Fresh frozen osteochondral allografts are a viable alternative when treating large osteochondral lesions, thereby avoiding morbidity of autologous donor areas or arthrodesis procedures.