Cymet-Ramírez J

Language: Spanish
References: 14
Page: 297-302
PDF size: 99.28 Kb.

ABSTRACT

The ankle is a loading joint with a small contact surface and it is therefore very vulnerable to trauma, as it is an exposed region. It is a unique joint because it forms several joints. In this joint the load falls on the contact area, which is one third of the knee or the hip, and it is the most important part of our musculo-skeletal system designed for ambulation and bipedestation. In case of ankle injuries, arthrodesis is a procedure performed to relieve pain, decrease deformity and provide stability. An optimum result of this procedure may be easily achieved if the ankle is fixed in the right position, so this technique will continue to be a treatment alternative. With «minimally invasive percutaneous fixation (MIPF)» fixation is safe, it relieves pain and stops the progression of regeneration, it is a minimally invasive method performed through a small posteromedial incision on the ventral surface of the distal tibial metaphysis, which minimizes soft tissue dissection thus eliminating wound complications. In this study we included patients with severe joint damage and pain, with a physically demanding type of work, in whom other treatments had previously failed and in whom total arthroplasty was not possible (due to questionable results). Patients with a varus-valgus › 15°, talar necrosis, bone defects requiring a graft or subtalar arthrosis were excluded. Our results are no different from the world literature concerning the incidence rate of complications by age and diagnosis as well as the healing rate. Postoperative patient management was better as no rigid immobilization was required. Even though weight bearing was not immediate, at two weeks they could use an unloading boot for partial weight bearing, and total weight bearing was possible by week six. Therefore, there were less complications and in failed cases salvage surgery was possible.

REFERENCES

1. Stauffer R, Chae E, Brewster R: Force and motion analysis of the normal, diseased and prosthetic ankle joint. Clin Orhtop 1977; 127: 189-96.

2. Lundberg A: Kinematics of the ankle and foot. In vivo roentgen stereophotogrammetry. Acta Orthop Scand 1989; 233(s19): 1-24.

3. Waters RL, Barnes G, Husserl T, Silver L, Liss R: Comparable energy expenditure after arthrodesis of the hip and ankle. J Bone Joint Surg Am 1988; 70(7): 1032-7.

4. Coester L, Saltzman C, Leupold J, Pontarelli W: Long-Term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg 2001; 83A(2): 219-28.

5. Calhoun JH, Li F, Ledbetter BR, Viegas SF: A comprehensive study of pressure distribution in the ankle joint with inversion and eversion. Foot Ankle Int 1994; 15(3): 125-33.

6. Shepherd DE, Seedhom BB: Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis 1999; 58(1): 27-34.

7. Brown TD, Shaw DT: In vitro contact stress distributions in the natural human hip. J Biomech 1983; 16(6): 373-84.

8. Nihal A, et al: Arthrodesis. Foot & Ancle Surg 2008; 14: 1-10.

9. Midis N, et al: Revision ankle arthrodesis. Foot Ankle Int 2002; 23(3): 243.

10. Dyrby C, et al: Functional evaluation of the scandinavian total ankle replacement. In: The 17th Annual Summer Meeting of the American Orthopedic Foot and Ankle Society. San Diego, California, U.S.A. The American Foot and Ankle Society. 2001.

11. Daniels T: Gait analysis and functional outcomes of isolated ankle arthrodesis. In: International Federation of Foot and Ankle Societies Triennial Scientific Meeting. San Fransisco. 2002.

12. Trepman E, et al: Charcot neuroarthropathy of the foot and ankle. Foot & Ankle Int 2005; 26: 46-63.

13. Lui TH: Opening wedge low tibial osteotomy: a minimally invasive approach. Foot Ankle Surg 2011; 17(1): 1-7.

14. Conti SF: Gait before and after total ankle arthroplasty with a comparison to arthrodesis. In: International Federation of Foot and Ankle Societies Triennial Scientific Meeting. San Francisco, California, USA: IFFAS. 2002.