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- Author or Editor: Ali Turgut x
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Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results.
Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination.
Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot.
Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. (J Am Podiatr Med Assoc 98(6): 451–456, 2008)
Optimum Screw Configuration for the Fixation of Sanders Type IIC Tongue-Type Fractures?
A Biomechanical Study
Background:
The minimally invasive technique (percutaneous screw fixation) is one of the options for treating tongue-type IIC fractures successfully. The aim of this study was to assess the biomechanics of four different screw configurations used for the fixation of tongue-type IIC calcaneal fractures.
Methods:
Identical osteotomies, recapitulating a type IIC injury, were created in synthetic calcaneus specimens using a saw. The specimens were randomly assigned to one of the four fixation groups (n = 7 per group): two divergent screws, two parallel screws, two parallel screws plus one screw axially oriented toward the sustentaculum tali, and three parallel screws. A load test was performed on all of the groups, and the specimens were then tested using offset axial loading until 2, 4, and 5 mm of fracture displacement occurred.
Results:
Mean force values for the three–parallel screw construct at 2-, 4-, and 5-mm fracture displacements were found to be significantly higher compared with those for the other groups.
Conclusions:
The use of a three–parallel screw construct seems to provide more stability in the treatment of tongue-type IIC fractures.
Background
Fifth metatarsal base fractures are the most commonly seen fractures of the foot. Ankle sprains occur with inversion and plantarflexion mechanisms, similar to most fifth metatarsal base fractures. We sought to investigate the possible ankle injuries that accompany fifth metatarsal base fractures.
Methods
A hospital's digital database was searched for the International Classification of Diseases, Tenth Revision codes for metatarsal bone fractures (codes S92.30 and S92.35) between January 2015 and January 2018. Thirty-nine patients with fifth metatarsal base fracture who underwent ankle magnetic resonance imaging (MRI) within 14 days of injury were included in the study. The MRI findings were evaluated, and comparisons were performed according to fracture zone, sex, and age.
Results
The most common MRI finding was talocrural joint effusion, which was observed in 28 patients (71.8%). Bone marrow edema was observed in 16 patients (41.0%). Chondral injury at the medial dome of talus was observed in three patients (7.7%). Grade 1 ligament sprain was observed in six patients (15.4%): two in the lateral ligament and four in the deltoid ligament.
Conclusions
Although most fifth metatarsal base fractures and ankle sprains occur as a result of a common mechanism, physical examination findings and patients' complaints are very important. Routine MRI should be unnecessary for most patients. If a patient with a fifth metatarsal base fracture has complaints about the ankle joint, one should be aware of bone marrow edema, which was observed in 41.0% of the study population.
Background: Three main computed tomography (CT)–based classification systems have been defined and used for posterior malleolar fractures. The intraobserver and interobserver reliability of two of these systems has never been investigated. The aim of this study was to investigate the intraobserver and interobserver reliability of the Haraguchi (HC) and Bartoníček-Rammelt (BRC) classifications.
Methods: Axial and sagittal CT sections and three-dimensional reconstruction images of 60 fractures were evaluated twice by six observers at a 6-week interval. Cohen κ values for intraobserver reliability and Fleiss κ values for interobserver reliability were calculated.
Results: The interobserver reliability of the HC was fair in both assessments (Fleiss κ: 0.263 and 0.249 for the first and second evaluations, respectively). The interobserver reliability of the BRC was moderate in both evaluations (Fleiss κ: 0.535 and 0.447, respectively). The intraobserver reliability values (Cohen κ) of the HC were determined to be between 0.532 and 0.927 for the six observers. These values indicated moderate agreement for one observer, substantial for four, and very good for one. Intraobserver reliability values for the BRC were determined to be between Cohen κ of 0.626 and 0.884. Based on these values, the BRC's intraobserver reliability indicated substantial agreement for two observers and very good for four observers.
Conclusions: Intraobserver and interobserver reliability values of the BRC were higher than those of the HC.
