Thursday 07 December |
08:00 |
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R
08:00 - 08:30
Registration
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08:30 |
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OC
08:30 - 08:40
Opening Ceremony
Speakers:
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
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08:40 |
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F
08:40 - 10:30
FOREFOOT
Moderators:
Nuno CORTE REAL (Clinical Director) (Moderator, Cascais, Portugal), Christina STUKENBORG-COLSMAN (XXX) (Moderator, Hannover, Germany)
08:40 - 08:50
Recurrence after hallux valgus reconstruction.
Aleksas MAKULAVICIUS (Team leader) (Speaker, Vilnius, Lithuania)
08:50 - 09:00
Hallux varus after hallux valgus reconstruction.
Geoffroy VANDEPUTTE (MD) (Speaker, Lier, Belgium)
09:00 - 09:10
Nonunion after attempted first toe arthrodesis.
Jean-Luc BESSE (Praticien Hospitalier) (Speaker, Lyon, France)
09:10 - 09:25
#37489 - OP1 Progressive hallux varus after flat foot correction.
Progressive hallux varus after flat foot correction.
Iatrogenic hallux varus stands as a feared complication of hallux valgus surgery. This complication involves a deformity of the first ray, where the first phalanx exhibits a medial misalignment concerning the metatarsal axis.
The association of pes planus with the development of hallux valgus is controversial. On the other hand, although the relationship between hallux valgus and flatfoot is controversial, some authors find an association between the severity of flatfoot and the recurrence of hallux valgus deformity.
Clinical Case:
A 54-year-old male presented with complaints of pes planus deformity previously managed with insoles and hallux valgus in his right foot. Surgical intervention involved lateral column lengthening and an L-shaped osteotomy. The initial postoperative X-rays displayed satisfactory outcomes. However, X-rays taken at the 6-month and 12-month postoperative assessments revealed a progressively developing hallux varus deformity, while maintaining the achieved correction of the talonavicular coverage. Clinically, the patient complains of pain beneath the medial sesamoid but does not report any issues with footwear.
Our case is about a patient with iatrogenic hallux varus following simultaneous surgery for hallux valgus and flatfoot. We consider that lengthening the lateral column simultaneously with the correction of the hallux valgus may have contributed to its varus deformity. However, this does not explain its progressive varisation, especially considering that the correction of the talonavicular coverage has been maintained or has even worsened over time.
M. Concepción CASTRO ÁLVAREZ (Barcelona, Spain), Juan Manuel MORELL LUQUE, Judit SIERRA OLIVA, Paula SERRANO CHINCHILLA, Camila CHANES PUIGGROS, Félix CASTILLO GARCIA
Discussion and cases from delegates
09:25 - 09:40
#37475 - OP2 Missing first metatarsal: amputate or reconstruct?
Missing first metatarsal: amputate or reconstruct?
Twenty-five-years-old women presented in our Emergency Department after a car accident (moto vs car) with a large wound and a subtotal loss of first metatarsal of her right foot.The foot was warm and rose, very dirty and contaminated from the street and it was impossible to test the nerve because of the pain.Under ALR subarachnoid, after irrigation with saline solution, the wound was explored and the surgeons highlight the loss of the vascular bundle of the first metatarsal head, but confirm he presence of the tendon of EPA, the hallux-flexor, and the vascular bundle of pedidia’s artery.The opstion for treatment were: debridement and Mini-FEA for the maintenance of length and alingnment
a spacer and antibiotic or Amputation.An antibiotic loaded cement spacer (with Vancomincin 1 gr) pro 1 MTT was located and stabilized with a Kirschner wire on intermediate and lateral cuneiform. A K wire stabilized the articular fracture of P1 .Finally, the wound was largely irrigated, and a drain was placed. After 7 months a reconstruction procedure was performed with removal of the spacer and using a suitable first metatarsal fresh frozen from the bone bank stabilized with plates on the 1cuneiform and the head of the metatarsal. Cancelluos bone from the iliac crest was introduced in the metatarsal from the donator for better integration and biology. At 2 years of follow-up the patient had a recovery of the soft tissue and return to the previous activity. Massive bone allograft is a good functional choice of treatment missing metatarsal.
Elena SAMAILA, Bruno MAGNAN (Verona, Italy)
Discussion and cases from delegates
09:40 - 09:50
Transfer metatarsalgia after hallux valgus surgery.
Xavier OLIVA MARTIN (Speaker, Barcelona, Spain)
09:50 - 10:00
Floating toe and painful hammertoe after forefoot surgery.
Antonio VILADOT (orthopaedic Surgeon) (Speaker, Barcelona, Spain)
10:00 - 10:15
#37476 - OP3 Revision for metatarsalgia after malunion of distal chevron for hallux valgus.
Revision for metatarsalgia after malunion of distal chevron for hallux valgus.
"We present a case of a 54-year-old female smoker with metatarsalgia and a 2nd toe deformity, 4 years after bunion surgery, resulting in a movable malunion of a distal chevron osteotomy. The patient complained of instability of the 2nd ray with burning sensation but no pain on the 1st unstable ray.
Scanner and ultrasound evaluations were performed. After smoking cessation, we conducted 2 surgeries spaced 6 weeks apart. The first surgery involved a lengthening osteotomy of the 1st metatarsal using cortical cancellous allograft and plate osteosynthesis. The second surgery took place 6 weeks later and included percutaneous osteotomies of type DMMO on the 2nd and 3rd rays, along with tenotomies of the extensors and flexor digitorum brevis of the 2nd toe, followed by a first phalanx osteotomy of the same toe.
The results were satisfactory, demonstrating a flexible 1st metatarsophalangeal joint and good weight-bearing support. Follow-up was conducted over the course of one year.
This case highlights the option of metatarsal lengthening as an alternative to 1st metatarsophalangeal fusion. It emphasizes successful consolidation using allograft and underscores the importance of smoking cessation."
Barbara PICLET, Pilar M. DE ALBORNOZ TORRENTE (Madrid, Spain)
Discussion and cases from my hospital locker
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10:30 |
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CB
10:30 - 11:00
Coffee Break, Exhibition
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11:00 |
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M
11:00 - 13:00
MIDFOOT
Moderators:
Elena SAMAILA (Associated Professor) (Moderator, Verona, Italy), Geoffroy VANDEPUTTE (MD) (Moderator, Lier, Belgium)
11:00 - 11:10
Lapidus nonunion.
Senthil KUMAR (Consultant Orthopaedic Surgeon) (Speaker, Glasgow, United Kingdom)
11:10 - 11:20
Lapidus malunion.
Christian PLAASS (Consultant) (Speaker, Hannover, Germany)
11:20 - 11:30
Naviculocuneiform nonunion.
Christina STUKENBORG-COLSMAN (XXX) (Speaker, Hannover, Germany)
11:30 - 11:40
#37484 - OP4 Arthroscopic triple fusion for Mueller – Weiss disease. Technical description and case report.
OP4 Arthroscopic triple fusion for Mueller – Weiss disease. Technical description and case report.
A 55-year-old female patient suffering from Mueller-Weiss disease underwent an arthroscopic triple fusion. The subtalar joint, the talo-naviculo-cuneiform, and calcaneocuboid joints were fused. With the patient in prone position and a thigh tourniquet inflated up to 300mg, hindfoot endoscopy was performed through a posteromedial and a posterolateral portal. After meticulous debridement, the posterior facet of the subtalar joint was recognized, and the cartilage was excised using an arthroscopic burr. Two lateral (sinus tarsi) portals were established. At first the anterior and middle facet of the subtalar joint were debrided, and the cartilage was excised. Then the calcaneocuboid joint was debrided, followed by the talonavicular joint. Under fluoroscopic guidance, fusion was performed with 3 cannulated screws. The calcaneocuboid joint was fused first, followed by the talo-naviculo-cuneiform and the last joint was the subtalar. After wound closure, a below-knee cast was applied for 6 weeks postoperatively, and a walking boot was applied. A minor complication was noted, a lateral portal wound hematoma, which was managed with additional per os antibiotics and drainage. No major complications were noticed. AOFAS score increased from 52 to 87 at 6 months postoperatively.
Michail KOTSAPAS (NAOUSA, Greece), Nerantzoula GOUTSIOU, Grigorios ANAGNOSTOU, Apostolos POLYZOS, Paschalis PAPANIKOLAOU, Ioannis VASIADIS, Menelaos PAPADAKIS
Discussion and cases from delegates
11:40 - 11:50
#37451 - OP5 Subtalar instability; hindfoot issue for concern.
OP5 Subtalar instability; hindfoot issue for concern.
Background: subtalar instability can occur in conjunction with tibiotalar instability or in an isolated form. Some reports have indicated that the calcaneofibular ligament (CFL) is the most important primary stabilizer for the subtalar joint while others have indicated that the interosseous talocalcaneal ligament (ITCL).
Method: 29 years old male with history of road traffic accident 2 years ago and operated for fracture shaft tibia by ILN. He presented with ankle giving way and guarding with walking on uneven ground. On examination; Excessive subtalar ROM, No obvious foot and ankle deformity. Negative ankle anterior drawer test (in comparison with the contralateral side).
Radiological exanination revealed separation of the posterior talocalcaneal facet of more than 7mm on weight bearing lateral ankle radiograph.
Open ITCL reconstruction plus CF repair were done. ITCL Ligamentoplasty is performed using a slip from peroneal tendons. The attenuated CFL is repaired using an anchor sutures. Posterior ankle splint for 3 weeks followed by AFO. Partial weight bearing is allowed in the 5th postoperative week.
Physiotherapy including mobility exercises, electrotherapy, muscle strengthening and proprioception exercises is allowed. Within the 9th week, return to sports participation is allowed.
Results: the follow up period was 38 months. The VAS score was improved from 5 to 1. The AOFAS score was improved from 65 to 89 points with patient satisfaction due to absence of giving way with improve gait.
Conclusion: Surgical treatment of STI is indicated after failure of conservative treatment. ITCL reconstruction and CFL repair seems to be a good option.
Mahmoud ABOUZIED (Benha, Egypt)
Discussion and cases from delegates
11:50 - 12:00
Abducted flatfoot after Lisfranc injury.
Nikolaos GOUGOULIAS (Consultant Orthopaedic Surgeon) (Speaker, Katerini, Greece)
12:00 - 12:10
Lisfranc nonunion.
Donald MC BRIDE (Consultant Orthopaedic Foot and Ankle Surgeon) (Speaker, Stoke on Trent, United Kingdom)
12:10 - 12:20
Double tarsal fusion with varus malunion.
Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Speaker, Napoli, Italy)
12:20 - 12:30
Subtalar recalcitrant nonunion.
Maneesh BHATIA (Virtual Film Festival videos) (Speaker, Leicester, United Kingdom)
12:30 - 13:00
Discussion and cases from my hospital locker.
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Free Paper Speaker, Madrid, Spain), Pilar M. DE ALBORNOZ TORRENTE (Orthopaedic Surgeon. F&A specialist) (Free Paper Speaker, Madrid, Spain)
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13:00 |
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L01
13:00 - 14:30
Lunch, Exhibition
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S02
13:00 - 14:30
Symposium STRYKER
Infinity with Adaptis & Everlast -
Innovative technology, another step forward for your primary Total Ankle Replacements
Speakers:
Sunil DHAR (Speaker, Nottingham, United Kingdom), Steven HADDAD (Speaker, Chicago, USA)
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13:15 |
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S01
13:15 - 14:00
Symposium PARAGON 28
Getting it Right the First Time: Ankle Fracture Treatment and Strategies for Improved Clinical Outcomes
Speakers:
Chris BLUNDELL (Speaker, Sheffield, United Kingdom), Callum CLARK (Consultant Orthopaedic Foot & Ankle surgeon) (Speaker, Windsor, UK, United Kingdom)
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Neptuno Room |
14:30 |
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H
14:30 - 16:30
HINDFOOT
Moderators:
Bryan DEN HARTOG (Physician Moderator) (Moderator, Minneapolis Minnesota, USA), Donald MC BRIDE (Consultant Orthopaedic Foot and Ankle Surgeon) (Moderator, Stoke on Trent, United Kingdom)
14:30 - 14:40
Cavovarus with undercorrection after previous surgery.
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
14:40 - 14:50
Dropfoot after common peroneal nerve palsy.
Henryk LISZKA (senior assistant) (Speaker, Krakow, Poland)
14:50 - 15:00
Equinovarus after compartment syndrome.
Manfred THOMAS (Head of department) (Speaker, Augsburg, Germany)
15:00 - 15:15
#37549 - OP6 A rare case of high-grade synovial sarcoma of the hindfoot.
A rare case of high-grade synovial sarcoma of the hindfoot.
Synovial Sarcoma (SS) is a rare mesenchymal-origin neoplasm representing about 8–10% of all soft tissue sarcomas (STS). It can arise at any age, but it is typically found in children and young adults, where it has a better prognosis. In general, it is considered an aggressive high-grade malignancy with a poor prognosis and a life expectancy of 5 years, in adult patients.
Although lower extremities are the most involved site, the occurrence of SS in the hindfoot area is particularly rare, and only limited data are available in the literature.
We present our experience in an uncommon case of high-grade synovial sarcoma occurring in the hindfoot of a 54-year-old Caucasian man. After clinical and instrumental assessments, and a biopsy of the lesion confirming the diagnosis, the patient underwent surgical excision of the tumor mass. A marginal resection of the calcaneus was performed, and coverage of the large skin gap was achieved with an anterolateral thigh (ALT) flap, without recurrence during the follow-up.
This study aims to assess our personal experience of a rare case of high-grade SS of the hindfoot. The complex management requires the presence of a reference center for foot and ankle surgery, and a multidisciplinary team that includes expert orthopedic and plastic surgeons, as well as oncologists, to ensure an optimal and correct treatment of the condition.
Carlo PERISANO (ROMA, Italy), Tommaso GRECO, Camillo FULCHIGNONI, Chiara COMISI, Antonio MASCIO, Chiara POLICHETTI, Elisabetta PATAIA, Giulio MACCARURO
Discussion and cases from delegates
15:15 - 15:30
Discussion.
15:30 - 15:40
Failed flatfoot reconstruction after osteotomies.
Norman ESPINOSA (Owner / Member) (Speaker, Zurich, Switzerland)
15:40 - 15:50
Calcaneocuboid pain after lateral lengthening osteotomy.
Paulo AMADO (Director of Orthopedic Departement) (Speaker, Porto, Portugal)
15:50 - 16:00
Deltoid insufficiency/valgus ankle after flatfoot reconstruction.
Helka KOIVU (Consultant) (Speaker, Turku, Finland)
16:00 - 16:10
Failed subtalar distraction arthrodesis.
Pascal RIPPSTEIN (head) (Speaker, Zürich, Switzerland)
16:10 - 16:20
#37339 - OP8 Tibialis posterior tendinopathy and lateral ankle sprain in an elite Gaelic player.
OP8 Tibialis posterior tendinopathy and lateral ankle sprain in an elite Gaelic player.
Background:
Tibialis posterior tendinopathy (TPT) or traumatic tears following a lateral ankle sprain are not commonly reported in the literature. The purpose of this study was to report our case of TPT in an athlete who underwent a lateral ankle stabilisation.
Case study:
A 27-year-old male, elite Gaelic football athlete suffered a non-contact inversion ankle injury. MRI revealed a high grade ATFL tear and minor TPT. The initial management of physiotherapy led rehabilitation was unsuccessful. Consequently, the patient was progressed to surgical management via Brostrom stabilisation. Post-operative protocol was backslab for 2 weeks in a neutral position. The patient subsequently wore a boot for 2 weeks followed by physiotherapy. Therapy consisted of proprioceptive rehabilitation, peroneal and functional lower limb strength training. The patient was re-introduced to a return to run protocol at 5 weeks post-operative. At 8 weeks, the patient returned to sport having successfully passed criteria. However, his progress was limited due to the onset of medial ankle pain.
Objective:
To treat clinically symptomatic TPT via ultrasound guided injection and progressive strengthening exercises as part of a return to play programme.
Discussion:
This case highlights the presence of TPT in high grade ATFL tears. TPT should be included within differential diagnosis for persistent medial sided pain following a lateral ankle sprain. Vigilance is required when managing such athletes as MRI findings can be subtle. Clinical assessment with dynamic USS followed by a guided injection may assist in ensuring a prompt return to sport following Brostrom stabilisation.
Yasser ALJABI, Pierce ANTHONY, Laneza ADÚRIZ (Dublin, Ireland)
Discussion and cases from my hospital locker
16:20 - 16:30
#37341 - OP9 OP8 Posterior Subtalar Distraction Arthrodesis in Calcaneal Fracture Sequelae: A Case Report.
OP8 Posterior Subtalar Distraction Arthrodesis in Calcaneal Fracture Sequelae: A Case Report.
Fractures of the calcaneus can affect the biomechanics and anatomy of the subtalar joint in different ways. Subtalar distraction arthrodesis has become an alternative technique for correcting the residual hindfoot deformity and specially, for restoring the talus orientation. Additionally, the uncommon posterior approach facilitates the correction of calcaneal height and its axis.
Case
A 48-year-old male with a history of bilateral calcaneal fractures due to a three-meter fall. Conservative management with cast immobilization and non-weightbearing was decided.
After two years of follow-up, the patient developed a right painful flatfoot even though the physiotherapy. Radiographic results showed dorsal flexion of the talus with depression of the calcaneus. Computed tomography showed a severe post-traumatic subtalar arthropathy.
It was decided to perform a subtalar arthrodesis with allograft. The procedure was carried out through a posterior approach. A posterior tuberosity osteotomy was need to visualize the subtalar joint. Progressive distraction was achieved and the calcaneus height was corrected. The subtalar joint was fixed with two screws.
After 6 weeks, the patient started weight bearing and at 6-month follow-up arthrodesis consolidation was observed in CT. The ankle movement improved significantly.
Subtalar distraction arthrodesis by inserting a structural bone graft is a reliable option to improve calcaneus height and restore talus calcaneus axes. Limited ankle dorsiflexion improves once talus orientation is corrected by this procedure.
Fa-Binefa MANEL (BARCELONA, Spain), Arribas Vallejo ANDREA, López Capdevila LAIA, Lopez Hervas SERGIO, Fernandez De Retana PABLO
Discussion and cases from my hospital locker
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16:30 |
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CB2
16:30 - 17:00
Coffee Break, Exhibition
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17:00 |
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SAFS
17:00 - 18:00
STRATEGY AFTER FAILED SURGERY/MARGINAL GAINS
Moderators:
Maneesh BHATIA (Virtual Film Festival videos) (Moderator, Leicester, United Kingdom), Christian PLAASS (Consultant) (Moderator, Hannover, Germany)
17:00 - 17:10
Optimizing medical/surgical status in a complex revision case.
Ian WINSON (Consultant Orthopaedic and Trauma Consultant) (Speaker, Bristol, United Kingdom)
17:10 - 17:20
Grafting, biologics, both, anything else?
James RITCHIE (orthopaedic Foot and Ankle Surgeon) (Speaker, Tunbridge Wells, United Kingdom)
17:20 - 17:30
I definitely need a plastic surgeon.
Daniele MARCOLLI (Foot and Ankle Surgeon) (Speaker, Milano, Italy)
17:30 - 17:40
Medicolegal issues.
Ian WINSON (Consultant Orthopaedic and Trauma Consultant) (Speaker, Bristol, United Kingdom)
17:40 - 18:00
Discussion.
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18:00 |
"Thursday 07 December"
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ER
18:00 - 18:25
EFAS RESEARCH GRANTS & IFFAS PRIZE
Moderators:
Fabian KRAUSE (Head Foot & Ankle surgery) (Moderator, Berne, Switzerland), Victor VALDERRABANO (Chairman) (Moderator, Basel, Switzerland)
18:00 - 18:05
Best Presidential prize.
Fabian KRAUSE (Head Foot & Ankle surgery) (Keynote Speaker, Berne, Switzerland), Victor VALDERRABANO (Chairman) (Keynote Speaker, Basel, Switzerland)
18:05 - 18:10
EFAS Research Foundation-MEDARTIS Research Grant for Foot & Ankle Arthrodesis.
18:10 - 18:15
EFAS Research Foundation-MEDARTIS Research Grant for Foot & Ankle Disorders.
18:15 - 18:20
IFFAS Best Case Prize.
18:20 - 18:25
Discussion.
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18:25 |
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Al
18:25 - 19:05
Alumni Group (Invited people)
Moderator:
Nuno CORTE REAL (Clinical Director) (Moderator, Cascais, Portugal)
18:30 - 18:40
Presentation of the EFAS - AOFAS Fellowship.
18:40 - 18:50
Presentation of the Duke Fellowship.
18:50 - 19:00
Presentation of the Research Fellowship.
19:00 - 19:10
Presentation of the Travelling Fellowship.
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Callao Room |
19:05 |
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A
19:05 - 19:05
Adjourn
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Friday 08 December |
08:10 |
"Friday 08 December"
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IL
08:10 - 08:40
INVITED LECTURE
Moderator:
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Moderator, Madrid, Spain)
08:10 - 08:40
Royal Collection Gallery: Time as construction material.
Emilio TUÑON (Keynote Speaker, Spain)
An internationally renowned architect, that has just received the Architectural National Prize and has just finished a masterpiece of architecture, Galería de Colecciones Reales.
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08:40 |
"Friday 08 December"
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AN
08:40 - 10:30
ANKLE
Moderators:
Helka KOIVU (Consultant) (Moderator, Turku, Finland), Manuel SOUSA (Foot and Ankle Surgeon) (Moderator, Lisbon, Portugal)
08:40 - 08:50
Abundant cysts and ankle pain after ankle replacement.
Mostafa BENYAHIA (Surgeon) (Speaker, Copenhagen, Denmark)
08:50 - 09:00
Progressive talar collapse after ankle replacement.
Victor VALDERRABANO (Chairman) (Speaker, Basel, Switzerland)
09:00 - 09:10
Failed ankle replacement with massive bone loss and infection.
Markus WALTHER (Medical Director) (Speaker, München, Germany)
09:10 - 09:25
#37008 - OP10 The Implications of MTP-I Fusion after Ankle Fusion with Complex Deformity.
The Implications of MTP-I Fusion after Ankle Fusion with Complex Deformity.
A 35-year-old female patient presented with progressively worsening pain in her left ankle accompanied by inability to walk, approximately 10 months after undergoing an MTP-I fusion for osteoarthritis. The patient's history revealed an episode of septic arthritis of the ankle joint at the age of 3.5 years. This inflammatory event resulted in excessive bone growth in the epiphyseal region, without proper adaptation or physiological development. As a result, a complex deformity emerged, characterized by increased limb length, ankle joint fusion, and multiplanar deformities including varus alignment and internal rotation. The MTP-I fusion had effectively terminated any remaining adaptive capacity of the foot. To address the patient's condition, a reconstructive surgery was performed, involving ankle fusion take-down and total ankle arthroplasty. This intervention resulted in a significant improvement in the patient's symptoms; however, residual deformities persisted including supramalleolar internal rotation and varus alignment. Therefore, a corrective osteotomy was performed. At the most recent follow-up, conducted five years post-surgery, the patient expressed satisfaction with the outcome. She reported being free of pain and experiencing no limitations in her daily activities.
Peter KVARDA (Liestal(CH), Switzerland), Roxa Ruiz RUIZ, Beat HINTERMANN
Discussion and cases from delegates
09:25 - 09:40
Discussion.
09:40 - 09:50
Tibiotalar arthrodesis with symptomatic subtalar nonunion.
Martinus RICHTER (Director) (Speaker, Rummelsberg, Germany)
09:50 - 10:00
Infection and nonunion after attempted ankle arthrodesis.
Joris HERMUS (Orthopedic surgeon) (Speaker, Maastricht, The Netherlands)
10:00 - 10:15
#37467 - OP12 Recalcitrant subtalar nonunion after tibiotalocalcaneal fusion.
Recalcitrant subtalar nonunion after tibiotalocalcaneal fusion.
Tibiotalocalcaneal arthrodesis (TTCA) is commonly used for severe ankle and subtalar arthritis, though it carries risks such as non-union and infections. A 38-year-old man with bilateral ankle deformity but no pain was diagnosed with Charcot-Marie-Tooth disease (CMT) involving cavus foot and varus hindfoot. He had successful TTCA using a T2 Ankle arthrodesis nail on his left leg, later repeating the procedure on his right leg with favorable immediate outcomes.
At 6 months post-surgery on his right leg, the patient's progress was slow, showing signs of incomplete talocalcaneal fusion, with no signs of infection from blood analysis. A new subtalar fusion was conducted, using lyophilized bone graft and cannulated compression screws, ruling out infection through sample testing. After 6 months, partial clinical improvement was noted, but non-union persisted. Therefore, a new debridement surgery with iliac crest autograft and osteosynthesis was proposed.
Following a pain-free postoperative period and gradual weight-bearing, the patient presented with fever and lateral ankle pain at 7 weeks post-surgery. Debridement was conducted, retaining osteosynthesis material, and empirical antibiotics were administered, switching to specific intravenous antibiotics due to S. Aureus infection. This was followed by oral antibiotics for 12 weeks.
One- and three-month postoperative check-ups showed ongoing improvement, with the patient comfortably ambulating and no swelling or pain. At 8 months post-surgery, a lateral plate rupture was observed, with SPECT CT scans indicating incomplete consolidation in the subtalar area. Despite this, the patient resumed work activities and remained infection-free.
What should we do now?
M. Concepción CASTRO ÁLVAREZ (Barcelona, Spain), Juan Manuel MORELL LUQUE, Judit SIERRA OLIVA, Borja GARCIA TORRES, Marcos CRUZ SÁNCHEZ, Félix CASTILLO GARCIA
Discussion and cases from my hospital locker
10:15 - 10:30
#37364 - OP13 The use of talar allograft for tibiotalocalcaneal arthrodesis as a treatment approach for talar osteonecrosis.
The use of talar allograft for tibiotalocalcaneal arthrodesis as a treatment approach for talar osteonecrosis.
A 52-year-old male patient presented to our clinic as an outpatient, complaining of left ankle pain mainly while walking or ascending/descending stairs. The pain began two years after undergoing surgical treatment for a left fibular fracture sustained from falling approximately 3 meters during rock climbing seven years ago. Physical examination revealed reduced range of motion in the ankle joint, tenderness, and swelling, but no signs of fever or erythema were observed. There were no significant findings in the patient's past medical history or blood tests. However, imaging examinations revealed evidence of talar osteonecrosis and deformation in the fibula.
The patient underwent surgical treatment. Employing the traditional lateral transfibular approach, the necrotic and unstable talus was removed. A meticulously sized talus allograft, previously prepared to match the contralateral talus carefully tailored, and all cartilage was meticulously excised. Afterward, the prepared talus allograft was inserted into the defect and stabilized using K-wires. Tibiotalocalcaneal arthrodesis was conducted using a retrograde intramedullary (IM) nail. To provide additional fixation, a 3.5 cannulated screw was utilized to secure the allograft to the existing talar head.
Out of a total of 11 cases, all but one demonstrated evidence of successful union, with only one case showing ankle joint nonunion and one case showing subtalar nonunion.
The utilization of a bulk talar allograft represents a potentially effective therapeutic approach for managing severe bone loss associated with talar osteonecrosis in individuals deemed suitable for tibiotalocalcaneal (TTC) arthrodesis.
Younguk PARK, Young Wook SEO (Seoul, Republic of Korea)
Discussion and cases from my hospital locker
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10:30 |
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CB3
10:30 - 11:00
Coffee Break, Exhibition
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11:00 |
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TS
11:00 - 12:00
TENDONS & SOFTIES
Moderators:
Antonio DALMAU (Head of Department) (Moderator, Barcelona, Spain), Markus WALTHER (Medical Director) (Moderator, München, Germany)
11:00 - 11:10
Symptomatic equinus after posterior ankle arthroscopy.
Jesus VILA Y RICO (Chief of Department) (Speaker, Madrid, Spain)
11:10 - 11:20
Discussion.
11:20 - 11:30
Recurrent peroneal tendinopathy after split brevis repair.
Yves TOURNÉ (Chirurgien) (Speaker, Grenoble, France)
11:30 - 11:40
Persistent Achilles insertional tendinopathy after surgical repair.
Manuel SOUSA (Foot and Ankle Surgeon) (Speaker, Lisbon, Portugal)
11:50 - 11:55
#37426 - OP14 Not just a simple drop foot - Case Report about M.C., 27 years old.
Not just a simple drop foot - Case Report about M.C., 27 years old.
The patient sustained an MVA which involved her left leg.Within a few hours she developed
an acute compartment syndrome which was treated only 3 days after presentation by
surgical fasciotomies (lateral and anterior compartments).She developed an abducted drop
foot that was treated with physical therapy for 18 months however without functional
improvement.
Clinical examination revealed a complete drop foot, a drop hallux and full loss of strength of
the anterior compartment muscles.The external and deep posterior compartments were
intact ie physiologic PTT strength. Upon weight baring load, the Left foot showed increased
abduction and hindfoot valgus that were correlated with to the index trauma. WB
radiographs demonstrated dorso-lateral peritalar subluxation (AP view) and collapsing
medial arch (lateral view).
Decision was made to treat both the dynamic (drop foot) and the static (posttraumatic
collapsing foot) deformities.
Surgery consisted in:Transfers of the tibialis posterior and peroneus longus tendons into the
lateral cuneiform bone;EHL and EDL tenorrhaphy onto the transferred tendons;IP-joint
arthrodesis (first toe);percutaneous tenotomies of FDL II-V with temporary fixation. These
procedures addressed the dynamic component of the problem. An arthrodesis of the talo-
navicular joint addressed the static part.
Teaching point: surgeons should be aware that in the setting of a drop foot secondary to
neurological or muscle compartment issues, there may coexist a traumatic structural
deformity within the foot. The latter may not result from the compartment syndrome itself,
but from ligamentous injuries. Therefor it is important to clearly identify both issues so so that
they can be addressed specifically.
Nils REYMOND (Geneva, Switzerland), Julia LENZ, Elisabeth SCHAUER, Lisca DRITTENBASS, Maximilian SCHINDLER, Victor DUBOIS-FERRIERE, Mathieu ASSAL
Discussion and cases from delegates
11:55 - 12:00
#37498 - OP15 Avulsion fracture of os calcis – management of a case with recurrent failure of fixation with soft tissue issues.
OP15 Avulsion fracture of os calcis – management of a case with recurrent failure of fixation with soft tissue issues.
Avulsion fractures of the calcaneus are serious injuries with a high potential for complications. Irrespective of the type of fixation, the rate of failure can be as high as 30%. Loss of fixation is often associated with skin breakdown and infection which makes the management of these cases challenging.
Our report will present the journey of a 64-year-old lady who sustained this injury. It was a closed fracture but the skin was tense. X-rays confirmed a ‘beak’ avulsion fracture of the tuberosity of the calcaneus. She underwent an open reduction and internal fixation the following morning. A hybrid form of fixation using plate and screws, was used. At 12 days post-surgery, there was evidence of early failure of fixation with re-displacement of the fracture. The wound had broken down. She underwent immediate revision surgery, a fresh set of plate and screws were used. However, postoperative x-rays demonstrated a recurrent early failure of fixation. The soft tissues were not conducive to further fixation; hence it was decided to monitor the fracture and soft tissues closely. She underwent a further revision surgery 4 months after the initial injury, the sinus was excised and debridement of soft tissues and bone was undertaken; the Achilles tendon was also lengthened. We are pleased to report that the skin remains well healed with no evidence of infection, the fracture is progressing to heal and the fixation remains stable. This case demonstrates the complexity and challenges associated with the management of these difficult injuries.
Pujol Nicolas ANDREA (Glasgow, United Kingdom), Jane MADELEY, Senthilkumar CHINNASAMY
Discussion and cases from delegates
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12:00 |
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AAE
12:00 - 13:00
AOFAS AT EFAS
Speakers:
Mark EASLEY (Faculty) (Speaker, Durham, USA), Charles SALTZMAN (Speaker, USA)
Moderators:
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium), Bryan DEN HARTOG (Physician Moderator) (Moderator, Minneapolis Minnesota, USA)
12:00 - 12:10
Asymmetrical post-traumatic ankle arthritis. I can save the ankle with osteotomies.
Mark EASLEY (Faculty) (Speaker, Durham, USA)
12:10 - 12:20
Symmetrical post-traumatic ankle arthritis. When to fuse and when to replace?
Charles SALTZMAN (Speaker, USA)
12:20 - 13:00
Discussion AOFAS and EFAS.
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13:00 |
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L02
13:00 - 14:00
Lunch, Exhibition
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L1
13:00 - 14:00
Forum of diversity, equity and inclusion.
Moderator:
Kristian BUEDTS (Md) (Brussels, Belgium)
13:00 - 13:10
Academic and research position: where is Italy in 2023.
Elena SAMAILA (Associated Professor) (Speaker, Verona, Italy)
13:10 - 13:20
Position of senior surgeons in EFAS: expertise, experience, wisdom.
Yves TOURNÉ (Chirurgien) (Speaker, Grenoble, France)
13:20 - 13:30
Young Minds think alike.
Joris ROBBERECHT (Consultant) (Speaker, Turnhout, Belgium)
13:30 - 13:40
My Humanitarian Mission.
Greta DEREYMAEKER (Orthopedic surgeon) (Speaker, Leuven Belgium, Belgium)
13:40 - 13:50
Inclusion of the Disabled Surgeon.
Geoffroy VANDEPUTTE (MD) (Speaker, Lier, Belgium)
13:50 - 14:00
Embrasing Diversity and Inclusion in Foot and Ankle Surgery, the BOFAS EDI Journey.
Rick BROWN (Clinical lead) (Speaker, Oxford, United Kingdom)
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13:15 |
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S04
13:15 - 14:00
Symposium WBCT
Weightbearing CT All the Way in Ankle OA!
Moderators:
Arne BURSSENS (Foot and ankle surgeon) (Ghent, Belgium), Charles SALTZMAN (USA)
Speakers:
Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Speaker, Napoli, Italy), Arne BURSSENS (Foot and ankle surgeon) (Speaker, Ghent, Belgium)
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S03
13:15 - 14:00
Symposium Geistlich
Evidence and Innovation for AMIC® Chondro-Gide® in the MTP and Ankle Joint
Speakers:
Martinus RICHTER (Director) (Speaker, Rummelsberg, Germany), Victor VALDERRABANO (Chairman) (Speaker, Basel, Switzerland), Markus WALTHER (Medical Director) (Speaker, München, Germany)
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Callao Room |
14:00 |
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GA
14:00 - 15:00
General Assembly
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15:00 - 17:00
TRAUMA
Moderators:
Joris HERMUS (Orthopedic surgeon) (Moderator, Maastricht, The Netherlands), Daniele MARCOLLI (Foot and Ankle Surgeon) (Moderator, Milano, Italy)
15:00 - 15:10
Symptomatic osteochondral lesion of the talus (OLT) after microfractures.
Paolo CECCARINI (Ortopaedic Surgeon) (Speaker, Perugia, Italy)
15:10 - 15:20
Symptomatic OLT after autologous matrix induced chondrogenesis.
Fabian KRAUSE (Head Foot & Ankle surgery) (Speaker, Berne, Switzerland)
15:20 - 15:30
Recurrent ankle instability after Brömstrom repair.
Nuno CORTE REAL (Clinical Director) (Speaker, Cascais, Portugal)
15:30 - 15:45
#37385 - OP16 Intramedullary Cylindrical Grafting for Proximal Fifth Metatarsal Fracture Non-union.
OP16 Intramedullary Cylindrical Grafting for Proximal Fifth Metatarsal Fracture Non-union.
Fractures of the proximal fifth metatarsal account for 25% of metatarsal fractures, with a significant number occurring as stress fractures in sports. Fracture pattern recognition and correct management are important to avoid potential complications, considering the tendency towards poor bone-healing. Zone-3 fractures usually occur as chronic overuse lesions, with non-union rates of 25-28%. Torg further classifies these fractures according to their healing potential, with type-3 describing a complete obliteration of the medullary canal by sclerotic bone. We present a case of a 24year-old male professional athlete (futsal) with a zone-3 Torg-3 fracture non-union, previously submitted to two surgical interventions. The initial fracture was diagnosed following a period of overuse and consecutive sprains, when percutaneous screw fixation was first attempted. However, the athlete returned to practice earlier than recommended, with consequent failure of osteosynthesis. Revision surgery, with plating and autologous graft implantation was performed. After resolution of a wound complication, the athlete resumed training maintaining residual complains. A second non-union was diagnosed; management with hyperbaric chamber, ultrasound, growth-factors, magnetotherapy, insoles failed. The patient was then admitted for a third intervention using a novel grafting technique that we describe. First reaming of the medullary canal and fracture site curettage were performed. Then a cylindrical bone graft, from the calcaneus, mixed with bone marrow aspirate concentrate was introduced into the medullary canal, followed by plate fixation. Partial weightbearing was initiated at 6-weeks. After a 4-month follow-up, complete bone healing was present (CT-scan) with a painless functional foot, allowing the athlete to resume practice.
Emanuel CORTESÃO DE SEIÇA (Figueira da Foz, Portugal), Rui DOMINGOS, João VIDE, Daniel MENDES, Manuel RESENDE SOUSA
Discussion and cases from delegates
15:45 - 16:00
#37357 - OP17 HOW TO MANAGE SEVERAL RECURRENCES AND INFECTIONS DURING THE TREATMENT OF COMPLEX FRACTURE OF BILATERAL TIBIAL PLAFONDS?
HOW TO MANAGE SEVERAL RECURRENCES AND INFECTIONS DURING THE TREATMENT OF COMPLEX FRACTURE OF BILATERAL TIBIAL PLAFONDS?
Introduction: bilateral complex fractures of tibial plafond are very rare and the treatment is high-demanding.
Case report: a 50yrs old male patient was taken to hospital after a fall at work: imaging demonstrated complex factures of bilateral tibial plafonds. A primary damage control by external fixators was performed.
After a few days, the patient underwent to ORIF with medial tibia plate (right), ORIF with autologous bone graft and anterolateral tibia plate plus fibular plate (left). At one-month, dehiscence of left tibial incision was treated by plastic surgeons with VAC therapy and a left thigh flap. Because of necrosis of this flap, plastic surgeons performed a second right thigh flap. Fistulae of the skin were treated by oral antibiotics.
One year later, devices were removed from left ankle because poor tolerance. The patient fell again rifracturing his left tibia: radical bone debridement was performed with positioning of antibiotic cemented spacer. After six weeks, the bone defect was treated with bone transport by circular external fixator (Ilizarov technique).
After nine months, the fixator was removed and an under-knee-cast was positioned. Patient newly crashed fracturing at dock point. Thus, TTC arthrodesis with nail and synthesis with proximal tibia MIPO plate were ultimately performed.
Discussion: Complex fracture of tibial plafond should be treated only by skilled surgeons, even more if bilateral. Complications should be expected: surgeon has to consider several approaches for treatment.
Giacomo RIVA (Varese, Italy), Luca MONESTIER, Fabio D'ANGELO
Discussion and cases from delegates
16:00 - 16:10
Ankle pain with significant bone loss and necrosis after talar fracture.
Elena SAMAILA (Associated Professor) (Speaker, Verona, Italy)
16:10 - 16:20
Fifth metatarsal refracture in athlete.
Antonio DALMAU (Head of Department) (Speaker, Barcelona, Spain)
16:20 - 16:30
Nonunion after navicular stress fracture.
Yasser ALJABI (Consultant) (Speaker, Dublin, Ireland)
16:30 - 16:40
Achilles rerupture after MIS repair in a pro athlete.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
16:40 - 16:50
#37375 - OP18 Irreducible ankle dislocation because of tibialis posterior tendon entrapment in the interosseous membrane.
Irreducible ankle dislocation because of tibialis posterior tendon entrapment in the interosseous membrane.
A 44-year-old-male presented to the emergency department with right ankle pain following a high energy workplace accident. Physical examination revealed ankle deformity with skin intact. No neurovascular abnormalities were observed. Ankle dislocation was confirmed with plain radiographs (Fig 1 - Left). Closed reduction was attempted immediately; however, the talus appeared to be displaced laterally and anteriorly. Provisional external fixation was performed the following morning. Postoperative X-ray and CT showed persistent ankle subluxation, syndesmotic widening and a lateral malleolar fragment. After 14 days of anti-inflammatory and corticotherapy treatment, soft tissues were amenable to definitive surgery. Through a medial incision the following findings were noted: the medial ligamentous complex was completely detached from the talus and tibialis posterior tendon was dislocated laterally, impeding reduction (Fig. 1 - Right). A lateral incision was performed to reduce the tendon prior gentle longitudinal traction of the talus. The syndesmosis was fixed using a one-third tubular plate and 2 cortical screws. Syndesmosis and medial ligamentous complex were reattached using sutures and 2 suture anchors, one to fibula and another to the talus. There were no postoperative neurological or vascular deficits. A short leg splint was applied for 6 weeks postoperatively. Ten weeks after surgery, the syndesmotic screws and one-third tubular plate were removed and full weight-bearing was permitted. At 6 months after surgery the patient walked independently without discomfort, and achieved a nearly complete ankle joint range of motion.
Jose Javier LLORENTE PÉREZ (VIGO, Spain), Ignacio VÁZQUEZ ANDRADE, Fletcher LILY, Lago ADRIÁN, De La Orden ELENA, Nori GABRIEL ADOLFO
Discussion and cases from my hospital locker
16:50 - 17:00
#37356 - OP19 OPEN FRACTURE DISLOCATION OF THE TALUS WITH EXTRUSION IN A YOUNG SEMI-PROFESSIONAL CYCLIST: A CASE REPORT.
OPEN FRACTURE DISLOCATION OF THE TALUS WITH EXTRUSION IN A YOUNG SEMI-PROFESSIONAL CYCLIST: A CASE REPORT.
Introduction: open fracture of the talus with extrusion is rare. In this report, we present a case of a talar fracture in semi-professional young cyclist.
Case report: a 24yrs old male semi-professional cyclist fell off a bike crushing into a gutter. Taken to trauma center hospital, imaging demonstrated complex facture of the talus with extrusion. Patient immediately underwent to debridement: grass blades and soil was found in the ankle. A damage control with external fixation was performed. Because of the fall into a gutter, intravenous antibiotics and antifungal drugs were started.
A week later, talar necrosis was found during a second-look surgery: we decided to completely excise the talus and fill the gap with vancomycin-gentamycin cemented pearls. After eight weeks, no local signs of infection were reported, confirmed by blood tests: thus, antibiotic pearls were removed and the talar gap was filled by cadaveric femoral head, specifically modeled, and autologous iliac bone graft. Then, TTC arthrodesis with retrograde nail and anterior plate was performed.
After six months, imaging reported the fusion of the tibio-graft-calcaneal arthrodesis and the patient returned gradually to his daily and sport activities.
Discussion: Complex fracture of talar with extrusion should be treated only expertized surgeons in trauma centers. Step-by-step planned surgery leads to better successful outcomes.
Luca MONESTIER (VARESE, Italy), Giacomo RIVA, Fabio D'ANGELO
Discussion and cases from my hospital locker
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17:00 |
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C
17:00 - 17:15
CONCLUSION AND CLOSING REMARKS
Speakers:
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
17:00 - 17:15
Best Case prize.
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