Friday 18 October |
08:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PL1
08:00 - 08:30
PRESIDENTIAL INVITED LECTURE
08:00 - 08:30
Moderator.
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium)
|
AUDITORIUM |
08:40 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PS2
08:40 - 10:00
PLENARY SESSION 2:
TIBIAL MALALIGNEMENT AFFECTING THE FOOT AND ANKLE
08:40 - 10:00
Moderators.
Markus WALTHER (Medical Director) (Moderator, München, Germany), Mark Bowen DAVIES (Consultant Orthopaedic Surgeon) (Moderator, Sheffield, United Kingdom)
08:40 - 08:50
Proximal tibia – varus or valgus knee.
Aleksas MAKULAVICIUS (Team leader) (Speaker, Vilnius, Lithuania)
08:50 - 09:00
Diaphyseal / torsional deformities.
Christian PLAASS (Consultant) (Speaker, Hannover, Germany)
09:00 - 09:10
Supramalleolar – varus/valgus.
Victor VALDERRABANO (Chairman) (Speaker, Basel, Switzerland)
09:10 - 09:20
Supramalleolar – multiplanar and sagittal plane.
Matthias WALCHER (Orthopaedic Surgeon) (Speaker, Würzburg, Germany)
09:20 - 09:30
Progressive correction with circular external fixation.
Antti YLITALO
09:30 - 10:00
Discussion.
|
AUDITORIUM |
10:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
CB3
10:00 - 10:30
Coffee Break, Exhibition and Poster Walks
|
10:05 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWP5
10:05 - 10:25
Poster Walks presentations 5
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Speakers:
Stefan CLOCKAERTS (Foot and ankle Surgeon) (Speaker, Mechelen, Belgium), Antti YLITALO
10:05 - 10:25
#42587 - PKW17 Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.
Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.
Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets, posing risks to certain os calcis subtalar joint (OCST) subtypes. H-LCL is performed between the posterior and middle facets, potentially suitable for all OCSTs. Both osteotomies can lead to increased subtalar osteoarthritis, suggesting iatrogenic damage. Distance mapping (DM) visualizes the relative distance between two articular surfaces using color patterns. This study aims to measure the safe zones for LCL using 3D models and DM, hypothesizing high reproducibility.
Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. They independently measured four angles. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies, while the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. The surface area available for safe osteotomies was calculated. Interclass correlation assessed rater agreement, with analysis of variance and Mann-Whitney U tests comparing safe zones between OCSTs.
Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees, respectively. The ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. No significant differences were found between OCSTs. The raters showed good to excellent agreement. In 18 cases, planning for H-LCL or E-LCL osteotomies was not feasible
Efrima BEN, Agustin BARBERO (Milan, Italy), Kuharajan RAMALINGAM, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
10:05 - 10:25
#42589 - PKW18 Abnormal axial rotation of the talus on weight-bearing computed tomography in patients with osteochondral lesion of the talus and functional instability of the ankle.
Abnormal axial rotation of the talus on weight-bearing computed tomography in patients with osteochondral lesion of the talus and functional instability of the ankle.
Introduction:
Osteochondral lesions of the talus (OLT) are commonly associated with ankle sprains, often leading to chronic ankle instability (CAI), both mechanical and functional. While diagnosing mechanical CAI is straightforward, identifying functional CAI presents challenges. Microinstability, attributed to superior anterior talofibular ligament (S-ATFL) tear, is proposed as a factor in functional CAI, resulting in anterior translation and internal rotation of the talus. Weight-bearing computed tomography (WBCT) provides valuable insights into hindfoot alignment, particularly under load-induced deformation, making it a promising tool for evaluating patients with functional instability. This study aims to compare talus axial rotation in symptomatic OLT patients with subjective signs of functional CAI to asymptomatic volunteers and assesses the reliability of these measurements.
Materials and Methods:
Forty ankles with symptomatic OLT and micro-instability signs were compared to a control group of asymptomatic individuals. Three-dimensional models were generated using WBCT and image analysis software, allowing for semi-automatic hindfoot alignment measurements. Additional analysis was conducted to assess the agreement between measurements.
Results:
Symptomatic OLT patients displayed significantly increased external talus rotation compared to controls, with a mean difference of -4.5 ± 4.5 degrees (P < 0.001). Intraobserver reliability showed good to excellent correlation (ICC 0.88, ICC 0.92), while interobserver agreement was excellent (ICC 0.93, ICC 0.90).
Conclusion:
Patients with symptomatic OLT and functional CAI exhibit abnormal external rather than internal talus rotation. Preoperative WBCT reliably identifies abnormal external rotation, suggesting caution regarding procedures like lateral ligament surgeries that may exacerbate joint incongruence.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Amit BENADY, Federico USUELLI
10:05 - 10:25
#42627 - PKW19 Are large language models efficient as triage tools for surgical management of foot and ankle patients?
Are large language models efficient as triage tools for surgical management of foot and ankle patients?
Large Language Models (LLMs) like ChatGPT and Bard have emerged as potential but not risk-less tools, offering specialized answers based on context and prior knowledge. In Foot and Ankle (FA) surgery, efficient triage is crucial due to the variety of conditions and limited surgical time. This study evaluates LLMs' ability to guide patients towards appropriate medical or surgical management compared to board-certified FA surgeons.
Forty-four fictitious clinical scenarios were created, incorporating chronicity, onset, and anatomic localization. Outcomes were assessed on a Likert scale (1-5) for the likelihood of needing surgical management, and the primary outcome was a binary decision towards surgical (1,2,3 for certain, probable or uncertain) or medical follow up (4,5 for improbable and not required). Four FA surgeons and ChatGPT and Bard were evaluated, with agreement analyzed using Fleiss' and Cohen's Kappas.
Overall Likert scale agreement was -0.003, indicating no concordance. Agreement on the decision (surgical versus medical orientation of patients) improved to low (0.17). Pairwise comparison showed slight agreement among surgeons (0.02) and moderate between LLMs (0.52), with ChatGPT aligning slightly with surgeons (0.13), and Bard poorly (0.09). Strikingly, agreement between surgeons was even worse (0.067).
LLMs require refinement for clinical reliability. Moderate agreement between them suggests a common knowledge base which could be promising regarding their reliability, although ChatGPT's higher surgeon agreement suggests some models may better capture clinical judgment nuances. Future research should enhance LLMs interpretive algorithms based on a common nomenclature of conditions and explore their supportive role in medical decision-making.
François LINTZ (Toulouse), Antoine ACKER, Kepler (Alencar Mendes) CARVALHO, May LABIDI, Gianluca GONZI, Marie-Aude MUNOZ, Alessio BERNASCONI, Cesar DE CESAR DE NETTO
10:05 - 10:25
#42987 - PKW20 Ankle fracture with well-repaired syndesmotic injury versus ankle fracture with no syndesmotic injury: a prospective cohort study of surgical outcomes.
Ankle fracture with well-repaired syndesmotic injury versus ankle fracture with no syndesmotic injury: a prospective cohort study of surgical outcomes.
Introduction
This prospective cohort study was to compare treatment outcomes between ankle fractures with well-repaired syndesmotic injury and with no syndesmotic injury following standard fixations.
Methods
All 34 patients were divided into group-1: ankle fracture with well-repaired syndesmotic injury (n = 21) and group-2: ankle fracture with no syndesmotic injury (n = 13). In group-1, syndesmotic evaluations before/after syndesmotic repairs were done via hook tests/external rotation stress tests under fluoroscopic control and/or open syndesmotic viewing. Syndesmotic articulation was reduced and fixed/repaired to be close to anatomic alignment as possible under fine-tune confirmation as mentioned. Other fractures at ankle area were fixed as standard manners. Tibiofibular (TF) clear space was measured as a main parameter to determine quality of syndesmotic repair. Validated Visual analogue scale foot and ankle (VASFA) scores and Short Form-36 (SF-36) were postoperatively recorded.
Results
There were no significant differences between the two groups in terms of postoperative VASFA scores (group-1: mean-value = 82.26 +/- 17.20 vs group-2: mean-value = 74.53 +/- 22.16, P-value = 0.269) and quality of syndesmotic repair via postoperative TF clear space distances (group-1: mean-value = 3.84 +/- 1.78 mm vs group-2: mean-value = 3.84 +/- 1.06 mm, P-value = 1). VASFA moderately correlated with SF-36 scores via Pearson Correlation Coefficient (r): 0.5016.
Conclusions
Ankle fracture patients with well-repaired syndesmotic injury were able to demonstrate similar outcomes to a cohort with no syndesmotic injury following surgery. Syndesmotic injury did not always produce negative outcome provided that it was well repaired under proper treatment.
Angthong CHAYANIN (Bangkok, Thailand)
|
10:30 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
F2
10:30 - 11:30
Foot and Ankle Trauma FORUM
10:30 - 11:30
Moderators.
Stefan RAMMELT (Head, Foot & Ankle Center) (Moderator, Dresden, Germany), Nikolaos GOUGOULIAS (Consultant Orthopaedic Surgeon) (Moderator, Katerini, Greece)
10:30 - 10:40
Operative versus non-operative treatment of ankle fractures – What do we know?
Nikolaos GOUGOULIAS (Consultant Orthopaedic Surgeon) (Speaker, Katerini, Greece)
10:40 - 10:50
When and how to treat deltoid ligament ruptures in ankle fractures?
Hans POLZER (Speaker, France), Sebastian BAUMBACH (Speaker, Germany)
10:50 - 11:00
When and how to treat anterior and posterior malleolar fractures?
Andrzej BOSZCZYK (consultant) (Speaker, Warsaw, Poland)
11:00 - 11:10
What to do differently in patients with relevant comorbidities?
Stefan RAMMELT (Head, Foot & Ankle Center) (Speaker, Dresden, Germany)
11:10 - 11:30
Discussion.
|
AUDITORIUM |
|
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
EDI
10:30 - 11:30
EDI (Equality, Diversity, Inclusion) FORUM:
10:30 - 11:30
Moderators.
Elena SAMAILA (Associated Professor) (Moderator, Verona, Italy), Rick BROWN (Clinical lead) (Moderator, Oxford, United Kingdom)
10:30 - 10:40
Ethnicity in Foot & Ankle surgery.
Mostafa BENYAHIA (Surgeon) (Speaker, Copenhagen, Denmark)
10:40 - 10:50
LGTBQ+ in Foot & Ankle Surgery.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
10:50 - 11:00
EDI in Orthopaedics in Eastern Europe.
Iozefina BOTEZATU (MDPhD) (Speaker, bucharest, Romania)
11:00 - 11:10
“Briser le plafond de glace”- Breaking the glass ceiling. How can institutions make it easier for future women to progress in F&A surgery?
Barbara PICLET (chirurgien) (Speaker, Marseille, France)
11:10 - 11:20
Establishing a mentorship Programme for Foot & Ankle Surgeons.
Anna CHAPMAN (Speaker, United Kingdom)
11:20 - 11:30
Discussion.
|
AQUARIUM |
11:30 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
GA
11:30 - 13:00
EFAS GENERAL ASSEMBLY
|
STUDIO |
13:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
L2
13:00 - 15:00
Lunch, Exhibition, Industry Workshops & Poster Walks
|
EXHIBITION AREA |
13:10 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWP6
13:10 - 13:30
Poster Walks presentations 6
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Laurens DE COCK (Md) (Moderator, Dendermonde, Belgium), Matthias WALCHER (Orthopaedic Surgeon) (Moderator, Würzburg, Germany)
13:10 - 13:30
#40837 - PWK21 Automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) is valid.
Automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) is valid.
Background
The purpose of this study was to compare automatic software-based angular measurement (AM, Autometrics 2.0, Curvebeam, Warrington, PA, USA) with validated measurement by hand (MBH) regarding angle values and time spent for Weight-Bearing CT (WBCT) scans.
Methods
Five-hundred bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were included in the study. Five angles (1st - 2nd intermetatarsal angle, talo-metatarsal 1-angle (TMT) dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch angle) were measured with MBH and AM on the foot/ankle (side with pathology). Angles and time spent of MBH and AM were compared (t-test, homoscedatic).
Results
Mean age of the patients was 49 years (range, 18-85), 214 (43%) were male. 243 (49%) right and 257 (51%) left feet were analyzed with the following specific pathologies: osteoarthritis/instability, n=147 (29%); Haglund deformity/Achillodynia, n=41 (8%); forefoot deformity, n=108 (22%); Hallux rigidus, n=37 (7%); flatfoot, n=35 (7%); cavus foot, n=10 (2%); osteoarthritis except ankle, n=82 (16%). The angles did not differ between MBH and AM (each p>0.36, table 1). The null hypothesis was rejected. The power was 0.92. The time spent for MBH / AM was 44.5 / 1s on average per angle (p<.001).
Conclusions
AM provided angles which were not different from validated MBH and can be considered as a validated angle measurement method. The time spent was 97% lower for AM than for MBH. The investigator time spent is 97% lower for AM (1s per angle) than for MBH (44.5s per angle).
Martinus RICHTER (Rummelsberg, Germany), Stefan ZECH, Issam NAEF, Stefan A MEISSNER, Regina SCHILKE, Fabian DUERR
13:10 - 13:30
#41204 - PWK22 Delayed Wound Healing in Complex Hindfoot Surgery – An underappreciated problem?
Delayed Wound Healing in Complex Hindfoot Surgery – An underappreciated problem?
Delayed wound healing results in increased costs, repeated appointments, and unsatisfactory patient experience. We conducted an audit assessing incidence of delayed wound healing and causative factors.
This was a prospective audit of 109 patients undergoing foot and ankle surgery in a tertiary unit over four months. The standard was for 90% of wounds to heal by two weeks. Patients were seen by clinical nurse specialists at two weeks for wound review and management as required. We examined demographics, co-morbidity, type of surgery, and wound closure. Procedures included Forefoot (43%), Midfoot (13%), Non-fusion Ankle (14%) Hind foot/Ankle Fusion (14.5%), and Cavus /Planus correction (15.5%). Multinomial logistic regression was used to identify factors associated with delayed healing.
18 patients (16.5%) had delayed wound healing, requiring an additional 4 weeks to heal (2-20 extra weeks). All patients wounds healed with dressings and only 2 required antibiotics. Delays were seen in 32% of patients with multiple co-morbidity versus 12% in those without (p=0.03). The strongest predictive factor was type of surgery, with complex cases (hindfoot/ankle fusion; cavus/planus correction) associated with a delayed healing rate of 42.4% versus 5.3% for others (p<0.001, Odd’s Ratio 19.6). When considering complexity of surgery, co-morbidity did not independently predict wound healing delays.
Healing rates for simple cases met our audit standard. However, complex ankle/hindfoot cases had a 20-fold increase in delayed healing. Units undertaking complex work should be cognisant of the increased burden to patients and clinic time. Patients should be counselled, and complications monitored within a governance framework.
Angelica GHEORGHE, Karen ALLIGAN, Karan MALHOTRA, Cullen NICHOLAS, Shelain PATEL, Wilthelmino RONGAVILLA, Matthew WELCK (london, United Kingdom)
13:10 - 13:30
#42546 - PWK23 Radiological Posterior Medial Safe Zone of the Ankle. Protecting the Posterior Tibial Tendon During Ankle or Pilon Fracture Fixation.
Radiological Posterior Medial Safe Zone of the Ankle. Protecting the Posterior Tibial Tendon During Ankle or Pilon Fracture Fixation.
Background: The surgical treatment of pilon and posterior malleolar fractures can risk damage to the posterior tibial tendon (PTT). Our aim in this study was to identify the medial fluoroscopic safe zone, to prevent inadvertent injury to PTT during both direct and indirect fixation.
Methods: A cadaveric study was performed using 9 fresh frozen cadavers. A medial posteromedial approach was performed on each specimen to expose the PTT sheath. A flexible wire was placed down the lateral aspect of PTT sheath as a radio opaque marker. Fluoroscopic imaging was performed in the anteroposterior and lateral position to identify a medial safe zone.
Results: In all specimens, the wire was located medial to a vertical line corresponding to the articular surface (the medial safe zone line) of the medial malleolus on anteroposterior imaging. On lateral imaging, the marker followed the medial malleolus obliquity and continued to correspond to 30% of the posterior plafond.
Conclusion: This study demonstrated that a medial safe zone fluoroscopic landmark is unambiguous in localizing the PTT sheath and that any metal work medial to this line is likely to be at risk of damaging the tibialis posterior tendon. The lateral radiograph showed that any anteroposterior screw could involve the PTT sheath even if the penetration is only 70% across the tibial width.
Clinical relevance: We described a radiographic and clinical safe zone to protect PTT during fixation and hardware placement. This information will assist surgeons in avoiding hardware placement that can damage PTT.
Vasileios LAMPRIDIS (UK, United Kingdom), Ben JONES, Junaid AAMIR, William HARRISON, Kyle ROUGHNEEN, Alastair BOND, Lyndon MASON
13:10 - 13:30
#42585 - PWK24 Distance mapping patterns analysis of tibiotalar joint in ankle osteoarthritis: The battleship technique.
Distance mapping patterns analysis of tibiotalar joint in ankle osteoarthritis: The battleship technique.
Background: Weightbearing computed tomography (WBCT) enables the creation of intraarticular distance mapping (DM), an algorithm which assesses the distance between articular surfaces and assigns predetermined colors to generate a visual representation of the joint interaction. Similar foot and ankle (FA) alignments have demonstrated to share DM patterns. This study aims to create predictable DM patterns in patients with OA of the tibiotalar joint, using a novel method created by the authors coined the "battleship technique," and evaluate whether these patterns correspond to FA alignment.
Methods: Forty OA ankles were included. We calculated the DM weighted sum of the tibiotalar joint using the battleship technique (BTT) to obtain a single coordinate representing the deformity's apex on the X- and Y-axis. Patients were divided into two coronal groups (valgus and varus) and two sagittal groups (anterior translation and posterior translation) and compared.
Results: There was a statistically significant difference between the coronal group in α,
talar surface, hindfoot alignment, and talar tilt angles and β angle and tibiotalar ratio in the sagittal groups. A statistically significant correlation was found between the talar surface and talar tilt angle to the location of the X-coordinate and between the β angle and the tibiotalar ratio to the location of the Y-coordinate.
Conclusion: The battleship technique can create predictable DM patterns in patients with advanced OA changes in the tibiotalar joint. This pattern corresponds to the ankle alignment in the coronal and sagittal plane, indicating that this technique could locate the intraarticular deformity's apex.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Federico USUELLI
|
13:35 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWK7
13:35 - 13:55
Poster Walks presentations 7
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Nick CULLEN (Consultant foot and ankle surgeon) (Stanmore uk, United Kingdom), Ezequiel PALMANOVICH (ezepalm@gmail.com) (Kfar Saba, Israel)
13:35 - 13:55
#42577 - PKW25 The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: a review of 247 cases.
The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: a review of 247 cases.
The initial management for unstable ankle fractures involves urgent fracture reduction and immobilisation. However, opinions vary on the definition of an adequate pre-operative reduction. We hypothesised that residual tibiotalar subluxation may limit the resolution of soft tissue swelling and impair post-operative wound healing. This study aimed to evaluate the rate of wound complications following ankle fracture fixation according to the quality of pre-operative reduction. We conducted a retrospective case series of all ankle fractures in adults (> 18 years old) treated with surgical fixation at a district general hospital from January 2020 until July 2023. Pre-operative reduction was categorised as adequate or inadequate according to the absence or presence of residual tibiotalar joint subluxation on post-manipulation radiographs, respectively. Wound complication was defined as any wound problem requiring dressing care, antibiotics, or a return to theatre. 247 patients were included in this study, with a mean follow-up duration of 21.6 weeks. 98 (39.7%) patients had an inadequate pre-operative reduction with residual subluxation of the tibiotalar joint. There were 29 (11.7%) cases of post-operative wound complications, of which 7 (24.1%) required surgical interventions. The rate of wound complications was higher in patients with an inadequate pre-operative reduction compared to those in whom adequate reduction was achieved (17.3% versus 8.1% respectively, p = 0.026). Inadequate pre-operative reduction with residual tibiotalar subluxation is a risk factor for post-operative wound complications in ankle fractures. Urgent intervention is warranted in cases with persistent subluxation despite multiple attempts at closed reduction.
Rye Yern YAP (Hereford, United Kingdom), Peter LOGAN, Mohammad IQBAL, Vishwajeet KUMAR, Zaid AL-WATTAR
13:35 - 13:55
#42578 - PKW26 Comparison of the measurement of the Calcaneal X/Y ratio on plain radiographs and CT scan.
Comparison of the measurement of the Calcaneal X/Y ratio on plain radiographs and CT scan.
Background:
In 2018, Tourne et al introduced the X/Y ratio as a novel radiological parameter to assess relative calcaneal length. Their research concluded that any calcaneum showing a ratio less than 2.5 can be considered “long” predisposing for the Haglund's syndrome.
The aim of our study was to evaluate the accuracy of the XY ratio measurement on the plain radiographs reflecting the morphology of the calcaneum.
Methods:
Two assessors measured the X/Y ratio of fifty patients on the plain radiograph using the Tourne et al’s technique. The X/Y ratio was also assessed on sagittal cuts of the CT scan of the ankle joint, with the axis of the CT scan image adjusted on the axial cut to run parallel to the long axis of the calcaneum.
Results:
The mean X/Y ratio measurements of the two assessors on X-ray (2.71±0.43 and 2.69±0.41) were lower than those measured on CT (3.14±0.44 and 3.10±0.44). The intra-observer agreement for X-ray and CT scan ratios was poor for both assessors (ICC = .487 and .476). Interobserver reliability of the X/Y ratio measured on plain radiographs was good, and it was excellent when measured on CT scans (ICC = .808 and .956).
Conclusions:
The poor agreement between the measurement on X-ray and CT scan indicates that the X/Y ratio on X-ray doesn’t necessarily reflect the true morphology of the Calcaneum. Our study is the first to assess the X/Y ratio on CT scan. the excellent interobserver agreement shows that it is a reliable method.
Hesham OSHBA (Crowthorne, United Kingdom), Kate NICHOLLS, Togay KOC, Neeraj PUROHIT, Raghda SHAABAN
13:35 - 13:55
#42590 - PKW27 Enhancing precision in osteochondral lesion of the talus measurements and improving agreement in surgical decision-making: A comprehensive evaluation using weight-bearing computed tomography and distance mapping for preoperative planning.
Enhancing precision in osteochondral lesion of the talus measurements and improving agreement in surgical decision-making: A comprehensive evaluation using weight-bearing computed tomography and distance mapping for preoperative planning.
Purpose: Weight-bearing CT (WBCT) enables three-dimensional modeling of ankle morphology, while distance mapping (DM) provides color-coded representation of intraarticular distance, particularly beneficial for delineating osteochondral lesions of the talus (OLT). This study aims to assess DM's reliability in measuring OLT surface, depth, and volume and its role in achieving consensus among surgeons regarding optimal surgical intervention.
Methods: Thirty-six patients with 40 OLTs underwent WBCT and DM evaluation. Two raters utilized DM to define lesion boundary (LB) and lesion fundus (LF) and calculate lesion depth, surface, and volume. Treatment options were selected based on measurements, and inter-rater and intra-rater agreement were assessed.
Results: Interrater and intrareader agreement for lesion depth surface showed excellent correlation (0.90 - 0.94, p < 0.001). Cohen's Kappa analysis indicated near-perfect agreement (Kappa = 0.834, p < 0.001) for preferred preoperative plans. The study demonstrated that WBCT and DM together offer reliable measurements of OLT parameters, facilitating accurate treatment planning and enhancing interrater consensus among surgeons.
Conclusion: WBCT-based 3D modeling and DM prove to be valuable tools for evaluating OLTs, providing precise measurements of surface, depth, and volume with excellent reliability. Integration of these techniques into preoperative planning enhances surgical decision-making, ensuring optimal outcomes for patients with OLTs. Further research may explore the broader applicability of WBCT and DM in orthopedic practice to improve treatment strategies and patient care.
Efrima BEN, Agustin BARBERO (Milan, Italy), Jari DAHMEN, Amit BENADY, Cristian INDINO, Camilla MACCARIO, Gino KERKHOFFS, Federico USUELLI
13:35 - 13:55
#42592 - PKW28 Comparison of hindfoot preoperative alignments and postoperative total ankle arthroplasty positioning using weight-bearing computed tomography-generated 3 dimensional models.
Comparison of hindfoot preoperative alignments and postoperative total ankle arthroplasty positioning using weight-bearing computed tomography-generated 3 dimensional models.
Background: Traditional imaging methods for total ankle arthroplasty (TAA) suffer from rotational bias and bone superimposition, necessitating more precise assessment techniques. Weight-bearing computed tomography (WBCT) and 3D models from WBCT have revolutionized foot and ankle alignment visualization, offering unparalleled detail. This study aims to compare preoperative hindfoot alignment with postoperative outcomes in TAA across three planes and assess measurement reliability.
Methods: Eighty-one TAA patients underwent preoperative and postoperative WBCT, measuring five coronal angles (Alpha, TSA, TT, SA, TCA), three sagittal angles (Beta, Gamma, TTR), and one axial angle (PTARA). Two raters evaluated measurements pre- and post-surgery in separate sessions. Pre- and postoperative measurements were compared, and inter-rater and intra-rater reliability were calculated.
Results: Significant changes were observed in three coronal (TSA, TT, SA) and two sagittal angles (Beta, Gamma) (P < 0.001). Alpha, TCA, TTR, and PTARA showed no significant changes (P > 0.05). Intra- and inter-rater reliability scores ranged from 0.885 to 0.97, indicating good to excellent correlation.
Conclusion: WBCT-based 3D modeling facilitates detailed comparison of preoperative alignment and postoperative TAA positioning across coronal, sagittal, and axial planes, highlighting significant adjustments in coronal and sagittal alignments. The high reliability underscores the value of WBCT and 3D modeling in preoperative planning, enhancing surgical intervention accuracy.
Efrima BEN, Agustin BARBERO (Milan, Italy), Amit BENADY, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
|
14:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWK8
14:00 - 14:20
Poster Walks presentations 8
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Elisabeth ELLINGSEN HUSEBYE (Norway), Anja HELMERS
14:00 - 14:20
#42593 - PWK29 Reliability of cone beam weightbearing computed tomography analysis of total ankle arthroplasty positioning and comparison to weightbearing x-ray measurements.
Reliability of cone beam weightbearing computed tomography analysis of total ankle arthroplasty positioning and comparison to weightbearing x-ray measurements.
Background:
The current reference standard for postoperative evaluation of total ankle arthroplasty (TAA) positioning, weightbearing radiography (WBXR), is subject to technical bias. Weightbearing cone beam computed tomography (WBCT) enables visualization of the foot's complex 3-dimensional (3D) structure under standing load. To date, no WBCT-based system for TAA positioning has been validated. The purpose of this study was to (1) assess TAA positioning using WBCT 3D models and (2) evaluate the agreement levels between 2 raters and thus evaluate the intermethod reliability with respect to WBXR.
Methods:
Fifty-five consecutive patients were retrospectively reviewed. Two raters independently created a 3D WBCT model using dedicated software and recorded the following measurements: α angle, tibiotalar surface angle (TSA), hindfoot angle (HFA), tibiotalar ratio (TTR), β angle, γ angle, and Φ angle. Measurements were repeated 2 months apart in similar, independent fashion and compared to WBXR. Interobserver, intraobserver, and intermethod agreements were calculated.
Results:
All 7 measurements showed good to excellent intraobserver and interobserver reliability (ICC 0.85-0.95). The intermethod (WBCT vs WBXR) agreement showed good agreement for the γ angle (ICC 0.79); moderate agreement levels for the α angle, TSA angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, and 0.69, respectively); poor agreement for the HFA (ICC 0.25); and negative agreement for the φ angle (ICC −0.2).
Conclusion:
Position analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. Additionally, a negative to moderate agreement between standard WBCT and standard
WBXR was found.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Federico USUELLI
14:00 - 14:20
#42602 - PWK30 Anterior Translation of the Talus Post Anterior Pilon Fixation. Are we Missing Something?
Anterior Translation of the Talus Post Anterior Pilon Fixation. Are we Missing Something?
Background: Anterior Pilon fractures are uncommon injuries to the ankle. Fixation of the fracture is commonly undertaken, however concomitant injury to the anterior talofibular ligament (ATFL) is not commonly addressed. There are no current studies assessing talus translation in anterior Pilon fractures.
Objective: To assess incidence of persistent talus anterior translation in Pilon fractures affecting the anterior plafond.
Methods: A retrospective analysis of a prospectively collected database in a major trauma centre was undertaken to establish eligible patients. All patients with Pilon fractures with anterior components undergoing reduction and fixation were included. Intraoperative and weightbearing postoperative radiographs were assessed for fracture reduction and anterior talus translation. The Topliss Classification was used for pilon type characterisation.
Results: A total of 57 patients were identified who could be included in the study. The mean age of patients was 43.60 years (95% CI 39.87, 47.33). Out of the full cohort, 80.70% (46/57) were judged to be anatomically reduced. There were 39 patients (68.42%) with persistent anterior talus translation. There was no significant difference between types of Pilon fractures (p=.581). There was a higher rate of persistent anterior translation with coronal fracture types 72.73% (32/44) as compared to sagittal fracture types 53.85% (7/13).
Conclusion: Over half the patients in this study had persistent anterior talus translation post fixation despite being anatomically reduced. The fracture mechanism to sustain an anterior Pilon is likely to injure the ATFL, which if unrepaired, may remain unstable. Cartilage loss and over compression of the fracture are other possible aetiologies.
Vasileios LAMPRIDIS (UK, United Kingdom), James MCEVOY, William HARRISON, Lyndon MASON
14:00 - 14:20
#42612 - PWK31 Impact of Initial Tendon Gap Size on Outcomes of Functional Rehabilitation in Achilles Tendon Rupture.
Impact of Initial Tendon Gap Size on Outcomes of Functional Rehabilitation in Achilles Tendon Rupture.
This study investigates the relationship between the initial gap size of a ruptured Achilles tendon and patient outcomes following a functional rehabilitation program. Factors like age and activity level typically influence treatment decisions, but the gap size between tendon ends remains debated. The research focuses on defining any correlation between the initial tendon gap and outcomes in patients treated non-surgically with functional rehabilitation.
Method:
A prospective case series study was conducted on patients with acute Achilles tendon rupture treated non-surgically with a functional rehabilitation program from 2016 to 2018. The tendon gap was measured via ultrasound at the initial presentation. Patients were followed for at least 12 months and evaluated using the Achilles Tendon Rupture Score (ATRS), plantarflexion strength, and re-rupture rate.
Results:
Out of 56 patients who completed the one-year follow-up, 2 experienced re-ruptures. The average plantarflexion gap was 13.7 mm. The mean ATRS at 12 months was 85.12. No statistically significant correlation was found between the final ATRS and the initial rupture gap.
Conclusion:
The outcome following non-operative functional rehabilitation treatment of ruptured Achilles tendon did not correlate with the size of the tendon gap, and the authors recommend that the decision on functional rehabilitation should not be based on these criteria.
Amr ABOUELELA (England, United Kingdom), Islam MUBARK
14:00 - 14:20
#42652 - PWK32 Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries.
Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries.
The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES.
Babk OTOUKESH, Shayan AMIRI (Tehran, Islamic Republic of Iran)
|
14:20 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWK9
14:20 - 14:40
Poster Walks presentations 9
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Hans-Jörg TRNKA (Director) (Vienna, Austria), Alistair WILSON (Consultant) (Belfast, United Kingdom), Emre BACA (assoc. prof) (istanbul, Turkey)
14:20 - 14:40
#42759 - PWP33 The kinematics of the distal tibiofibular joint in syndesmosis instability and its reconstruction - a biomechanical in vitro study.
The kinematics of the distal tibiofibular joint in syndesmosis instability and its reconstruction - a biomechanical in vitro study.
The aim of the present study was to investigate the stability of the syndesmosis after transection and the effect of stabilization with rigid and dynamic reconstruction techniques.
Syndesmosis stability was investigated using a six-axis industrial robotic arm on human lower leg specimens (n=14). In neutral position, dorsiflexion and plantar flexion, stability was examined using an external rotation stress test under an axial load of 200 Newtons. The examination was performed on the intact syndesmosis and the sequentially transected syndesmosis (1. transection of anterior inferior tibiofibular ligament (AITFL); 2. transection of interosseous ligament (IOL); 3. transection of posterior inferior tibiofibular ligament (PITFL). Reconstruction was then performed using either various screw techniques (n=7) or a dynamic suture button system (Arthrex Tightrope, n=7).
In the coronal plane, both rigid and dynamic reconstruction techniques led to an equivalent reduction in lateralization.
In the axial plane, transection of the AITFL did not lead to significant rotational instability, whereas transection of the IOL led to instability. Stability could be reconstructed by implantation of 2 tricortical set screws, whereas instability remained with dynamic reconstruction.
In the sagittal plane, a dorsal displacement of the AITFL already occurred when the AITFL was cut. This could be stabilized with all screw reconstructions, but not with the suture button procedures.
The results indicate instability of the fibula, particularly in the sagittal and axial plane. In addition, our model shows an equivalence of the different screw techniques and the reconstruction with two suture buttons.
Alexander MILSTREY (Muenster, Germany), Vivienne HOELL, Jens WERMERS, Stella GARTUNG, Michael RASCHKE, Julia EVERS, Sabine OCHMAN
14:20 - 14:40
#42886 - PWP34 Bio-integrative screws versus metallic screws for calcaneus osteotomies: a non-inferiority randomized clinical trial.
Bio-integrative screws versus metallic screws for calcaneus osteotomies: a non-inferiority randomized clinical trial.
Introduction
The use of bio-integrative implants in orthopedic surgery is growing. While many biomechanical and histological reports could sustain its structural and biological properties, few clinical studies support its use. This trial aims to determine the bio-integrative screws' capacity to reach non-inferior clinical and radiographical outcomes of current metallic screws in calcaneus osteotomies.
Methods
This was a single center, in parallel groups, randomized, non-inferiority clinical trial (NCT05018130) including patients undergoing open calcaneal sliding osteotomy. Surgeries were performed respecting the same technique, using 2 canulated 4mm screws, either titanium or fiber. Primary outcome was bone healing by weight-bearing computed tomography at the 6th postoperative week. Secondary outcomes included healing, minor and major assessed until 48 weeks of follow-up. Readings were performed by two assessors.
Results
24 feet were included in the study. Groups were similar demographically (ps>0.37), with 12 allocated to the bio-integrative and 12 to the metallic groups. The mean follow-up was 23.3 months (15-33) with no losses. Considering bone healing at six weeks, the bio (83.3%) and the metallic (66.7%) groups had similar rates (p=0.320), what was maintained at 12 weeks (100% vs. 91.7% respectively; p=0.500). Minor complications were similar between groups (16.7% vs. 16.7%; p=1), all resolved by six weeks. No major complications and no secondary surgeries were observed.
Conclusion
Bio-integrative screws presented non-inferior results to metallic screws when used in calcaneus osteotomies, considering bone healing and complications. Larger and longer trials are necessary to determine the superiority of any implant and its impact on orthopedic surgery.
Nacime Salomao BARBACHAN MANSUR, Eli SCHMIDT, Francois LINTZ, Chinelati ROGERIO, Matthieu LALEVEE, Cesar DE CESAR NETTO (Iowa City, USA)
14:20 - 14:40
#42888 - PWP35 Biomechanical evaluation of screw vs. k-wire reconstructions for instable Lisfranc injuries.
Biomechanical evaluation of screw vs. k-wire reconstructions for instable Lisfranc injuries.
There is currently no consensus regarding the choice of implant for instable Lisfranc injuries. The aim of this study was to investigate the effects of a transection of the Lisfranc ligaments on the height of the foot and the distance between the Os cuneiforme mediale (CM) and Os metatarsale 2 (MT2). In a second step, the stability of screw vs. K-wire reconstruction was investigated.
16 human specimens were loaded with 200N and 700N in a testing machine. Sequential measurements were performed in the native state and after cutting the dorsal, interosseous and plantar Lisfranc ligaments. In a final step, the entire tarsometatarsal (TMT) ligaments were transected.
Subsequently, in two groups of 8 paired specimens each, TMT joints 1-3 were addressed with 3.5mm screws or 2.0mm K-wires, TMT joints 4-5 were always addressed with 2.0mm K-wires. Biomechanical and radiological analysis was performed.
Already at 200N loading, there was a relevant loss of height of the CM (p=0.0005) and MT2 (p=0.002) after transection of the dorsal ligament. The screw reconstruction successfully restored the height and distance of both the CM (p=0.0101) and the MT2 (p=0.0088). The K-wire reconstruction did not achieve a significant improvement on both the CM (p=0.8358) and the MT2 (p=0.9981) under load.
Especially in unstable Lisfranc injuries, the screw versus K-wire reconstructions were superior. Vertical instability could be determined as a sensitive parameter that is not yet regularly used in diagnostics. An increase in the axial distance between CM and MT2 only occurs when all ligaments are injured.
Alexander MILSTREY (Muenster, Germany), Franziska WERMELING, Julia EVERS, Michael RASCHKE, Sabine OCHMAN
14:20 - 14:40
#42961 - PWP36 Research on Determining Bony Landmarks for Accurate Tibiofibular Syndesmotic Fixation: Cadaveric Validity and Safety Analysis of Angle Bisector Method.
Research on Determining Bony Landmarks for Accurate Tibiofibular Syndesmotic Fixation: Cadaveric Validity and Safety Analysis of Angle Bisector Method.
Introduction
Determining the optimal intraoperative fixation angle for syndesmosis remains uncertain and depends on the surgeon. This study aims to evaluate whether the angle bisector method can provide a patient- and level-specific syndesmotic fixation angle that is reproducible and safe in a cadaveric setting.
Methods
Funded by the AOFAS Research Grants Program, cadaveric leg specimens underwent fixation using the angle bisector method at two levels (2-cm and 3.5-cm proximal) parallel to the tibial plafond by two surgeons. The angle bisector method involved a drill and screw directed along the bisector of the angle, formed between two K-wires at the fixation level. Post-fixation CT images were analyzed to measure the angle between the true centroidal axis and the screw axis. Distances between the centroidal axis and screw entry points, as well as between K-wires and major neurovascular structures, were measured and documented.
Results
The average angle between the centroidal axis and screw trajectory was 2.7 degrees at the 2-cm level and 1.8 degrees at the 3.5-cm level. The distance between entry points averaged 1.7 mm at 2-cm and 1.2 mm at 3.5-cm. Results showed low inter-surgeon variability and high intra- and inter-observer reliability (ICC > 0.80). Trajectories differed significantly between levels. The distance between K-wires and neurovascular structures was always over 5 mm, with no damage noted, confirming the method's safety.
Conclusion
The angle bisector method provides an accurate and safe syndesmotic fixation trajectory. This technique can be easily implemented using K-wires or a specially designed jig.
Bedri KARAISMAILOGLU (Istanbul, Turkey), Julian HOLLANDER, Jiyong AHN, Siddhartha SHARMA, Matthias PEIFFER, Lorena BEJARANO-PINEDA, Daniel GUSS, John Y KWON, Christopher DIGIOVANNI, Soheil ASHKANI-ESFAHANI, Gregory WARYASZ
|
15:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
FP3
15:00 - 16:00
FREE PAPERS 3: Forefoot
Moderators:
Alberto GINÉS CESPEDOSA (Adjunto) (Moderator, Barcelona, Spain), Sabine OCHMAN (Consultant) (Moderator, Muenster, Germany)
15:00 - 15:06
#41114 - OP21 The surgical treatment of brachymetatarsia by one-stage lengthening of the metatarsal bone using an autograft from tubular bones of the foot.
The surgical treatment of brachymetatarsia by one-stage lengthening of the metatarsal bone using an autograft from tubular bones of the foot.
Introduction. Brachymetatarsia is a fairly rare pathology that is characterized by shortening of the metatarsal (or metatarsals) bones due to premature closure of the growth plate. However, most patients suffering from this pathology require surgical treatment.
Purpose of the study: to improve the results of treatment of patients with brachymetatarisis by introducing into surgical practice the method of simultaneous lengthening of the metatarsal bone using an autograft from the tubular bones of the foot.
Materials and methods. This article presents a comparison of treatment results between two groups of patients. The main group of patients (40 patients, 50 feet) underwent simultaneous lengthening of the shortened metatarsal bone using autografts from tubular bones of the foot. The control group of patients (25 patients, 33 feet) underwent distraction osteosynthesis of the metatarsal bone using an external fixation device.
Results. The results obtained during the study suggest the advantage of the method of one-step lengthening of the metatarsal bone using autografts from tubular bones of the foot over the distraction method. Patients in the main group had a shorter healing period compared to the control group (8.1±1.3 and 16.2±2.4 weeks, respectively), and fewer complications. Also, patients of the main group in the early postoperative period noted a high cosmetic result of the operation.
Conclusions. By using the developed method of surgical treatment, we were able to significantly reduce the treatment time for patients, as well as achieve high aesthetic results.
Levon MAKINYAN (Moscow, Russia), Albert MANNANOV, Vladislav APRESYAN
15:06 - 15:12
#41639 - OP22 Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus Without Metatarsalgia.
Minimally Invasive Chevron Akin (MICA) Osteotomy Corrects Radiographic Parameters but Not Central Metatarsal Loading in Moderate to Severe Hallux Valgus Without Metatarsalgia.
Background: Central metatarsal pressure is increased in patients with hallux valgus, but the pedographic outcomes after hallux valgus (HV) correction are inconclusive. No known literature reports the pedographic outcomes after HV correction with Minimally Invasive Chevron and Akin Osteotomy (MICA).
Methods: A consecutive series of 31 feet from 25 patients with moderate-to-severe symptomatic HV without metatarsalgia underwent MICA and were prospectively evaluated using radiographic parameters and pedographic measurements (Footscan®, RSscan International, Olen, Belgium). Data were collected preoperatively and 3 months after surgery.
Results: Radiographic parameters of hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, first metatarsal head lateral shape, and lateral sesamoid grade significantly improved after MICA. The corrected first metatarsal length was significantly shortened by 2.3 mm, with consistent second metatarsal protrusion distance, lateral Meary’s angle, and calcaneal pitch angle. Max force, max pressure, cumulative force, and cumulative pressure on the central metatarsals did not show significant changes between pre- and post-operative measurements, while these parameters significantly decreased in the hallux and first metatarsal area.
Conclusion: MICA effectively corrects radiographic parameters but does not reduce central metatarsal loading in patients with moderate-to-severe HV without metatarsalgia.
Hsu WEI-KUO, Tie TUNG-HEE ALBERT, Yanyu CHEN (Changhua, Taiwan)
15:12 - 15:18
#43158 - OP23 Comparative Biomechanical Study of Different Screw Fixation Methods Following Minimally Invasive Chevron-Akin (MICA): A Finite Element Analysis.
Comparative Biomechanical Study of Different Screw Fixation Methods Following Minimally Invasive Chevron-Akin (MICA): A Finite Element Analysis.
Background: Minimally Invasive Chevron-Akin (MICA) hallux valgus (HV) deformity correction utilizes an extra-articular distal first metatarsal chevron osteotomy that is held with rigid fixation using two fully threaded screws, of which one is bicortical to provide stability. However, the necessity of two screws is debated, as is the necessity of bicortical fixation. Despite the clinical success of MICA, there is a lack of biomechanical studies assessing the stability and strength of different fixation constructs.
Methods: A 3D foot finite element model was developed from computed tomography images of a female patient with moderate HV deformity. Five different screw configurations were assessed using FEA, including fourth-generation MICA fixation with 2 screws (one bicortical and one intramedullary), 2 intramedullary screws, 2 bicortical screws, 1 intramedullary screw, and 1 bicortical screw. Loading conditions involved a vertical ground reaction force applied to the midfoot, with simulated 150N and 300N loads. Stress analysis considered osteotomy displacement, maximum and minimum principal stresses, and equivalent von Mises stress for both implants and bone.
Results: FEA indicated that MICA fixation with two screws (one bicortical and one intramedullary) demonstrated the lowest values for osteotomy displacement, minimum and maximum total stress, and equivalent von Mises stress on the bone and screws in both loading conditions.
Conclusion: This biomechanical analysis provides valuable insights into the strength of different MICA screw fixation configurations, highlighting the superiority of classical MICA fixation configurations with two screws in terms of stability and stress distribution.
Thomas LEWIS, Henrique MANSUR, Gabriel FERREIRA, Miguel VILHO, Leonardo BATTAGLION, Roberto ZAMBELI, Robbie RAY (London, United Kingdom), Gustavo NUNES
15:18 - 15:24
#42948 - OP24 Does decompressive chevron osteotomy decrease subchondral bone density of the 1st metatarsophalangeal joint in hallux rigidus?
Does decompressive chevron osteotomy decrease subchondral bone density of the 1st metatarsophalangeal joint in hallux rigidus?
Objective: To investigate the impact of decompressive chevron osteotomy on subchondral
bone density at the first MTP joint.
Methods: Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron
osteotomy. Pre- and post-operative standing cone beam 3DCT were assessed, and clinical
data was collected. Radiologic measurements, including bone density using Hounsfield units
(HU), were conducted. Statistical analyses were performed to evaluate changes and
correlations.
Results: Post-operative bone density significantly decreased in proximal (Pre, 650.9±149.1;
Post, 312.4±115.9; p<0.001) and distal (Pre, 910.4±143.3; Post, 639.0±167.1; p<0.001)
components of the first MTP (joint and the first TMT (Pre, 762.9±166.6; Post, 611.5±165.9;
p=0.015) joint. No significant difference was measured at the TT joint (Pre, 497.5±143.6;
Post, 534.3±130.7; p=0.463). Length of the first metatarsal (Pre, 60.4±3.4; Post, 54.3±3.0;
p<0.001) and metatarsal protrusion index (MPI) (Pre, -0.9±3.0; Post, -9.0±3.6; p<0.001)
significantly decreased post-operatively. Clinical assessments showed significant
improvements in AOFAS scores (36.1±14.5 points) and pain on VAS scale (- 5.3±1.9).
Conclusion: Decompressive chevron osteotomy leads to a significant decrease in
subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the
first TMT joint.
Luca TANEL (Bolzano, Italy), Matthieu LALEVEE, Philippe BEAUDET
15:24 - 15:30
#42986 - OP25 The presence of an avulsion fracture of the 1st tarso-metatarsal joint in Lisfranc injuries is a useful adjunct in the detection of 1st TMTJ instability.
The presence of an avulsion fracture of the 1st tarso-metatarsal joint in Lisfranc injuries is a useful adjunct in the detection of 1st TMTJ instability.
Aims
Ligamentous Lisfranc injuries often feature avulsion fractures of the tarso-metatarsal joint (TMTJ). A proportion of these will have a congruent TMTJ joint on initial imaging, and many of these patients will have an unstable TMTJ which requires stabilisation.
The study aimed to determine the relationship between the presence of an avulsion fracture on initial imaging and instability of the first TMTJ.
Methods
A prospective database of Lisfranc fracture-dislocations was analysed for the presence of TMTJ1 avulsion fractures. All cases were managed with examination under anaesthesia (EUA) and stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of TMTJ1 instability and the sensitivity and specificity of the presence of an avulsion in detecting instability was determined.
Results
153 patients with a mean age of 35.2 years were included. 99 injuries (64.7%) had an avulsion fracture of TMTJ1 on imaging. Of these, 76.7% had a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture demonstrated instability on EUA stress testing. Amongst the 54 cases showing no avulsion, 23 (42.6%) were unstable on EUA. The presence of an avulsion had a sensitivity of 79.8% and a specificity of 79.5% in the detection of instability.
Conclusions
The presence of an avulsion fracture of TMTJ1 is highly suggestive of instability. This finding should lower the threshold to perform EUA stress testing. A high proportion of Lisfranc injuries without avulsion fractures have TMTJ1 instability, and therefore the absence of this finding does not reliably exclude instability.
Prashant SINGH (London, UK, United Kingdom), Neil JONES, Marco PES, Francesc MALAGELADA, Amit PATEL, Lucky JEYASEELAN
15:30 - 15:36
#41019 - OP26 Noninferiority of copper dressings compared to negative pressure wound therapy in diabetic foot – an RCT study.
Noninferiority of copper dressings compared to negative pressure wound therapy in diabetic foot – an RCT study.
Aim:
Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper Oxide Dressings (COD) in the management of diabetic foot wounds (DFW).
Method:
A Randomized controlled trial (RCT) with 46 DFW, in whom NPWT was indicated. Twenty-three patients were enrolled in the COD and NPWT arm for three months or wound closure. The primary endpoint was wound size reduction, assessed by "Tissue Analytic" program. Secondary endpoints were convenience, application time, pain, and cost.
Results:
The initial wound area was 19.9±4.36 and 14.1±2.32 cm2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). 11 (47.8%) and 8 (34.8%) wounds were closed during the study in the COD and NPWT arms respectively (P=0.37). COD therapy was more convenient for the patients (Visual Analog Score [VAS] was 8.44 vs. 5.33; p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007), and less painful (1.15 vs. 2.19; p=0.67) in the COD arm compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p<0.001). The cost of COD is estimated to be 84% less than NPWT treatment.
Conclusion:
This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.
Eyal MELAMED (Haifa, Israel), Jihad DABBAH, Michael PINZUR
15:36 - 16:00
Discussion.
|
AUDITORIUM |
|
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
FP4
15:00 - 16:00
FREE PAPERS 4: Midfoot & Hindfoot
Moderators:
Johannes HAMEL (Germany), Antonio VILADOT (orthopaedic Surgeon) (Barcelona, Spain)
15:00 - 15:06
#42939 - OP27 Middle Facet Subluxation in PCFD: Effects of Plane Orientation on WBCT Measurements.
Middle Facet Subluxation in PCFD: Effects of Plane Orientation on WBCT Measurements.
Introduction:
Middle facet subluxation (MFS) and middle facet incongruence angle (MFIA) are commonly reported as marker of peritalar subluxation (PTS) in Progressive Collapsing Foot Deformity (PCFD). In the literature MFS and MFIA are assessed a true coronal plane which differs from the plane of the middle facet. We hypothesized that changes in the plane’s of measurement would lead to changes in the MFS and MFIA and as well its “dysplastic” appearance.
Method:
retrospective case-control study, 89 patients with PCFD and 11 controls. Measurements of MFS, MFIA, and middle facet dysplasia were conducted using both the classical method (taking measurements in the coronal plane as described in the literature) and the new method ( taking measurements after rotation of the coronal plane until it was perpendicular to the middle facet plane). A p-value of <0.05 was considered statistically significant.
Results:
Significant differences were observed between the two methods across all parameters, the new method demonstrated lower MFS (25.4% vs. 40.3%, p<0.0001), lower MFIA (4.7 degrees vs. 13.1 degrees, p<0.0001), and fewer dysplastic joints (1% vs. 37%, p<0.0001)
For controls, only the MFIA was significantly different (p:0.0045) between methods.
Conclusion:
MFS is a complex deformity influenced by multiple parameters. The new method showed lower MFS, MFIA, and dysplasia measurements compared to current classical method. When assessing MFS, surgeons should be mindful that the plane of measurement relative to the structure is critical. We suggest using a plane of measurement perpendicular to the plane of the middle facet when assessing its subluxation.
Antoine ACKER (Geneva, Switzerland), Tommaso FLORIN VALECCHI, Emily LUO, Erik HUANUCO CASAS, Grayson TALASKI, Albert ANASTASIO, Samuel ADAMS, Cesar DE CESAR NETTO
15:06 - 15:12
#43152 - OP28 Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment.
Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment.
Background: While many studies were able to determine the hind- and midfoot alignment after a medializing calcaneal osteotomy (MCO), the subtalar joint alignment remained obscured by superposition on plain radiography. Therefore, we aimed to assess the hind-, midfoot- and subtalar joint alignment pre- compared to post-operatively using 3D weightbearing CT (WBCT).
Methods: Seventeen patients with a mean age of 42±17 years were retrospectively analyzed. Inclusion criteria consisted of PCFD deformity corrected by a MCO as main procedure and imaged by WBCT before and after surgery. Exclusion criteria were patients who had concomitant calcaneal lengthening osteotomies, mid-/hindfoot fusions, hindfoot coalitions, and supramalleolar procedures. Image data were used to generate 3D models and compute the hindfoot (HA), midfoot (MA) - and subtalar joint (STJ) alignment in the coronal, sagittal and axial plane, as well as distance maps.
Results: Pre-operative measurements of the HA and MA improved significantly relative to their post-operative equivalents p<0.05). The post-operative STJ alignment showed significant inversion (2.8°±1.7), abduction (1.5°±1.8), and dorsiflexion (2.3°±1.7) of the talus relative to the calcaneus (p<0.05) compared to the pre-operative alignment. The displacement between the talus and calcaneus relative to the sinus tarsi increased significantly (0.6 mm±0.5;p<0.05).
Conclusion: This study detected significant changes in the sagittal, coronal, and axial plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings contribute to our clinical practice by demonstrating the magnitude of alteration in the subtalar joint alignment that can be expected after PCFD correction with MCO as main procedure.
Loïc RAES, Matthias PEIFFER, Tim LEENDERS, Kvarda PETER, Ahn JIYONG, Emmanuel AUDENAERT, Arne BURSSENS (Ghent, Belgium)
15:12 - 15:18
#42935 - OP29 Distinct Weight-Bearing CT Parameters in Pediatric vs. Non-Pediatric PCFD: Less Forefoot Abduction and Less Middle Facet Subluxation in Pediatric Cases.
Distinct Weight-Bearing CT Parameters in Pediatric vs. Non-Pediatric PCFD: Less Forefoot Abduction and Less Middle Facet Subluxation in Pediatric Cases.
Introduction:
This study aims to evaluate differences with Weight-Bearing CT (WBCT) among a cohort of symptomatic Progressive Collapsing Foot Deformity (PCFD) patients with a history of pediatric flat foot (=pediatric PCFD), without (=non-pediatric PCFD), and a control group. We hypothesized that pediatric PCFD would display distinct WBCT parameters.
Method:
In this retrospective case-control study, pediatric PCFD was defined as flat feet since childhood, non-pediatric PCFD as foot shape changed in adulthood. 37 pediatric PCFD patients were compared to 52 non-pediatric PCFD patients and 11 control. Significance was set at a p-value < 0.05. A multivariate regression analysis was conducted to identify parameters associated with pediatric PCFD.
Results:
Compared to non-pediatric PCFD, the pediatric PCFD group showed a lower Foot and Ankle Offset (p<0.001), lower sagittal talus-first metatarsal angle (TFM) (p<0.001), lower axial TFM (p 0.0001), lower hindfoot moment arm (HMA)(p=0.0002), lower talonavicular uncoverage (p<0.0001), lower middle facet subluxation (p=0.0021), higher sinus tarsi (p<0.001), higher subfibular impingement (p<0.0001. Differences between the pediatric and control groups in (HMA) (p=0.053) and SF (p=0.07) were not statistically significant. When considering only WBCT parameters, multivariate regression analysis indicated that axial TFM (p:0.005), MFS (p:0.013), and ST (p:0.03) were the best predictors of pediatric PCFD. (R2 : 0.27).
Conclusion:
Pediatric PCFD is characterized by distinct WBCT parameters compared to non-pediatric PCFD, notably exhibiting less forefoot abduction, less middle facet subluxation a lower FAO and a hindfoot alignment closer to that of the control group. TFM, MFS, and ST stand out as parameters associated with pediatric PCFD.
Antoine ACKER (Geneva, Switzerland), Tommaso FLORIN VALECCHI, Emily LUO, Grayson TALASKI, Erik HUANUCO CASAS, Albert ANASTASIO, Cesar DE CESAR NETTO
15:18 - 15:24
#42931 - OP30 Comparable postoperative outcomes in obese and non-obese patients following surgery for insertional Achilles tendinopathy.
Comparable postoperative outcomes in obese and non-obese patients following surgery for insertional Achilles tendinopathy.
Introduction
Higher body mass index (BMI) levels can increase the risk of complications and poor outcomes following surgical interventions for various orthopaedic conditions, including insertional Achilles tendinopathy (IAT). However, the exact impact of BMI on postoperative outcomes for IAT is still unclear and warrants further investigation.
Methods
Prospectively collected registry data of 75 patients who underwent surgery for unilateral IAT were reviewed. Patients were separated into 2 groups based on BMI: normal (<30 kg/m2) and obese (≥30 kg/m2). Clinical assessment at preoperative, 6-month and 2-year follow-up was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, as well as assessment of postoperative satisfaction.
Results
There were 47 patients in the normal BMI and 28 patients in the obese group. Both groups showed significant improvement in AOFAS score, VAS score, SF-36 PCS and MCS at 6 months and 2 years postoperatively. However, there were no significant differences in these scores between the two groups and both groups achieved similar final postoperative scores at 2 years. Wound complications were more common in obese (n = 2, 7.1%) compared to normal BMI (n = 1, 2.1%) patients, but did not reach statistical significance (p =.284). Postoperative satisfaction (p = .394) were also similar between the two groups.
Conclusion
Obese patients undergoing surgery for IAT can achieve similar outcomes as those with normal BMI without the increased risk of complications.
Adriel You Wei TAY (Singapore, Singapore), Rui Xiang TOH, Kizher Shajahan MOHAMED BUHARY, Zongxian LI, Kae Sian TAY
15:24 - 15:30
#42989 - OP31 Objective diagnosis and evaluation of isolated gastrocnemius tightness in standing position: An Alternative to the Silfverskiöld Test.
Objective diagnosis and evaluation of isolated gastrocnemius tightness in standing position: An Alternative to the Silfverskiöld Test.
INTRODUCTION
Gastrocnemius-soleus complex (GSC) tightness leads to functional pseudoequinism in the gait cycle, which translates into increased forefoot pressure. One of the most used tests to diagnose it is the Silfverskiöld test. We propose a different test to objectively evaluate the GSC shortening: In a standing position, a goniometer is used to evaluate ankle dorsiflexion.
OBJECTIVES
The main objective is to compare the reliability of the Silfverskiöld test versus the standing test.
MATERIALS AND METHODS
A cross-sectional observational study was conducted with 2 independent observers. The Silfverskiöld test was performed with goniometric measurement. Then, in standing position with both feet parallel facing forward, patients move one leg backwards with the knee fully-extended, progressively bending the knee placed in front. When discomfort appears in the calf region, a goniometric measurement is performed. Next, patients bend the knee placed backwards and same measurement is taken maintaining the heel touching the floor. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) Two-way-Random-effects, mean of 2 raters, Absolute agreement (ICC2k) statistical test.
RESULTS
We performed 50 measurements for each test. Higher ICC was observed in the standing test (ICC=0.75) than Silfverskiöld test (ICC=0.68), making it more reliable (p<0,001). Normal dorsiflexion values in standing test ranged from 110,49º with knee extension to 119,85º with knee flexion. Patients with positive Silfverkiöld test, increased 13º in ankle dorsiflexion with standing test.
CONCLUSION
The standing position test could be a reliable alternative to the Silfverskiöld test in the diagnosis of GSC tightness, but more studies are needed.
Saiz Modol CONRADO (Pamplona, Spain), Lopez Capdevila LAIA, Llombart-Blanco RAFAEL, Valverde Gestoso CARMEN, Jimenez-Villarejo FRANCISCO, Dominguez Sevilla ALEJANDRO
15:30 - 15:36
#42032 - OP32 The size of Haglund’s deformity does not matter to insertional Achilles tendinopathy: A matched case control study.
The size of Haglund’s deformity does not matter to insertional Achilles tendinopathy: A matched case control study.
Background
We aimed to investigate the effect of Haglund’s deformity size on insertional Achilles tendinopathy (IAT) using a new measurement system and identify independent risk factors of IAT with Haglund’s deformity.
Methods
We reviewed medical records of patients with IAT and age/sex-matched patients with diagnoses other than Achilles tendinopathy. Radiographs were reviewed to identify posterior/plantar heel spur, and intra-Achilles tendon calcification, and to measure Fowler-Philip angle, calcaneal-pitch angle, and Haglund’s deformity angle/height. Multivariate logistic regression analysis was performed to identify independent risk factors of IAT with Haglund’s deformity.
Results
50 patients were enrolled in the study group, equaling the size of the age/sex-matched control group. Our new Haglund’s deformity measurement system showed excellent intraobserver /interobserver reliability. No significant differences between the two groups were noted in Haglund’s deformity angle and height: 6.0° in both groups, and 3.3mm Vs.3.2mm in the study and control group, respectively. The study group had significantly higher calcaneal pitch angle, incidence of posterior heel spur, plantar heel spur, and intra-Achilles tendon calcification: 5.2° Vs.23.1°(P=.044); 81.8% Vs.36.4%(P<.001); 76.4% Vs.34.5%(P=.003); 67.3% Vs.5.5%(P<.001), respectively. Multivariate logistic regression analysis identified independent risk factors of IAT: posterior heel spur(OR=3.650), intra-Achilles tendon calcification(OR=55.671) and increased calcaneal pitch angle(OR=6.317).
Conclusion
Based on our results, the Haglund’s deformity size was not associated with IAT, suggesting a routine Haglund’s deformity resection may be unnecessary in the surgical treatment of IAT. If patients with Haglund’s deformity have posterior heel spur, intra-Achilles tendon calcification, or increased calcaneal pitch angle, a higher chance of IAT can be predicted.
Wonyong LEE (Sayre, PA, USA, USA), Colt CRYMES
15:36 - 16:00
Discussion.
|
AQUARIUM |
16:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
DF5
16:00 - 17:00
DISCUSSION FORUM
Evidence for Controversies in Foot and Ankle
16:00 - 17:00
Moderators.
Paolo CECCARINI (Ortopaedic Surgeon) (Moderator, Perugia, Italy), Antonio DALMAU (Head of Department) (Moderator, Barcelona, Spain)
16:00 - 16:10
Syndesmotic fixation – screw vs flexible.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
16:10 - 16:20
Plantar fasciopathy – gastroc lengthening vs proximal plantar fasciotomy.
Alberto GINÉS CESPEDOSA (Adjunto) (Speaker, Barcelona, Spain)
16:20 - 16:30
Metatarsalgia - plantar plate repair vs isolated osteotomy.
Nick CULLEN (Consultant foot and ankle surgeon) (Speaker, Stanmore uk, United Kingdom)
16:30 - 16:40
Ankle lateral instbility – Open vs all-inside-arthroscopic.
Nuno CORTE REAL (Clinical Director) (Speaker, Cascais, Portugal)
16:40 - 17:00
Discussion.
|
AQUARIUM |
|
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
DF6
16:00 - 17:00
DISCUSSION FORUM
State-of-the-art MP1 Arthrodesis Technique
16:00 - 17:00
Moderators.
Christian PLAASS (Consultant) (Moderator, Hannover, Germany), Maneesh BHATIA (Virtual Film Festival videos) (Moderator, Leicester, United Kingdom)
16:00 - 16:04
Open approach: Dorsal (4 mins).
Donald MC BRIDE (Consultant Orthopaedic Foot and Ankle Surgeon) (Speaker, Stoke on Trent, United Kingdom)
16:04 - 16:08
Open approach: Medial (4 mins).
Jean-Luc BESSE (Praticien Hospitalier) (Speaker, Lyon, France)
16:10 - 16:14
Joint preparation: Flat cuts (4 mins).
Oliver MICHELSSON (Consultant) (Speaker, Helsinki, Finland)
16:14 - 16:18
Joint preparation: Ball-cup reamers (4 mins).
Daniele MARCOLLI (Foot and Ankle Surgeon) (Speaker, Milano, Italy)
16:18 - 16:22
Joint preparation: Step-cut (4 mins).
Dimitrios HATZIEMMANUIL (Orthopaedic Surgeon) (Moderator, THessaloniki, Greece)
16:25 - 16:29
Implants: Plate and screws (4 mins).
Xavier OLIVA MARTIN (Speaker, Barcelona, Spain)
16:29 - 16:33
Implants: Staples/crossed screws (4 mins).
Elisabeth ELLINGSEN HUSEBYE (Speaker, Norway)
16:33 - 16:37
Postop (weightbearing/return to work-sport) (4 mins) .
Alistair WILSON (Consultant) (Speaker, Belfast, United Kingdom)
16:37 - 17:00
Discussion.
|
AUDITORIUM |
17:00 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
CB4
17:00 - 17:30
Coffee, Exhibition, and Poster Walks
|
17:05 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PWP10
17:05 - 17:25
Poster Walks presentations 10
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters:
Moderators:
Paulo AMADO (Director of Orthopedic Departement) (Porto, Portugal), Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Napoli, Italy), Dimitrios HATZIEMMANUIL (Orthopaedic Surgeon) (THessaloniki, Greece)
17:05 - 17:25
#42977 - PWP37 Benefits of circular external fixation in superconstruct reconstruction for challenging deformities: a prospective cohort study.
Benefits of circular external fixation in superconstruct reconstruction for challenging deformities: a prospective cohort study.
Introduction
Unsatisfactory union of fusion sites is not uncommon following superconstruct fixation in challenge deformities. This study is to propose a new concept as the addition of circular external fixation to the conventional superconstruct for improving outcomes following the management of mentioned conditions at foot and ankle.
Methods
We prospectively introduce the circular external fixation to augment the internal fixation for the reconstruction of ankle-hindfoot, and forefoot-midfoot deformities in several conditions such as Charcot neuroarthropathy and severe equinocavovarus, etc. We divided all 24 patients who underwent corrective osteotomy and/or fusion into two groups as an advanced superconstruct group (combination of circular external fixation and internal fixation) and conventional superconstruct group (only internal fixation). The demographic characteristics were collected including union rate at 3-6 months postoperatively and union time of fusion.
Results
From the available data, union rates were 100% and 58.3% in advanced and conventional groups, respectively (p-value>0.05). Times to acceptable union were 69.3 and 107.4 days in advanced and conventional groups, respectively (p-value: 0.169). For the subgroup analysis in the Charcot neuroarthropathy patients (n=13), the union rate was also higher in the advanced group than the conventional group. For the non-Charcot patients (n=11), it seemed that there was no remarkable difference of union rates between the two groups.
Discussion and Conclusion
Advanced superconstruct using the addition of circular external fixation to the conventional fixation seems to provide additional benefits to increase union rate and reduce union time in the foot and ankle deformity corrections, especially in Charcot neuroarthropathy patients.
Angthong CHAYANIN (Bangkok, Thailand)
17:05 - 17:25
#42983 - PWP38 Minimally invasive surgery versus arthroscopic surgery for the first tarsometatarsal arthrodesis: a randomized comparative study.
Minimally invasive surgery versus arthroscopic surgery for the first tarsometatarsal arthrodesis: a randomized comparative study.
Introduction
Little is known about the different outcomes between the minimally invasive surgery (MIS) and arthroscopic surgery (AS) for the first tarsometatarsal (TMT) arthrodesis. This study was to compare the outcomes of this joint preparation for fusion regarding effectiveness and safety between MIS and AS in the cadaveric specimens.
Methods: All 16 cadaveric feet were randomly divided into two groups as 8 feet for MIS (under fluoroscopic control) group and 8 feet for AS group. They were operated by the fellowship-trained foot and ankle orthopaedic surgeons. Following complete procedures, all feet were dissected and recorded for areas of joint preparation on metatarsal and medial cuneiform sides via photographs and the ImageJ program. The injury of adjacent structure was noted in each specimen.
Results: Average areas of joint preparation on metatarsal and medial cuneiform sides were 130.92 and 119.65 mm2, respectively. Average areas of joint preparation on metatarsal sides were 162.13 and 99.72 mm2 in MIS and AS, respectively (P-value = 0.067). Average areas of joint preparation on medial cuneiform sides were 129.87 and 109.42 mm2 in the MIS and AS, respectively (P-value = 0.557). For safety profiles, rate of adjacent injury was insignificantly higher in MIS group (42.86%) than AS group (0%) (P-value = 0.192). All injuries were found at extensor hallucis longus tendon.
Conclusions: There were no significant differences of the effectiveness and safety profiles between MIS and AS groups. However, MIS seemed to provide more effectiveness on joint surface preparation but higher risk to adjacent structure than AS.
Angthong CHAYANIN (Bangkok, Thailand)
17:05 - 17:25
#42994 - PWP39 Effects of Medial Displacement Calcaneal Osteotomy and Lateral Column Lengthening Osteotomy Variations on Foot Alignment in Patients with Progressive Collapsing Foot Deformity.
Effects of Medial Displacement Calcaneal Osteotomy and Lateral Column Lengthening Osteotomy Variations on Foot Alignment in Patients with Progressive Collapsing Foot Deformity.
Background:
Progressive Collapsing Foot Deformity (PCFD) is a complex condition marked by collapse of the medial longitudinal arch, forefoot abduction, decreased talonavicular coverage, and hindfoot valgus alignment. This study aimed to assess changes in foot alignment using two surgical options: medial displacement calcaneal osteotomy (MDCO) and lateral column lengthening osteotomy (LCLO), as well as their combinations.
Method:
Weightbearing CT scans of six patients with stage I PCFD were converted into 3D models. For each patient, fifteen models were created: MDCO with 5mm,10mm and 15mm sliding, LCLO with 5mm,10mm and 15mm lengthening, and their combinations, totaling 90 models. Measurements were conducted using Mimics Innovation Suite (Materialise, Leuven, Belgium) software.
Results:
We evaluated talonavicular coverage, Meary’s angle, calcaneal pitch, talocalcaneal angle, talar-first metatarsal angle, and tibiocalcaneal angle across different osteotomy types and correction amounts. LCLO more effectively increased talonavicular coverage, while MDCO better corrected calcaneal valgus. Minor deformities required less adjustment, whereas severe deformities benefitted from greater adjustments and the combination of both osteotomies proved more effective in such cases.
Conclusion:
Deformities should be individually assessed, with surgical technique decisions tailored to each patient to avoid over- or under-correction. Preoperative 3D modeling can enhance surgical precision, providing critical data for osteotomy planning. This study supports the use of 3D models for precise surgical planning in treating PCFD, offering valuable reference values.
Ece DAVUTLUOGLU (istanbul, Turkey), Mete OZER, Yahya DENIZ, Soheil ASHKANI-ESFAHANI, Christopher DIGIOVANNI, Bedri KARAISMAILOGLU
17:05 - 17:25
#43093 - PWP40 Redefining hallux rigidus classification through an objective hounsfield unit algorithm via weightbearing computed tomography.
Redefining hallux rigidus classification through an objective hounsfield unit algorithm via weightbearing computed tomography.
Introduction/Purpose:
Hallux Rigidus (HR) is one of the most common conditions affecting the 1st metatarsophalangeal (MTP) joint. While the current Coughlin and Shurnas’ classification system is a more quantitative approach to diagnosing HR, 2D radiographic staging remains subjective. Weightbearing Computed Tomography (WBCT) may offer a more objective understanding of HR’s 3D pathology. The purpose of this study was to compare the Coughlin and Shurnas’ system with a novel WBCT based approach of classifying HR.
Methods:
WBCT scans of 31 cases of HR and 10 healthy controls were compared retrospectively to their Coughlin and Shurnas’ classification. Computational analysis using Hounsfield units [HU]) profiles was performed along five lines (central, inferolateral, inferomedial, superolateral, superomedial) within a volume of interest perpendicular to the 1st metatarsal head. HU distribution and joint space width (JSW) were calculated.
Results:
Average JSW was 1.28 mm for controls and 1.23 mm for HR group (p < 0.05). There was an increase in JSW from control (stage 0) to stage 1, a decrease from stage 1 to 2, and stage 3 consistently had the lowest JSW (p < 0.0001). The superomedial aspect of the joint had the most significant decrease in JSW (p < 0.05). Our model was most accurate in predicting stage 1 and 3 HR. For a JSW >=2.02 mm, there was an 89.4% probability the case was stage 1. JSW<1.09mm was more likely to be stage 2 or 3.
Conclusion:
In this study, we describe a novel quantitative approach to understanding and predicting HR deformity.
Emily LUO (Durham, NC, USA), Erik HUANUCO CASAS, Tommaso FORIN VALVECCHI, Hannah STEBRAL, Grayson TALASKI, Antoine ACKER, Kepler CARVALHO, James NUNLEY, Cesar DE CESAR NETTO
|
17:30 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
PS3
17:30 - 18:40
PLENARY SESSION 3
AOFAS at EFAS – Functional Hallux Limitus/Rigidus
17:30 - 18:40
Moderators.
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium), Michael ARONOW (not applicable) (Moderator, West Hartford, CT, USA, USA)
17:30 - 17:40
Pathomechanics.
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
17:40 - 17:50
Joint preserving surgery.
Michael ARONOW (not applicable) (Speaker, West Hartford, CT, USA, USA)
17:50 - 18:00
Arthrodesis.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
18:00 - 18:10
Arthroplasty/resurfacing (Cartiva).
David THORDARSON (Speaker, USA)
18:10 - 18:20
Hallux rigidus in the young athlete – US Speaker.
Eric GIZA (Speaker, USA)
18:20 - 18:40
Discussion.
|
AUDITORIUM |
18:45 |
"Friday 18 October"
Added to your list of favorites
Deleted from your list of favorites
CD1
18:45 - 18:50
Adjourn
with prizes for the best oral presentation and best poster
|
AUDITORIUM |