Effect of Fixation Type and Bone Graft on Tarsometatarsal Fusion

Buda, Matteo; Hagemeijer, Noortje; Kink, Shaun; Johnson, Anne H.; Guss, Daniel; DiGiovanni, Christopher W.

doi:10.1177/1071100718793567

Cited by 36 publications

(34 citation statements)

References 33 publications

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“…However, neither of these determinants was associated with a higher risk of nonunion or wound healing problems (P > .05). Buda et al 3 analyzed 88 patients after midfoot arthrodesis and did not identify a higher nonunion rate in obese patients or patients aged ≥60 years. However, they also detected an association between the number of columns treated and higher complication rates.…”

Section: Discussionmentioning

confidence: 98%

“…To our knowledge, there is only one clinical study focusing on the fixation technique. 3 This study group identified isolated plate fixation as a risk factor for nonunion.…”

Section: Introductionmentioning

confidence: 97%

“…Symptomatic nonunion rates are reported from 7% up to 11%. 3,6,15 For the first TMT joint, several studies observed a reduced nonunion rate while using a combination of a compression screw and dorsomedial or plantar plating. 5,7,11 So far, there is no consensus regarding the optimal fixation technique for the central column.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors

et al. 2021

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Background: The common treatment for end-stage tarsometatarsal (TMT) arthritis is an arthrodesis of the affected joints. This study was performed to examine the clinical and radiographic outcome after TMT arthrodesis and to identify risk factors for postoperative complications. Methods: A total of 101 patients with tarsometatarsal arthritis of at least 2 joints were retrospectively examined. Data were acquired using clinical and radiographic examination, pedobarographic analysis, and standardized questionnaires, including the European Foot and Ankle Society Score, the Foot and Ankle Outcome Score, a pain numeric rating scale (NRS), the 36-Item Short Form Health Survey, and the University of California at Los Angeles Activity (UCLA) Score. The fixation technique, any complications, and revision surgery were recorded. Results: All scores improved significantly, except for the UCLA Score. The mean pain NRS score was significantly reduced from 7.7 preoperative to 3.0 postoperative ( P < .05). The overall nonunion rate was 12.6%. Compared with 2 crossed-screw fixation, locking plate plus compression screw fixation was associated with a decreased nonunion rate (odds ratio [OR] 0.165, 95% confidence interval [CI] 0.032-0.854; P = .017). A body mass index >27 was significantly associated with a higher nonunion rate and wound healing problems (OR 12.05, 95% CI 1.430-101.468; P = .006; OR 5.03, 95% CI 1.273-19.871; P = .013). The overall reoperation rate was 25.2%. Conclusion: TMT arthrodesis of the medial and central column resulted in significant improvement in foot function and pain. A major complication was nonunion. Locking plate plus compression screw fixation was associated with a lower nonunion rate. Level of Evidence: Level III, comparative series.

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Section: Discussionmentioning

confidence: 98%

“…To our knowledge, there is only one clinical study focusing on the fixation technique. 3 This study group identified isolated plate fixation as a risk factor for nonunion.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors

et al. 2021

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“…The author noted that locking plates combined with a compression screw presented a favorable tension-side implant location that closed the fusion site under load. In a recent study, Buda et al [ 30 ] compared the nonunion complications in 88 patients (189 joints) who underwent first cuneometatarsal joint fusion. The fixations were made using three different fastening systems: with a plate only, with screws only, and with hybrid construction using plate and screws.…”

Section: Discussionmentioning

confidence: 99%

Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy

Ortiz-Romero

Cicchinelli²,

Fernández-Garzón³

et al. 2021

IJERPH

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We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.

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“…Für Lisfranc-Arthrodesen liegen die Raten noch ein wenig höher, je nach Patientenkollektiv, zwischen 7 und 11 % [24]. Buda et al konnten in ihrem Kollektiv nachweisen, dass für die Lisfranc-Arthrodesen die Verwendung einer Kombination von Kompressionsschrauben und Platten sowie die Anlage von autologer Spongiosa erhöhte Fusionsraten mit sich brachte [24].…”

Section: Pseudarthrosen Bei Arthrodesen Im Bereich Des Fußesunclassified

Pseudarthrosen nach Eingriffen am Fuß

Evers¹,

Ochman²,

Milstrey³

et al. 2019

OP-JOURNAL

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ZusammenfassungPseudarthrosen können mit Schmerzen und Einschränkungen der Lebensqualität einher gehen. Das Risiko ihr Entstehung kann patientenassoziiert sein und durch Nebenerkrankungen wie Diabetes mellitus, pAVK, Nikotin- oder Alkoholabusus oder fehlende Compliance bedingt sein. Aber auch operationstechnische Komplikationen wie postoperative Infektionen, instabile Osteosynthesen, fehlendes Alignment oder insuffiziente Knochenpräparation bei Arthrodesen sind Faktoren, die zu Pseudarthrosen führen können.Bei instabilen Osteosynthesen, Infektionen oder Knochendefekten sind Revisionseingriffe häufig unvermeidbar. Aber auch im Verlauf kann eine Pseudarthrose persistieren.Mechanische Knochenstimulation mit LIPUS oder fhESWT können eine Konsolidierung erzielen ohne die durch einen operativen Eingriff möglichen Risiken in Kauf nehmen zu müssen. Biologische Knochenstimulation mit osteoinduktiven Effekten werden im Bereich der Fußchirurgie verwendet, haben hier jedoch keine Zulassung.Bei Vorliegen einer Pseudarthrose des Fusses ist die Stabilität des selbigen häufig nicht eingeschränkt wie es bei den langen Röhrenknochen häufig der Fall ist. In straffen Pseudarthrosen ohne entsprechende Symptome ist der Revisionseingriff nicht indiziert und eine orthopädieschuhtechnische Versorgung kann ausreichend sein.

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Effect of Fixation Type and Bone Graft on Tarsometatarsal Fusion

Abstract: Level III, retrospective comparative study.

Cited by 36 publications

References 33 publications

Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors

Comparison of Isolated Screw to Plate and Screw Fixation for Tarsometatarsal Arthrodesis Including Clinical Outcome Predictors

Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy

Pseudarthrosen nach Eingriffen am Fuß

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