March ahead in the March ahead🦶
Discover more from Brew with Bones
March ahead in the March ahead🦶
Enjoy the exclusive issue on Foot and ankle.
The screw with a link:
…. (Sir David Attenborough’s narration) …. We know some implants may break; some may need to be removed while some work after a partial collapse.
We have not entirely conquered this territory or are slow in our advances. Quite often, we make a breakthrough to better at least one of these difficulties and one such winner is ‘FIBULINK’.
It’s a revolutionary idea with a screw and suture construct which gives the operating surgeon, the option of adjustable tension in the system. The short, high-strength suture bridge gives you flexibility while the screw gives you the fixation.
Studies show three times fixation strength with only one-third of the displacement compared to the Arthrex syndesmosis tightrope. A case series of fourteen patients with a mean follow-up of 9.5 months showed a mean AOFAS score of 94, the VAS score at final follow-up was 1.1. There were no instances of loss of reduction, hardware removal, repeat surgeries, wound issues, or other complications.
Like I told you (in Attenborough’s voice earlier), this is a breakthrough, and the fixation no longer relies on a three-cortex screw that needs to be removed or can be expected to break. Of course, there is Tightrope style fixation, but this looks to have an upper hand.
A classic Rag to Riches’ story:
A young doc from Russia migrated to the US after WWI. With little proficiency in English and starting his career at the Flower-Fifth Avenue Hospital’s kitchen, He went on to introduce a new subspeciality in Orthopedics.
We are speaking about Dr. Paul Lapidus, widely regarded as the father of foot and ankle surgery. After working for several weeks in the kitchen, he applied for and became the first resident at the Hospital for Joint Diseases. His interest in foot and ankle pathology led him to treat over 3,000 patients per year. Dr. Lapidus was one of the founding members of the American Orthopedic Foot Society. He published the first descriptions of hallux valgus with metatarsus primus varus, overlapping fifth toe, peroneal spastic flatfoot, soft tissue lesions of the foot, clawed hallux, physical anthropology, and the inconstant bones of the foot, among other topics.
“The Lapidus Procedure,” has remained a regularly utilized procedure. He was a keen observer, an astute clinician, a dedicated sincere teacher, and an honestly frank, stern disciplinarian in respect to his students, patients, and especially himself. He remained academically active, even after his retirement, completing an in-depth Chapter on "The Toenail" shortly before his death.
Technical pearl: Start looking through the bone
Had difficulty in scoping the OCDs on the medial talar dome?
Annoyed of medial malleolus osteotomies?
Consider this technique by Massey et al
View through the anterolateral portal
Use an ACL zig to drill from superomedial to inferolateral direction through medial malleolus
Scope through or screw through it.
Well, the technique is not without limitations. Check out the video here
Syndesmotic Injury - What do the Australians tell?
Here are the salient points from the Australian ankle syndesmosis injury survey.
26.4% of the surgeons chose two 3.5mm syndesmotic screws while 23.2% of them chose one suture button.
44% of surgeons employed a dynamic stabilization method while 54.4% used a static stabilization method.
Half of the surgeons recommended routine removal of syndesmosis screws.
One-third of surgeons who most commonly use screws in their practice prefer a suture button for their syndesmosis injury.
Dynamic fixation may hold the future.
Tibiotalar or Tibiotalocalcaneal fusion - What's your choice for end-stage tibiotalar arthritis?
The choice to include the subtalar joint in the fusion for ankle arthritis is controversial. Monteagudo et al. recommend tibiotalocalcaneal fusion for ankle arthritis with the idea that triceps progressively shifts the subtalar joint into varus following tibiotalar arthrodesis alone, resulting in the blockade of the compensatory midtarsal joint. Subtalar varus is the common complication of tibiotalar arthritis.
They found comparative results between the two fusion constructs despite an additional joint getting fused in tibiotalocalcaneal fusion. Hence, irrespective of the subtalar joint involvement tibiotalocalcaneal fusion is recommended for ankle arthritis.
Answer to the last month Question
Open or arthroscopic arthrodesis of the ankle joint: Which is better?
Single line? When indications are right any procedure is better!
Comparative studies show the advantages of the arthroscopic technique in terms of complication rate, length of hospitalization, the proportion of ossification, and functional outcome. Indications for arthroscopic fusion should be strictly considered, especially in the case of malalignment, as major axis corrections are difficult to perform. In such cases, the open fusion of the upper ankle joint still seems superior to the arthroscopic method.
Events lining up:
IASCON 2022 - from the Indian Arthroscopy Society
First-time shoulder dislocation in a young individual! Conserve or operate?
To know what the evidence tells us, wait for our amazing April issue…
Have a marvelous March ahead!