Artrodese subtalar of the foot for the Ilizarov method

Abstracts

Foram tratados 28 pacientes num total de 29 pés, com idade média de 25,8, predomínio do sexo masculino 16 pacientes (57,2%), cor branca 25 pacientes (89,2%), lado direito 16 pacientes (57,2%). Quanto à etiologia houve um predomínio das seqüelas de fraturas de calcâneo 11 pacientes (37,9%) e poliomielite 11 pacientes (37,9%), as outras causas foram necrose do talus 2 pacientes (6,9%), barra óssea 2 pacientes (6,9%), artrose primária 2 pacientes (6,9%) e paralisia cerabral 1 paciente (3,5%). O tempo médio de consolidação foi de 3,5 meses. Foram utilizados enxerto ósseo em 11 pacientes (44%). Houve necessidade em 2 casos (6,9%) de se promover o alongamento do calcâneo para se aumentar o pitch do mesmo. A montagem é simples e se baseia em 2 anéis com fixação transóssea através de 2 fios olivados no talus e 2 no calcâneo. Como resultado foi obtido 100% de consolidação, ausência de dor e osteoporose e boa sensibilidade do pé. Das complicações encontradas além das costumeiras ou próprias do método 1 (3,5%) paciente apresentou infecção profunda em 1 dos fios. O método mostrou-se eficiente independente da etiologia com 100% de consolidação além de permitirem uma certa independência ao paciente durante o tratamento.

ARTIGO ORIGINAL

Artrodese subtalar of the foot for the Ilizarov^* method

José Carlos Bongiovanni^I; Hilário Boatto^II; Emílio Palazzo Neto^III; Carlos Luis Engelen^IV; Antonio Augusto Couto de Magalhães^V; Paulo Roberto Mussi^VI

^IDoutor em Medicina, Professor Adjunto do Departamento de Ortopedia e Traumatologia, Chefe do Grupo de Fixadores Externos da Unifesp - Escola Paulista de Medicina

^IIMestre em Ortopedia e Traumatologia, Assistente do Grupo de Fixadores Externos da Unifesp - Escola Paulista de Medicina

^IIIMestre em Ortopedia e Traumatologia, Assistente do Grupo de Fixadores Externos da Unifesp - Escola Paulista de Medicina

^IVPós Graduando do Departamento de Ortopedia e Traumatologia, Assistente do Grupo de Fixadores Externos da Unifesp - Escola Paulista de Medicina

^VDoutor em Medicina, Professor Adjunto do Departamento de Ortopedia e Traumatologia, Chefe do Grupo de Pé da Unifesp - Escola Paulista de Medicina

^VIColaborador do Grupo de Fixadores Externos da Unifesp - Escola Paulista de Medicina

SUMMARY

There had been heated 28 patients in a total of 29 feet, with na age average of 25,8, predominance in the quality of being male 16 patients (57,2%), white color 25 patients (89,2%), right side 16 patients (57,2%). As the ethiology there were a predominancy of the calcaneum fracture´s consequence 11 patients (37,9%) and poliomyelitis 11 patients (6,9%), bone bar 2 patients (6,9%), primary arthrosis 02 patients (6,9%) abd cerebral palsy 1 patient (3,5%). The average time of consolidation was 3,5 months. There had been used bone graft in 11 patients (44%). There were the necessity to promote the calcaneum extension to raise the pitch of itself, in 2 cases (6,9%). The mounting is simple and it relies on 2 rings transbone settlement through 2 strings fixed in the talus and 2 in the calcaneum. As the result was obtained in 100% of consolidation, pain´s absence and osteopethosis and feet´s great sensibility. In the complications there were found, besides the usual or method itself 1 (3,5%) patient. Showed deep infection in 1 of the strings. The method has showed efficient, independent of the ethiology with 100% of consolidation beyond to permit a certain independancy of the patient during the treatment.

INTRODUCTION

Countless they are the existent methods to promote Artrodese Subtalar of the Foot that is going from simpler procedures as used him/it by the technique of the trefina (Magalhães and Col. )21 even more complex procedures in than there are need of graft placement and osteossíntese it interns.

The authors show a new treatment option in the cases in that the need of the artrodese subtalar exists or of the artrodese triple through the fixation expresses, with the development of a simplified personal

MATERIAL AND METHOD

The casuistry consists of 28 patient, with a total of 29 feet treated in the Department of Orthopedics and Traumatologia of the Federal University of São Paulo - School From São Paulo of Medicine, in the period from 1989 to 1997. The minimum age was of 15 years and the 54 year-old maxim with a 25,8 year-old average. With relationship to the sex 16 patient (57,2%) they were masculine and 12 (42,8%) feminine; the white color presented 25 patient (89,3%) and not white 03 patient (10,7%). With relationship to the side, 16 feet (55,2%) they were of the right and 13 (44,8%) of the left. The minimum time of treatment was of 2,8 months and the maximum was of 6,5 months, with an average of 3,8 months. The time of minimum following was of 1 year and the 8 year-old maximum with a 4,3 year-old average. With relationship to the aetiology there was prevalence of the sequels of fractures of the calcâneo in 11 feet (37,9%), poliomyelitis sequel in 11 feet (37,9%) being the other causes necrosis of the talus in 2 feet (6,9%), it obstructs bony 2 feet (6,9%), artrose primary 2 feet (6,9%) and paralysis cerebral 1 foot (3,5%).

All the patients presented pain incapacitante to the support and the march and some deviation in I beat and valgo of the retro foot in the operative pré.

One of the patients with necrosis of the talus and osteossíntese with screw, presented concomitantemente infection (Staphilococus aureus) that reached the tíbio társica.

The used methodology was the idealização of an assembly simplified to 2 semi-rings coupled to connection plates, a fastened in the talus with 2 threads crossed olivados and a semi-ring also fastened in the calcâneo with 2 threads olivados.

When there was need of if artrodesar the médiotársica (shaft-navicular and calcâneo-cubóidea) a 3º thread was coupled in the system in arched form so that there was possibility of compression of those articulations or the same ones were fastened with agrafes of Blount. In the cases in that there was not an important lesion to articulate, the previous opening of the articulation was promoted, with cruentização of the same and compression through the fixador.

In 13 feet (44,8%) there was the need of use of bony graft, retired of the ilíaco against lateral, for completion of the space to articulate. In 02 cases (6,9%) there was the need to promote the subsequent prolongation of the calcâneo to increase the pitch of the same.

Partial load with crutches was presented in immediate P.O and after 2 to 3 weeks, after the retreat of the points and to have given up the inflammatory process provoked by the act surgical total load it was liberated. An orientation fisioterápica was given and accomplished in the operative powders.

Figure 1

Figure 2

RESULTS

It was obtained consolidation in the 29 feet (100%). In all the cases there was disappearance of the pain. In 24 cases (82,7%) there was total correction of the deviation of the retro foot and in 3 feet (10,3%) deviation stayed, 2 in I beat and 1 in valgo that didn't surpass 5º and 1 patient stayed with I beat smaller than 5º. The case that presented necrosis of the talus, cured after artrodese of the tíbio-társica.

COMPLICATIONS

Besides the smaller complications common to the method as the pain, edema, superficial infection, one of the patients presented deep infection in one of the threads having need of the change of the same with cure of the process.

The patient that presented necrosis of the talus with osteossíntese for screw (fracture-dislocation sequel) it presented regression of the picture after the retreat of the synthesis material, there was reagudização of the process during the evolution period having need to promote the artrodese of the tíbio társica with total cure of the infectious process.

Figure 3

Figure 4

RESULTS

- There was consolidation in 100% of the artrodeses.

- Disappearance of the pain incapacitente in all the cases.

- Correction of deformity of the retro foot in 82,7% and in 10,3% of the cases, the deformities that stayed they were not of fundamental importance.

CONCLUSIONS

The method was shown efficient independently of the aetiology with 100% of the consolidation, disappearance of the painful symptom and corrections of the deformities besides giving option in the cases in that there is a great sinking of the calcâneo with elevation of the subsequent tuberosidade of the same of promoting the abaixamento with subsequent prolongation and down, increasing of that sorts out the pitch of the calcâneo.

For the simplicity of the assembly it makes possible a comfort to the patient in the immediate operative powders allowing load total precocemente.

Figure 5

Figure 6

Figure 7

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*

Trabalho realizado no Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo - Escola Paulista de Medicina (Serviço do Prof. Dr. José Laredo Filho).

Publication Dates

• Publication in this collection
  22 May 2007
• Date of issue
  June 2000