Surgical Arthrodesis Research Articles

Biomechanical Comparison of Nitinol Compression Staples vs Fully Threaded Lag Screws for Talonavicular Arthrodesis Following 24-Hour Incubation at Body Temperature

Category: Hindfoot; Other Introduction/Purpose: Arthrodesis of the talonavicular joint is indicated for injury- and arthritis-related pain. The standard treatment for talonavicular arthrodesis is lag screw fixation. Despite favorable results using lag screw fixation, it is associated with significant effects on foot biomechanical motion, and suboptimal complication rates. Nitinol staples have been used for talonavicular arthrodesis for their potential to address shortcomings of lag screw fixation. This study tested the null hypothesis that nitinol staples would not be significantly different from fully threaded lag screws based on biomechanical properties. Methods: Cadaveric feet (n=10) were acquired from 5 donors. Either nitinol staples or two cannulated lag screws were used to perform surgical arthrodesis of the talonavicular joint. Samples were incubated for 24-hours at 38°C, allowing for activation of the thermal nitinol compression properties. 38°C was chosen to mimic in vivo conditions. Biomechanical motion analysis was conducted. Specimens were loaded to 445N and held for 1 minute. A continuous compressive load of 445N was applied while cycling between plantarflexion to dorsiflexion for 10 cycles and then inversion to eversion for 10 cycles. Data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p< 0.05) differences were determined. Results: No statistically significant differences in functional biomechanical testing properties were noted between nitinol compression staple fixation and lag screw fixation for talonavicular arthrodesis following 24 hours of incubation. Static compression, plantarflexion, dorsiflexion, inversion, and eversion testing resulted in nonsignificant translation in the X, Y, and Z planes, as well as nonsignificant rotation in roll, pitch, and yaw directions. Conclusion: Based on clinically relevant biomechanical properties measured during robotic testing, nitinol staples can be considered an appropriate option for talonavicular arthrodesis. Further work to assess long term outcomes of nitinol compression staples for talonavicular arthrodesis is currently ongoing. Biomechanical Data Mean translation and rotation for static and dynamic cyclical compression testing in plantarflexion, dorsiflexion, inversion, and eversion of the foot to assess talo- navicular arthrodesis fixation.

Teriparatide and clodronate combination as a potential treatment for complex regional pain syndrome type I in delayed consolidation after foot surgery: a case report and review of the literature

BackgroundComplex regional pain syndrome type I is a pathological condition characterized by an exaggerated response of tissues to low or moderate pain stimuli. The exact pathogenesis and optimal medical treatment for complex regional pain syndrome type I are still not fully understood, although bisphosphonates have shown positive effects in reducing pain. Foot surgery can be complicated by the development of complex regional pain syndrome type I, leading to functional decline and difficulties in weight-bearing.Case presentationThe authors present a clinical case involving complex regional pain syndrome type I that developed after surgical foot arthrodesis. The patient, a 42-year-old Caucasian male, did not respond to clodronate treatment but experienced successful outcomes upon the addition of teriparatide, which effectively stimulated the healing of arthrodesis.ConclusionTeriparatide cannot be considered the primary treatment for complex regional pain syndrome due to insufficient solid clinical data. However, when complex regional pain syndrome is associated with or caused by delayed union, teriparatide can be used to address the underlying cause of complex regional pain syndrome.

Evaluating Surgical Cervical Arthrodesis With a Novel MRI Grading Score.

This was a single-institution retrospective study. Evaluate a magnetic resonance imaging (MRI)-scoring system to differentiate arthrodesis from pseudoarthrosis following anterior cervical discectomy and fusion. Diagnostic workup following fusion surgery often includes MRI to evaluate neural structures and computed tomography (CT) and/or dynamic x-rays to evaluate instrumentation and arthrodesis. The use of MRI alone for these evaluations would protect patients from harmful CT and x-ray ionizing radiation. Neurosurgical attending evaluated CTs for arthrodesis or pseudoarthrosis. Blinded neuroradiology attending and neurosurgery senior resident evaluated independent T1 and T2 region of interest (ROI) signal intensity over instrumented disk space. Cerebral spinal fluid (CSF) at the cisterna magnum and distal adjacent uninstrumented vertebral body (VB) were also calculated. ROI interspace /ROI CSF and ROI interspace /ROI VB quotients were used to create T1- and T2-interspace interbody scores (IIS). Study population (n=64 patients, 50% female) with a mean age of 51.72 years and 109 instrumented levels with 45 fused levels (41.3%) were included. T1-weighted MRI, median T1-IIS CSF for arthrodesis was 176.20 versus 130.92 for pseudoarthrosis ( P <0.0001), T1-IIS VB for arthrodesis was 68.52 and pseudoarthrosis was 52.71 ( P <0.0001). T2-weighted MRI, median T2-IIS CSF for arthrodesis was 27.72 and 14.21 for pseudoarthrosis ( P <0.0001), while T2-IIS VB for arthrodesis was 67.90 and 41.02 for pseudoarthrosis ( P <0.0001). The greatest univariable discriminative capability for arthrodesis via AUROC was T1-IIS VB (0.7743). We describe a novel MRI scoring system that may help determine arthrodesis versus pseudoarthrosis following anterior cervical discectomy and fusion. Postoperative symptomatic patients may only require MRI, which would protect patients from ionizing radiation. Level IV.

485 Evaluating Surgical Arthrodesis With Novel MRI Grading Score

INTRODUCTION: Diagnostic imaging following cervical fusion often involves magnetic resonance imaging (MRI) to evaluate neural structures and computed tomography (CT) and/or dynamic radiographs to evaluate instrumentation and arthrodesis. CT and radiographs use ionizing radiation that increases risk for malignancy. Using MRI alone would protect patients and decrease healthcare utilization. METHODS: Single institution retrospective study evaluating patients who received postoperative CT and MRI following ventral cervical fusion procedures. Radiographic standards were used to evaluate for arthrodesis or pseudo-arthrosis. Blinded observers evaluated signal intensity using a region of interest (ROI) over the instrumented disc space, homogenous cerebral spinal fluid (CSF), and distal uninstrumented vertebral body (VB). A quotient (ROIinterspace/ROICSF and ROIinterspace/ROIVB) was used to create T1- and T2-interspace interbody scores (IIS). Additionally, T1 hypointense lines along endplates and facet joints were evaluated for degree of discontinuity. RESULTS: Study included 60 patients (50% female) with 110 instrumented levels and mean age 51.7 years-old. For T1-weighted MRI, median T1-IISCSF for arthrodesis was 176.2 compared to 130.9 for pseudo-arthrosis (p &lt; 0.0001) while T1-IISVB for arthrodesis was 68.5 and pseudo-arthrosis was 52.7 (p &lt; 0.0001). For T2-weighted MRI, median T2-IISCSF for arthrodesis was 27.7 and 14.2 for pseudo-arthrosis (p &lt; 0.0001) while T2-IISVB for arthrodesis was 67.9 and 41.0 for pseudo-arthrosis (p &lt; 0.0001). Median T1 hypointense discontinuity was graded at the endplates, left facet, and right facet as 1.5, 0.25, and 0.5 compared to pseudo-arthrosis as 1.0, 0.0, and 0.0, respectively (p &lt; 0.0001, p = 0.002, and p = 0.001). The greatest area under the curve (AUC) after receiver operator characteristic (ROC) analysis was T1-IISVB (0.7743). CONCLUSIONS: We describe a novel scoring system that may help determine arthrodesis versus pseudo-arthrosis on MRI following ventral cervical fusion. Postoperative symptomatic patients may only require MRI for workup, which would protect patients from harm while decreasing healthcare utilization.

ANKLE ARTHRODESIS WITH INTRAMEDULLARY RETROGRADE NAIL FOR BONE TUMORS. PRELIMINARY RESULTS AND SURGICAL TECHNIQUE.

Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

Diagnosis and Treatment of Neuropathic Ankle Fractures.

Standard 3-view ankle radiographs are the first-line imaging modality for suspected neuropathic ankle fractures. Computed tomography is helpful to evaluate for concomitant osseous changes and soft-tissue infection. Nonoperative management may be considered for low-demand, elderly, or comorbid patients for whom surgery and anesthesia are contraindicated. However, the presence of comorbidities alone should not necessarily preclude operative intervention. Given the overall poor results of nonoperative treatment in the neuropathic ankle fracture population, operative intervention may in fact be less risky to the patient. The authors have 2 preferred treatment techniques. For cases in which the vascular supply and bone stock are adequate, open reduction and internal fixation (ORIF) with locking fixation for the fibula, a medial buttress/hook plate with lag screws for the medial malleolus, multiple syndesmotic screws for additional fixation even in the absence of a syndesmotic injury, and temporary transfixation Steinmann pins from the calcaneus into the tibia are used. For cases in which there is a concern for wound healing or previously failed ORIF, minimally invasive surgical tibiotalocalcaneal arthrodesis with a retrograde locked intramedullary nail is used.

Surgery for chronic arthropathy in people with haemophilia.

Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the absence or deficiency of a clotting factor protein. Staging classifications, such as the Arnold-Hilgartner classification for haemophilic arthropathy of the knee, radiologically reflect the extent of knee joint destruction with underlying chronic synovitis. Management of this highly morbid disease process involves intensive prophylactic measures, and chemical or radioisotope synovectomy in its early stages. However, failure of non-surgical therapy in people with progression of chronic arthropathy often prompts surgical management, including synovectomy, joint debridement, arthrodesis, and arthroplasty, depending on the type of joint and extent of the damage. To date, management of people with mild to moderate chronic arthropathy from haemophilia remains controversial; there is no agreed standard treatment. Thus, the benefits and disadvantages of non-surgical and surgical management of mild to moderate chronic arthropathy in people with haemophilia needs to be systematically reviewed. OBJECTIVES: To assess the efficacy and safety of surgery for mild to moderate chronic arthropathy in people with haemophilia A or B. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and two trial registers to August 2022. We also handsearched relevant journals and conference abstract books. Randomized controlled trials (RCTs) and quasi-RCTs comparing surgery and non-surgical interventions, for any joint with chronic arthropathy, in people with haemophilia, who were at least 12 years old. The review authors did not identify any trials to include in this review. The review authors did not identify any trials to include in this review. The review authors did not identify any trials to include in this review. Due to a lack of research in this particular area, we plan to update the literature search every two years, and will update review if any new evidence is reported. There is a need for a well-designed RCT that assesses the safety and efficacy of surgical versus non-surgical interventions for chronic arthropathy in people with haemophilia.

Catastrophic fracture of the middle phalanx following intra‐articular ethanol injection for facilitated proximal interphalangeal joint ankylosis

SummaryFacilitated ankylosis using intra‐articular ethanol has been reported as a viable alternative to proximal interphalangeal (PIP) arthrodesis for owners with financial constraints or reservations regarding the invasiveness of surgical arthrodesis. An 18‐year‐old gelding presented for a left front leg lameness (Grade 4/5 on the AAEP scale) localised to the pastern region. Radiographs revealed severe osteoarthritis of the proximal interphalangeal joint (PIJ). Facilitated ankylosis of the PIJ with 95% alcohol was elected. The horse presented 6 weeks later with a significant worsening of the lameness, swelling of the pastern region and was noticed with the toe elevated off the ground when transiently weight bearing. Radiographs revealed a comminuted fracture of the middle phalanx. The horse was humanely euthanised. Necropsy revealed a severe chronic closed comminuted fracture of the middle phalanx with partially devitalised bone. Potential aetiologies are a decreased bone quality prior to alcohol injection, or that the desensitisation due to the alcohol injection could have resulted in an overuse by the horse or a traumatic accident. While previously unreported, veterinarians should educate owners that catastrophic fracture is an unlikely but possible complication following intra‐articular ethyl alcohol injection.

ROSAI-DORFMAN DISEASE WITH ISOLATED INVOLVEMENT OF THE FIFTH LUMBAR VERTEBRA: A CASE REPORT

Rossi-Dorfman Disease (RDD), or Sinus Histiocytosis with Massive Lymphadenopathy (SHML), is a rare benign disease of unknown etiology and self-limited character that typically presents as painless cervical lymphadenopathy and fever. To report a case of RDD with isolated involvement of the fifth lumbar vertebra. A 27-year-old male patient was admitted to the medical clinic with low back pain for six months, evolving with plegia of the lower limbs. Magnetic resonance imaging showed a collapse of the fifth lumbar vertebra, with a 50% reduction in height, associating the heterogeneity of the remaining bone matrix with an infiltrative pattern and posterior retropulsion promoting obliteration of the L5-S1 right lateral process. Surgical decompression and L5 arthrodesis were performed. The bone matter was sent for histopathological evaluation and immunohistochemical profile, revealing CD68+, S100+ and Vimentin+, aspects compatible with DRR. Laboratory tests were within normal limits. Chest and abdominal computed tomography did not reveal lymph node enlargement. It was decided to carry out 25 adjuvant radiotherapy sessions for local control and prevention of possible recurrences. RDD is a disease belonging to the group of primary histiocytosis histologically defined by the phenomenon of emperipolesis, engulfment of intact lymphocytes or plasma cells in the cytoplasm of histiocytes or giant cells. While the etiology remains unknown, infectious and autoimmune mechanisms are suspected to be involved. The natural history of the disease has a benign and self-limited course; in 70% of patients, the disease is permanent and stable, 20% have spontaneous remission, and 10% progress to generalization. It mainly affects children and young adults, the mean age being 19-year-olds, with a slight predilection for males. The clinical presentation is dependent on the location and size of the lesions. The involvement is classically confined to lymph nodes, however, in 23% of cases, the pathology can be present in extra-lymph node sites, such as skin, soft tissues, nasal cavity, paranasal sinuses, eye sockets, bones, salivary glands and the central nervous system. Of these cases, only 11% have presentation in the bones. Laboratory tests commonly show polyclonal hypergammaglobulinemia, increased red cell segmentation index, and anemia. Histopathological examination with immunohistochemical technique is essential to confirm the diagnosis. Treatments include steroids, chemotherapy and radiotherapy. RDD is a rare benign disease whose symptoms stem from the location and size of the neoplastic growth which can produce a variety of clinical syndromes. Without recognition and proper management, the disease is a diagnostic challenge that can evolve unfavorably.

Use of Locking Compression Plate and Locking Compression T-Plate for Surgical Arthrodesis of the Carpometacarpal and Distal Tarsal Joints in 13 Horses.

The aim of this study was to describe the use of the locking compression plate (LCP) and locking compression T-plate (LCTP) in cases of carpometacarpal and distal tarsal arthrodesis for the treatment of osteoarthritis and small carpal or tarsal bone fractures, and to document clinical outcomes. Case records of horses treated with carpometacarpal or distal tarsal arthrodesis via internal fixation using an LCP or LCTP between 2013 and 2021 were reviewed. All cases were evaluated retrospectively. Follow-up information was gained via phone conversation with owners and referring veterinarians. Data were collected for 13 horses that fulfilled the study criteria. A total of eight horses underwent distal tarsal arthrodesis, and five underwent carpometacarpal arthrodesis. Twelve of thirteen horses went back to some level of athletic performance. Eight of 13 returned to the same level, while 4 of 13 returned to a lower level. Minor postoperative complications were recorded in 3 of 13 cases, with all horses suffering manageable short-term complications returning to the same level of work. Two horses suffered a major complication, with one resulting in euthanasia. Carpometacarpal and distal tarsal arthrodesis performed using the LCP and LCTP allowed all surviving horses in the study to obtain immediate postoperative comfort and eventual return to use.

Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI): Validation of a Novel Scoring System Quantifying the Effect of Postarthrodesis Cervical Stiffness on Patient Quality of Life.

Cross-sectional study. The aim was to create and validate a novel patient-reported outcome measure (PROM) focusing on stiffness-related patient functional limitations after cervical spine fusion. Cervical arthrodesis is a common treatment for myelopathy/radiculopathy, however, results in increased neck stiffness as a collateral outcome. No current PROM exists quantifying the impact of postoperative stiffness on patient function. The Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI) was created through a modified Delphi process. The resultant 10-item questionnaire yields a score out of 100 with higher scores indicating increased functional difficulty related to neck stiffness. Cross-sectional study of control and postoperative patients was completed for CSRS-CSDI validation. Retest reliability (intraclass correlation coefficient), internal consistency (Cronbach alpha), responsiveness (levels fused vs. CSRS-CSDI scores), and discriminatory validation (CSRS-CSDI vs. neck disability index) scores) were completed. Fifty-seven surgical and 24 control patients completed the questionnaire. Surgical patients underwent a variety of procedures: 11 (19%) motion preserving operations, nine (16%) subaxial 1-2 level fusions, seven (12%) subaxial 3-5 level fusions, five (9%) C1-subaxial cervical spine fusions, 20 (35%) C2-upper thoracic spine fusions, five (9%) occiput-subaxial or thoracic spine fusions. The questionnaire demonstrated high internal consistency (Cronbach alpha=0.92) and retest reliability (intraclass correlation coefficient=0.95, P <0.001). Good responsiveness validity with a significant difference between fusion cohorts was found ( P <0.001, rs =0.63). Patient CSRS-CSDI scores also correlated with neck disability index scores recorded ( P <0.001, r =0.70). This is the first study to create a PROM addressing the functional impact of cervical stiffness following surgical arthrodesis. The CSRS-CSDI was a reliable and valid measure of postoperative stiffness impact on patient function. This may prove useful in counseling patients regarding their expected outcomes with further investigation demonstrating its value in a prospective fashion.

History of Bone Grafts in Spine Surgery.

Bone grafting replaces damaged or missing bone with new bone and is used for surgical arthrodesis. Patients benefit from a huge variety of bone graft techniques and options for spinal fusions. This article reviews the rich history of bone grafts in surgery with particular emphasis on spinal fusion. During the early years of bone grafting in spine surgery, bone grafts were used on tuberculosis patients, and the structural support of the graft was most the important consideration. Between 1960 and 2000, many advances were made, specifically in the use of bone graft substitutes. The field of bone grafts in spine surgery has evolved rapidly since first described.

Pseudoarthrosis after long adult deformity reconstruction

Pseudoarthrosis after long adult deformity reconstruction is defined as failure of bony union when surgical arthrodesis is attempted. It accounts for nearly a quarter of reoperation and can present with pain and hardware failure. A thorough work-up, including infectious labs, radiographs, CT, and MRI, should be utilized for treatment planning. Surgery for pseudoarthrosis should correct alignment, improve stiffness of the construct and augment bony healing with use of adjuncts, such as autograft, allograft or BMP.

Multiple synostoses syndrome: Radiological findings and orthopedic management in a single institution cohort

Multiple synostoses syndrome (MSS) is a rare genetic condition. Classical features consist of joint fusions which notably start at the distal phalanx of the hands and feet with symphalangism progressing proximally to carpal, tarsal, radio-ulnar, and radio-humeral joints, as well as the spine. Usually, genetic testing reveals a mutation of the NOG gene with variable expressivity. The goal was to present the anatomical, functional, and radiological presentations of MSS in a series of patients followed since childhood. Patients with more than 3 synostoses affecting at least one hand joint were included. When possible, genetic screening was offered. A retrospective study was performed from 1972 to 2017 and included 14 patients with a mean follow-up of 18.6 years. Mutation of the NOG protein coding gene was seen in 3 patients. All presented with tarsal synostoses including 9 carpal, 7 elbow, and 2 vertebral fusions. Facial dysmorphia was seen in 6 patients and 3 were hearing-impaired. Surgical treatment of tarsal synostosis was performed in 4 patients. Progressing joint fusions were invariably seen on x-rays amongst adults. Long radiological follow-up allowed the assessment of MSS progression. Feet deformities resulted in a severe impact on quality of life, and neurological complications secondary to spine fusions warranted performing at least one imaging study in childhood. As there is no treatment of ankylosis, physiotherapy is not recommended. However, surgical arthrodesis for the treatment of pain may have reasonable outcomes.

223. The psychological burden of disease among patients undergoing cervical spine surgery: are we underestimating our patients’ inherent disability?

<h3>BACKGROUND CONTEXT</h3> Recent studies have suggested that for patients with chronic neck pain, both psychological and psychosomatic symptoms need to be addressed as psychological distress is associated with poor outcomes in these patients. The fear avoidance model has been used to explain how maladaptive thoughts and behaviors contribute to chronicity and disability. Certain mental health scores have been previously analyzed in patients with pathologies in different spinal regions. However, these rates have yet to be assessed against patients undergoing cervical spine surgery. <h3>PURPOSE</h3> Identify the psychological burden among patients undergoing surgical treatment for their symptomatic cervical degenerative disease. <h3>STUDY DESIGN/SETTING</h3> Single-center prospective double-blinded, randomized control trial that consists of patients undergoing surgical arthrodesis for 3 single- or multilevel cervical disease, resulting in cervical radiculopathy. <h3>PATIENT SAMPLE</h3> This study included 47 symptomatic cervical degenerative disorders patients. <h3>OUTCOME MEASURES</h3> Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS). Neck Disability Index (NDI), EuroQol Five Dimensions (EQ5D). <h3>METHODS</h3> A total of 47 patients age >18 with symptomatic cervical degenerative disease were included and those with active depression or history of major depression were excluded from the study. Basic demographics and baseline HRQLs (NDI, EQ5D, PCS, FABQ) were assessed via descriptive analyses. Patient psychosomatic scores that measure preoperative pain catastrophe and fear avoidance of procedure (PCS, FABQ) were compared to previously published benchmarks in a lumbar spine population. These mental health components and disability were further stratified by their severity as previously published (PCS >30; FABQ >34). Correlations assessed the relationship between these mental health components and severity of disability described by NDI (Not Disabled=0-4, Mild=5-14, Moderate=15-24, Severe=25-34, Complete=34+). Furthermore, logistic regressions were analyzed to determine whether NDI was an independent predictor of psychological burden described by PCS and FABQ. <h3>RESULTS</h3> Forty-seven patients were enrolled (age 53.6 years, BMI 29.4 kg/m2). 32% of these patients were diagnosed with radiculopathy, 26% with myelopathy, and 42% with concomitant imaging diagnosis (hnp, ddd, spondylosis all with or without central stenosis). These patients were all scheduled to undergo spinal fusions with decompression and had failed at least 3 months of conservative treatment. The average number of levels fused was 2.27±1.4. At baseline, the average PCS was 27.4 and FABQ: 40. By overall health metrics, the patient population had an average EQ5D score of 9.3 and an NDI of 25.6. 57.1% of patients had a severe FABQ, 40.8% had a severe PCS, and 27.7% had a severe NDI score. As compared to historical controls of lumbar patients, the patients in this study had greater levels of psychosomatic pathology measured by FABQ (40 vs 17.55; p<0.001) and PCS (27.4 vs 19.25; p<0.001). PCS was positively correlated with FABQ scores (r=0.55; p<0.001). Increasing neck disability was correlated with greater PCS measured disability (Overall r=0.7, Complete r=0.58; p<0.05). Being completely disabled was also identified to have a significant relationship with having a severe PCS score independent of levels fused and diagnosis (OR=11.7[1.5-90.5]; p=0.019). This trend was similarly identified for FABQ (Overall r=0.5, Complete r=0.4; all p<0.05). Age was also not a significant predictor for baseline severe PCS and FABQ nor were diagnosis and presence of stenosis. <h3>CONCLUSIONS</h3> Cervical spine patients have an overall great amount of mental health pathology; however, a large portion of these patients also have high fear avoidance beliefs and pain catastrophizing at baseline. These rates were identified to be higher than previously identified benchmarks of lumbar spine patients. Because this study excluded patients with an official diagnosis of depression or other psychological condition, it is reasonable to say that the mental health pathology of patients undergoing cervical surgery is greatly underestimated and should warrant preoperative treatment to help mitigate these mental health scores at baseline. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Proximal interphalangeal joint arthrodesis in horses: concepts, indications, and techniques

Surgical arthrodesis is effective for treating proximal interphalangeal joint (PIJ) injuries in horses. Despite several techniques described so far, the use of a 3-hole, 4.5mm-locking compression plate, associated with two 5.5-mm transarticular cortex screws, is currently considered the “gold standard.” This review describes the anatomy of the pastern, as well as causes, indications, and possibilities for arthrodesis in the equine PIJ. A description of the current surgical technique for joint fixation is also presented.

Arthroscopic ankle arthrodesis – Surgical technique

End-stage ankle arthritis causes significant pain, disability, and reduction in the quality of life. The common causes of ankle arthritis are post-traumatic (70%), secondary to rheumatoid arthritis (12%), and idiopathic (7%). Surgical arthrodesis of the tibiotalar joint is used to help alleviate the symptoms and signs of end-stage ankle arthritis. The first documented description of ankle arthrodesis is by Albert of Vienna in 1879 who reported curettage of the articular cartilage to enable fusion of the ankle joint. Since that time, this process has been refined significantly culminating in the introduction of arthroscopic ankle arthrodesis (AAA) by Schneider in 1983. AAA is now considered as the current gold standard to help achieve effective and predictable pain relief and improved function for patients who suffer with end-stage ankle arthritis.

Proximal interphalangeal arthrodesis in seven horses: A retrospective study in Brazil (2011-2019)

ABSTRACT: This study discussed several cases of proximal interphalangeal arthrodesis in horses at a veterinary hospital in Brazil. The medical records of seven horses that underwent proximal interphalangeal arthrodesis between 2011 and 2019 were analyzed for indication, technique, and complications. Short- and long-term outcomes were obtained from both the medical records and telephone interviews with the owners. A dynamic compression plate (DCP) was used in one of the seven horses that underwent surgical arthrodesis, and locking compression plates (LCP) were used in the others. Hospital discharge was recorded in 71.4% (5/7) of the horses, with an average hospital stay of 79 ± 45 days. Casting was maintained for 59 ± 26 days. Contact with owners was possible in four cases, two of which regained their prior level of function. The proximal interphalangeal arthrodesis may improve a horse’s well-being, especially when it is considered an early intervention, minimizing the chances of immediate postoperative complications. Additional cases of surgical arthrodesis should be evaluated in long term to better characterize the outcomes of this procedure in Brazil.

A Retrospective Analysis of Outcomes from Foot and Ankle Arthrodesis and Open Reduction and Internal Fixation using Cellular Bone Allograft Augmentation

Category:Other; Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Surgical arthrodesis of joints in the foot and ankle is common in patients who have failed nonoperative management for a variety of conditions. ViviGen is an allogeneic cellular bone matrix product that contains lineage-committed bone cells, and can be used as an alternative to autograft bone or other augments in order to aid in arthrodesis or to enhance bony healing in open reduction and internal fixation (ORIF) procedures. However, compared with autograft bone, ViviGen does not introduce potential for donor site morbidity. Due to the lack of studies examining outcomes following foot and ankle surgeries in which ViviGen is utilized, further investigation is required to determine its efficacy and safety for use in foot and ankle joint arthrodesis and skeletal fracture fixation.Methods:This study included 153 consecutive patients undergoing ankle, midfoot or hindfoot arthrodesis or ORIF procedures in which ViviGen was used as an augment. Pediatric patients and cases involving structural allografts or metal wedges were excluded. Patients were not excluded based on the amount of ViviGen used, type of instrumentation or implants used, or due to comorbidity. This series included revision as well as primary arthrodesis procedures and included various fixation types. Retrospective chart review was used to identify patient demographic factors and medical comorbidities, as well as to evaluate clinical and radiographic data to determine outcome.Results:135 patients were available for analysis at final evaluation. 113 patients underwent arthrodesis (mean age of 56.29 years, mean body mass index of 32.19). 22 patients underwent an ORIF procedure (mean age of 36.35 years, mean body mass index of 32.79). The fusion rate for the arthrodesis cohort was 97/113 (85.8%). Table 1 demonstrates the fusion rate stratified by region of the foot. Smokers had significantly lower rates of fusion compared to nonsmokers (p=0.01). There was not a statistically significant difference in the rate of fusion between primary and revision arthrodesis (p=0.8650). The rate of fusion was significantly lower in patients with Charcot foot in comparison to patients without Charcot foot (p=0.0076). The bony healing rate for the ORIF cohort was 19/22 (86.4%).Conclusion:This large case series of patients undergoing a wide variety of procedures about the ankle, hindfoot, and midfoot with ViviGen bone graft augmentation demonstrates satisfactory outcomes with regard to fusion rate and successful union, as well as minimal complications. To date, this is the largest case series in the literature of patients undergoing foot and ankle procedures with an allogenic cellular bone matrix product that contains lineage-committed bone cells. Our findings help to introduce ViviGen as a safe and efficacious alternative to other forms of augmentation for fusion and ORIF procedures about the foot and ankle.

The Effect of Ring Finger Distal Interphalangeal Joint Stiffness on Grip Strength: A Simulated Study in Normal Participants

Background: Pain of the hand distal interphalangeal joints may result from trauma, osteoarthritis or inflammatory arthritis. When symptoms are not controlled by non-operative means, surgical arthrodesis may be performed, resulting in complete stiffness of the joint and possible weakening of grip strength. This study aims to quantify the effect of a stiff ring finger distal interphalangeal joint on overall grip strength. Methods: One hundred participants were screened to exclude upper limb pathology. A Jamar dynamometer was used to assess overall hand grip strength. A splint was used to prevent distal interphalangeal joint flexion, thus replicating a fused distal interphalangeal joint. Participants were tested with and without the splint and the results compared. The mean of three grip strength tests was taken. Results: The participants included 55 females. Mean age was 31 (18-60 years). 76 participants had a reduction in grip strength with splinting, with a significant difference seen (p < 0.05) on Wilcoxon signed rank test. The median reduction in grip strength with splinting was 1.67 kg. However only 10 participants (10%) had a grip strength loss of greater than 6.5 kg, which is the minimal clinically important difference. Conclusions: This study found a significant loss in overall hand grip strength when the ring finger distal interphalangeal joint was stiffened. However, despite this significant change, only 10 (10%) participants experienced a reduction of greater than 6.5 kg. This is the level of weakness felt to be required to reduce function. Thus our results suggest that 90% of patients with a stiff ring finger distal interphalangeal joint are unlikely to have a clinically identifiable functional reduction in grip strength as a result.