JBJS Essential Surgical Techniques最新文献

{"title":"Robotic-Arm-Assisted Lateral Unicompartmental Knee Arthroplasty with a Fixed-Bearing Implant.","authors":"Ajay Premkumar, Tarik Bayoumi, Andrew D Pearle","doi":"10.2106/JBJS.ST.21.00012","DOIUrl":"10.2106/JBJS.ST.21.00012","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5% to 10% of patients with knee arthritis have isolated lateral compartment arthritis; however, lateral unicompartmental knee arthroplasty (UKA) comprises just 1% of all knee arthroplasties<sup>1</sup>. This low proportion is partly because of the perceived complexity of lateral UKA and concerns over implant longevity and survivorship compared with total knee arthroplasty (TKA)<sup>2,3</sup>. With an improved understanding of knee kinematics alongside advances in implant design and tools to aid in appropriate restoration of limb alignment, lateral UKA can be an appealing surgical alternative to TKA for certain patients with lateral knee arthritis<sup>4,5</sup>. In appropriately selected patients, lateral UKA has been associated with reduced osseous and soft-tissue resection, more natural knee kinematics, less pain, shorter hospitalization, decreased blood loss and infection rates, and excellent survivorship and patient-reported outcomes<sup>6-9</sup>.</p><p><strong>Description: </strong>This surgical approach and technique described for lateral UKA utilizes robotic-arm assistance and modern fixed-bearing implants<sup>10</sup>. The specific steps involve appropriate patient evaluation and selection, extensive radiographic and computed-tomography-based preoperative templating, a lateral parapatellar approach, intraoperative confirmation of component position and alignment, and robotic-arm assistance to perform osseous resections to achieve limb alignment and kinematic targets<sup>10</sup>. Final implants are cemented in place, and patients typically are discharged home on the day of surgery<sup>10</sup>.</p><p><strong>Alternatives: </strong>Nonoperative treatment for end-stage knee arthritis includes weight loss, activity modification, assistive devices, bracing, nonsteroidal anti-inflammatory medications, and various injections<sup>11</sup>. Alternative surgical treatments include TKA<sup>4</sup> and, in certain patients, an offloading periarticular osteotomy<sup>12</sup>.</p><p><strong>Rationale: </strong>Lateral UKA is an appealing surgical option for nonobese patients who have disabling knee pain isolated to the lateral compartment, good preoperative range of motion, and a passively correctable valgus limb deformity<sup>10,13</sup>.</p><p><strong>Expected outcomes: </strong>Patients are typically discharged home on the day of surgery, or occasionally on postoperative day 1 if medical comorbidities dictate hospital monitoring overnight<sup>10</sup>. Patients return to light activities, including walking, immediately postoperatively. By 3 months postoperatively, patients will generally have returned to all desired activities<sup>9</sup>. The mid-term outcomes of this procedure, as performed by the corresponding author, have been published recently<sup>14,15</sup>. The 5-year survivorship of 171 lateral UKAs was 97.7%, with 72.8% of patients reporting that they were very satisfied with their procedure ","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Talar Replacement: Surgical Technique.","authors":"Akira Taniguchi, Yasuhito Tanaka, Takuma Miyamoto, Shigeki Morita, Hiroaki Kurokawa, Yoshinori Takakura","doi":"10.2106/JBJS.ST.22.00030","DOIUrl":"10.2106/JBJS.ST.22.00030","url":null,"abstract":"<p><strong>Background: </strong>Total talar replacement is a salvage procedure for end-stage osteonecrosis of the talus. A customized total talar implant is designed with use of computed tomography scans of the healthy opposite side and made of alumina ceramic. The use of such an implant is potentially recommended, with a guarded prognosis, for the treatment of traumatic, steroidal, alcoholic, systemic lupus erythematous, hemophilic, and idiopathic pathologies. The talus is surrounded by the tibia, fibula, calcaneus, and navicular bones, which account for a large portion of the articular surface area. Yoshinaga<sup>9</sup> reported that alumina ceramic prostheses were superior in terms of congruency and durability of articular cartilage compared with 316L stainless steel in an in vivo test in dogs. Therefore, alumina ceramic is an ideal material for replacement of the talus to preserve postoperative hindfoot mobility.</p><p><strong>Description: </strong>Total talar replacement is performed with the patient in a supine position. The anterior ankle approach is utilized to exteriorize the talus, facilitating dissection of the ligaments and joint capsule attached to talus. The first osteotomy is performed around the talar neck, perpendicular to the plantar surface of the foot. The talar head fragment is then removed. Subsequent talar osteotomies are performed parallel to the first cutting line, at approximately 2-cm intervals. The attaching articular capsule and ligaments are dissected in each step. The removal of the posterior talar bone fragments is succeeded by careful dissection of the ligament and joint capsule under the periosteum. After dissecting the remaining interosseous talocalcaneal ligament, the foot is distally retracted and a customized talar implant is inserted. After testing and confirming the stability and mobility of the implant, the wound is irrigated with use of normal saline solution. A suction drain is placed anterior to the implant, and the skin is closed after repairing the extensor retinaculum.</p><p><strong>Alternatives: </strong>In cases with a limited area of necrosis, symptoms may improve with a patellar tendon-bearing brace. However, in many cases of symptomatic osteonecrosis of the talus, nonoperative treatment is not expected to improve symptoms. Alternative surgical procedures include ankle arthrodesis and hindfoot arthrodesis, but there are risks of nonunion, leg-length discrepancy as a result of extensive bone loss, and functional decline because of loss of hindfoot motion.</p><p><strong>Rationale: </strong>Total talar replacement is a fundamentally unique treatment concept in which the entire talus is replaced with an artificial implant. Compared with ankle or hindfoot arthrodesis, this procedure preserves the range of motion of the foot and allows for earlier functional recovery. Postoperative results were satisfactory in the subjective evaluation, with no failure requiring revision. This procedure reduces the ri","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67755137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Excision of Dorsal Wrist Ganglion.","authors":"Muhammad Ali Elahi, M Lane Moore, Jordan R Pollock, Jack M Haglin, Cara Lai, Nathaniel B Hinckley, Kevin Renfree","doi":"10.2106/JBJS.ST.21.00043","DOIUrl":"10.2106/JBJS.ST.21.00043","url":null,"abstract":"<p><strong>Background: </strong>Ganglion cysts are benign soft-tissue tumors that are most commonly found in the wrist. Within the wrist, 60% to 70% of ganglion cysts occur on the dorsal side and 20% to 30% occur on the volar side<sup>1</sup>. Although ganglia arise from multiple sites over the dorsal wrist, dorsal ganglia most commonly originate at the scapholunate joint<sup>2,3</sup>. Open excision is the standard surgical treatment for dorsal wrist ganglia. This procedure is considered when symptoms such as pain and range-of-motion deficits begin to impact activities of daily living.</p><p><strong>Description: </strong>Open excision of a dorsal wrist ganglion is commonly performed with the patient under general anesthesia or a regional block. The patient is placed in the supine position, and a tourniquet is applied on the affected upper limb. After outlining the periphery of the palpable ganglion, the surgeon makes a transverse or longitudinal incision over the ganglion. The surgeon then begins a deep dissection, dissecting through the subcutaneous tissue and isolating the ganglion while avoiding any rupture, if possible. Once the cyst has been identified, extensor tendons surrounding the cyst are retracted and the cyst and stalk are mobilized. The cyst and stalk are subsequently excised, and the wound is closed<sup>4</sup>.</p><p><strong>Alternatives: </strong>Alternative treatments for dorsal wrist ganglia include nonoperative interventions such as observation, aspiration, controlled rupture, and injection. Operative treatments include arthroscopic and open dorsal wrist ganglion resections.</p><p><strong>Rationale: </strong>Although nonoperative treatment can produce successful outcomes, the various modalities have been associated with recurrence rates ranging from 15% to 90%<sup>4</sup>. As a result, surgical excision remains the gold standard of treatment and is typically indicated when weakness, pain, and limited range of motion interfere with activities of daily living. Among surgical interventions, arthroscopic excision is a minimally invasive procedure that has become more common because of the reduced scarring and faster recovery<sup>5</sup>. However, open excision, which does not involve complex equipment, is regarded as the standard among surgical treatments. Although the rates of recurrence for arthroscopic versus open dorsal ganglion excision are similar, arthroscopic excision is less effective with regard to pain relief<sup>5,6</sup>. This difference in pain relief could potentially be the result of the neurectomy of the posterior interosseous nerve in an open excision. In contrast, an arthroscopic procedure may provide less relief of pain from the posterior interosseous nerve stump attaching to the scarred capsule<sup>5</sup>.</p><p><strong>Expected outcomes: </strong>Open excision of a dorsal wrist ganglion is a safe, reliable procedure. The recurrence rate after open excision is similar to that after arthroscopic excision and ","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibiotalocalcaneal Arthrodesis with Intramedullary Fibular Strut Graft and Adjuvant Hardware Fixation.","authors":"Matthew Sankey, Thomas Sanchez, Sean M Young, Chad B Willis, Alex Harrelson, Ashish B Shah","doi":"10.2106/JBJS.ST.22.00004","DOIUrl":"10.2106/JBJS.ST.22.00004","url":null,"abstract":"<p><strong>Background: </strong>In patients with irreparable damage to the articular surfaces of the hindfoot, hindfoot arthrodesis is frequently chosen to provide pain relief and improve activities of daily living. Common etiologies leading to hindfoot arthrodesis procedures include osteonecrosis, failed total ankle arthroplasty, and deformities resulting from Charcot arthropathy or rheumatoid arthritis. Traditionally, this operation utilizes an intramedullary nail to obtain fusion of the tibiotalocalcaneal joint. Although 80% to 90% of patients achieve postoperative union, the remaining 10% to 20% experience nonunion<sup>1-3</sup>. Factors affecting the rate of nonunion include Charcot neuroarthropathy, use of nonsteroidal anti-inflammatory drugs or methotrexate, osteopenic bone, and smoking<sup>4</sup>. In the present video article, we describe a tibiotalocalcaneal arthrodesis performed with use of a fibular strut autograft for repeat arthrodesis following failure of primary tibiotalocalcaneal arthrodesis or as a salvage operation in end-stage pathologies of the hindfoot. Our surgical technique yields union rates of approximately 80% and provides surgeons with a viable surgical technique for patients with complex hindfoot pathologies or fusion failure.</p><p><strong>Description: </strong>The patient is placed in the supine position, and a 10-cm curvilinear incision is made including the distal 6 to 8 cm of the fibula. The incision is centered directly lateral on the fibula proximally and transitions to the posterolateral aspect of the fibula distally. As the incision continues distally, it extends inferiorly and anteriorly over the sinus tarsi and toward the base of the 4th metatarsal, using an internervous plane between the superficial peroneal nerve anteriorly and the sural nerve posteriorly. Exposure of the periosteum is carried out through development of full-thickness skin flaps. The periosteum is stripped, and a sagittal saw is used to make a beveled cut on the fibula at a 45° angle, approximately 6 to 8 cm proximal to the ankle. The fibular strut is decorticated, drilled, and stripped of the cartilage on the distal end. Preparation of the tibiotalar and subtalar joints for arthrodesis are completed through the lateral incision. The foot is placed in 0° of dorsiflexion, 5° of external rotation in relation to the tibial crest, and 5° of hindfoot valgus while maintaining a plantigrade foot. This placement can be temporarily maintained with Kirschner wires if needed. Next, the plantar surface overlying the heel pad is incised, and a guidewire is passed through the center of the calcaneus and into the medullary cavity of the tibia. Correct alignment of the guidewire is then confirmed on fluoroscopy. The fibular strut autograft is prepared for insertion while the tibiotalocalcaneal canal is reamed to 1 to 2 mm larger than the graft. The graft is tapped into position, followed by placement of two 6.5-mm cancellous screws to immobilize the join","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"13 2","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation.","authors":"Miraj N Desai, Kevin D Martin","doi":"10.2106/JBJS.ST.21.00066","DOIUrl":"10.2106/JBJS.ST.21.00066","url":null,"abstract":"<p><strong>Background: </strong>This closed reduction and percutaneous fixation (CRPF) technique utilizing suspensory fixation is indicated for the treatment of Lisfranc injuries with displacement or instability of the tarsometatarsal joint complex-and typically only for low-energy, purely ligamentous Lisfranc injuries. The goal of this procedure is to restore joint stability and prevent common complications of Lisfranc injuries (e.g., midfoot arch collapse and posttraumatic arthritis) while avoiding the complications and risks associated with open reduction and internal fixation (ORIF) and primary arthrodesis. We recommend performing the procedure within 10 to 14 days of the injury; otherwise, an open debridement may be necessary to address scar tissue formation.</p><p><strong>Description: </strong>We start with the patient in the supine position and perform a fluoroscopic stress examination of the joint. Next, the Lisfranc joint undergoes closed reduction, which is held in place with a clamp. Following reduction, a guidewire is drilled from the lateral border of the base of the 2nd metatarsal medially through the medial cuneiform, followed by a medial-to-lateral cannulated drill. The suspensory fixation is then passed lateral-to-medial, placing the suture button on the lateral cortex of the 2nd metatarsal base. The tape is then tensioned while a bioabsorbable interference screw is inserted to maintain tension.</p><p><strong>Alternatives: </strong>Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique<sup>1-3</sup>. The 2 most common operative alternatives are ORIF and primary arthrodesis<sup>4</sup>.</p><p><strong>Rationale: </strong>CRPF with suspensory fixation offers several benefits over both traditional surgical techniques such as ORIF and primary arthrodesis, as well as over percutaneous reduction and internal fixation (PRIF) with a screw. Compared with ORIF and primary arthrodesis, a number of studies have shown that percutaneous treatment of Lisfranc injuries minimizes soft-tissue trauma and reduces the risk of postoperative complications such as wound breakdown, infection, and complex regional pain syndrome, while allowing for earlier participation in rehabilitation<sup>5-10</sup>. A systematic review of outcomes following PRIF with screw fixation also showed that percutaneous treatment of Lisfranc injuries is a safe and effective technique with good functional outcomes<sup>11</sup>. When comparing PRIF with a screw to our technique of CRPF with suspensory fixation, CRPF has the added benefit of creating a nonrigid fixation in the Lisfranc joint, which allows for increased range of motion of the medial column and improved return t","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Debridement for Acute and Chronic Osteomyelitis in Children.","authors":"Ernest Ekunseitan, Coleen S Sabatini, Ishaan Swarup","doi":"10.2106/JBJS.ST.21.00039","DOIUrl":"10.2106/JBJS.ST.21.00039","url":null,"abstract":"<p><strong>Background: </strong>Osteomyelitis is an infection of the bone that commonly occurs in pediatric populations. First-line treatment most often involves a course of antibiotics. In recent studies, surgical debridement, in addition to antibiotics, has been shown to provide positive clinical and functional outcomes in children. Debridement is most often indicated in patients with an abscess or in those who do not respond to empiric antibiotic therapy; however, there are limited video resources describing this technique in pediatric patients.</p><p><strong>Description: </strong>The key steps of the procedure, which are demonstrated in the present video article, are (1) preoperative planning, (2) positioning, (3) subperiosteal exposure and debridement, (4) cortical window creation, (5) irrigation, (6) adjunctive treatment, (7) drain placement, (8) wound closure, (9) dressing and immobilization, and (10) wound check and drain removal.</p><p><strong>Alternatives: </strong>Nonoperative treatment is usually indicated for acute osteomyelitis in which patients present with little to no necrotic tissue or abscess formation. In these cases, a course of broad-spectrum antibiotics may be sufficient for a cure.</p><p><strong>Rationale: </strong>This procedure allows for the removal of necrotic bone and soft tissue, thus facilitating the recovery process. It also allows for the retrieval of tissue samples that may be used to guide selection of the appropriate antibiotic therapy. Surgical debridement is a safe and reliable technique that has been associated with positive long-term outcomes.</p><p><strong>Expected outcomes: </strong>We expect that some patients will require repeat surgical debridement procedures to decrease pathogen burden and prevent future complications. However, we expect that the majority of patients who undergo surgical debridement for uncomplicated osteomyelitis will recover full functionality of the affected limb with no associated long-term sequelae¹⁰.</p><p><strong>Important tips: </strong>Understand preoperative imaging to identify areas of infection, localize critical structures and the physis, and plan surgical approaches.Use extensile approaches and preserve vascularity during the approach.Perform subperiosteal dissection and create a cortical window to debride areas of infection, but avoid excessive periosteal stripping.Close the dead space and wound in a layered manner.</p><p><strong>Acronyms and abbreviations: </strong>MRI = magnetic resonance imagingK-wire = Kirschner wireMRSA = methicillin-resistant <i>Staphylococcus aureus</i>PDS = polydiaxonone.</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achilles Tendon Rupture Repair Using the Mini-Open Approach in a Supine Position.","authors":"Thomas C Sanchez, Matthew T Sankey, Chad B Willis, Sean M Young, Alex Harrelson, Ashish Shah","doi":"10.2106/JBJS.ST.21.00070","DOIUrl":"10.2106/JBJS.ST.21.00070","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The mini-open approach with supine patient positioning is a useful technique to consider for acute Achilles rupture repair, ideally performed within 2 weeks from the time of injury. The traditional surgical approach is completed with the patient in the prone position with an extensile midline incision. Here we describe a mini-open approach with supine positioning that utilizes a single incision measuring approximately 3 to 4 cm in length and avoids the pitfalls of prone positioning, which include greater operative time and potential difficult airway management, vision loss, and brachial plexus palsies&lt;sup&gt;1&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;When positioning the patient supine, lower-extremity bolsters are placed beneath the contralateral hip and the operative ankle in order to allow for exaggerated external rotation of the ankle and improved medial visualization. A thigh tourniquet is then applied on the operative side in a standard sterile fashion.After appropriate draping, begin by palpating the tendon rupture site and mark a 3 to 4-cm incision line just medial to the tendon. Sharp dissection through the skin to the level of the paratenon is then performed. Incise the paratenon with a knife, separate the paratenon from the underlying Achilles tendon with a Freer elevator or scissors, subsequently remove any hematoma formation, and cut the paratenon proximally and distally with scissors or a knife. Debride any damaged tendon thoroughly.The steps of the procedure are performed under direct visualization. If the sural nerve is encountered, it is noted and retracted, and extra care is taken to avoid damaging it with instruments or suture.Now that the proximal and distal ends of the Achilles tendon are free, utilize a 4-stranded double Krackow locking stitch with two #2 FiberWires (Arthrex) on both the proximal and the distal stump. The stumps of the ruptured tendon are approximated by tying the free suture ends together with use of a simple surgeon's knot. A running epitendinous repair is performed with use of number-0 Vicryl (Ethicon) suture in a cross-stich weave technique to provide additional strength to the repair. Finally, test the integrity of the repair via an intraoperative Thompson test. The postoperative protocol includes non-weight-bearing with the operative limb in a posterior splint for 2 weeks. At the 2-week follow-up, stitches are removed and the limb is placed in a tall CAM (controlled ankle motion) walker boot with 2 heel wedges measuring 6.35 mm (0.25 inches) apiece. The patient can begin partial weight-bearing with crutches at 2 weeks postoperatively. At 4 weeks postoperatively, 1 heel wedge is removed, and at 6 weeks postoperatively, the second heel wedge is removed. Patients are instructed to begin gentle range-of-motion exercises at 2 weeks, with formal physical therapy scheduled to begin at 6 weeks. Most patients are out of the boot at 8 to 10 weeks postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alte","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Achilles Tendon Repair.","authors":"M Lane Moore, Jordan R Pollock, Phillip J Karsen, Jack M Haglin, Cara H Lai, Muhammad A Elahi, Anikar Chhabra, Martin J O'Malley, Karan A Patel","doi":"10.2106/JBJS.ST.21.00054","DOIUrl":"10.2106/JBJS.ST.21.00054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;An open Achilles tendon repair is performed in patients who have suffered an acute rupture. All patients with this injury should be counseled on their treatment options, which include open operative repair and functional rehabilitation. We prefer the use of an open repair in high-level athletes and those who have delayed presentation. Typically, this injury-and the resulting open repair-are seen in young or middle-aged patients as well as athletes. Operative repair of a ruptured Achilles tendon is associated with a much faster return to activity/sport when compared with nonoperative alternatives. This surgical procedure is especially useful in allowing this patient population to return to their previous activity level and functional capacity as quickly as possible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;Open repair of a ruptured Achilles tendon begins with a 6 to 8-cm incision over the posteromedial aspect of the lower leg. Superficial and deep dissections are performed until the 2 ends of the ruptured tendon are identified. Adhesions are debrided to adequately mobilize and define the proximal and distal segments of the tendon. With use of a fiber tape suture, a modified locking Bunnell stitch is utilized to secure both ends. The fiber tape is tied securely, and the repair is reinforced with Vicryl suture (Ethicon). Once the tendon is repaired, the paratenon layer is identified and repaired with a running 0 or 2-0 Vicryl suture. This is an important step to minimize postoperative wound complications. The wound is then closed, and the extremity is splinted in maximum plantar flexion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Alternative treatments include minimally invasive surgical techniques such as percutaneous Achilles tendon repair and nonoperative treatment with functional rehabilitation, which can provide excellent outcomes but can also lead to a slight decrease in explosiveness as the patient returns to sport&lt;sup&gt;1,2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Nonoperative and operative treatment of Achilles tendon rupture can both result in excellent patient outcomes. Appropriate patient selection is critical. Younger patients hoping to return to more highly competitive athletics should consider operative repair&lt;sup&gt;3&lt;/sup&gt;. Possible differences have been identified in peak torque when comparing operative versus nonoperative treatment, with patients who had undergone operative repair having greater peak torque (i.e., explosiveness)&lt;sup&gt;2&lt;/sup&gt;. Otherwise, findings are similar between treatment options as long as the patients meet the criteria for nonoperative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Expected outcomes: &lt;/strong&gt;Overall, the scientific literature demonstrates that the functional outcomes following operative repair are good to excellent. In a study by Hsu et al.&lt;sup&gt;4&lt;/sup&gt;, 88% of patients were able to return to their baseline level of activity by 5 months postoperatively, with a complication rate of 10.6% and no rerup","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.","authors":"Kevin D Martin, Christian Curatolo, James Gallagher, Paul Alvarez","doi":"10.2106/JBJS.ST.22.00007","DOIUrl":"10.2106/JBJS.ST.22.00007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more traditional open approaches such as medial, lateral, or even dual anterolateral. The TARIF approach allows for nearly anatomic fracture reduction and fixation of talar neck, body, and posterior dome fractures while minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;Following initial closed fracture reduction and any associated procedures, we recommend obtaining computed tomography scans of the injured ankle in order to evaluate the fracture pattern and allow for preoperative planning. Most patients can be positioned prone for this procedure, except for those with fractures associated with anterior loose bodies and those with neck fractures requiring reduction, which are both amenable to lateral positioning&lt;sup&gt;1&lt;/sup&gt;. The feet are positioned off the end of the bed in a neutral position with room to plantar flex and dorsiflex the ankle freely for reduction maneuvers. Following induction of anesthesia and positioning of the patient, the fluoroscopic screen and arthroscopy equipment are positioned on the side opposite the surgeon. A mini C-arm is utilized for the fluoroscopy. The team may then proceed with preparing and draping the surgical field. The surgeon proceeds with creating posteromedial and posterolateral portals to view the fracture site. For talar neck fractures, we utilize standard posterolateral and posteromedial portals directly adjacent to the Achilles tendon at the level of the tip of the medial malleolus, which have previously been established as safe with respect to neurovascular structures&lt;sup&gt;4&lt;/sup&gt;. Of note, for talar body fractures these portals are placed slightly more distal at the level of the distal fibula, allowing the screws to be placed perpendicular to the fracture site. An accessory sinus tarsi portal can be established if further reduction to correct varus is needed. The flexor hallucis longus tendon serves as a landmark throughout the case to maintain orientation. We prefer to utilize a 1.9-mm malleable arthroscopic NanoScope (Arthrex), which maximizes our view in the small subtalar space and allows for visualization over the talar dome. A shaver is then utilized to clear out the deep joint capsule and remove fracture hematoma. In our experience, after the initial primary reduction attempt by the orthopaedic trauma provider, the fracture is relatively stable and often held by an external fixator. The remaining reduction is performed with use of manipulation of the ankle in combination with an accessory sinus tarsi portal, utilizing an elevator or a small reduction tool in 1 of the posterior portals. We have also utilized percutaneous Kirschner wires to \"joystick\" the fragments prior to the placement of the guidewires. We the","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hammer Toe Correction with Proximal Interphalangeal Joint Arthrodesis.","authors":"Eric Olsen, Jesse King, Jordan R Pollock, Mathieu Squires, Ramzy Meremikwu, David Walton","doi":"10.2106/JBJS.ST.21.00046","DOIUrl":"10.2106/JBJS.ST.21.00046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;First described by Soule in 1910, arthrodesis of the proximal interphalangeal joint is a common operative method of treatment of hammer toe, or fixed-flexion deformity of the proximal interphalangeal joint of the lesser toes&lt;sup&gt;1&lt;/sup&gt;. The deformity is often caused by imbalance in intrinsic and extrinsic muscle function across the interphalangeal joint and metatarsophalangeal joint&lt;sup&gt;2,3&lt;/sup&gt;, which can be effectively addressed through proximal interphalangeal joint straightening and arthrodesis in conjunction with soft-tissue balancing of the metatarsophalangeal joint.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;Following longitudinal skin incision over the joint, a transverse extensor tenotomy and capsulotomy reveal the proximal interphalangeal joint and provide appropriate exposure of the head of the proximal phalanx. With the soft tissues protected, the proximal and middle phalanges undergo resection of the articular surfaces to allow osseous apposition. This step can be performed with a rongeur sagittal saw or with osteotomes&lt;sup&gt;4,5&lt;/sup&gt;. The head of the proximal phalanx is resected proximal to the head-neck junction, and the proximal portion of the middle phalanx is removed to expose the subchondral bone. Often, there is a dorsal contracture of the metatarsophalangeal joint that is elevating the toe, which is addressed with use of a longitudinal incision over the metatarsophalangeal joint, a Z-lengthening of the long extensor tendon to the toe, and a subsequent capsulectomy. If there is an angular component to the deformity, the collateral ligaments are released from the metatarsal neck, and the toe can be balanced. If there is residual subluxation of the joint that is incompletely corrected by soft-tissue procedures, a metatarsal osteotomy should be considered. Fixation is then performed with use of a smooth Kirschner wire. The wire is inserted from the middle phalanx out the tip of the toe and subsequently inserted retrograde across the proximal interphalangeal joint, often into the metatarsal head and neck, holding the metatarsophalangeal joint in appropriate position. This step can also be completed with use of novel methods including screws, bioabsorbable pins, or intramedullary implants&lt;sup&gt;6-8&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Nonoperative treatments for hammer toe deformity are generally pursued prior to surgery and include shoe modifications such as a wide toe-box, soft uppers, and padding of osseous prominences&lt;sup&gt;3,9,10&lt;/sup&gt;. Alternative surgical treatments include proximal interphalangeal arthroplasty, soft-tissue capsulotomy, extensor tendon lengthening, and amputation&lt;sup&gt;11&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Although nonoperative treatment can alleviate symptoms temporarily, surgical treatment is often necessary for definitive treatment of hammer toe. Soft-tissue procedures such as tendon lengthening can provide a stabilizing benefit, but the degenerative bone changes associate","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67754458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}