Category: Midfoot/Forefoot Introduction/Purpose: We report the middle-term outcomes after performing Lisfranc ligament anatomical reconstruction surgery (LARS), using an optimal route of reconstruction based on anatomical measurements of and biomechanical experiments with cadavers. Methods: Subjects included 20 patients (8 female and 12 male, mean age: 35.5 years, mean follow-up period: 35 months) who were diagnosed with Lisfranc joint injury and underwent surgical treatment from 2012 to 2015. Acute case were fourteen cases, chronic cases were 6 cases. The optimal anatomical route of reconstruction was calculated from anatomical measurements obtained from 78 legs of cadavers. The Myerson’s classification and the Kaar’s classification based on stress X-rays were used to classify the injuries at the time of their occurrence. Furthermore, the Japanese Society for Surgery of the Foot (JSSF) Midfoot scale and Stein’s radiographic assessment were used for clinical evaluation postoperatively. Results: According to the Myerson’s classification, Type B1 was one case, Type B2 was 15 cases, Type C1 and Type C2 were each 2 cases. According to the Kaar’s classification, 17 patients had transverse-type injuries and 3 patients had longitudinal-type injury. Partial weight bearing was encouraged within 6 week and return to exercise within 12 weeks. Average JSSF scores at final follow-up were 93.8 points in both examples (85-100) respectively. Joint congruities on X ray were appropriate in most cases but admitted a little diastasis by one case of chronic and one acute case. Conclusion: LARS achieves both static and dynamic stability, does not require removal of the internal fixation material, and enables all patients to support a full load 8 weeks postoperatively. LARS is beneficial for maintaining anatomical reduction, preserving the joint, and shortening the post-therapy period. Our newly developed ligament reconstruction is not only able to acute injuries but also to the chronic injuries.
The effect of two different methods of reconstruction of flatfoot deformity and the role of the posterior tibial tendon on the contact characteristics of the hindfoot joints were quantified using pressure-sensitive film. Each of 10 cadaver feet was loaded quasi-statically by an axial compressive force to simulate varying loads. First, a specimen was tested intact, then it was tested after sectioning the spring ligament and loading the specimen cyclically to create one type of flatfoot deformity. It was then tested again after reconstructing the deformity. Reconstructions used were the Dillwyn-Evans procedure (bone graft in osteotomy of the calcaneus) or the calcaneocuboid distraction arthrodesis (CCDA). We found that surgically produced flatfoot deformity altered mainly the talonavicular joint, by decreasing its contact area. The Dillwyn-Evans method had less effect on the talonavicular joint (altering 2 of 6 measured parameters) than the CCDA (3 of 6) and more effect on the anteriomedial facet (altering 3 of 6 parameters) than the CCDA (1 of 6). The Dillwyn-Evans method had more effect on the posterior facet (altering 2 of 6 measured parameters) than the CCDA (1 of 6). Function of the posterior tibial tendon had no effect on contact characteristics of the hindfoot joints after either type of reconstruction. These findings are based on measurements using a quasi-statically-loaded foot model at three selected positions, and results may be different with dynamic loading.
Forty-one clubfeet in 22 patients with amyoplasia were studied retrospectively at a mean duration after surgery of 118 months (range, 45-253). The clubfeet were managed by a regimen including initial stretching casts, posteromedial release, and postoperative splinting at night. The mean age at the time of surgery was 7.3 months. Correction of deformity without recurrence was achieved in 11 (27%). Recurrent deformity was corrected by serial casting in eight feet and required secondary operative procedures in 20 feet. In the feet without recurrence of deformity, the duration of splinting at night after surgery was significantly longer than in those with recurrence(p < 0.05). At follow-up, 39 (95%) feet were plantigrade and were considered satisfactory. Our findings suggest that most clubfeet in amyoplasia can be effectively corrected by posteromedial release and that the recurrence of deformity can be reduced by splinting at night and often corrected by serial cast treatment.
Aim: Recently, numerous reports have demonstrated that oxidative stress and related chondrocyte aging may participate in the development of osteoarthritis (OA). To further understand the pathogenesis and degenerative process of OA, we have studied water-soluble polyhydroxylated C60 fullerene, a strong free radical scavenger, as an anti-oxidant.
Method: We examine the therapeutic effects of five types of water-soluble polyhydroxylated C60 fullerenes [C60(OH)10, C60(OH)24, C60(OH)26, C60(OH)36, C60(OH)44] on OA-related factor-induced catabolic responses in osteoarthritic chondrocytes. In the presence or absence of polyhydroxylated C60 fullerenes [C60(OH)10, C60(OH)24, C60(OH)26, C60(OH)36, C60(OH)44] (0.1, 1.0, 10.0 or 100 nM), human osteoarthritic chondrocytes were treated with IL-1β (10.0 ng/mL). After 24 hours incubation, chondrocyte activities were examined.
Results: Water-soluble polyhydroxylated C60 fullerenes inhibited OA-related catabolic responses (IL-1β- upregulation of cartilage degrading enzyme production and downregulation of proteoglycan production) in OA chondrocytes. C60(OH)10 C60(OH)24 and C60(OH)26 showed a stronger chondroprotective effect than C60(OH)36 or C60(OH)44.
Conclusion: Our findings indicate that polyhydroxylated C60 fullerenes, especially C60(OH)10 C60(OH)24 and C60(OH)26, may have a part to protect against OA related factor-mediated downregulation of osteoarthritic chondrocyte activities. These data may reveal a novel pathologic mechanism linking oxidative stress-induced development of OA.
There are no reports of pyogenic spinal infections secondary to an arterioenteric fistula in the literature. Herein, we report a case of recurrent pyogenic spinal infection caused by vascular graft penetration into the sigmoid colon. A 66-year-old man with a history of diabetes and abdominal aortic aneurysm surgery suffered from low back pain and fever. He visited his previous hospital, where a lumbar magnetic resonance imaging revealed a spinal infection. The patient received conservative therapy with antibiotics and underwent several surgeries. However, there was no improvement in his symptoms. The patient was referred to and hospitalized at our university hospital. Because intestinal bacteria were repeatedly detected in his blood cultures, a colonoscopy was performed, which revealed the exposure of a vascular graft in the sigmoid colon confirmed by contrast-enhanced computed tomography. We diagnosed the patient with recurrent pyogenic spinal infection caused by secondary arterioenteric fistula. He then underwent sigmoidectomy, resection of the infected vascular graft, and femoral–femoral artery bypass grafting. There was improvement in his symptoms after the surgery. Gastrointestinal examinations should be performed early when intestinal resident bacteria are detected in blood cultures in patients with pyogenic spinal infections.
Purpose To elucidate the utility of a navigated high-speed drill used after the version upgrade in surgeries assisted by a spinal robotics system. Methods The subjects were 166 patients who underwent screw placement using a spinal robotics system between April 2021 to July 2023. A significant change during the study was the introduction of a navigated high-speed drill in 80 post-upgrade cases, aimed at improving drilling accuracy. Screw accuracy was analyzed using the Gertzbein and Robbins classification on postoperative CT scans. Screws placed before (pre-upgrade group: 718 screws in 86 cases) and after the system upgrade (post-upgrade group: 747 screws in 80 cases) were compared in terms of perfect accuracy and deviation rates. Results There were no significant differences in demographics or surgical details between the two groups. No significant differences were observed in the overall perfect accuracy rate and deviation rate (2.4% pre-upgrade vs. 2.0% post-upgrade) between the two groups. For the percutaneous pedicle screw (PPS), the perfect accuracy rate was significantly higher, and the deviation rate was significantly lower in the post-upgrade group (26.1% pre-upgrade vs. 4.4% post-upgrade). Notably, the post-upgrade group achieved 100% perfect accuracy and 0% deviation for the cortical bone trajectory screw (CBT) technique. Conclusions The introduction of the navigated high-speed drill did not significantly alter the overall perfect accuracy or deviation rates for robotic-assisted screw placement. However, its use did demonstrate improved outcomes in specific techniques such as PPS and CBT, indicating its potential value in addressing skiving in robotic-assisted minimally invasive surgeries.
