Combined Type II Odontoid Fracture With Axis Anterior Arch Fracture

Associated fractures of the atlas and axis are frequent, particularly in the elderly patients following a simple low-energy fall. This injury can be easily misdiagnosed on initial plain radiographs, and therefore computed tomography scan is a useful adjunct in patients with a degenerative spine. There is still no consensus as to the optimal treatment of combined axis–atlas fractures, and the majority of authors propose a therapeutic strategy dependent on the odontoid fracture pattern. We describe a combined atlas and axis fracture in a 92-year-old patient who was managed with nonoperative treatment in a rigid collar. The association of C1 anterior arch with a C2 type II odontoid fracture is a rare combination, which to our knowledge has never been reported following nonoperative treatment. There was a good functional outcome at 1-year follow-up with the fracture progressing to a fibrous nonunion of the odontoid process

Clinical Outcomes and Complications of the Zadek Calcaneal Osteotomy in Insertional Achilles Tendinopathy: A Systematic Review and Meta-analysis

Category: Hindfoot; Ankle Introduction/Purpose: Insertional Achilles Tendinopathy (IAT) is a degenerative process at the insertion of Achilles tendon onto the calcaneal tuberosity that often coexists with retrocalcaneal bursitis and Haglund’s deformity. The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with IAT that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT. Methods: PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95% confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). Results: Ten studies with 232 patients were included. The AOFAS (American Orthopaedic Foot and Ankle Society) Ankle- Hindfoot Score and the VISA-A score (Victorian Institute of Sports of Australia-Achilles score) were significantly improved after the Zadek osteotomy (p < 0.00001). Pain levels were also significantly reduced (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia. Conclusion: The Zadek osteotomy is a safe and effective procedure for patients with IAT. The osteotomy improves pain levels and functions and is associated only with minor complications and a low complication rate. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this

A Novel Use of Arthroereisis in the Adult Flat Foot

Category: Hindfoot Introduction/Purpose: The use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. Here we present a case comparison series involving the use of an arthroereisis screw to augment reconstruction in adult patients with Tibialis Posterior Insufficiency. Methods: All patients (36 feet in 34 patients) underwent flexor digitorum longus transfer, reefing of the spring ligament and a translational medialising calcaneal osteotomy. In 23 cases the reconstruction was augmented with an arthroereisis screw (Kalix, Integra), which was removed 6 months later in all cases. The mean age was 58 years and most patients were female. Weight bearing radiographs were taken after removal of the implant and assessed using previously published parameters. Patients were evaluated at follow up using validated functional outcome questionnaires (MOXFQ, EQ-5D and a health VAS). Results: One patient in the group without augmentation went on to have a triple fusion 13 months after reconstruction. In both cohorts the calcaneal pitch was raised, Meary’s angle decreased, the medial cuneiform height increased and the talonavicular coverage angle improved post-operatively compared to pre-operative measurements (p < 0.05, Wilcoxon Signed Rank tests). There was a trend towards better radiographic correction in the augmented group and the difference in correction of the talonavicular coverage angle was statistically significant (p < 0.05, Students T test). There was however no difference between the MOXFQ, EQ-5D and heath VAS scores between the two groups at mean follow up of 4 years. Conclusion: We conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in tibialis posterior insufficiency