A bioinspired mineralized collagen scaffold promotes enthesis healing and activates Gli1 expression in preclinical models.

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Abstract

[Indexed for MEDLINE] 15. Oper Orthop Traumatol. 2016 Jun;28(3):177-92. doi: 10.1007/s00064-016-0438-8. Epub 2016 Feb 19. [Subtalar arthrodesis]. [Article in German] Fuhrmann RA(1), Pillukat T(2). Author information: (1)Klinik für Fuß- und Sprunggelenkchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97616, Bad Neustadt, Deutschland. ReneeAndrea.Fuhrmann@fusschirurgie-bad-neustadt.de. (2)Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt, Deutschland. OBJECTIVE: Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. INDICATIONS: Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction. CONTRAINDICATIONS: Inflammation, vascular disturbances, nicotine abuse. SURGICAL TECHNIQUE: Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws. POSTOPERATIVE MANAGEMENT: Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle. RESULTS: Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients. DOI: 10.1007/s00064-016-0438-8