SLR - January 2013 - Thao
Reference: Lechler P, Graf S, Xaver FX, Schaumburger J, Grifka J, Handel M, Arthrodesis of the talonavicular joint using angle-stable mini-plates: a prospective study. International Orthopaedics. 2012 Oct 6, DOI: 10.1007/s00264-012-1670-y
Scientific Literature Review
Reviewed by: David Thao, DPM
Residency Program: Central Alabama Veteran Health Care System, Montgomery, AL
Podiatric Relevance:
The talonavicular joint (TNJ) plays an important role in the structure and overall motion of the foot. Degeneration of this joint is found in a variety of pathological processes including inflammatory, degenerative, and post-traumatic arthritis. This may lead to significant pain, instability, and decrease in function of the foot. A variety of fixation techniques for TNJ fusion have been described in the literature with satisfactory results for relief of pain and medial column stability. However, the risk for osseous non-union is an important factor to consider when performing TNJ arthrodesis.
Methods:
The authors prospectively enrolled 30 patients (12 male, 18 female) with a mean age of 58.8 years (range, 22-74 years) between 2005 and 2007. Talonavicular joint fusion was performed using two types of angle-stable mini-plates (multidirectional, n=25 and monodirectional, n=5). If reduction of the TNJ could not be achieved intraoperatively, bone graft was harvested from the iliac crest for interposition. Postoperatively, all patients followed the same immobilization and weight bearing protocols. All patients were assessed preoperatively and postoperatively by clinical examination, plain film x-rays, AOFAS and VAS scores.
Results:
Of the 30 TNJ fusions, 29 healed uneventfully. Non-union and plate fracture occurred in one patient. After revision surgery using an autologous iliac crest bone graft, the patient went on to osseous union at 10 weeks. The average time to complete osseous union was 10.9 weeks. The mean AOFAS improved from 31.7 to 82.3. The mean VAS decreased from 8.6 to 1.7. Autologous iliac crest bone grafts were used in six patients, and this did not influence the time to osseous union, the AOFAS or the VAS score. Age and gender did not influence the score results significantly.
Conclusions:
The authors provided short-term data that using angle-stable mini-plates for TNJ fusion led to good patient outcome with high rates of osseous union. Further studies with larger samples, longer follow-up period, and comparison to other fixation devices are necessary to confirm these results.