Discusión entre pares / 78 year old female with rocker bottom foot, recurrent callus and preulcerative change...

Michael Dujela‎Indian Orthopaedic Research Group

78 year old female with rocker bottom foot, recurrent callus and preulcerative change to plantar medial column. Gastroc recession, midfoot arthrodesis, structural graft to first TMT to address length.

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  Harish Kurup ALPS ? Have you tried putting plates on plantar side ( 1st TMT) ?

  18 horas · Me gusta
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  Michael Dujela Thanks Harish Kurup usually I put on the medial/plantar medial (tension side) wasn't happy with it there today particularly as my graft was trapezoidal wider dorsally. I agree that we typically place plantar . Thanks for comment . I use alps periodically as well

  18 horas · Me gusta · 1
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  Michael Dujela Thanks Harish Kurup usually I put on the medial/plantar medial (tension side) wasn't happy with it there today particularly as my graft was trapezoidal wider dorsally. I agree that we typically place plantar . Thanks for comment . I use alps periodically as well

  18 horas · Me gusta
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  Michael Dujela Orthohelix plate and where I normally place it

  

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  Venu Kavarthapu Excellent case example. I felt Gastroc recession would not always work and routinely do percutaneous TA release. Good to know that Gastroc recession works well.

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  Umer Zeb Khan Excellent sir

  17 horas · Me gusta · 1
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  Praveen Koppad excellent sir. surely inspiring

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  Alok Jain Excellent case....
  Thanks for sharing.....

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  Kir Pat Good correction and fixJust for curiosity,If you have added beam pillar screws in 1st and 3-4th metatarsal temporarily ,it would have been more stable in this bone and double arthrodesis(sagging at talonav likely in future if unlimited mobility of subtalar ,I assume)..Great.

  9 horas · Me gusta · 1
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  Rahul B Tanga Michael ideally how much of flap should be left between two suture lines in foot case.

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  Michael Dujela I have had good success with fairly small skin bridges Rahul , it's not the same as the ankle. Minimal issues with a few cm as long as you raise full thickness flaps and are gentle with retraction

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  Michael Dujela @Kiran Patel, I gave a lecture at our national surgical meeting last year on beam screws. I love them, just not in patients who are sensate . Only useful in neuropathic patients since we create a 6.5 mm or larger hole in the first met head cartilage . Occasionally I will go from posterior through talus down medial column. Have you used them successfully in patients who are sensate?

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  Kir Pat yes, as it gives good sleep as you have not to rely on compliance of pt.apart from its biomech value..Do you think ,it helps in consequent toe contracture in some case as in TSF,IT IS USUALLY RECOMMENDED in such fix.

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  Kir Pat I have old design zimmer flexible screw long 9it is not in market) but flexibilt prevents from cutout

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