PRESENTER:- DR. PARTH PATEL (M.S. ORTHO ASST. PROFESSOR) Abstract - - PowerPoint PPT Presentation

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Aug 31, 2022 33 likes •264 views

PRESENTER:- DR. PARTH PATEL (M.S. ORTHO ASST. PROFESSOR) Abstract no.- 1131 Contact no.- +919426264600 CO-AUTHOR:- DR. NEEL PATEL (2 ND YEAR RESIDENT) DR. MALKESH SHAH (2 ND YEAR RESIDENT) GUIDED BY:- PROF. DR. J. J. PATWA(M.S. ORTHO)

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PRESENTER:- DR. PARTH PATEL (M.S. ORTHO ASST. PROFESSOR) Abstract no.-1131 Contact no.- +919426264600 CO-AUTHOR:- DR. NEEL PATEL (2ND YEAR RESIDENT)

DR. MALKESH SHAH

(2ND YEAR RESIDENT) GUIDED BY:- PROF. DR. J. J. PATWA(M.S. ORTHO) S.B.K.S.M.I.R.C ,PIPARIA, WAGHODIA, VADODARA, GUJARAT, INDIA.

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CLOSE UP VIEW OF CALCANEOUS DEFORMITY AWKWARD GAIT

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PLANTER FLEXOR SEQUALY OF DEFORMITY PARALYSIS CALCANEOUS DEFORMITY LONG TOE FLEXORS POWERFUL ACT AS A SECONDARY PLANTER FLEXOR SECONDARY CAVUS

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CALCANEO CAVUS DEFORMITY SEQUALY OF DEFORMITY IF TIBIALIS POSTERIOR ALSO PARALYSED CALCANEO CAVO VALGUS DEFORMITY LOSS OF PUSH OFF PHASE OF GAIT AWKWARD AND DIFFICULT GAIT

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TREATMENT IS DIFFICULT BEACAUSE

LACK OF SUITABLE TENDON FOR TRANSFER
NEED CORRECTION OF EXTREME DEFORMITY

SURGERY IS MANDATORY AS EARLY AS POSSIBLE EVEN IN SKELETALLY IMMATURE PATIENT

TO HALT PROGRESSION OF DEFORMITY
TO RESTORE THE POWER OF PUSH-OFF
IN SKELETALLY MATURE PATIENT FOOT CORRECTION

DONE BY DIFFERENT TYPES OF BONY SURGERY LIKE GRICE GREEN EXTRA ARTICULAR FUSION

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FAILURE DUE TO

 TOTAL PARALYSIS OF PLANTAR FLEXORS  PERONEOUS LONGUS IS WEAK

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AS PER CAMPBELL THEY PUT DOUBLE INCISION SO CHANCES OF DEVELOPMENT OF FAT NECROSIS IS MORE AND THAT IS WHY WE PUT ONE CONTINEUOUS POSTERO –LATERAL INCISION OVER ANKLE AND FOOT

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OUR CONTINEUOUS POSTERO- LATERAL INCISION

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Principle

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Peroneus longus tendon dissected

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In our technique we avulse the whole heel on medial side and expose calcaneal tubercle

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A posterior and plantar slot is made

ver the tubercle of calcaneum

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By button hook pull peroneus longus brought under the slot to convert everter in plantar flexor without disturbing origin and insertion

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Lock peroneal tendon in slot

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Few sutures are taken over the tendon From soft tissue over plantar and posterior aspect to prevent popped out of tendon

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Peroneal sheath closed over the peroneus brevis

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Heel is placed in its original position and wound closed rest given for 3 weeks under plaster

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Fibular graft Grice green operation Along with this operation extra articular fusion can be done for preventing valgus

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CRITERIA FOR RESULT

 Power and R.O.M. of plantar flexion  R.O.M. and its lag of dorsiflexion  Pattern of push off phase of walking  Weight bearing capacity over head of the metatarsals  Maintenance of balance between dorsiflexors and plantar flexors  Improvement of gait

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RESULT

Cases operated 58 Lost to follow up 08 >2 yrs. Follow up 50 Excellent 30(60%) Good 10(20%) Poor 10(20%)

COMPLICATION

Skin edge necrosis in 8 cases & Restricted dorsiflexion in 8 cases

DISADVANTAGES

Occasional skin edge necrosis, mild eqinus deformity and in absence of long toe flexors power of plantar flexor is not balanced with dorsiflexors

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ADVANTAGES

 No need of any sutures or implants  No need of waiting for starting of physiotherapy for new insertion to take the Place  Peroneous muscle gradually hypertrophied on use  Open steindler’s procedure for cavus deformity can be done at a same stage  With minimal dissection “Grice Green” extra-articular fusion can be done at same time  No double incisions or underwining of skin flap so chances of skin necrosis is less  Agonistic tendon selected which always give better power  Long lever arm acting via lever of tuberosity of calcaneum on short lever arm so with less power one will get better planter flexion  Improved push off of walking  It halt calcaneous deformity

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