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Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans.

Roth KE, Mueller R, Schwand E, Maier GS, Schmidtmann I, Sariyar M, Maus U - J Foot Ankle Res (2014)

Bottom Line: After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery.The two groups did not differ significantly with regard to BMD (p > 0.1).The extent of the resection fell by 0.011 cm(3) per 1 mg/cm(3) areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density.

View Article: PubMed Central - PubMed

Affiliation: Center of Orthopedic and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, Mainz, 55131 Germany.

ABSTRACT

Background: It has been claimed that endoscopic calcaneoplasty offers some advantages over open techniques in the surgical treatment of Haglund's deformity due to reduced postoperative complications like stiffness and pain. Bony over-resection places patients at risk of these complications. The resulting question with regard to the quantitative differences of the extent of the bone removed using these two techniques has not yet been answered. The purpose of the study was to determine the resection volume of calcaneal bone for open and endoscopic surgical techniques.

Methods: 16 feet obtained from body donors were operated on in equal parts using either open surgical or endoscopic techniques, with the technique selected on a random basis. High-resolution CT scans were obtained before and after the interventional procedure and analysed to obtain 3-D polygon models. Post-operative models were subtracted from pre-operative models to provide the volume change resulting from the intervention. This was then correlated with the bone mineral density (BMD) of the preparation.

Results: The extent of bony resection was greater in open surgical techniques than in endoscopic approaches. The average volume of bone resection was 0.80 (±0.34) cm(3) in the endoscopic group and 3.04 (±2.91) cm(3) in the group that underwent open surgery. After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery. The two groups did not differ significantly with regard to BMD (p > 0.1). The extent of the resection fell by 0.011 cm(3) per 1 mg/cm(3) areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density.

Conclusions: Assuming that the resection volume was adequate to treat the patient's complaints a smaller resection volume seen in our study using an endoscopic technique might lead to fewer postoperative complaints and faster recovery.

No MeSH data available.


Related in: MedlinePlus

Representation of the resected volume objects, spatial resolution of the course of resection.
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Fig3: Representation of the resected volume objects, spatial resolution of the course of resection.

Mentions: The study involved eight freshly frozen body donors. The use of cadaveric specimens was approved by the ethics committee of the national medical association Rhineland-Palatinate, Mainz, Germany. The specimens had no evidence of prior surgery or musculoskeletal disease. In each case both feet were separated above the malleoli and all sixteen preparations thawed at room temperature. These were then placed in the open or endoscopic groups on a random basis. A computerized random-number generator was used to formulate an allocation schedule. Subjects were randomized to either treatment with use of the method of randomly permuted blocks. The randomization scheme was generated with use of the web site www.randomization.com. Eight preparations were randomized into 2 blocks. Bone mineral density (BMD) was determined in the distal tibia using peripheral quantitative computed tomography (pQCT-XCT 2000, Stratec, Germany) and correlated with the dimensions of the resection. High-resolution CT data sets (Volume Zoom, Siemens Medical systems, Germany, Scanning protocol; Table 1) were obtained pre- and post-operatively. These were then converted to a 3-dimensional graphic representation using the Dextroscope planning system (Volume Interactions, Singapore) and the software iPlan (Brainlab AG, Feldkirchen, Germany). The calcaneus from every preparation was then segmented using “smart-brush” online tools under the same parameters and its volume was calculated. Subtraction of the post-operative from the pre-operative volume provided the volume of the resection with an accuracy of ± 0.01 mm3. A spatial representation of the resection was obtained by overlaying the pre- and post-operative data sets using the “image-fusion” function. The resected part of the calcaneus was displayed as a separate object volume (Figures 1, 2, and 3).Table 1


Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans.

Roth KE, Mueller R, Schwand E, Maier GS, Schmidtmann I, Sariyar M, Maus U - J Foot Ankle Res (2014)

Representation of the resected volume objects, spatial resolution of the course of resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4300584&req=5

Fig3: Representation of the resected volume objects, spatial resolution of the course of resection.
Mentions: The study involved eight freshly frozen body donors. The use of cadaveric specimens was approved by the ethics committee of the national medical association Rhineland-Palatinate, Mainz, Germany. The specimens had no evidence of prior surgery or musculoskeletal disease. In each case both feet were separated above the malleoli and all sixteen preparations thawed at room temperature. These were then placed in the open or endoscopic groups on a random basis. A computerized random-number generator was used to formulate an allocation schedule. Subjects were randomized to either treatment with use of the method of randomly permuted blocks. The randomization scheme was generated with use of the web site www.randomization.com. Eight preparations were randomized into 2 blocks. Bone mineral density (BMD) was determined in the distal tibia using peripheral quantitative computed tomography (pQCT-XCT 2000, Stratec, Germany) and correlated with the dimensions of the resection. High-resolution CT data sets (Volume Zoom, Siemens Medical systems, Germany, Scanning protocol; Table 1) were obtained pre- and post-operatively. These were then converted to a 3-dimensional graphic representation using the Dextroscope planning system (Volume Interactions, Singapore) and the software iPlan (Brainlab AG, Feldkirchen, Germany). The calcaneus from every preparation was then segmented using “smart-brush” online tools under the same parameters and its volume was calculated. Subtraction of the post-operative from the pre-operative volume provided the volume of the resection with an accuracy of ± 0.01 mm3. A spatial representation of the resection was obtained by overlaying the pre- and post-operative data sets using the “image-fusion” function. The resected part of the calcaneus was displayed as a separate object volume (Figures 1, 2, and 3).Table 1

Bottom Line: After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery.The two groups did not differ significantly with regard to BMD (p > 0.1).The extent of the resection fell by 0.011 cm(3) per 1 mg/cm(3) areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density.

View Article: PubMed Central - PubMed

Affiliation: Center of Orthopedic and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, Mainz, 55131 Germany.

ABSTRACT

Background: It has been claimed that endoscopic calcaneoplasty offers some advantages over open techniques in the surgical treatment of Haglund's deformity due to reduced postoperative complications like stiffness and pain. Bony over-resection places patients at risk of these complications. The resulting question with regard to the quantitative differences of the extent of the bone removed using these two techniques has not yet been answered. The purpose of the study was to determine the resection volume of calcaneal bone for open and endoscopic surgical techniques.

Methods: 16 feet obtained from body donors were operated on in equal parts using either open surgical or endoscopic techniques, with the technique selected on a random basis. High-resolution CT scans were obtained before and after the interventional procedure and analysed to obtain 3-D polygon models. Post-operative models were subtracted from pre-operative models to provide the volume change resulting from the intervention. This was then correlated with the bone mineral density (BMD) of the preparation.

Results: The extent of bony resection was greater in open surgical techniques than in endoscopic approaches. The average volume of bone resection was 0.80 (±0.34) cm(3) in the endoscopic group and 3.04 (±2.91) cm(3) in the group that underwent open surgery. After adjustment for bone mineral density the extent of the resection was significantly larger (p = 0.018) in the group undergoing open surgery. The two groups did not differ significantly with regard to BMD (p > 0.1). The extent of the resection fell by 0.011 cm(3) per 1 mg/cm(3) areal bone mineral density, i.e., a slightly lower degree of bone resection was associated with a higher bone mineral density.

Conclusions: Assuming that the resection volume was adequate to treat the patient's complaints a smaller resection volume seen in our study using an endoscopic technique might lead to fewer postoperative complaints and faster recovery.

No MeSH data available.


Related in: MedlinePlus