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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

Box plots of bone mineral density for both procedures.
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Fig5: Box plots of bone mineral density for both procedures.

Mentions: The average bone mineral density of the preparations was 222.25 (±96.42) mg/cm3, the mean pre-operative calcanear volume amounted 57.64 (±8.58) cm3 (Figure 4). The preparations that underwent endoscopic surgery had a bone mineral density of 224.02 (±47.94) mg/cm3 and an initial volume of 58.50 (±6.21) cm3, while the preparations that underwent open surgery had a bone mineral density of 220.34 (±132.72) mg/cm3 and an initial volume of 56.78 (±10.83) cm3. Thus it may be seen that randomization led to some differences between the bone mineral density and pre-operative volume of the two small groups. Nevertheless the levels remained analogous, as could be seen from p values greater than 0.1 that were obtained in the descriptive Mann–Whitney tests. The outlying values obtained from preparations 15 and 16 (Table 2) may be regarded as responsible for the higher standard deviation obtained from the preparations that underwent open surgery. This is also apparent from the corresponding box plot diagram (Figure 5).Figure 4


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)

Box plots of bone mineral density for both procedures.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Box plots of bone mineral density for both procedures.
Mentions: The average bone mineral density of the preparations was 222.25 (±96.42) mg/cm3, the mean pre-operative calcanear volume amounted 57.64 (±8.58) cm3 (Figure 4). The preparations that underwent endoscopic surgery had a bone mineral density of 224.02 (±47.94) mg/cm3 and an initial volume of 58.50 (±6.21) cm3, while the preparations that underwent open surgery had a bone mineral density of 220.34 (±132.72) mg/cm3 and an initial volume of 56.78 (±10.83) cm3. Thus it may be seen that randomization led to some differences between the bone mineral density and pre-operative volume of the two small groups. Nevertheless the levels remained analogous, as could be seen from p values greater than 0.1 that were obtained in the descriptive Mann–Whitney tests. The outlying values obtained from preparations 15 and 16 (Table 2) may be regarded as responsible for the higher standard deviation obtained from the preparations that underwent open surgery. This is also apparent from the corresponding box plot diagram (Figure 5).Figure 4

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