Browsing by Author "Shah, Ashish"

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    Biomechanical comparison of plantar-to-dorsal and dorsal-to-plantar screw fixation strength for subtalar arthrodesis.
    (Einstein (Sao Paulo, Brazil), 2020-01) Chaudhari, Nileshkumar; Godoy-Santos, Alexandre Leme; Netto, Cesar de Cesar; Rodriguez, Ramon; Dun, Shouchen; He, Jun Kit; McKissack, Haley; Fleisig, Glenn S; Pires, Eduardo Araujo; Shah, Ashish
    OBJECTIVE:To compare screw fixation strength for subtalar arthrodesis. METHODS:Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student's t test, with p=0.05 used to determine statistical significance. RESULTS:Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). CONCLUSION:In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.
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    Extensive Synovial Chondromatosis Involving All Flexor Tendons in the Tarsal Tunnel: A Case Report.
    (Revista brasileira de ortopedia, 2019-02) Pinter, Zachariah; Shah, Ashish; Netto, Cesar de Cesar; Smith, Walter; O'Daly, Andres; Godoy-Santos, Alexandre Leme
    Synovial chondromatosis is a rare condition characterized by benign chondrogenic meta- plasia of extra-articular synovial tissue. It usually affects a single tendon sheath of the hand or foot. This report describes a rare case with extensive synovial chondromatosis affecting all flexor tendons in the tarsal tunnel, its radiological features, surgical treatment, and clinical outcome. The authors present a unique case of extensive synovial chondromatosis in a 48-year-old male involving the tendon sheaths of the flexor hallucis longus, flexor digitorum longus, and posterior tibialis tendons, at the level of the tarsal tunnel, with extension into the plantar aspect of the foot. The patient initially presented with symptoms of tarsal tunnel compression and was found to have a 4-cm mass in the posteromedial aspect of the ankle. The presumptive diagnosis of synovial chondromatosis was made based on radiographic and magnetic resonance imaging evidence. The patient underwent surgical resection of the tumor, as well as tarsal tunnel release and gastrocnemius recession. The diagnosis was confirmed postoperatively by surgical histopathology. The postoperative course of the patient was uncomplicated and his tarsal tunnel symptoms resolved. This represents a case of extensive synovial chondromatosis involving all flexor tendons in the tarsal tunnel that was correctly diagnosed by clinical and imaging findings, which required early surgical resection to avoid long-term neurovascular complications.
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    ROLE OF BONE GRAFTS AND BONE GRAFT SUBSTITUTES IN ISOLATED SUBTALAR JOINT ARTHRODESIS.
    (Acta ortopedica brasileira, 2017-09) Shah, Ashish; Naranje, Sameer; Araoye, Ibukunoluwa; Elattar, Osama; Godoy-Santos, Alexandre Leme; Cesar, Cesar DE

    Objectives

    The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes.

    Methods

    We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically.

    Results

    There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56).

    Conclusion

    Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.