Papers by Florian Nickisch
Techniques in Foot & Ankle Surgery, 2009
ABSTRACT Talar body fractures are severe injuries with a historically poor prognosis. Outcomes of... more ABSTRACT Talar body fractures are severe injuries with a historically poor prognosis. Outcomes of the injuries are optimized by stable accurate internal fixation. We describe a posteromedial approach for the treatment of posterior talar body fractures, which forgoes the need for a periarticular osteotomy of the fibula or the medial malleolus.
Techniques in Foot & Ankle Surgery, 2008
ABSTRACT The correction of malalignment of the lesser toes can be one of the most challenging and... more ABSTRACT The correction of malalignment of the lesser toes can be one of the most challenging and often underestimated problems in foot and ankle surgery. In this paper, we present a simple but effective treatment for this problem when soft tissue correction fails. An osteotomy at the proximal phalangeal base of the lesser toes provides consistent correction with minimal added morbidity.
PURPOSE Tears of the anterior, superficial deltoid have been reported by Hintermann et al as impo... more PURPOSE Tears of the anterior, superficial deltoid have been reported by Hintermann et al as important in ankle instability. Our purpose was to asses the prevalence of abnormalities in this region in patients presenting for ankle instability surgery, and to compare them to the prevalence of superficial deltoid abnormality in cadaveric ankles. METHOD AND MATERIALS Following IRB approval, retrospective chart review was performed of all patients over a 3 year interval who underwent ankle MRI followed by surgery for a primary diagnosis of ankle instability. Fifty-three patients were identified who met criteria. MRI was reviewed by 2 observers for extent of abnormalities in the lateral collateral ligaments and the deep and superficial deltoid ligaments. Fifteen cadaveric ankles with no known history of ankle abnormality were chosen as a control population, and underwent ankle MRI. RESULTS Of 53 patients undergoing surgery for ankle instability, 20 had a partial stripping of the origin of...
Foot & ankle international, Jan 20, 2015
The objective of this study was to identify factors influencing operative outcomes in straightfor... more The objective of this study was to identify factors influencing operative outcomes in straightforward, uncomplicated open ankle fusions. We reviewed all primary open ankle fusions conducted at 1 institution over an 11-year period to identify straightforward, uncomplicated open ankle fusions. Inclusion required a minimum of 6 months follow-up. Patients were excluded for neuropathic arthropathy, insensate limb, failed total ankle replacement, simultaneous arthrodesis of the subtalar joint, or fusions performed within 1 year of injury to salvage failed fixation and painful function due to (1) open fractures, (2) segmental bone loss greater than 1 cm, (3) infection, or (4) talar body fractures. The primary outcome variable was radiographic union at 6 months. Other operative complications were analyzed as secondary outcomes. Five hundred twenty-eight ankle fusion surgeries were performed on 440 patients at 1 institution during the study period. Two hundred fifteen surgeries met inclusion...
Foot & Ankle International
The Journal of the American Academy of Orthopaedic Surgeons
The potential for disabling malunion following calcaneal fracture is high, regardless whether a p... more The potential for disabling malunion following calcaneal fracture is high, regardless whether a patient is treated nonsurgically or surgically. Fracture displacement typically results in loss of hindfoot height, varus heel position, and widening of the hindfoot, with possible subfibular impingement and irritation of the peroneal tendon and/or sural nerve. Frequently, the subtalar joint develops posttraumatic arthritis. In symptomatic patients with calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment, such as activity modification, bracing, orthoses, and injection, is effective in many patients. Surgical treatment may involve simple ostectomy, subtalar arthrodesis with or without distraction, or corrective calcaneal osteotomy. A high rate of successful arthrodesis and of patient satisfaction has been reported with surgical management.
Foot and Ankle Clinics, 2015
There is a high potential for disability following calcaneal fracture. This potential exists whet... more There is a high potential for disability following calcaneal fracture. This potential exists whether a patient is treated with conservative or operative management. Subfibular impingement and irritation of the peroneal tendon and sural nerve may also be present. Posttraumatic arthritis of the subtalar joint can occur. In patients with symptomatic calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment may be effective. One surgical treatment option is subtalar distraction arthrodesis. High rates of successful arthrodesis and patient satisfaction have been reported with this surgical option in correctly selected patients.
American journal of orthopedics (Belle Mead, N.J.), 2009
Recent epidemiologic studies highlight lateral talar process fractures as snowboarder's fract... more Recent epidemiologic studies highlight lateral talar process fractures as snowboarder's fracture or snowboarder's ankle. Snowboarding is the fastest growing sport worldwide, so lateral talar process fractures are increasing in frequency and mandating a more careful assessment of injury patterns, surrounding tissue involvement, and treatment strategy. In this study, we evaluated the effects of lateral talar process fracture on the footprints of 3 lateral stabilizing ligaments of the ankle and subtalar joint-the lateral talocalcaneal ligament (LTCL), the anterior talofibular ligament (ATFL), and the posterior talofibular ligament (PTFL). The musculotendinous structures from 10 fresh cadaveric limbs were removed and the distal fibula reflected to provide visualization of the lateral talar process and ligamentous attachments. Length and width of the LTCL, ATFL, and PTFL footprints on the lateral process of the talus were measured with calipers before and after removal of a 1-cm(...
Foot and ankle clinics, 2011
Traumatic injury to the ankle and hindfoot often results in tibiotalar or subtalar arthritis. The... more Traumatic injury to the ankle and hindfoot often results in tibiotalar or subtalar arthritis. The associated joint pain, stiffness, and deformity may be difficult to treat with conservative measures. For such problems, arthrodesis of the ankle or hindfoot joints is the mainstay of treatment. This article discusses the application of the posterior approach to complete a tibiotalar and tibiotalocalcaneal arthrodesis as well as its use for converting a failed total ankle arthroplasty to an arthrodesis.
Foot and ankle clinics, 2008
This article focuses on the cavovarus foot shape, with particular emphasis on those patients who ... more This article focuses on the cavovarus foot shape, with particular emphasis on those patients who have Charcot-Marie-Tooth disease. Recent greater understanding of this deformity has led to a better appreciation of how the underlying condition drives deformity progression and treatment of the problems associated with it. The basic science underpinning the development of Charcot-Marie-Tooth disease is reviewed and some elements of the importance of the genetic variability are emphasized. The mechanics of the development of the cavovarus foot deformity in patients who have this neuromuscular condition are reviewed and the evaluation of such patients is described. The surgical options for treatment are reviewed and the outcomes of studies relevant to surgical planning for this patient population are summarized.
Foot & ankle international, 2005
The Journal of foot surgery
Osteonecrosis is a pathologic condition that affects bones in the lower extremity. Circulatory im... more Osteonecrosis is a pathologic condition that affects bones in the lower extremity. Circulatory impairment, forces of weightbearing, and increased intraosseous bone marrow pressure can interact to create this malady. Radiologic identification is paramount to accurate diagnosis. The authors present various examples of this condition in the foot.
JBJS Essential Surgical Techniques, 2012
Background: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and pos... more Background: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has been utilized for the treatment of various disorders. However, there is limited literature addressing the postoperative complications of this procedure. In this study, the postoperative complications in patients treated with posterior ankle and hindfoot arthroscopy were analyzed to determine the type, rate, and severity of complications.
Foot and ankle clinics, 2006
This article outlines the pathoanatomy of malunited calcaneal fractures and reviews the literatur... more This article outlines the pathoanatomy of malunited calcaneal fractures and reviews the literature on resulting painful sequelae, diagnostic work-up, as well as reconstructive treatment options and their outcome.
The Journal of the American Academy of Orthopaedic Surgeons, 2011
The potential for disabling malunion following calcaneal fracture is high, regardless whether a p... more The potential for disabling malunion following calcaneal fracture is high, regardless whether a patient is treated nonsurgically or surgically. Fracture displacement typically results in loss of hindfoot height, varus heel position, and widening of the hindfoot, with possible subfibular impingement and irritation of the peroneal tendon and/or sural nerve. Frequently, the subtalar joint develops posttraumatic arthritis. In symptomatic patients with calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment, such as activity modification, bracing, orthoses, and injection, is effective in many patients. Surgical treatment may involve simple ostectomy, subtalar arthrodesis with or without distraction, or corrective calcaneal osteotomy. A high rate of successful arthrodesis and of patient satisfaction has been reported with surgical management.
Operative Techniques in Sports Medicine, 2010
ABSTRACT Deltoid ligament injuries are a source of valgus and rotational ankle instability and of... more ABSTRACT Deltoid ligament injuries are a source of valgus and rotational ankle instability and often occur as a result of athletic injury. The anatomy of the medial ankle ligament complex is reviewed and pertinent radiological findings are emphasized. The clinical evaluation of athletes with medial ankle instability as well as methods of repair and reconstruction of the deltoid ligament complex in those patients requiring surgical care are described.
Journal of Orthopaedic Trauma, 2011
Fractures of the calcaneal tuberosity, although rare, present a challenge for the treating surgeo... more Fractures of the calcaneal tuberosity, although rare, present a challenge for the treating surgeon. The goal of treatment is restoration of function of the gastrocnemius-soleus complex and the Achilles tendon. These fractures often occur in diabetics and elderly osteoporotic patients and therefore fixation of the displaced fragment is difficult. Displaced fractures, if not recognized and promptly reduced, often result in secondary soft tissue compromise. Often, the fragment is a small shell of osteoporotic bone, which is less than optimal for bony fixation. We present our technique for surgical fixation of calcaneal tuberosity fractures using a suture placed through bone tunnels in the calcaneal body. This technique is used by itself for smaller fragments or supplemented with screw fixation for larger fragments.
The Journal of Bone and Joint Surgery (American), 2007
The mechanism of physeal closure is poorly understood, although both mechanical and biological fa... more The mechanism of physeal closure is poorly understood, although both mechanical and biological factors may play a role in the process. In this study, we evaluated the effect of the application of a chemokine stromal cell-derived factor-1 (SDF-1) to rabbit physes in vivo with regard to growth inhibition. A continuous infusion system consisting of a fenestrated catheter and an osmotic pump were implanted into the right proximal tibial physis of twenty six-week-old New Zealand White rabbits. Ten of the pumps were loaded with human recombinant SDF-1alpha, and ten were loaded with phosphate-buffered saline solution (sham treatment). The left leg was used as the uninvolved control. The growth of the tibiae was followed radiographically for eight weeks, and histologic analysis was performed for both the SDF-1-treated rabbits and the sham-treated rabbits at two, four, and eight-week time-points. Radiographic evaluation showed a significant growth inhibition in the SDF-1alpha-treated physes (4.5 +/- 3.0 mm; p = 0.007) compared with the sham-treated physes after eight weeks. No difference was noted when the sham-treated leg was compared with the contralateral, control leg (0.2 +/- 2.9 mm; p = 0.465). Histologic evaluation showed marked physeal disorganization, narrowing, and proteoglycan loss and a significant decrease in physeal height (p < 0.0001) for the SDF-1-treated group. Reversible growth slowing was noted in the uninvolved, control leg of the SDF-1-treated group at six weeks, with resolution of the difference by eight weeks. SDF-1 may be used to induce physeal closure through a targeted infusion system. However, transient systemic effects of SDF-1 may exist and must be evaluated further prior to its clinical use for epiphysiodesis.
The Journal of Bone and Joint Surgery (American), 2012
Background: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and pos... more Background: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has been utilized for the treatment of various disorders. However, there is limited literature addressing the postoperative complications of this procedure. In this study, the postoperative complications in patients treated with posterior ankle and hindfoot arthroscopy were analyzed to determine the type, rate, and severity of complications.
Uploads
Papers by Florian Nickisch