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Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor
Javier Masquijo1, Victoria Allende, Armando Torres-Gomez
1*Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina †ABC Medical Center, Mexico City, México ‡Saint Louis Children's Hospital, Washington University School of Medicine; and Saint Louis Shriners Hospital for Children, Saint Louis, MO.
Surgical resection of calcaneonavicular coalitions with fat graft or bone wax interposition offers superior pain relief and functional outcomes compared to extensor digitorum brevis (EDB) grafts. These methods also significantly reduce coalition reossification rates.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Foot and Ankle Surgery
Background:
- Calcaneonavicular coalitions are the most common tarsal coalition.
- Surgical resection is the preferred treatment for symptomatic cases.
- No studies have directly compared interposition techniques post-resection.
Purpose of the Study:
- To retrospectively compare pain relief, functional outcomes, and complications.
- To evaluate different interposition materials after calcaneonavicular coalition resection.
- To compare fat graft, bone wax, and extensor digitorum brevis (EDB) interposition.
Main Methods:
- Retrospective review of 48 patients (56 feet) undergoing resection-interposition.
- Groups: fat graft (23 feet), bone wax (18 feet), EDB (15 feet).
- Pain assessed via Visual Analog Scale (VAS); function via American Orthopaedic Foot and Ankle Society (AOFAS) score.
Main Results:
- Fat graft and bone wax groups showed significantly better pain relief and AOFAS scores than EDB.
- Coalition reossification occurred in 4% (fat graft), 6% (bone wax), and 40% (EDB).
- EDB group had 5 cases of progressive symptoms.
Conclusions:
- Autogenous fat graft and bone wax are superior to EDB for interposition after calcaneonavicular coalition resection.
- Fat graft and bone wax provide better pain relief, functional outcomes, and prevent reossification.
- Further research is needed to assess bone wax safety.
