Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-03-29 DOI: 10.1016/j.foot.2025.102158

Sara Behforootan , Panagiotis E. Chatzistergos , Nicola Eddison , Nachiappan Chockalingam

Ankle-foot orthoses (AFOs) are of important in the management of gait deformities in most neurological conditions through stabilising and supporting the ankle and foot. Despite its importance, there is a lack of knowledge about how some design parameters, particularly trimline geometry, affect AFO stiffness. This study employs a parametric finite element (FE) model to quantify the impact of trimline design on rigidity to improve standardisation of AFO prescription manufacture, and quality control. A parametric model was developed to systematically modify trimline placement and analyse its effect on AFO stiffness. A dorsiflexion moment of 30 Nm was employed to simulate loading conditions, with experimentally determined material properties of polypropylene. The parametric model was developed and validated against experimental results. Trimline positions were manipulated systematically by 1 mm in the proximal and 10 mm in the distal direction of ankle to investigate their impact on stiffness. Thickness, loading, and constraints were controlled for in the analysis. The results of this study verify that the model accurately predicts ankle dorsiflexion, and there are small discrepancies between calculation and experiment. Having more than five transverse plates proximal to the footplate and distal to the ankle does not significantly impact stiffness. Furthermore, trimline position has significant effect in AFO rigidity, that even small changes affect stiffness. Change in trimline posterior to the ankle produced a linear decrease in stiffness, while trimline adjustments distal to the ankle had a nonlinear effect. These findings emphasise the importance of precise prescription and quality control of trimlines to optimise the AFO function.

踝足矫形器（AFOs）通过稳定和支持脚踝和足，在大多数神经系统疾病的步态畸形管理中具有重要意义。尽管它很重要，但人们对一些设计参数，特别是边缘几何形状，如何影响AFO刚度缺乏了解。本研究采用参数化有限元（FE）模型，量化三棱线设计对刚性的影响，以提高AFO处方生产的标准化和质量控制。建立了一个参数化模型，系统地修改了切线位置，并分析了其对AFO刚度的影响。采用30 Nm的背弯力矩模拟加载条件，并通过实验确定聚丙烯的材料性能。建立了参数化模型，并与实验结果进行了对比验证。系统地在踝关节近端和远端分别操作1 mm和10 mm的边缘线位置，以研究它们对刚度的影响。在分析中控制了厚度、载荷和约束条件。本研究结果验证了该模型能准确预测踝关节背屈，且计算与实验误差较小。在足底近端和踝关节远端有超过5个横向钢板不会显著影响僵硬度。此外，侧边线位置对AFO刚度有显著影响，即使很小的变化也会影响刚度。踝关节后侧线的改变会产生线性的刚度降低，而踝关节远端侧线的调整则会产生非线性的影响。这些发现强调了精确处方和质量控制的重要性，以优化AFO功能。

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引用次数: 0

Risk factors associated with subtalar fusion within 5 years following calcaneal ORIF 跟骨ORIF术后5年内距下融合的相关危险因素

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2024-12-20 DOI: 10.1016/j.foot.2024.102154

Elisabeth White , Sylvester Okoro , Ameer Tabbaa , Ariel N. Rodriguez , Bhavya Sheth , Andrew Horn , Afshin E. Razi , Amr A. Abdelgawad

Background

Although most calcaneal fractures are managed with open reduction internal fixation (ORIF), they can ultimately lead to subtalar arthritis and pain requiring subtalar fusion when conservative treatments prove ineffective. Understanding the risk factors associated with subtalar fusion (STF) after calcaneal ORIF is crucial for optimizing patient outcomes and treatment strategies. This study aimed to comprehensively evaluate these risk factors and their association with the incidence of STF, including patient demographics, medical comorbidities, same day and 90-day reimbursement data.

Methods

A retrospective analysis was performed using the PearlDiver Mariner 157 national claims database from January 1st, 2010 to October 31st, 2021. Patients who underwent calcaneal ORIF, identified using Current Procedural Terminology (CPT) and ICD Procedure Codes were queried for 5-year rates of STF and reimbursement data. Patient demographics and comorbidities were recorded, and multivariate logistic regression was employed to determine the association of risk factors with STF.

Results

Patients with STF had a higher proportion of alcohol abuse (21.3 % vs. 16.2 %), depression (58.1 % vs. 43.1 %), drug abuse (29.1 % vs. 19.7 %), obesity (40.3 % vs. 28 %) and tobacco use (62.2 % vs. 50.3 %), all exhibiting a p-value of less than 0.001. Those with depression (OR: 1.54; 99 % CI:1.29–1.84; P < 0.001) and obesity (OR:1.58; 99 % CI: 1.32–1.88; P < 0.001) as comorbidities had a higher odds ratio of association with STF following calcaneal ORIF.

Conclusion

Patients who ultimately require STF within 5 years of calcaneal ORIF had higher rates of alcohol abuse, tobacco use, drug use, obesity, and depression. There was no significant difference observed between those with and without STF in average same-day and 90-day reimbursements and demographics.

背景：虽然大多数跟骨骨折采用切开复位内固定（ORIF）治疗，但当保守治疗无效时，它们最终会导致距下关节炎和需要距下融合的疼痛。了解跟骨ORIF术后距下融合（STF）的相关危险因素对于优化患者预后和治疗策略至关重要。本研究旨在全面评估这些风险因素及其与STF发病率的关系，包括患者人口统计学、医疗合并症、当日和90天报销数据。方法：对2010年1月1日至2021年10月31日期间PearlDiver Mariner 157国家索赔数据库进行回顾性分析。使用现行程序术语（CPT）和ICD程序代码对接受跟骨ORIF的患者进行了5年的STF率和报销数据查询。记录患者人口统计学和合并症，并采用多因素logistic回归来确定危险因素与STF的关系。结果:患者算法有较高比例的酗酒(21.3 % 16.2 vs %)、抑郁(58.1 % 43.1 vs %),药物滥用(29.1 % 19.7 vs %),肥胖(40.3 %和28 %),烟草使用(62.2 % 50.3 vs %),所有展出的假定值小于0.001。抑郁症患者(OR: 1.54；99 %置信区间:1.29—-1.84;P 结论：在跟骨ORIF术后5年内最终需要STF的患者有更高的酗酒、吸烟、吸毒、肥胖和抑郁率。有STF和没有STF的患者在平均当天和90天的报销以及人口统计数据方面没有显著差异。

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引用次数: 0

Association of calcaneal pitch angle with recurrence of postoperative hallux valgus in patients with rheumatoid arthritis 跟骨角度与类风湿关节炎患者术后拇外翻复发的关系。

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2024-12-18 DOI: 10.1016/j.foot.2024.102155

Wataru Uehara, Toshifumi Fujiwara, Ryosuke Yamaguchi, Hidetoshi Tsushima, Daisuke Hara, Yukio Akasaki, Yasuharu Nakashima

Hallux valgus (HV) and flatfoot deformities are frequently seen in patients with rheumatoid arthritis (RA). This study aimed to determine whether flatfoot deformity contributes to the recurrence of HV in RA patients. This study examined 62 feet from 45 RA patients who were diagnosed with HV and underwent the first metatarsal joint-preserving surgery between November 2010 and October 2021. Recorded data included age at surgery, sex, disease duration, body mass index [BMI], RA disease duration, medical treatment of RA, Larsen grade, blood test, pre/postoperative Japanese Society for Surgery of the Foot, HV angle, M1M2 angle, M1M5 angle, calcal pitch angle, and Meary’s angle. HV recurrence on radiography was defined as an HV angle exceeding 20°. HV recurrence was observed in 17 feet. Significant differences were observed due to risk factors such as BMI, disease duration, Larsen grade 4–5, and preoperative calcaneal pitch angle. Multivariate logistic regression analysis identified that lower BMI, a higher M1M2 angle, and a lower calcaneal pitch angle are preoperative risk factors for the recurrence of postoperative HV in RA patients.

Level of evidence

3

拇外翻（HV）和平足畸形常见于类风湿关节炎（RA）患者。本研究旨在确定平足畸形是否与类风湿关节炎患者的HV复发有关。这项研究检查了45名被诊断为HV的RA患者的62英尺，这些患者在2010年11月至2021年10月期间接受了第一次跖关节保留手术。记录的数据包括手术年龄、性别、病程、体重指数（BMI）、RA病程、RA用药情况、Larsen分级、血液检查、日本足部外科学会术前/术后、HV角、M1M2角、M1M5角、尺距角、Meary’s角。x线摄影上的HV复发定义为HV角超过20°。在17英尺中观察到HV复发。BMI、病程、Larsen分级4-5级、术前跟骨俯仰角等危险因素均存在显著差异。多因素logistic回归分析发现，较低的BMI、较高的M1M2角、较低的跟骨俯仰角是RA患者术后HV复发的术前危险因素。证据等级：3。

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引用次数: 0

Effect of plantar sensory exercises on balance and fall risk in nursing home elderly 足底感觉锻炼对养老院老年人平衡和跌倒风险的影响

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-03-22 DOI: 10.1016/j.foot.2025.102156

Müyesser Cavlak , Emre Ata , Z. Candan Algun

Background

Loss of balance and consequent falls are leading causes of mortality and morbidity in the geriatric population. In terms of ease of application, plantar sensory-based exercises seem to be superior to other balance development exercises. Our study's objective is to examine the effects of plantar sensation education-based exercises on balance and falls.

Materials and methods

16 healthy, voluntary nursing home residents with the average age 77.50 ± 5.5. Individuals had plantar sensory exercises 40 min sessions for 3 days/week during eight weeks. The study was planned as a self-controlled prospective study. Functional balance was evaluated using Berg Balance Scale, dynamic balance was evaluated using 30 Second Chair Stand Test, static balance and fall risk were assessed using Biodex Balnce System.

Results

The measurements of static balance and fall tests with the Biodex balance device after 8 weeks of plantar sensation exercises program showed significant improvement compared to the results before the treatment (p < 0.05). The measurements of the Biodex balance device before the treatment were 3.45 ± 2.41, whereas the ones after the treatment showed 2.61 ± 2.18. The result of the fall risk measured by the Biodex balance device was 3.43 ± 3.11 before the treatment, whereas it came out as 2.46 ± 2.02 after the treatment. (p < 0.05)

Conclusion

Static balance and fall risc play a significant role in the well-being of nursing home residents through exercise programs designed for plantar sensation. According to these outcomes, we believe that exercises intended for plantar sensation will be an effective treatment approach in terms of increasing the static balance and decreasing the fall risk with nursing home residents.

背景：失去平衡和随之而来的跌倒是导致老年人群死亡和发病的主要原因。在易于应用方面，足底感觉为基础的练习似乎优于其他平衡发展练习。我们的研究目的是检验以足底感觉教育为基础的运动对平衡和跌倒的影响。材料与方法健康自愿住在养老院的16人，平均年龄77.50 ± 5.5。在八周的时间里，每个人每周进行3天的足底感觉练习，每次40分钟 。本研究是一项自我控制的前瞻性研究。使用Berg平衡量表评估功能平衡，使用30秒椅子站立测试评估动态平衡，使用Biodex平衡系统评估静态平衡和跌倒风险。结果经过8周的足底感觉训练后，使用Biodex平衡装置测量的静态平衡和跌倒测试结果与治疗前相比有显著改善（p <； 0.05）。治疗前Biodex平衡器测量值为3.45 ± 2.41，治疗后测量值为2.61 ± 2.18。治疗前使用bidex平衡器测量跌倒风险的结果为3.43 ± 3.11，治疗后测量跌倒风险的结果为2.46 ± 2.02。（p <； 0.05）结论静力平衡和跌倒风险通过足底感觉运动方案对养老院居民的幸福感有显著作用。根据这些结果，我们相信针对足底感觉的锻炼将是一种有效的治疗方法，可以增加静力平衡，降低养老院居民跌倒的风险。

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引用次数: 0

Displaced, intra-articular fractures of the calcaneus: Review of non-operative management, open reduction internal fixation and novel minimally invasive techniques 跟骨移位、关节内骨折：非手术治疗、切开复位内固定和新型微创技术综述

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-03-26 DOI: 10.1016/j.foot.2025.102160

Adrian J. Talia , David W. Shepherd , Sasha Roshan-Zamir

Calcaneal fractures comprise 1–2 % of all fractures and typically occur in younger, working age male patients. These injuries result in a significant burden to the patient in terms of residual pain, inability to work or participate in sports, difficulty with shoe wear and secondary reconstructive surgery such as subtalar arthrodesis. They also result in a significant burden to the healthcare system. Calcaneal fractures can be sub-classified into extra-articular and intra-articular, two-thirds of calcaneal fractures involve the articular facets of the subtalar joint. The treatment of displaced intra-articular calcaneal fractures is controversial, with many authors recommending non-operative treatment. The concerns with this approach include painful malunion, articular surface disruption, heel varus and increased calcaneal width, with a significant rate of secondary reconstructive surgery. Traditional operative approaches for calcaneal fractures allowed the surgeon to restore anatomic parameters, but have been associated with high rates of soft tissue complications, up to 40 % in some series. Newer, less invasive techniques for fixation allow the surgeon to obtain a similar anatomic reduction with reduced tissue compromise. We performed a systematic literature search which identifed forty articles on which this review is based. In this review article we discuss the background of displaced, intra-articular calcaneal fractures and compare the current knowledge base of operative vs. non-operative management. We then compare and contrast the three common surgical approaches used for treatment of these injuries: the extensile lateral approach, the sinus tarsi approach and newer percutaneous/minimally invasive techniques. At the current time, the sinus tarsi approach is the mainstay for treating these fractures, with most authors favouring this over the extensile lateral approach. There is momentum for adoption of newer minimally invasive techniques which show promising results, with reduced soft tissue complications and satisfactory functional outcomes.

跟骨骨折占所有骨折的1-2 %，通常发生在年轻，工作年龄的男性患者。这些损伤给患者带来了严重的负担，包括残余疼痛、无法工作或参加运动、穿鞋困难和继发性重建手术，如距下关节融合术。它们也给医疗保健系统带来了沉重的负担。跟骨骨折可分为关节外骨折和关节内骨折，三分之二的跟骨骨折涉及距下关节的关节面。移位的跟骨关节内骨折的治疗是有争议的，许多作者推荐非手术治疗。该入路的问题包括疼痛的骨不愈合、关节面破裂、足跟内翻和跟骨宽度增加，并且二次重建手术的发生率很高。跟骨骨折的传统手术方法允许外科医生恢复解剖参数，但与软组织并发症的高发生率相关，在某些系列中高达40% %。更新的、侵入性更小的固定技术使外科医生能够在减少组织损伤的情况下获得类似的解剖复位。我们进行了系统的文献检索，确定了本综述所依据的40篇文章。在这篇综述文章中，我们讨论了移位，关节内跟骨骨折的背景，并比较了目前手术与非手术治疗的知识基础。然后，我们比较和对比了用于治疗这些损伤的三种常见手术入路：可伸展外侧入路、跗骨窦入路和较新的经皮/微创技术。目前，跗骨窦入路是治疗此类骨折的主要方法，大多数作者倾向于采用这种入路而不是可伸展外侧入路。有动力采用新的微创技术，显示有希望的结果，减少了软组织并发症和令人满意的功能结果。

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引用次数: 0

Implants for proximal interphalangeal joint arthrodesis of the lesser toes: Where are we? A systematic review 小趾近端指间关节关节置换术的植入物：进展如何？系统回顾

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-03-16 DOI: 10.1016/j.foot.2025.102157

Vinodh Arumugam , Shreyas Sanjeev Chitnis , Esha Singh , Alba Morillo Paterson , Matthew Welck

Introduction

Proximal interphalangeal joint (PIPJ) arthrodesis is indicated for the treatment of lesser toe deformities. K-wires have traditionally been the standard of care for PIPJ arthrodesis, however intramedullary implants may be superior. This systematic review evaluates the union rate and outcomes of implants for PIPJ arthrodesis.

Methods

MEDLINE, CENTRAL, EMBASE and Google Scholar databases were reviewed for studies reporting on outcomes of intramedullary implants for PIPJ arthrodesis in hammer or claw toe. The primary outcome measure was union rate. Secondary outcome measures included pain scores, functional improvement, patient satisfaction, quality of life and complications.

Results

12 studies comparing 12 different implants in 797 patients with 1118 treated toes were reviewed. Fusion rates ranged from 22.2 % to 96 % with the highest fusion rates demonstrated with Ossiofiber (96 %, n = 24), Smart toe (43.6–93.8 %, n = 217) and Nextra (84.44 %, n = 47) respectively. 4 studies compared 3 implants to K-wire (Smart toe, Tenfuse and Nextra) with improved union rates demonstrated compared to K-wire (p < 0.05). Function, pain relief, patient satisfaction and quality of life all improved following PIPJ arthrodesis with implants, however these outcomes were equivocal to K-wire. All studies were rated as high or critical risk of bias.

Conclusion

A definitive judgement on the best implant for PIPJ arthrodesis is currently unobtainable due to the high risk of bias in the reviewed studies. Given the high cost of intramedullary implants and equivocal functional outcomes to K-wire, further comparative study with randomised control trials is advised to establish the standard of care for PIPJ arthrodesis.

导言近端指间关节（PIPJ）关节置换术适用于治疗小趾畸形。传统上，K线是PIPJ关节置换术的标准护理方法，但髓内植入物可能更胜一筹。本系统性综述评估了髓内植入物用于 PIPJ 关节置换术的结合率和疗效。方法回顾了MEDLINE、CENTRAL、EMBASE 和 Google Scholar 数据库中有关髓内植入物用于锤状趾或爪状趾 PIPJ 关节置换术疗效的研究报告。主要结果指标为关节结合率。结果回顾了 12 项研究，比较了 12 种不同植入物对 797 名患者 1118 个脚趾的治疗效果。融合率从 22.2% 到 96% 不等，融合率最高的分别是 Ossiofiber（96%，n = 24）、Smart toe（43.6-93.8%，n = 217）和 Nextra（84.44%，n = 47）。4 项研究将 3 种植入物与 K 线（Smart toe、Tenfuse 和 Nextra）进行了比较，结果表明，与 K 线相比，植入物的结合率有所提高（p < 0.05）。使用植入物进行 PIPJ 关节固定术后，患者的功能、疼痛缓解、满意度和生活质量都有所提高，但这些结果与 K 型钢丝的效果不相上下。所有研究均被评为高偏倚风险或严重偏倚风险。结论由于所审查的研究存在较高的偏倚风险，因此目前还无法对PIPJ关节置换术的最佳植入物做出明确判断。考虑到髓内植入物的高昂成本以及与K线相比模棱两可的功能结果，建议进一步开展随机对照试验比较研究，以确定PIPJ关节置换术的护理标准。

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引用次数: 0

The position, orientation and morphology of the peroneus longus tubercle in hallux valgus – A weight-bearing CT assessment 拇外翻腓骨长肌结节的位置、方向和形态-负重CT评估

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-04-02 DOI: 10.1016/j.foot.2025.102161

Christopher J. Marusza , Howard Stringer , James Redfern , Dhrumin Sangoi , Matthew Welck , Lyndon W. Mason , Karan Malhotra

Background

Hallux valgus (HV) may be associated with a dysfunctional peroneus longus, however there is very little research into the link between these pathologies. The peroneus longus tubercle (PLT) may serve as a surrogate marker for peroneus longus function. Our objective was to compare the position, orientation and morphology of the PLT in feet with and without HV.

Methods

In this single center series, we analyzed weight-bearing CT scans of 20 feet (12 patients) with HV and 20 feet (12 patients) without HV. Groups were age matched. We compared differences between groups for recently reported measurements assessing the PLT: tubercle-to-floor distance (T-F distance), bisecting angle of the PLT, tubercle-to-metatarsals angle (T-MT angle), and cross-sectional areas and roundness of the PLT.

Results

The T-F distance was significantly lower in the HV group (p = 0.001). The bisecting angle was lower (less vertical) in the HV group (p = 0.017). T-MT angle was lower in the HV group (p = 0.041). There was no difference in the cross-sectional area or roundness of the PLT between groups.

Conclusion

We found patients with HV had differences in orientation of the PLT (with a less vertical tubercle). This could indicate a relationship between direction of pull of the peroneus longus and HV. There were no differences in size of the PLT suggesting strength of the peroneus longus may not play a role in developing HV. Further research is needed to build upon this preliminary work and determine the link between the observed differences and the pathogenesis of HV.

背景足外翻（HV）可能与腓骨长肌功能障碍有关，但对这些病症之间联系的研究却很少。腓骨长肌结节（PLT）可作为腓骨长肌功能的替代标记。我们的目的是比较有 HV 和没有 HV 的足部的腓骨长肌结节的位置、方向和形态。两组患者的年龄相匹配。我们比较了各组间最近报告的 PLT 测量值的差异：小结节到地面的距离（T-F 距离）、PLT 的分叉角、小结节到跖骨的角度（T-MT 角度）以及 PLT 的横截面积和圆度。HV 组的分叉角度较低（垂直度较低）（p = 0.017）。HV 组的 T-MT 角更低（p = 0.041）。结论我们发现 HV 患者的 PLT 方向存在差异（小结节的垂直度较低）。这可能表明腓骨长肌的牵拉方向与 HV 之间存在关系。PLT的大小没有差异，这表明腓骨长肌的力量在腓骨肌萎缩症的发病中可能不起作用。我们需要在这项初步研究的基础上开展进一步研究，以确定所观察到的差异与 HV 发病机制之间的联系。

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引用次数: 0

Do operative or weight-bearing delays lead to worse outcomes in ankle surgery? 踝关节手术延迟或负重延迟会导致更糟糕的结果吗？

Q2 Health Professions

Foot

Pub Date : 2025-03-01 Epub Date: 2025-03-29 DOI: 10.1016/j.foot.2025.102159

Alexander Carver , Marc Choong , Robert Fawdry , Conor T. Boylan , Nikhil Nanavati

Background

Ankle fractures comprise 10 % of fractures seen in ED. Despite this, debate remains regarding the optimal timing of surgery and weight bearing post-operatively. There is no clear consensus whether delaying ankle ORIF leads to better outcomes. There is also debate whether early post-operative weight bearing (WB) impacts post-operative outcomes.

The aim of this study was to investigate whether a delay in operation or a prolonged post-operative weight-bearing plan led to (1) increased complications and (2) poorer outcomes in patient-recorded outcome measures (PROMs).

Methods

In this retrospective study, 160 patients were analysed. Primary outcomes were post-operative complications. Secondary outcomes were PROMs, using EQ-5D and MOxFQ questionnaires.

Data was analysed using SPSS26. Analysis used independent two-tailed Mann-Whitney U tests for continuous data with nominal independent variables, and Kruskal-Wallace tests for ordinal independent variables. Fisher-exact tests were used for categorical variables.

Results

Delay in operation had no statistically significant impact on overall complication rate (p = 0.482). There was no statistically significant difference in EQ-5D (p = 0.433) and MOxFQ (p = 0.325) scores regardless of delay in operation.

Additionally, time spent until WB post-operatively had no statistically significant impact on overall complication rate (p = 0.634). There was no statistically significant difference in EQ-5D (p = 0.358) and MOxFQ (p = 0.089) scores regardless of post-operative WB plan.

Conclusions/Findings

Our results suggest that a delay in ankle ORIF operation does not lead to an increase in complications or poorer PROMs post-operatively, endorsing GIRFT principles. Early post-operative WB also had no impact on complication rate or PROMs, meaning early mobilisation may accelerate patient rehabilitation, facilitate independence, and reduce prolonged inpatient hospital stay.

背景：踝关节骨折占ED骨折的10. %。尽管如此，关于手术的最佳时机和术后负重的争论仍然存在。延迟踝关节ORIF是否会带来更好的结果，目前还没有明确的共识。早期术后负重（WB）是否影响术后预后也存在争议。本研究的目的是探讨延迟手术或延长术后负重计划是否会导致(1)并发症增加和(2)患者记录结果测量（PROMs）结果较差。方法回顾性分析160例患者的临床资料。主要结局为术后并发症。次要指标为PROMs，采用EQ-5D和MOxFQ问卷。数据采用SPSS26进行分析。分析使用独立的双尾Mann-Whitney U检验对具有名义自变量的连续数据，使用Kruskal-Wallace检验对有序自变量。分类变量采用fisher精确检验。结果手术延迟对总并发症发生率无统计学意义（p = 0.482）。不论手术延迟与否，EQ-5D评分（p = 0.433）和MOxFQ评分（p = 0.325）差异均无统计学意义。此外，术后WB时间对总并发症发生率无统计学意义（p = 0.634）。无论术后WB方案如何，EQ-5D评分（p = 0.358）、MOxFQ评分（p = 0.089）差异均无统计学意义。我们的研究结果表明，踝关节ORIF手术的延迟不会导致并发症的增加或术后预后较差，支持GIRFT原则。术后早期WB对并发症发生率或prom也没有影响，这意味着早期活动可以加速患者康复，促进独立，并缩短住院时间。

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引用次数: 0

Patient-reported and radiological outcomes of short Scarf osteotomy fixed with a single screw: A prospective study of 271 osteotomies 用单螺钉固定短疤痕截骨术的患者报告和放射学结果：271例截骨手术的前瞻性研究

Q2 Health Professions

Foot

Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI: 10.1016/j.foot.2024.102130

Freideriki Poutoglidou , Iqraa Khan, Andrea Sott, Paul Hamilton, Sun Jeong, Sohail Yousaf

The Scarf osteotomy involves inherent risks and technical challenges. The short scarf osteotomy with single screw fixation has emerged as an alternative approach. This study aims to evaluate the patient-reported outcome measures (PROMs), radiological outcomes, and complications associated with the short scarf osteotomy fixed with a single screw for hallux valgus correction. A prospective cohort study was conducted between October 2018 and October 2023 at a single center, encompassing 271 osteotomies. PROMs were collected prospectively preoperatively and at various postoperative intervals. Radiographic data, including hallux valgus angle (HVA) and intermetatarsal angle (IMA), were measured preoperatively and six weeks postoperatively. Complications were also documented. Statistically significant improvements were observed in all PROMs and were sustained up to 24 months postoperatively. The Visual Analog Scale (VAS) pain score demonstrated a significant reduction from 46.97 at baseline to 12.52 at 24 months (p < 0.001). Likewise, the EQ-5D score improved notably from 0.73 preoperatively to 0.81 at 24 months (p = 0.002). Analysis of the Manchester-Oxford Foot Questionnaire (MOXFQ) revealed substantial improvements across its pain, walking/standing, and social interaction domains over the same period, with all changes showing statistical significance (all p < 0.001). Radiographically, the mean HVA improved significantly from 31.33° preoperatively to 13.33° postoperatively (p < 0.001). Similarly, the mean IMA improved significantly from 14.67° to 7.66° (p < 0.001). The most common complication was superficial wound infection, effectively managed with oral antibiotics. The were no cases of avascular necrosis or fracture. In conclusion, the short Scarf osteotomy fixed with a single screw demonstrates favorable outcomes. These findings support its efficacy and safety as a treatment option, with potential advantages over the conventional technique. Further prospective studies are warranted to validate these findings.

瘢痕截骨术存在固有风险和技术挑战。单螺钉固定的短瘢痕截骨术已成为一种替代方法。本研究旨在评估患者报告的结果指标（PROMs）、放射学结果以及用单螺钉固定的短瘢痕截骨术矫正拇指外翻的相关并发症。一项前瞻性队列研究于 2018 年 10 月至 2023 年 10 月在一个中心进行，共进行了 271 例截骨手术。前瞻性地收集了术前和术后不同时间段的PROM。术前和术后六周测量放射学数据，包括拇指外翻角（HVA）和跖骨间角（IMA）。并发症也记录在案。所有 PROM 均有统计学意义上的明显改善，并持续到术后 24 个月。视觉模拟量表（VAS）疼痛评分从基线时的 46.97 分显著降至 24 个月时的 12.52 分（p < 0.001）。同样，EQ-5D 评分也从术前的 0.73 显著提高到 24 个月时的 0.81（p = 0.002）。对曼彻斯特-牛津足部问卷（MOXFQ）的分析表明，同期的疼痛、行走/站立和社会交往领域均有显著改善，所有变化均具有统计学意义（均为 p < 0.001）。从影像学角度来看，平均 HVA 从术前的 31.33° 显著改善到术后的 13.33°（p < 0.001）。同样，平均 IMA 也从 14.67° 显著改善到 7.66°（p <0.001）。最常见的并发症是表皮伤口感染，通过口服抗生素得到了有效控制。无血管性坏死或骨折病例。总之，用单螺钉固定的短疤痕截骨术效果良好。这些研究结果支持其作为一种治疗方案的有效性和安全性，与传统技术相比具有潜在优势。为验证这些研究结果，有必要开展进一步的前瞻性研究。

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引用次数: 0

Fracture dislocation of the ankle joint in low energy trauma: Choosing between invasive damage control procedures and closed reduction in plaster 低能量创伤中的踝关节骨折脱位：在侵入性损伤控制程序和石膏闭合复位术之间做出选择

Q2 Health Professions

Foot

Pub Date : 2024-12-01 Epub Date: 2024-11-26 DOI: 10.1016/j.foot.2024.102146

Emmanouil Theodorakis , Georgios Touloupakis , Fabrizio Ferrara , Stefano Ghirardelli , Venuti Angelo , Guido Antonini

Introduction

The purpose of this study is to identify significant differences in the clinical outcomes of patients who sustained a low energy trauma resulting into an ankle fracture-dislocation, treated with invasive (external fixation or skeletal traction) and conservative damage control procedures (closed reduction in plaster).

Materials and methods

This is a retrospective comparative study including 52 patients with low energy ankle fracture-dislocation, surgically treated between January 2015 and January 2017. Patients included in this study had a minimum 24 months follow-up (range 24–36 months). Patients were divided in 2 groups, group A (n = 21) initially treated with invasive damage control procedures to maintain reduction and group B (n = 31) treated with non-invasive damage control procedures. Patients were evaluated clinically and radiographically. Clinical assessment was performed by evaluating ankle range-of-motion and the Olerud - Molander ankle score at 6, 12 and 24 months as endpoints for both groups.

Results

Groups were assessed for homogeneity with a chi-squared test, and no statistical differences were found regarding Weber classification, type of dislocation, and Tscherne classification. A significant improvement in the Olerud-Molander score was noted between the 6- and 12-month follow-ups (p 0.01), but not between the 12- and 24-month follow-ups. This improvement was not observed between the 12 and 24 months follow-up. No statistically significant differences in the Olerud-Molander score were found between the two groups at both the 6- and 24-month follow-ups.

Conclusions

Closed reduction in plaster for fracture-dislocations of the ankle joint following low-energy trauma appears capable of maintaining reduction with outcomes comparable to more invasive damage control procedures.

导言：本研究旨在确定低能量创伤导致踝关节骨折脱位的患者在接受侵入性治疗（外固定或骨骼牵引）和保守性损伤控制治疗（石膏闭合复位术）后临床疗效的显著差异。材料和方法这是一项回顾性比较研究，研究对象包括 52 名在 2015 年 1 月至 2017 年 1 月期间接受手术治疗的低能量踝关节骨折脱位患者。纳入本研究的患者至少接受了 24 个月的随访（范围为 24-36 个月）。患者被分为两组，A组（n = 21）最初采用有创损伤控制术治疗，以保持骨折复位；B组（n = 31）采用无创损伤控制术治疗。对患者进行临床和影像学评估。临床评估以两组患者在6、12和24个月时的踝关节活动范围和Olerud - Molander踝关节评分作为终点。结果用秩方检验评估两组患者的同质性，在韦伯分类、脱位类型和Tscherne分类方面未发现统计学差异。在6个月和12个月的随访中，Olerud-Molander评分有明显改善（P 0.01），但在12个月和24个月的随访中没有发现明显改善。而在 12 个月和 24 个月的随访中则没有观察到这种改善。结论对于低能量创伤后的踝关节骨折脱位，石膏闭合复位术似乎能够维持复位，其效果可与更具侵入性的损伤控制术相媲美。

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引用次数: 0