Q2 Health Professions

Foot

Pub Date : 2025-03-01 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 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

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 : 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 : 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

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 : 2024-11-26 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。

{"title":"Fracture dislocation of the ankle joint in low energy trauma: Choosing between invasive damage control procedures and closed reduction in plaster","authors":"Emmanouil Theodorakis , Georgios Touloupakis , Fabrizio Ferrara , Stefano Ghirardelli , Venuti Angelo , Guido Antonini","doi":"10.1016/j.foot.2024.102146","DOIUrl":"10.1016/j.foot.2024.102146","url":null,"abstract":"<div><h3>Introduction</h3><div>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).</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":12349,"journal":{"name":"Foot","volume":"61 ","pages":"Article 102146"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Kinematic coordination in the rearfoot, midfoot, and forefoot differs depending on subgroups based on foot stiffness and kinetic parameters during walking 根据行走过程中的足部僵硬度和运动参数，后足、中足和前足的运动协调性因分组而异

Q2 Health Professions

Foot

Pub Date : 2024-11-21 DOI: 10.1016/j.foot.2024.102144

Daiki Yamagiwa , Yoshitaka Iwamoto , Rei Konishi , Masahiro Kuniki , Nobuhiro Kito

This study aimed to classify subgroups of healthy young adults based on foot stiffness and related kinetic parameters during gait, as well as to analyze intra-foot sagittal kinematics within each subgroup. Data were collected from 25 males and 24 females using a 3D motion capture system, which measured the rearfoot, midfoot, and forefoot segments. Cluster analysis identified three subgroups based on the following variables: the truss coefficient, windlass coefficient, forward component of ground reaction force (F-GRF), and ankle plantar flexion power. Group 1 demonstrated the highest foot stiffness, as indicated by the largest truss coefficient, while Groups 2 and 3 exhibited lower stiffness, characterized by greater dorsiflexion of the midfoot and forefoot relative to the rearfoot during the stance phase. Additionally, the kinematic coordination patterns between the rearfoot-midfoot and midfoot-forefoot of Groups 2 and 3 during the early and late stance phases showed significant variation. Group 3, in particular, exhibited lower F-GRF and ankle plantar flexion power than Groups 1 and 2. These results suggest that midfoot movement during the late stance phase is critical in generating foot stiffness, with a midfoot-dominant kinematic pattern potentially serving as a key contributor. The study underscores the importance of understanding intersegmental coordination for managing foot stiffness, which could have implications for improving gait mechanics and preventing injuries. Further research is needed to explore how these findings can be applied to individuals with various foot conditions or pathologies.

本研究旨在根据步态过程中的足部僵硬度和相关运动参数对健康年轻成年人进行分组，并分析每个分组内的足部矢状运动学。研究人员使用三维运动捕捉系统收集了 25 名男性和 24 名女性的数据，该系统对后足、中足和前足进行了测量。聚类分析根据以下变量确定了三个亚组：桁架系数、辘轳系数、地面反作用力前向分量（F-GRF）和踝关节跖屈力。第 1 组的足部僵硬度最高，桁架系数最大，而第 2 组和第 3 组的僵硬度较低，在站立阶段，中足和前足相对于后足外展更大。此外，第 2 组和第 3 组的后脚掌-中脚掌和中脚掌-前脚掌在站立初期和后期的运动协调模式也有显著差异。尤其是第 3 组的 F-GRF 和踝关节跖屈力量低于第 1 组和第 2 组。这些结果表明，晚期站立阶段的中足运动是产生足部僵硬的关键，而中足为主的运动模式可能是关键因素。这项研究强调了了解节间协调对控制足部僵硬的重要性，这可能对改善步态力学和预防损伤有影响。还需要进一步的研究来探讨如何将这些发现应用于患有各种足部疾病或病理的个体。

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引用次数: 0

Flexible fixation versus open reduction internal fixation and primary arthrodesis for ligamentous Lisfranc injuries: A systematic review and meta-analysis 灵活固定与切开复位内固定术和初次关节固定术治疗韧带性 Lisfranc 损伤：系统回顾和荟萃分析。

Q2 Health Professions

Foot

Pub Date : 2024-11-16 DOI: 10.1016/j.foot.2024.102145

Kyle P. O’Connor , Erica R. Olfson , John T. Riehl

Introduction

Flexible fixation (FF) has allowed treatment of isolated ligamentous Lisfranc injuries while preserving joint motion. We hypothesize that patient-reported outcome measures (PROMs), complications, and return-to-activity rates will be similar between patients undergoing FF versus those undergoing open reduction internal fixation (ORIF) or primary arthrodesis (PA).

Methods

Databases included PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their inception to 5/13/2024. Search terms focused on treatment of Lisfranc injuries with FF, ORIF, or PA. Only English studies were included. Studies were included if the Lisfranc injury was purely ligamentous and had PROM scores. Quality, validity, and comparability were assessed using MINORS and GRADE criteria. Meta-analysis was conducted using pooled statistics. Cohen’s d and odds ratios (OR) determined effect sizes.

Results

Twenty-five studies were included. There were 184 patients undergoing FF, 236 patients undergoing ORIF, and 80 patients undergoing PA. Postoperatively, American Orthopaedic Foot and Ankle Society (AOFAS) scores were 89.7 ± 10.0, 78.7 ± 44.2, and 87.4 ± 31.8, VAS-pain scores were 1.5 ± 1.5, 1.6 ± 3.8, and 0.3 ± 2.6, and return to activity rates (RTA) were 100 %, 63.3 %, and 78.4 %, respectively. Rates of post-traumatic arthritis were 0 %, 13.0 %, and 0 %, hardware removal were 0 %, 86.0 %, and 22.5 %, and complications were 3.8 %, 17.7 %, and 23.5 %. Meta-analysis demonstrated that FF had superiority over ORIF regarding better AOFAS scores and RTA with lower rates of post-traumatic arthritis, hardware removal, and complications (p < 0.05). Also, FF had superiority over PA with higher RTA and lower rates of hardware removal and complications. PA demonstrated better VAS-pain scores (p < 0.05).

Conclusion

FF had satisfactory outcomes after Lisfranc injury treatment. Low-quality evidence suggested that FF had better outcomes, however, this conclusion was drawn from single-arm studies which have significant limitations. Further prospective, comparative studies should investigate this relationship.

简介：柔性固定术（FF）可治疗孤立的韧带性 Lisfranc 损伤，同时保留关节活动。我们假设，接受柔性固定与接受开放复位内固定术（ORIF）或初次关节固定术（PA）的患者的患者报告结果指标（PROMs）、并发症和恢复活动率相似：数据库包括 PubMed、OVID Medline、Embase、SCOPUS、Cochrane Central Register of Clinical Trials 和 clinicaltrials.gov（从开始到 2024 年 5 月 13 日）。搜索关键词主要集中在使用 FF、ORIF 或 PA 治疗 Lisfranc 损伤。仅纳入英文研究。如果Lisfranc损伤纯属韧带损伤，且有PROM评分，则纳入研究。采用 MINORS 和 GRADE 标准评估研究的质量、有效性和可比性。荟萃分析采用集合统计法。Cohen's d和几率比（OR）决定了效应大小：共纳入 25 项研究。共有184名患者接受了FF手术，236名患者接受了ORIF手术，80名患者接受了PA手术。术后，美国骨科足踝协会（AOFAS）评分分别为（89.7 ± 10.0）、（78.7 ± 44.2）和（87.4 ± 31.8），VAS疼痛评分分别为（1.5 ± 1.5）、（1.6 ± 3.8）和（0.3 ± 2.6），恢复活动率（RTA）分别为100%、63.3%和78.4%。创伤后关节炎发生率分别为0%、13.0%和0%，硬件拆除率分别为0%、86.0%和22.5%，并发症发生率分别为3.8%、17.7%和23.5%。Meta 分析表明，在更好的 AOFAS 评分和 RTA 方面，FF 比 ORIF 更有优势，创伤后关节炎、硬件移除和并发症的发生率更低（P 结论：FF 比 ORIF 更有优势：全膝关节置换术治疗 Lisfranc 损伤的效果令人满意。低质量的证据表明，前臂置换术的疗效更好，但这一结论是通过单臂研究得出的，具有很大的局限性。应进一步开展前瞻性比较研究来探讨这种关系。

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引用次数: 0

A systematic review: Radiological findings at a minimum of 3 years follow-up for unstable ankle fractures in adults treated with surgery 系统回顾：成人不稳定性踝关节骨折手术治疗至少 3 年随访的放射学结果

Q2 Health Professions

Foot

Pub Date : 2024-11-15 DOI: 10.1016/j.foot.2024.102143

Anthony Uzoma Okoye , Linzy Houchen-Wolloff , Jitendra Mangwani , Nimra Akram , Despina Laparidou , David Nelson , Sam Cooke

Background

Radiological investigations are critical to diagnosis and treatment of many musculoskeletal diseases including detecting earliest degenerative changes (osteoarthritis (OA)) seen in patients with unstable ankle fractures managed surgically. Despite the high incidence of ankle OA, research into early detection using imaging remains sparse.

Objectives

To identify the incidence of OA on postoperative imaging in adults with unstable ankle fractures after a minimum follow-up of 3 years with a correlation to patient reported outcomes.

Key findings

767 studies were identified on 5 database searches, and 492 abstract titles were screened, while 53 papers were selected for full review. From these only 8 articles met the inclusion criteria. A total of 905 participants aged 18 years and above (mean 46.4 years, 53.8 % male) presented with a range of ankle fracture classifications. This includes 423 cases of Weber classification, 225 cases of OTA/AO, 204 Lauge-Hansen classification, and 53 medial malleoli. From these, 34.7 % cases of OA were identified (minimum of the 3-year follow-up) on different imaging modalities. Our results revealed that mild to moderate OA is common, and functional outcome is mainly good to excellent.

Conclusion

1 in 3 patients treated for unstable ankle fracture with open reduction internal fixation will show signs of radiological OA after 3–7 years of index procedure, though with good functional outcome. We were unable to correlate the grade of radiological OA observed with clinical OA. Despite the low sensitivity of X-ray in early detection of OA, we identified a lack of studies in utilising MRI and/or CT imaging, indicating the need for further research. Clinicians should consider using MRI/CT imaging for early detection of OA for patients following unstable ankle fractures, to improve early detection and consequently improve patient reported outcomes.

Level of Clinical Evidence

Systematic review = 1.

背景放射学检查对许多肌肉骨骼疾病的诊断和治疗至关重要，包括检测手术治疗的不稳定踝关节骨折患者最早出现的退行性病变（骨关节炎 (OA)）。尽管踝关节 OA 的发病率很高，但利用影像学手段进行早期检测的研究仍然很少。主要发现通过 5 次数据库检索发现了 767 项研究，筛选了 492 篇摘要标题，并选择了 53 篇论文进行全面审查。其中只有 8 篇文章符合纳入标准。共有 905 名年龄在 18 岁及以上的参与者（平均 46.4 岁，53.8% 为男性）出现了不同的踝关节骨折分类。其中韦伯分类 423 例，OTA/AO 225 例，劳格-汉森分类 204 例，内侧踝关节 53 例。在这些病例中，34.7%的病例在不同的成像模式下发现了 OA（至少 3 年随访）。我们的研究结果表明，轻度至中度 OA 很常见，功能预后主要良好至极佳。结论每 3 名接受开放复位内固定术治疗的不稳定踝关节骨折患者中，就有 1 人在手术 3-7 年后出现放射学 OA 征象，但功能预后良好。我们无法将观察到的放射学 OA 等级与临床 OA 联系起来。尽管X光在早期发现OA方面的灵敏度较低，但我们发现缺乏利用核磁共振成像和/或CT成像的研究，这表明需要进一步研究。临床医生应考虑使用MRI/CT成像来早期检测不稳定踝关节骨折患者的OA，以提高早期检测率，从而改善患者报告的结果。

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引用次数: 0

The effectiveness of custom hard-shell 3D-printed foot orthoses in a cohort of patients who did not respond to treatment with custom ethylene-vinyl-acetate (EVA) foot orthoses 对使用定制乙烯-醋酸乙烯（EVA）足部矫形器治疗无效的一组患者使用定制硬壳 3D 打印足部矫形器的效果。

Q2 Health Professions

Foot

Pub Date : 2024-10-21 DOI: 10.1016/j.foot.2024.102142

Laura Barr , Nikki Munro , Kirsty Watters , Ross McCaig , Jim Richards , Graham J. Chapman

Background

Patients who do not achieve positive outcomes with custom ethylene-vinyl-acetate (EVA) foot orthoses will often be escalated to other services for treatment, which may include surgery.

Objective

This study aimed to explore the effectiveness of custom hard-shell 3D-printed foot orthoses for patients who did not respond to treatment with custom EVA foot orthoses and were being considered for treatment escalation.

Design

An eight-week clinical evaluation and a two-year review of relevant medical records.

Method

Thirty-six consecutive patients with a range of musculoskeletal lower limb pathology who remained symptomatic after 12-weeks use of custom EVA foot orthoses were fitted with custom hard-shell 3D-printed foot orthoses. The Foot Health Status Questionnaire was used to assess patients at baseline and eight-week follow-up in conjunction with the Client Satisfaction with Device module of the Orthotics and Prosthetics User Survey. Patients were categorised as responders or non-responders based on their change in pain scores. A review of relevant medical records two years after receiving their orthoses determined if patients required further treatment for their initial condition.

Results

Across the full cohort there were significant improvements in pain, function and foot health. At follow-up, responders reported significantly improved pain, function and foot health compared with non-responders. Twenty-six patients (12 responders, 14 non-responders) required no further treatment for their original condition after two years.

Conclusions

Custom hard-shell 3D-printed foot orthoses have the potential to improve pain, function, foot health, and provide satisfaction in patients with lower limb musculoskeletal conditions which do not improve with custom EVA foot orthoses.

背景：使用定制乙烯-醋酸乙烯（EVA）足部矫形器治疗效果不佳的患者通常会被升级到其他服务机构接受治疗，其中可能包括手术：本研究旨在探讨定制硬壳 3D 打印足部矫形器对使用定制 EVA 足部矫形器治疗无效并考虑升级治疗的患者的疗效：设计：为期八周的临床评估和为期两年的相关医疗记录回顾：方法：连续为36名患有各种下肢肌肉骨骼病症、使用定制EVA足部矫形器12周后仍无症状的患者安装定制硬壳3D打印足部矫形器。在基线和八周随访时，采用足部健康状况问卷对患者进行评估，并结合矫形器和假肢用户调查的 "客户对装置的满意度 "模块进行评估。根据疼痛评分的变化，将患者分为应答者和非应答者。在接受矫形器两年后，对相关医疗记录进行审查，以确定患者是否需要对最初的病情进行进一步治疗：所有患者在疼痛、功能和足部健康方面都有明显改善。在随访中，与未接受治疗者相比，接受治疗者在疼痛、功能和足部健康方面均有明显改善。26名患者（12名应答者，14名非应答者）在两年后无需对其原有病症进行进一步治疗：结论：定制硬壳 3D 打印足部矫形器有可能改善下肢肌肉骨骼疾病患者的疼痛、功能和足部健康，并为其提供满意的治疗效果。

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引用次数: 0

Regional changes in the free Achilles tendon volume in response to repeated submaximal contractions 跟腱游离体积在反复亚极限收缩时的区域变化。

Q2 Health Professions

Foot

Pub Date : 2024-10-07 DOI: 10.1016/j.foot.2024.102141

Eman Merza , Stephen Pearson , Glen Lichtwark , Peter Malliaras

Introduction

The Achilles tendon (AT) may become smaller in volume following acute bouts of heavy and sustained loading likely because of transient fluid exudation to the periphery and this could augment cellular mechanotransduction and tendon adaptation. Given the structure of the AT is distinct across its length, regional changes in the free AT volume may occur in response to loading. This study aimed to investigate whether the change in tendon volume in response to repeated submaximal loading is distinct across the free AT length.

Methods

Sixteen ATs of healthy males and females (age 24.4 ± 9.4 years, body mass 70.9 ± 16.1 kg, height 1.7 ± 0.1 m) were scanned at rest using freehand 3D ultrasound. Scanning was done before and immediately after submaximal (75 %) voluntary isometric plantarflexion contractions (8 s) involving four sets of ten repetitions. Regional volumetric changes were assessed across the free AT length by dividing the tendon into distal, mid, and proximal regions.

Results

Significant reduction in the free AT volume occurred across all tendon regions in response to the intervention, however, the mid- region exhibited the greatest reduction in volume compared to the proximal region (P = 0.025).

Discussion

The fact that volume reduction was greatest in the mid-region compared to the proximal region of the free AT may suggest greater tendon adaptation, via mechanotransduction pathways, in the mid-region and this may be important for tendon health and injury prevention.

简介：跟腱（AT）在承受急性重负荷和持续负荷后体积可能会变小，这可能是由于液体向外周短暂渗出，从而增强了细胞的机械传导性和肌腱的适应性。鉴于肌腱反射区的结构在整个长度上各不相同，因此游离肌腱反射区的体积可能会因负荷而发生区域性变化。本研究旨在探究肌腱体积对重复次最大负荷的响应变化在自由 AT 长度上是否不同：使用自由手持式三维超声波对 16 名健康男性和女性（年龄为 24.4 ± 9.4 岁，体重为 70.9 ± 16.1 千克，身高为 1.7 ± 0.1 米）的肌腱在静止时进行扫描。扫描是在亚极限（75%）自主等长跖屈收缩（8 秒）之前和之后立即进行的，包括四组 10 次重复。通过将肌腱分为远端、中间和近端区域，评估了游离肌腱长度上的区域容积变化：结果：所有肌腱区域的游离肌腱体积在干预后都有显著减少，但与近端区域相比，中端区域的体积减少幅度最大（P = 0.025）：讨论：与游离肌腱近端区域相比，游离肌腱中段区域的体积减少幅度最大，这一事实可能表明，通过机械传导途径，中段区域的肌腱适应性更强，这可能对肌腱健康和预防损伤非常重要。

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引用次数: 0

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