Foot & Ankle Orthopaedics最新文献

Background: A controlled ankle movement (CAM) walking boot introduces an artificial leg length discrepancy (LLD), which alters gait mechanics and may increase pain. Using a contralateral shoe lift in conjunction with the CAM boot is a common strategy to address this discrepancy; however, the extent to which the shoe lift restores gait biomechanics remains understudied. This study investigates the effects of the combination of CAM boot and contralateral shoe lift on gait parameters compared to normal (shod) conditions.

Methods: Thirty healthy adults (mean age 24.6 ± 7.9 years), including 15 men and 15 women, walked overground under 3 conditions: normal shod walking, unilateral CAM boot, and CAM boot with a contralateral shoe lift. A Vicon motion capture system tracked 16 markers to calculate spatiotemporal gait parameters as well as hip and knee kinematics and kinetics using the Plug-in-Gait model. A 1-way analysis of variance followed by Tukey pairwise comparisons identified significant effects of walking condition on various gait characteristics.

Results: The CAM boot with shoe lift restored kinematic parameters, including hip flexion (P = .036), knee flexion (P = .023), and hip abduction (P = .038), as well as kinetic parameters including knee axial compression force (P = .014) and hip medial-lateral force (P = .007), to normal walking levels on the booted limb. The reported P values reflect differences observed with the CAM boot alone, which were eliminated by the shoe lift.

Conclusion: A corrective contralateral shoe lift used with a CAM boot can restore some of the knee and hip kinematic and kinetic alterations introduced by the CAM boot. However, it has limited effect on other gait parameters and does not fully replicate the mechanics of normal shod walking.

Level of evidence: Level IV, case series.

Background: Cuboid fractures are rare, and there is a scarcity in evidence of the long-term functional outcome of these fractures in literature. This study aimed to evaluate functional outcome, complications, quality of life, and patient satisfaction after surgical treatment of cuboid fractures.

Methods: This retrospective study was conducted at a level 1 trauma center, reviewing patients ≥16 years with cuboid fractures operated between 2014 and 2024. Functional outcome was assessed using the Foot Function Index (FFI), the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score, and EQ-5D quality of life questionnaire. Complications such as nonunion, infection, and secondary arthrodesis were recorded.

Results: The total cohort of surgically managed patients was 45 (28 females and 17 males), with a median age of 39.1 (IQR, 24.2) years and median follow-up of 67.0 (IQR, 91) months. A subset of 42 patients were treated with open reduction and internal fixation within 4 weeks after the injury. Overall, AOFAS was fair to good (median 76, range 34-100) and treatment satisfaction was high (mean 8.7/10, SD 1.1). There were no infections and no cases of nonunion. Secondary calcaneocuboid joint fusion was required in only 2 patients. In multivariate linear regression analysis, the type of fixation (cuboid plate) was significantly associated with better AOFAS (P = .03, R ² 0.11).

Conclusion: Surgical intervention aimed at restoring articular congruence and column length with cuboid plate fixation can lead to union with overall fair to good functional outcome and high patient satisfaction.

Level of evidence: Level III, retrospective cohort study.

Background: Very few studies reported outcomes of common conservative surgeries with antibiotic-impregnated cement when treating diabetic foot osteomyelitis (DFO). The aim of this descriptive study is to report the results of the association of cement with a specific type of toe-sparing resection, combining total metatarsectomy/phalangectomy (internal pedal amputation) with partial bone excision, for acute on chronic forefoot DFO.

Methods: Six patients with confirmed acute on chronic DFO were included. A probe-to-bone test was performed for open wounds. For all patients, radiographs, magnetic resonance imaging (MRI), and pathology were conducted in search of osteomyelitis signs. The level of resection was defined as 1 cm away from the contrast enhancement shown on MRI. The polymethylmethacrylate (PMMA) cement was prepared with 2 g of vancomycin before being placed in the defect. A minimum period of 6 months of clinical follow-up was set.

Results: All patients demonstrated wound healing at last follow-up with normalized C-reactive protein. There were no clinical signs of osteomyelitis recurrence. One wound infection was recorded 4 weeks postoperatively and treated successfully with debridement and lavage. None of the cement had to be removed or exchanged. Subjectively, 5 patients were extremely satisfied scoring 5/5 on Likert scale, and 1 patient was moderately satisfied (3/5). All patients were able to walk with full weight using insoles.

Conclusion: This preliminary report demonstrated that PMMA cement could be a viable option when used to locally control infection following an internal pedal amputation for acute on chronic DFO of the toes. In addition to the high rate of healing, the esthetical result was highly appreciated by the patients.

Level of evidence: Level IV, case series.

Background: Despite the safety and versatility of circular external fixators (CEFs) for many indications, there is limited information on their contemporary usage and the factors contributing to their potential underutilization. This study aims to estimate the prevalence of contemporary CEF use, characterize barriers to adoption, and identify potential solutions among American Orthopaedic Foot & Ankle Society (AOFAS) members.

Methods: A multibranched survey was designed for distribution to all active practicing members of the AOFAS to collect data on demographics, training background, CEF usage profile, provider opinions, barriers to device adoption, and factors that could encourage greater use. Data were collected through Qualtrics XM. Statistical analysis analyzing respondent differences included descriptive statistics, χ² tests for independence, and unpaired t tests.

Results: Of 169 participants, 27.81% reported not using CEFs in their practice despite 94.08% of respondents agreeing that their use is critical for certain patients. Overall, 70.21% of nonusers believed it could have a role in their practice but had hesitations. In addition, 59.76% of participants received minimal to no exposure in residency, and this was a significant predictor for current usage (P = .0119). CEFs are most commonly used for Charcot neuroarthropathy (86.07%), infection management (83.60%), and other deformity corrections (65.67%). Nonusers are more likely to believe CEFs take too long to assemble intraoperatively, express greater concern about postoperative burden, and are less confident in postoperative care compared to users (all P < .01). The most popular interventions that would facilitate usage were access to longitudinal mentorship, further technological advancement, and attending non-industry-sponsored courses.

Conclusion: Perceived lengthy operative time, postoperative burden, and lack of postoperative management confidence were predominant reasons for the lack of CEF use. This survey suggests that these barriers could be addressed by more exposure during training, attending non-industry-sponsored courses, and longitudinal mentorship.

Level of evidence: Level IV, cross-sectional study.

Background: Most cases of tibia and fibula shaft fractures are treated without fixation of the fibula. However, there are some cases where fibula fixation is thought to improve patient outcome. The fibula can be stabilized by surface plating or medullary nailing but literature comparing these 2 fixation techniques is limited. This study evaluates postoperative complications and readmission rates between intramedullary (IM) nailing and surface plating of fibular fractures in patients undergoing concomitant tibial osteosynthesis.

Methods: Using the Nationwide Readmissions Database (NRD) from 2016 to 2021, we identified patients undergoing tibial open reduction and internal fixation (ORIF) for distal tibial fractures with concurrent fibular fixation using either IM nailing or plate fixation were identified. Propensity score matching was performed to balance demographic and clinical covariates. The prespecified primary endpoint was overall 90-day wound/infectious complications; secondary outcomes included specific complications and 30- and 90-day readmissions.

Results: After matching, 3497 IM nailing cases and 3381 plating cases were included. Baseline characteristics were similar between groups. IM fixation was associated with significantly lower rates of overall complications (7.5% vs 9.8%, P = .001), wound dehiscence (0.6% vs 1.8%, P < .001), infection (1.3% vs 2.8%, P < .001), malunion (0.4% vs 0.9%, P = .018), and abscess formation (0.1% vs 0.4%, P = .039). Although 30-day and total readmission rates were similar, the plate fixation group had significantly higher rates of infection- and wound-related readmissions.

Conclusion: In patients undergoing tibial ORIF for distal tibial fractures, adjunctive fibular IM nailing is associated with fewer wound-related complications and infections compared with plate fixation, without compromising union or readmission rates. IM nailing may be a lower-morbidity alternative for selected patients, pending prospective studies that incorporate fracture morphology and functional outcomes.

Level of evidence: Level III, prognostic.

Background: Suturing the deep posterior deltoid ligament in unstable ankle fractures is novel to established treatment. Some cadaveric and clinical trials support that adding deltoid ligament repair to plating of the lateral fracture will improve stability restoration.

Objectives: We will investigate the effects of deep deltoid ligament repair on patient-reported function, radiologic stability parameters, and the incidence of ankle osteoarthritis and the possible side effects from this additional procedure. The medial ankle injury patterns found will be described.

Study design: A randomised controlled nonblinded multicentre trial.

Methods: A total of 120 patients with Lauge Hansen SER 4B ankle fractures will be randomised (1:1 ratio) to conventional plating of the lateral malleolus only or additional suture of the deep deltoid ligament. The primary end point was patient-reported function measured in Olerud-Molander Ankle Score (OMAS) at 1 and 2 years. The secondary end points included Self-Reported Foot and Ankle Score (SEFAS), Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), VAS pain, and EuroQol-5D-5L scores; rates of treatment-related adverse events, reoperations, and incidence of posttraumatic arthritis; and comparison of side-to-side differences in tibiotalar medial clear space from bilateral weightbearing ankle radiographs and gravity stress on group level.

Background: The optimal surgical procedures for chronic Lisfranc injuries are controversial. This study aimed to demonstrate the clinical outcomes of fiber tape fixation for chronic Lisfranc injuries under early full weightbearing protocols.

Methods: This study included 11 feet from 10 patients who underwent fiber tape fixation for chronic Lisfranc injuries (undiagnosed for more than 6 weeks from injuries). All patients were allowed full weightbearing with normal shoes 4 weeks after the surgery. Clinical outcomes were evaluated with the Self-Administered Foot Evaluation Questionnaire. Radiographic outcomes were evaluated with a first cuneiform (C1)-second metatarsal (M2) distance from weightbearing anteroposterior plain foot radiography.

Results: The median follow-up period was 12 months (IQR, 12-16). The median C1-M2 distance improved significantly from 3.3 mm (IQR, 2.9-5.2) to 1.6 mm (IQR, 1.5-2.2). The pain, physical functioning, social functioning, shoe-related, and general health subscales of SAFE-Q improved significantly after the surgery, whereas the sports subscale did not reach statistical significance (P = .063). Five patients, who regularly participated in sports activities, were able to return to their preinjury sport level by 12 months. There were no complications, such as infection, nerve or tendon injuries, or hardware-related discomfort, in the entire cohort.

Conclusion: The fiber tape fixation device under early full weightbearing protocols led to short-term improvements in pain, function, and radiographic stability for chronic Lisfranc injuries, with no observed complications.

Level of evidence: Level IV, case series.

Visual abstract.