Foot & Ankle Orthopaedics最新文献

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.

Background: Ankle arthrodesis (AA) is a common treatment for end-stage ankle arthritis, chronic instability, and degenerative deformity. Although minimally invasive arthroscopic techniques may reduce soft tissue disruption, postoperative pain, and related morbidity, open techniques may be beneficial for treatment of patients with aberrant anatomy, insufficient bone stock, or complex deformity. This study aimed to determine whether arthroscopic AA is associated with lower rates of adverse events, pseudarthrosis, and health care use compared with open AA techniques at short-term and long-term intervals.

Methods: We conducted a retrospective analysis using the TriNetX research network. Patients undergoing AA were identified using Current Procedural Terminology (CPT) codes for arthroscopic (CPT 29899, n = 879) and open (CPT 27870, n = 10 604) procedures. Two cohorts were defined and propensity score-matched on age, sex, race, body mass index, nicotine dependence, chronic kidney disease, and type 2 diabetes mellitus (n = 873 each). Outcomes were evaluated within 30 days, 90 days, and 2 years.

Results: The arthroscopic AA cohort experienced significantly lower rates of any adverse event, infection, and hospital admission within the 30-day and 90-day outcome windows. Arthroscopic AA was associated with fewer emergency department visits and wound dehiscence within 90 days of surgery. A diagnosed pseudarthrosis within 2 years was more common in the open arthrodesis cohort. Rates of short-term myocardial infarction, cerebral infarct, transfusion, pulmonary embolism, and hematoma did not differ.

Conclusion: Arthroscopic AA was associated with significantly lower rates of medical complications at the short-term intervals, in addition to lower rates of nonunion within 2 years. Although observational, propensity-matched data are consistent with fewer short-term medical complications and lower 2-year nonunion after arthroscopic AA, the results should be interpreted with caution because of the inability to assess the degree of coronal or sagittal plane deformity in the included cases.

Level of evidence: Level III, retrospective cohort study.

Background: Achieving interfragmentary compression and stability is critical for successful bone healing in fracture fixation and arthrodesis procedures. Modern orthopaedic plating systems incorporating variable-angle screw designs offer greater versatility; however, the impact of screw trajectory on interfragmentary compression and contact area has not been adequately explored. We questioned if the resultant forces applied by screw orientation would follow the basic principles of vector geometry.

Methods: Interfragmentary compression and contact area were quantified in foam bone surrogate osteotomy models using plates allowing maximum screw angulation of either 15 or 30 degrees, with screws inserted at various angles. Cadaveric second-tarsometatarsal (TMT) arthrodesis constructs were subsequently used to validate the mechanical findings from surrogate testing.

Results: Compression and contact area increased from 0 degrees to 15 degrees to 30 degrees in surrogate models (overall analysis of variance P < .001). Angling screws in the second bone fragment after securing the plate to the first fragment produced the largest compression gains. In cadaveric second-TMT constructs, 30-degree divergence increased compression (~15-fold; 49.4 ± 35.1 N vs 3.4 ± 3.8 N; P < .001) and contact area (~4-fold; 47.8 ± 28.9 mm^² vs 12.8 ± 7.3 mm^²; P < .001) compared with 0-degree divergence.

Conclusion: With plate fixation, screw divergence from the arthrodesis/fracture line improved interfragmentary compression and contact area, particularly when divergent screws were inserted into the second bone fragment after the plate was secured to the first fragment. As hypothesized, the findings followed basic vector geometry.

Clinical relevance: Surgeons can optimize plate fixation quality and enhance stability in midfoot arthrodesis (and other procedures) by strategically angling locking screws in the second bone fragment after securing the plate to the first fragment. These biomechanical insights offer practical guidance for achieving superior interfragmentary compression and potentially reducing the risk of nonunion in clinical practice.

Background: Modified oblique Keller capsular interposition arthroplasty (MOKCIA) is a treatment for hallux rigidus that has been shown to have similar long-term outcomes compared with metatarsophalangeal (MTP) arthrodesis. The purpose of this study was to evaluate differences in the level of sport and other activity following MOKCIA or first MTP arthrodesis.

Methods: From 2005 to 2020, 58 MOKCIA and 112 arthrodesis patients were identified. Patients completed a sports-specific questionnaire (SSQ) along with the visual analog scale (VAS) pain/satisfaction, Foot and Ankle Ability Measure (FAAM), and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments, which yielded 14 MOKCIA and 15 arthrodesis subjects.

Results: At an average 13 years' follow-up, the MOKCIA group participated in a mean of 3.4 ± 1.7 sport activities preoperatively and 3.4 ± 1.9 postoperatively, whereas arthrodesis patients participated in 3.5 ± 1.7 activities preoperatively and 2.9 ± 1.4 postoperatively (P = .22). Compared with preoperative, the MOKCIA group rated sporting activities as less difficult (10/12) and same difficulty (2/12). Hundred percent of patients in the MOKCIA group were satisfied with their overall level of activity following surgery, whereas 87% patients (13/15) in the arthrodesis group were satisfied. Patients in the MOKCIA group were able to participate in similar numbers of activities postoperatively, but arthrodesis patients had decreased activities. PROMIS, VAS pain/satisfaction, and FAAM Sports scores were similar between the groups.

Conclusion: We found that MOKCIA compared similarly with MTP arthrodesis in sports physical function at long-term follow-up. These results must be interpreted in light of the very low follow-up and retrospective recall of preoperative activities.

Level of evidence: Level III, retrospective cohort study.

Graphical Abstract.

Background: Diabetic forefoot ulcers often result from increased pressure on bony prominences, neuropathy, and poor limb perfusion. The management of these ulcers, particularly when infected, is challenging and can often lead to minor or even major amputation. This study aims to evaluate the efficacy and safety of minimally invasive surgical offloading of recurrent diabetic ulcers of the fifth metatarsal by minimally invasive fifth metatarsal osteotomy and bunionette removal.

Methods: A retrospective case series study was conducted of patients who underwent surgical treatment for diabetic foot ulcers on the lateral or plantar side of the fifth metatarsal head between January 2020 and May 2025. Outcomes included time to healing of the primary ulcer and surgical wound, ulcer recurrence, postoperative complications, and reoperation rates. Clinical and radiologic parameters of the feet were assessed, and patient satisfaction Coughlin scores were collected.

Results: Ten feet from 9 patients who did not respond successfully to conservative offloading were included. The mean age of the patients was 69.5 years. Five feet were classified as Wagner grade 3 wounds, and 4 as Wagner grade 2 wounds. The ulcers healed completely in a mean time of 9.8 weeks postoperatively. Two patients required 6 weeks of antibiotic treatment because of preexisting osteomyelitis. One postoperative infection occurred. There were no corrective failures, and all patients returned to wearing orthopaedic shoes postoperatively. The overall patient satisfaction using the Coughlin satisfaction score was "good" to "excellent."

Conclusion: Minimally invasive fifth metatarsal osteotomy with bunionette removal appears safe and effective for treating refractory diabetic ulcers of the fifth metatarsal head, including cases with active infection. However, larger studies with functional outcomes are needed to establish definitive treatment guidelines.

Level of evidence: Level IV, case series.