Pub Date : 2025-04-01Epub Date: 2022-04-19DOI: 10.1177/19386400221088455
Naji S Madi, Aman Chopra, Selene G Parekh
Different procedures have been reported for severe and recurrent lesser toes deformity. These included DuVries metatarsophalangeal joint arthroplasty, resection arthroplasty, partial proximal phalangectomy, syndactylization, or lesser toe amputation. In the presence of a failed metatarsal head resection, the surgeon is faced with limited salvage options including Hoffman procedure or lesser toe amputation. The 3D printing technology has allowed orthopaedic surgeons to expand the therapeutic arsenal to address challenging situations. We herein present the first case of 3D-printed second lesser metatarsal replacement performed after a failed second metatarsal head resection.Level of Evidence: V.
{"title":"Three-Dimensional-Printed Lesser Metatarsal Replacement: The First Case Report.","authors":"Naji S Madi, Aman Chopra, Selene G Parekh","doi":"10.1177/19386400221088455","DOIUrl":"10.1177/19386400221088455","url":null,"abstract":"<p><p>Different procedures have been reported for severe and recurrent lesser toes deformity. These included DuVries metatarsophalangeal joint arthroplasty, resection arthroplasty, partial proximal phalangectomy, syndactylization, or lesser toe amputation. In the presence of a failed metatarsal head resection, the surgeon is faced with limited salvage options including Hoffman procedure or lesser toe amputation. The 3D printing technology has allowed orthopaedic surgeons to expand the therapeutic arsenal to address challenging situations. We herein present the first case of 3D-printed second lesser metatarsal replacement performed after a failed second metatarsal head resection.<b>Level of Evidence:</b> V.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"126-132"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43584372","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}
Pub Date : 2024-12-01Epub Date: 2022-05-19DOI: 10.1177/19386400221093861
Bonnie Y Chien, Eitan M Ingall, Steven Staffa, Caroline Williams, Christopher P Miller, John Y Kwon
Background: Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation-II (SER-II) injuries.
Methods: A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides.
Results: Final x-rays demonstrated no differences between normal and injured ankle MCS (P = .441). However, CT coronal/axial MCS measurements were different (P < .05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P < .001).
Conclusion: There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it.
{"title":"Are SER-II Ankle Fractures Anatomic? Computed Tomography Demonstrates Mortise Malalignment in the Setting of Apparently Normal Radiographs.","authors":"Bonnie Y Chien, Eitan M Ingall, Steven Staffa, Caroline Williams, Christopher P Miller, John Y Kwon","doi":"10.1177/19386400221093861","DOIUrl":"10.1177/19386400221093861","url":null,"abstract":"<p><strong>Background: </strong>Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation-II (SER-II) injuries.</p><p><strong>Methods: </strong>A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides.</p><p><strong>Results: </strong>Final x-rays demonstrated no differences between normal and injured ankle MCS (P = .441). However, CT coronal/axial MCS measurements were different (P < .05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P < .001).</p><p><strong>Conclusion: </strong>There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"545-551"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42418977","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}
Pub Date : 2024-12-01Epub Date: 2022-06-13DOI: 10.1177/19386400221098629
Semran B Thamer, Aaron W Lam, Ivan J Golub, Matthew L Magruder, Rushabh M Vakharia, Amiethab A Aiyer, Amr A Abdelgawad
Introduction: Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures.
Methods: A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch'st-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant.
Results: There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001).
Conclusion: This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures.
Level of evidence: Therapeutic, Level IV: Retrospective.
睡眠呼吸暂停(SA)是一种常见的睡眠障碍,可增加术后发病率。关于SA如何影响踝关节骨折手术固定后预后的研究有限。因此,本研究的目的是确定接受手术固定治疗双踝踝关节骨折的患者是否有更高的医疗并发症发生率和医疗费用。方法回顾性分析2005年1月1日至2014年3月31日期间,使用PearlDiver数据库的A、B部分Medicare数据。采用国际疾病分类第九版代码查询双踝踝关节骨折首次切开复位内固定(ORIF)当日有无SA的患者。Welch's -test用于比较护理成本。采用多元二项logistic回归模型计算不良事件的比值比(OR)。p值<。0.001被认为具有统计学意义。结果共20 560例患者(SA = 3150;对照队列= 17410),在研究期间因双踝踝关节骨折接受ORIF治疗。睡眠呼吸暂停患者的90天医疗并发症发生率和几率(21.42% vs 7.47%, OR: 3.11, P < 0.0001)和90天护理费用(7213.12美元vs 5415.79美元,P < 0.0001)均显著较高。结论:本研究表明,双踝踝关节骨折SA患者行ORIF术后并发症风险和医疗费用增加。证据水平:治疗性,IV级:回顾性。
{"title":"Sleep Apnea and Postoperative Medical Complications and Health Care Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Ankle Fractures.","authors":"Semran B Thamer, Aaron W Lam, Ivan J Golub, Matthew L Magruder, Rushabh M Vakharia, Amiethab A Aiyer, Amr A Abdelgawad","doi":"10.1177/19386400221098629","DOIUrl":"10.1177/19386400221098629","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures.</p><p><strong>Methods: </strong>A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch's<i>t</i>-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant.</p><p><strong>Results: </strong>There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001).</p><p><strong>Conclusion: </strong>This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures.</p><p><strong>Level of evidence: </strong>Therapeutic, Level IV: Retrospective.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"552-560"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43777031","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}
Pub Date : 2024-10-01Epub Date: 2022-04-13DOI: 10.1177/19386400221088456
Eric Lukosius, Aman Chopra, Selene Parekh
Background: Pigmented villonodular synovitis (PVNS) is a benign proliferative disease affecting tendon sheaths and synovial tissue. Pigmented villonodular synovitis in the foot and ankle has a high rate of recurrence, which can be destructive if incompletely removed. This case series analyzes functional outcomes after PVNS operative resection with an anterior ankle capsular reconstruction, using a novel technique.
Methods: Three patients with PVNS underwent surgery between 2010 and 2020. The operative technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion for the ankle and subtalar joints, visual analog scale (VAS) for pain, and return to daily activities was assessed along with appropriate radiographs and magnetic resonance imaging (MRI) imaging.
Results: All 3 surgeries had a mean follow-up period of 52.3 (range, 4-123) months and resulted in successful recovery as assessed by the VAS and self-reported activity. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were not statistically different. No complications or recurrence of PVNS was observed.
Conclusion: Further investigation is warranted to better understand the clinical outcomes of this technique designed to successfully eliminate PVNS recurrence.
{"title":"Anterior Capsule Reconstruction in the Setting of PVNS.","authors":"Eric Lukosius, Aman Chopra, Selene Parekh","doi":"10.1177/19386400221088456","DOIUrl":"10.1177/19386400221088456","url":null,"abstract":"<p><strong>Background: </strong>Pigmented villonodular synovitis (PVNS) is a benign proliferative disease affecting tendon sheaths and synovial tissue. Pigmented villonodular synovitis in the foot and ankle has a high rate of recurrence, which can be destructive if incompletely removed. This case series analyzes functional outcomes after PVNS operative resection with an anterior ankle capsular reconstruction, using a novel technique.</p><p><strong>Methods: </strong>Three patients with PVNS underwent surgery between 2010 and 2020. The operative technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion for the ankle and subtalar joints, visual analog scale (VAS) for pain, and return to daily activities was assessed along with appropriate radiographs and magnetic resonance imaging (MRI) imaging.</p><p><strong>Results: </strong>All 3 surgeries had a mean follow-up period of 52.3 (range, 4-123) months and resulted in successful recovery as assessed by the VAS and self-reported activity. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were not statistically different. No complications or recurrence of PVNS was observed.</p><p><strong>Conclusion: </strong>Further investigation is warranted to better understand the clinical outcomes of this technique designed to successfully eliminate PVNS recurrence.</p><p><strong>Level of evidence: </strong>IV- Retrospective case series.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"515-520"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41752832","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}
Pub Date : 2024-10-01Epub Date: 2022-04-19DOI: 10.1177/19386400221088453
Daniel J Cunningham, Ariana Paniagua, Isabel DeLaura, Gloria Zhang, Billy Kim, Jonathan Kim, Terry Lee, Micaela LaRose, Samuel Adams, Mark J Gage
Introduction: Regional anesthesia (RA) is commonly used in ankle and distal tibia fracture surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient demand in patients undergoing ankle and distal tibia fracture surgery compared with patients not receiving RA.
Methods: All patients aged 18 years and older undergoing ankle and distal tibia fracture surgery at a single institution between July 2013 and July 2018 were included in this study (n = 1310). Inpatient opioid consumption (0-72 hours postoperatively) and outpatient opioid prescribing (1 month preoperatively to 90 days postoperatively) were recorded in oxycodone 5-mg equivalents (OEs). Adjusted models were used to evaluate the impact of RA versus no RA on inpatient and outpatient opioid demand.
Results: Patients without RA had higher rates of high-energy mechanism of injury, additional injuries, open fractures, and additional surgery compared with patients with RA. Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OEs without RA vs 8.8 OEs with RA from 0 to 24 hours postoperatively, P < .001) but no significant difference after that time (9.7 vs 10.4 from 24 to 48 hours postoperatively, and 9.5 vs 8.5 from 48 to 72 hours postoperatively). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all time points (112.5 OEs without RA vs 137.3 with RA from 1 month preoperatively to 2 weeks, 125.6 vs 155.5 OEs to 6 weeks, and 134.6 vs 163.3 OEs to 90 days, all P values for RA <.001).
Discussion: In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient demand after adjusting for baseline patient and treatment characteristics. This study encourages the use of RA to decrease inpatient opioid use, although there was a worrisome increase in outpatient opioid demand.
Level of evidence: Level III: Retrospective, therapeutic cohort study.
区域麻醉(RA)常用于踝关节和胫骨远端骨折手术。然而,这种治疗对住院和门诊阿片类药物需求的实际影响尚不清楚。假设与未接受RA的患者相比,接受踝关节和胫骨远端骨折手术的患者RA会减少住院阿片类药物的消耗,对门诊需求的影响很小。方法本研究纳入2013年7月至2018年7月在同一医院接受踝关节和胫骨远端骨折手术的所有18岁及以上患者(n = 1310)。住院阿片类药物消耗(术后0-72小时)和门诊阿片类药物处方(术前1个月至术后90天)以羟可酮5毫克当量(OEs)记录。采用调整后的模型评估类风湿性关节炎与非类风湿性关节炎对住院和门诊阿片类药物需求的影响。结果与RA患者相比,无RA患者高能量机制损伤、附加损伤、开放性骨折和附加手术的发生率更高。调整后的模型显示,RA患者的住院阿片类药物消耗减少(术后0 - 24小时无RA的OEs估计为12.1 vs RA的OEs估计为8.8,P < 0.001),但此后无显著差异(术后24 - 48小时为9.7 vs 10.4, 48 - 72小时为9.5 vs 8.5)。在所有时间点,接受RA的患者估计门诊累计阿片类药物需求显著增加(术前1个月至2周,无RA的112.5次OEs vs有RA的137.3次OEs, 125.6次vs 155.5次OEs至6周,134.6次vs 163.3次OEs至90天,RA的P值均< 0.001)。在踝关节和胫骨远端骨折手术中,RA与早期住院阿片类药物需求减少有关,但在调整基线患者和治疗特征后,RA与门诊阿片类药物需求显著增加有关。本研究鼓励使用类风湿性关节炎来减少住院阿片类药物的使用,尽管门诊阿片类药物需求的增加令人担忧。证据水平III级:回顾性、治疗性队列研究。
{"title":"Regional Anesthesia Decreases Inpatient But Not Outpatient Opioid Demand in Ankle and Distal Tibia Fracture Surgery.","authors":"Daniel J Cunningham, Ariana Paniagua, Isabel DeLaura, Gloria Zhang, Billy Kim, Jonathan Kim, Terry Lee, Micaela LaRose, Samuel Adams, Mark J Gage","doi":"10.1177/19386400221088453","DOIUrl":"10.1177/19386400221088453","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia (RA) is commonly used in ankle and distal tibia fracture surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient demand in patients undergoing ankle and distal tibia fracture surgery compared with patients not receiving RA.</p><p><strong>Methods: </strong>All patients aged 18 years and older undergoing ankle and distal tibia fracture surgery at a single institution between July 2013 and July 2018 were included in this study (n = 1310). Inpatient opioid consumption (0-72 hours postoperatively) and outpatient opioid prescribing (1 month preoperatively to 90 days postoperatively) were recorded in oxycodone 5-mg equivalents (OEs). Adjusted models were used to evaluate the impact of RA versus no RA on inpatient and outpatient opioid demand.</p><p><strong>Results: </strong>Patients without RA had higher rates of high-energy mechanism of injury, additional injuries, open fractures, and additional surgery compared with patients with RA. Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OEs without RA vs 8.8 OEs with RA from 0 to 24 hours postoperatively, <i>P</i> < .001) but no significant difference after that time (9.7 vs 10.4 from 24 to 48 hours postoperatively, and 9.5 vs 8.5 from 48 to 72 hours postoperatively). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all time points (112.5 OEs without RA vs 137.3 with RA from 1 month preoperatively to 2 weeks, 125.6 vs 155.5 OEs to 6 weeks, and 134.6 vs 163.3 OEs to 90 days, all <i>P</i> values for RA <.001).</p><p><strong>Discussion: </strong>In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient demand after adjusting for baseline patient and treatment characteristics. This study encourages the use of RA to decrease inpatient opioid use, although there was a worrisome increase in outpatient opioid demand.</p><p><strong>Level of evidence: </strong><i>Level III: Retrospective, therapeutic cohort study</i>.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"486-500"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48223754","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}
Pub Date : 2024-10-01Epub Date: 2022-03-01DOI: 10.1177/19386400221079487
Muhammad Saad Ilyas, Rizwan Akram, Uruj Zehra, Amer Aziz
An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.Level of Evidence: Level V.
{"title":"Management of Giant Cell Tumor of Talus With Extended Intralesional Curettage and Reconstruction Using Polymethylmethacrylate Cement.","authors":"Muhammad Saad Ilyas, Rizwan Akram, Uruj Zehra, Amer Aziz","doi":"10.1177/19386400221079487","DOIUrl":"10.1177/19386400221079487","url":null,"abstract":"<p><p>An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.<b>Level of Evidence:</b> Level V.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"510-514"},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42883884","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}
Pub Date : 2024-08-01Epub Date: 2022-03-03DOI: 10.1177/19386400221079198
Mauricio Esteban Ghioldi, Lucas Nicolás Chemes, Eric Daniel Dealbera, Mariano De Prado, Jorge Javier Del Vecchio
Purpose: The expression "learning curve" indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called "minimally invasive surgery") has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet necessary to become skilled in a specific minimally invasive surgery (MIS) procedure.
Methods: From January 2015 to June 2018, 46 consecutive patients were evaluated and included in the study. Patients were divided into 2 groups according to the surgery period: first 30 feet (Group 1), and subsequent 30 feet (Group 2) from the whole population evaluated. Age, body mass index, and operative time were evaluated. Hallux valgus angle and the 1 to 2 intermetatarsal angle were also measured. Patients were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scale, the Foot and Ankle Ability Measure activities of daily living (FAAM ADL) subscale and the visual analog scale (VAS).
Results: The comparison of the 2 groups showed statistically significant differences in hallux valgus angle (HVA) but not in intermetatarsal angle (IMA). The mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS score in Group 1 were 12.83, 3.93, and 24.77 points, respectively. In Group 2, the mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS scores were 15.19, 4.3, and 24.5 points, respectively. The differences between groups in FAAM ADL score was statistically significant (P = 0.0364). Group 1 showed a global complication rate of 16.67% (n = 5) while group 2 showed 3,3% (n = 1).
Conclusion: After the first 30 cases, radiographic, clinical, and functional outcomes substantially improved, and the level of the perioperative complications decreased. The results suggest that the learning curve plateau for performing a percutaneous subcapital osteotomy can be reached after 30 surgeries.
{"title":"Modified Bösch Osteotomy Combined With a Percutaneous Adductor Tendon Release for the Treatment of Hallux Valgus Deformity: Learning Curve.","authors":"Mauricio Esteban Ghioldi, Lucas Nicolás Chemes, Eric Daniel Dealbera, Mariano De Prado, Jorge Javier Del Vecchio","doi":"10.1177/19386400221079198","DOIUrl":"10.1177/19386400221079198","url":null,"abstract":"<p><strong>Purpose: </strong>The expression \"learning curve\" indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called \"minimally invasive surgery\") has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet necessary to become skilled in a specific minimally invasive surgery (MIS) procedure.</p><p><strong>Methods: </strong>From January 2015 to June 2018, 46 consecutive patients were evaluated and included in the study. Patients were divided into 2 groups according to the surgery period: first 30 feet (Group 1), and subsequent 30 feet (Group 2) from the whole population evaluated. Age, body mass index, and operative time were evaluated. Hallux valgus angle and the 1 to 2 intermetatarsal angle were also measured. Patients were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scale, the Foot and Ankle Ability Measure activities of daily living (FAAM ADL) subscale and the visual analog scale (VAS).</p><p><strong>Results: </strong>The comparison of the 2 groups showed statistically significant differences in hallux valgus angle (HVA) but not in intermetatarsal angle (IMA). The mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS score in Group 1 were 12.83, 3.93, and 24.77 points, respectively. In Group 2, the mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS scores were 15.19, 4.3, and 24.5 points, respectively. The differences between groups in FAAM ADL score was statistically significant (P = 0.0364). Group 1 showed a global complication rate of 16.67% (n = 5) while group 2 showed 3,3% (n = 1).</p><p><strong>Conclusion: </strong>After the first 30 cases, radiographic, clinical, and functional outcomes substantially improved, and the level of the perioperative complications decreased. The results suggest that the learning curve plateau for performing a percutaneous subcapital osteotomy can be reached after 30 surgeries.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"343-351"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48856146","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}
Pub Date : 2024-08-01Epub Date: 2022-05-24DOI: 10.1177/19386400221093859
Milaan Shah, Brianna Stirling, J Benjamin Jackson, Tyler Gonzalez
Background: Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery.
Methods: A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs.
Results: The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%.
Conclusion: The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA.
Level of evidence: Level IV-Retrospective comparative study.
{"title":"Utilization of the Modified Lapidus Procedure for Correction of Moderate to Severe Hallux Valgus Deformity With Increased Distal Metatarsal Articular Angle.","authors":"Milaan Shah, Brianna Stirling, J Benjamin Jackson, Tyler Gonzalez","doi":"10.1177/19386400221093859","DOIUrl":"10.1177/19386400221093859","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery.</p><p><strong>Methods: </strong>A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs.</p><p><strong>Results: </strong>The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%.</p><p><strong>Conclusion: </strong>The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA.</p><p><strong>Level of evidence: </strong>Level IV-Retrospective comparative study.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"352-357"},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44890270","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}
Pub Date : 2024-06-01Epub Date: 2022-03-06DOI: 10.1177/19386400221079203
Kevin A Schafer, Brian M Cusworth, Gregory S Kazarian, Jonathon D Backus, Sandra E Klein, Jeffrey E Johnson, Jeremy J McCormick
Background: The management of symptomatic osteochondral lesions of the talus (OLTs) previously treated with arthroscopy is controversial. Minimal data exist on the role for repeat arthroscopy. Here, we describe our experience with repeat arthroscopy and microfracture for symptomatic OLTs.
Methods: Our database was queried over an 8-year period to identify patients undergoing repeat arthroscopy and microfracture as treatment for symptomatic OLTs. Phone surveys were conducted to assess residual pain, patient satisfaction, and need for subsequent surgery. We compared patient outcomes based on the size of their OLT (small lesions ≤150 mm2, large >150 mm2) and the presence or absence of subchondral cysts.
Results: We identified 14 patients who underwent repeat arthroscopy and microfracture for symptomatic OLTs. Patients reported reasonable satisfaction (7.6 ± 3.5 out of 10) but moderate residual pain (4.7 ± 3.4 out of 10) at midterm follow-up (5.1 ± 2.9 years). In total, 21% (3/14) of patients had undergone subsequent surgery. Patients with small (n = 5) and large OLTs (n = 9) had similar postoperative pain scores (4.2 ± 4.1 vs 4.9 ± 3.2) and postoperative satisfaction levels (6.4 ± 4.9 vs 8.3 ± 2.5).
Conclusion: At midterm follow-up, repeat arthroscopy for symptomatic OLTs demonstrated reasonable satisfaction but moderate residual pain. Lesion size or presence of subchondral cysts did not affect outcome, but our sample size was likely too small to detect statistically significant differences. These data show that repeat ankle arthroscopy can be performed safely with modest outcomes, and we hope that this report aids in managing patient expectations.Level of Evidence:Level IV Case Series.
背景关节镜治疗距骨(OLTs)症状性骨软骨病变的治疗方法存在争议。关于重复关节镜检查的作用,数据很少。在这里,我们描述了我们对有症状OLT的重复关节镜检查和微骨折的经验。方法对我们的数据库进行为期8年的查询,以确定接受重复关节镜检查和微骨折治疗有症状OLT的患者。进行电话调查以评估残余疼痛、患者满意度和后续手术的需求。我们根据OLT的大小(小病变≤150 mm2,大病变>150 mm2)和软骨下囊肿的存在与否对患者的预后进行了比较。结果我们确定了14名患者,他们因有症状的OLT而接受了重复关节镜检查和微骨折。患者在中期随访(5.1±2.9年)中报告了合理的满意度(7.6±3.5,满分10),但中度残余疼痛(4.7±3.4,满分10。总共有21%(3/14)的患者接受了后续手术。小型(n=5)和大型OLT(n=9)患者的术后疼痛评分相似(4.2±4.1 vs 4.9±3.2),术后满意度相似(6.4±4.9 vs 8.3±2.5)。病变大小或软骨下囊肿的存在不会影响结果,但我们的样本量可能太小,无法检测到统计学上的显著差异。这些数据表明,重复的踝关节镜检查可以安全地进行,结果适中,我们希望这份报告有助于管理患者的期望。证据级别:四级系列案件。
{"title":"Outcomes Following Repeat Ankle Arthroscopy and Microfracture for Osteochondral Lesions of the Talus.","authors":"Kevin A Schafer, Brian M Cusworth, Gregory S Kazarian, Jonathon D Backus, Sandra E Klein, Jeffrey E Johnson, Jeremy J McCormick","doi":"10.1177/19386400221079203","DOIUrl":"10.1177/19386400221079203","url":null,"abstract":"<p><strong>Background: </strong>The management of symptomatic osteochondral lesions of the talus (OLTs) previously treated with arthroscopy is controversial. Minimal data exist on the role for repeat arthroscopy. Here, we describe our experience with repeat arthroscopy and microfracture for symptomatic OLTs.</p><p><strong>Methods: </strong>Our database was queried over an 8-year period to identify patients undergoing repeat arthroscopy and microfracture as treatment for symptomatic OLTs. Phone surveys were conducted to assess residual pain, patient satisfaction, and need for subsequent surgery. We compared patient outcomes based on the size of their OLT (small lesions ≤150 mm<sup>2</sup>, large >150 mm<sup>2</sup>) and the presence or absence of subchondral cysts.</p><p><strong>Results: </strong>We identified 14 patients who underwent repeat arthroscopy and microfracture for symptomatic OLTs. Patients reported reasonable satisfaction (7.6 ± 3.5 out of 10) but moderate residual pain (4.7 ± 3.4 out of 10) at midterm follow-up (5.1 ± 2.9 years). In total, 21% (3/14) of patients had undergone subsequent surgery. Patients with small (n = 5) and large OLTs (n = 9) had similar postoperative pain scores (4.2 ± 4.1 vs 4.9 ± 3.2) and postoperative satisfaction levels (6.4 ± 4.9 vs 8.3 ± 2.5).</p><p><strong>Conclusion: </strong>At midterm follow-up, repeat arthroscopy for symptomatic OLTs demonstrated reasonable satisfaction but moderate residual pain. Lesion size or presence of subchondral cysts did not affect outcome, but our sample size was likely too small to detect statistically significant differences. These data show that repeat ankle arthroscopy can be performed safely with modest outcomes, and we hope that this report aids in managing patient expectations.<b>Level of Evidence:</b> <i>Level IV Case Series</i>.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"216-223"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49572892","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}
Pub Date : 2024-02-01Epub Date: 2022-10-26DOI: 10.1177/19386400221131910
Mikaela Engarås Hamre, Marius Molund, Fredrik Nilsen
Introduction: Metatarsal pronation is present in 87% of patients with hallux valgus (HV) deformity. The chevron osteotomy is commonly used worldwide to correct mild to moderate HV deformities. Many modifications have been described, but few address the rotational deformity of the first metatarsal. The rotational biplanar chevron osteotomy (RBCO), described by M. Prado et al, presents a variation of a biplanar chevron osteotomy that can be used to address first metatarsal rotation. The objective of this study is to investigate and verify the technique of the RBCO.
Methods: We conducted our study performing an RBCO on 9 cadaveric limbs. The technique uses a medial-based wedge parallel to the plantar limb of the osteotomy to make the distal fragment free to correct rotation. A goniometer was used by 2 individual surgeons to control the rotational correction achieved.
Results: The osteotomy was considered simple to perform and we experienced no complications, such as fractures or instability. The result was satisfactory alignment and adequate stability. On average, a 2 mm wedge resulted in 11° of rotational correction.
Conclusion: We predict that RBCO can safely be used for correcting the metatarsal rotation when necessary in mild to moderate HV deformity foot.
{"title":"A Cadaveric Study Verifying the Potential of a Rotational Biplanar Chevron Osteotomy to Correct the 3-Dimensional Hallux Valgus Deformity.","authors":"Mikaela Engarås Hamre, Marius Molund, Fredrik Nilsen","doi":"10.1177/19386400221131910","DOIUrl":"10.1177/19386400221131910","url":null,"abstract":"<p><strong>Introduction: </strong>Metatarsal pronation is present in 87% of patients with hallux valgus (HV) deformity. The chevron osteotomy is commonly used worldwide to correct mild to moderate HV deformities. Many modifications have been described, but few address the rotational deformity of the first metatarsal. The rotational biplanar chevron osteotomy (RBCO), described by M. Prado et al, presents a variation of a biplanar chevron osteotomy that can be used to address first metatarsal rotation. The objective of this study is to investigate and verify the technique of the RBCO.</p><p><strong>Methods: </strong>We conducted our study performing an RBCO on 9 cadaveric limbs. The technique uses a medial-based wedge parallel to the plantar limb of the osteotomy to make the distal fragment free to correct rotation. A goniometer was used by 2 individual surgeons to control the rotational correction achieved.</p><p><strong>Results: </strong>The osteotomy was considered simple to perform and we experienced no complications, such as fractures or instability. The result was satisfactory alignment and adequate stability. On average, a 2 mm wedge resulted in 11° of rotational correction.</p><p><strong>Conclusion: </strong>We predict that RBCO can safely be used for correcting the metatarsal rotation when necessary in mild to moderate HV deformity foot.</p><p><strong>Levels of evidence: </strong>Level IV.</p>","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"1 1","pages":"63S-67S"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43282605","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}