Pub Date : 2017-06-01DOI: 10.1177/1938640016679700
James M. Cottom, Joseph S Baker
Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective
{"title":"Restoring the Anatomy of Calcaneal Fractures: A Simple Technique With Radiographic Review","authors":"James M. Cottom, Joseph S Baker","doi":"10.1177/1938640016679700","DOIUrl":"https://doi.org/10.1177/1938640016679700","url":null,"abstract":"Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"235 - 239"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016679700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47606989","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 : 2017-06-01DOI: 10.1177/1938640016676340
N. Rensing, B. Waterman, R. Frank, Kenneth A. Heida, J. Orr
Introduction. Historically, Achilles tendon repairs and other surgeries about the hindfoot have demonstrated a significantly higher rate of wound healing complications and surgical site morbidity. The purpose of this study was to evaluate the comprehensive complication profile and risk factors for adverse short-term, clinical outcomes after primary repair of Achilles tendon ruptures. Methods. Between the years 2005 and 2014, all cases of primary Achilles tendon repair (Current Procedural Terminology code 27650) entered into the National Surgical Quality Improvement Project (NSQIP) database were extracted for analysis. Primary outcomes of interest were rates of total complication, reoperation, and rerupture within 30 days of index surgery. Independent risk factors associated with these selected endpoints were assessed with chi-square and logistic regression analysis and odds ratios with 95% confidence intervals were used to express relative risk. Results. Of 1626 patients with an average age of 44 years (SD 13.3), the average ASA classification was 1.69 and hypertension (20.7%), morbid obesity (8.3%), and diabetes (4.9%) were among the most common medical comorbidities. A total of 28 (1.7%) patients sustained perioperative complications, including 1.3% with local complications (0.7% superficial wound infection, 0.4% wound disruption) and no cases of peripheral nerve injury or early repair failure. Systemic complications occurred in 0.4%, most commonly with deep venous thrombosis or nonfatal thromboembolism. Preoperative albumin was independently associated with an increased risk of local wound complications (odds ratio [OR] 28.67; 95% CI 1.42-579.40; P = .029). Chronic obstructive pulmonary disease (OR 22.33, 95% CI 2.49-199.81; P = .006) and bleeding disorder (OR 14.83, 95% CI 1.70-129.50; P = .015) were more likely to result in a systemic complication, and preoperative creatinine correlated with an increased risk of any complication (OR 6.11, 95% CI 1.15-32.34; P = .033). In total there were 5 (0.3%) readmissions with 2 (0.1%) unplanned reoperations attributed to local wound complications. Conclusion. Among a broad-based demographic of the United States, the rate of local wound complications was exceedingly low in the short-term perioperative period, although this risk may be significantly magnified with subtle decreases in albumin levels. Preoperative risk stratifications should carefully scrutinize for subtle abnormalities in nutritional parameters and renal function prior to undergoing Achilles surgery. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial
介绍。从历史上看，跟腱修复和其他后足手术的伤口愈合并发症和手术部位发病率明显较高。本研究的目的是评估跟腱断裂初级修复术后的综合并发症概况和短期不良临床结果的危险因素。方法。提取2005 - 2014年国家外科质量改进工程(NSQIP)数据库中所有跟腱一期修复病例(现行程序术语代码27650)进行分析。主要观察指标为手术后30天内的总并发症、再手术和再破裂率。与这些选定终点相关的独立危险因素通过卡方和逻辑回归分析进行评估，并使用95%置信区间的优势比来表示相对风险。结果。在1626例平均年龄44岁(SD 13.3)的患者中，平均ASA分级为1.69，高血压(20.7%)、病态肥胖(8.3%)和糖尿病(4.9%)是最常见的合并症。共有28例(1.7%)患者出现围手术期并发症，其中1.3%出现局部并发症(0.7%创面浅表感染，0.4%创面破裂)，无周围神经损伤或早期修复失败病例。全身性并发症发生率为0.4%，最常见的是深静脉血栓形成或非致死性血栓栓塞。术前白蛋白与局部伤口并发症风险增加独立相关(优势比[OR] 28.67;95% ci 1.42-579.40;P = .029)。慢性阻塞性肺疾病(OR 22.33, 95% CI 2.49-199.81;P = 0.006)和出血性疾病(OR 14.83, 95% CI 1.70-129.50;P = 0.015)更容易导致全身性并发症，术前肌酐与任何并发症的风险增加相关(OR 6.11, 95% CI 1.15-32.34;P = .033)。总共有5例(0.3%)再入院，2例(0.1%)因局部伤口并发症而非计划再手术。结论。在美国广泛的人口统计中，局部伤口并发症的发生率在短期围手术期非常低，尽管这种风险可能会随着白蛋白水平的轻微下降而显着放大。术前风险分层应仔细检查进行跟腱手术前的营养参数和肾功能的细微异常。证据等级:治疗性，II级:前瞻性，比较试验
{"title":"Low Risk for Local and Systemic Complications After Primary Repair of 1626 Achilles Tendon Ruptures","authors":"N. Rensing, B. Waterman, R. Frank, Kenneth A. Heida, J. Orr","doi":"10.1177/1938640016676340","DOIUrl":"https://doi.org/10.1177/1938640016676340","url":null,"abstract":"Introduction. Historically, Achilles tendon repairs and other surgeries about the hindfoot have demonstrated a significantly higher rate of wound healing complications and surgical site morbidity. The purpose of this study was to evaluate the comprehensive complication profile and risk factors for adverse short-term, clinical outcomes after primary repair of Achilles tendon ruptures. Methods. Between the years 2005 and 2014, all cases of primary Achilles tendon repair (Current Procedural Terminology code 27650) entered into the National Surgical Quality Improvement Project (NSQIP) database were extracted for analysis. Primary outcomes of interest were rates of total complication, reoperation, and rerupture within 30 days of index surgery. Independent risk factors associated with these selected endpoints were assessed with chi-square and logistic regression analysis and odds ratios with 95% confidence intervals were used to express relative risk. Results. Of 1626 patients with an average age of 44 years (SD 13.3), the average ASA classification was 1.69 and hypertension (20.7%), morbid obesity (8.3%), and diabetes (4.9%) were among the most common medical comorbidities. A total of 28 (1.7%) patients sustained perioperative complications, including 1.3% with local complications (0.7% superficial wound infection, 0.4% wound disruption) and no cases of peripheral nerve injury or early repair failure. Systemic complications occurred in 0.4%, most commonly with deep venous thrombosis or nonfatal thromboembolism. Preoperative albumin was independently associated with an increased risk of local wound complications (odds ratio [OR] 28.67; 95% CI 1.42-579.40; P = .029). Chronic obstructive pulmonary disease (OR 22.33, 95% CI 2.49-199.81; P = .006) and bleeding disorder (OR 14.83, 95% CI 1.70-129.50; P = .015) were more likely to result in a systemic complication, and preoperative creatinine correlated with an increased risk of any complication (OR 6.11, 95% CI 1.15-32.34; P = .033). In total there were 5 (0.3%) readmissions with 2 (0.1%) unplanned reoperations attributed to local wound complications. Conclusion. Among a broad-based demographic of the United States, the rate of local wound complications was exceedingly low in the short-term perioperative period, although this risk may be significantly magnified with subtle decreases in albumin levels. Preoperative risk stratifications should carefully scrutinize for subtle abnormalities in nutritional parameters and renal function prior to undergoing Achilles surgery. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"216 - 226"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016676340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45425526","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 : 2017-06-01DOI: 10.1177/1938640016669795
S. Desai
Freiberg’s infarction is a well-known condition that most commonly effects the second metatarsophalangeal joint. The etiology of Freiberg’s infarction is not entirely clear and there is no consensus on treatment. The case report presents a patient successfully treated with a metatarsal shortening osteotomy, marrow stimulation, and micronized allograft cartilage matrix. This is to my knowledge the first reported case using the described technique for Freiberg’s infarction. Levels of Evidence: Therapeutic, Level V: Expert opinion
{"title":"Freiberg’s Infarction Treated With Metatarsal Shortening Osteotomy, Marrow Stimulation, and Micronized Allograft Cartilage Matrix: A Case Report","authors":"S. Desai","doi":"10.1177/1938640016669795","DOIUrl":"https://doi.org/10.1177/1938640016669795","url":null,"abstract":"Freiberg’s infarction is a well-known condition that most commonly effects the second metatarsophalangeal joint. The etiology of Freiberg’s infarction is not entirely clear and there is no consensus on treatment. The case report presents a patient successfully treated with a metatarsal shortening osteotomy, marrow stimulation, and micronized allograft cartilage matrix. This is to my knowledge the first reported case using the described technique for Freiberg’s infarction. Levels of Evidence: Therapeutic, Level V: Expert opinion","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"258 - 262"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016669795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45827436","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 : 2017-06-01DOI: 10.1177/1938640016676341
James M. Cottom, Joseph S Baker
Arthrodesis of the first metatarsal cuneiform joint, or Lapidus procedure, is a widely accepted treatment for hallux valgus. Recent studies have focused on comparing various constructs for this procedure both in the laboratory and clinical settings. The current study compared in a cadaveric model the strength of 2 constructs. The first construct utilized a medially applied low-profile locking plate and an interfragmentary screw directed from plantar-distal to dorsal-proximal. The second construct consisted of a plantarly applied plate with a compression screw placed through the plate from plantar-distal to dorsal-proximal. The ultimate load to failure for the 2 groups tested was 255.38 ± 155.38 N and 197.48 ± 108.61 N, respectively (P = .402). There was no significant difference found between the 2 groups with respect to ultimate load to failure, stiffness of the construct, or moment at time of failure. In conclusion, the medially applied plate with plantar interfragmentary screw appears to be stronger than the plantar Lapidus plate tested for first metatarsal cuneiform arthrodesis, though this difference did not reach statistical significance. Levels of Evidence: Level V: Biomechanical Study
第一跖楔形关节融合术，或Lapidus手术，是一种广泛接受的治疗拇外翻的方法。最近的研究集中在比较实验室和临床设置中该程序的各种结构。目前的研究在尸体模型中比较了两种构念的强度。第一种结构采用内侧应用的低轮廓锁定钢板和从跖远端到背近端的骨折间螺钉。第二种构造包括一个跖骨钢板，通过钢板从跖骨远端到背侧近端放置一个加压螺钉。两组的极限失效负荷分别为255.38±155.38 N和197.48±108.61 N (P = .402)。两组之间在失效的极限载荷、结构刚度或失效时的力矩方面没有显著差异。综上所述，在第一跖楔形关节融合术中，内侧应用带足底碎片间螺钉钢板似乎比足底Lapidus钢板更坚固，尽管这种差异没有达到统计学意义。证据等级:V级:生物力学研究
{"title":"Comparison of Locking Plate with Interfragmentary Screw Versus Plantarly Applied Anatomic Locking Plate for Lapidus Arthrodesis: A Biomechanical Cadaveric Study","authors":"James M. Cottom, Joseph S Baker","doi":"10.1177/1938640016676341","DOIUrl":"https://doi.org/10.1177/1938640016676341","url":null,"abstract":"Arthrodesis of the first metatarsal cuneiform joint, or Lapidus procedure, is a widely accepted treatment for hallux valgus. Recent studies have focused on comparing various constructs for this procedure both in the laboratory and clinical settings. The current study compared in a cadaveric model the strength of 2 constructs. The first construct utilized a medially applied low-profile locking plate and an interfragmentary screw directed from plantar-distal to dorsal-proximal. The second construct consisted of a plantarly applied plate with a compression screw placed through the plate from plantar-distal to dorsal-proximal. The ultimate load to failure for the 2 groups tested was 255.38 ± 155.38 N and 197.48 ± 108.61 N, respectively (P = .402). There was no significant difference found between the 2 groups with respect to ultimate load to failure, stiffness of the construct, or moment at time of failure. In conclusion, the medially applied plate with plantar interfragmentary screw appears to be stronger than the plantar Lapidus plate tested for first metatarsal cuneiform arthrodesis, though this difference did not reach statistical significance. Levels of Evidence: Level V: Biomechanical Study","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"227 - 231"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016676341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47478225","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 : 2017-06-01DOI: 10.1177/1938640016675407
R. Bijlani, L. Lomasney, M. Pinzur, Katherine E Dux
Introduction. Although Eichenholtz and the Schon systems are commonly used to evaluate foot Charcot arthropathy on radiographs, a novel system with expanded characterization may have added benefit. Methods. Patients with Charcot arthropathy and foot radiographs were grouped in nonsurgical group 1 (imaging sets at minimum 2-year interval) and surgical group 2 (imaging preceding fusion and/or amputation). Radiographs were scored with Eichenholtz and Schon systems, and a novel scoring system (summation of 0-3 rank for bone density, distention/swelling, debris, disorganization, and dislocation/subluxation). Summative scores of the 2 groups were compared. Differences in scores of each system from serial images of group 1 were compared and average scores from each of the systems for preoperative imaging sets of group 2 were compared. Results. A total of 111 patients were included (group 1, 19 patients; group 2, 92 patients). The novel system provided a broad numerical characterization of the radiographs (range 1-15). Summative scores of the novel system for groups 1 and 2 were statistically different with lower median score in the nonsurgical group (nonsurgical median score 6 vs surgical median score 9). Individual characteristic scores from 4 (distention, debris, disorganization, and dislocation) of 5 categories for the novel system were statistically different, with lower scores for the nonoperative group. The narrower numerical scores from the Eichenholtz and Schon systems did not yield statistically significant results. Conclusion. The novel scoring system provides a broad numerical description of radiographic findings in Charcot arthropathy of the foot and has potential advantage for surgical predictive value. Levels of Evidence: Level IV: Retrospective
{"title":"Examining the Potential Use of a Novel Radiographic Scoring System for Determining Surgical Intervention in Diabetic Charcot Arthropathy","authors":"R. Bijlani, L. Lomasney, M. Pinzur, Katherine E Dux","doi":"10.1177/1938640016675407","DOIUrl":"https://doi.org/10.1177/1938640016675407","url":null,"abstract":"Introduction. Although Eichenholtz and the Schon systems are commonly used to evaluate foot Charcot arthropathy on radiographs, a novel system with expanded characterization may have added benefit. Methods. Patients with Charcot arthropathy and foot radiographs were grouped in nonsurgical group 1 (imaging sets at minimum 2-year interval) and surgical group 2 (imaging preceding fusion and/or amputation). Radiographs were scored with Eichenholtz and Schon systems, and a novel scoring system (summation of 0-3 rank for bone density, distention/swelling, debris, disorganization, and dislocation/subluxation). Summative scores of the 2 groups were compared. Differences in scores of each system from serial images of group 1 were compared and average scores from each of the systems for preoperative imaging sets of group 2 were compared. Results. A total of 111 patients were included (group 1, 19 patients; group 2, 92 patients). The novel system provided a broad numerical characterization of the radiographs (range 1-15). Summative scores of the novel system for groups 1 and 2 were statistically different with lower median score in the nonsurgical group (nonsurgical median score 6 vs surgical median score 9). Individual characteristic scores from 4 (distention, debris, disorganization, and dislocation) of 5 categories for the novel system were statistically different, with lower scores for the nonoperative group. The narrower numerical scores from the Eichenholtz and Schon systems did not yield statistically significant results. Conclusion. The novel scoring system provides a broad numerical description of radiographic findings in Charcot arthropathy of the foot and has potential advantage for surgical predictive value. Levels of Evidence: Level IV: Retrospective","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"198 - 203"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016675407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48310305","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 : 2017-06-01DOI: 10.1177/1938640016670243
Lauren K. Szolomayer, P. Talusan, W. F. Chan, D. Lindskog
Leiomyoma is a benign soft-tissue tumor that can arise in any soft tissue; however, in the extremities, it is usually a subcutaneous mass. Masses in the foot and ankle in general are rare, and few reports in the literature describe leiomyoma in this region of the body. We present a series of 8 cases of leiomyoma of the foot and ankle, 4 of which are subclassified as angioleiomyomas. The characteristic patient presentation, imaging, and histological findings are presented here to increase awareness of this soft-tissue mass in the foot and ankle. Levels of Evidence: Level V
{"title":"Leiomyoma of the Foot and Ankle: A Case Series","authors":"Lauren K. Szolomayer, P. Talusan, W. F. Chan, D. Lindskog","doi":"10.1177/1938640016670243","DOIUrl":"https://doi.org/10.1177/1938640016670243","url":null,"abstract":"Leiomyoma is a benign soft-tissue tumor that can arise in any soft tissue; however, in the extremities, it is usually a subcutaneous mass. Masses in the foot and ankle in general are rare, and few reports in the literature describe leiomyoma in this region of the body. We present a series of 8 cases of leiomyoma of the foot and ankle, 4 of which are subclassified as angioleiomyomas. The characteristic patient presentation, imaging, and histological findings are presented here to increase awareness of this soft-tissue mass in the foot and ankle. Levels of Evidence: Level V","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"270 - 273"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016670243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42643682","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 : 2017-06-01DOI: 10.1177/1938640016679707
Zachary M. Thomas, K. K. Thomas
Two-incision endoscopic plantar fasciotomy (EPF) is an accepted surgical technique in the treatment of recalcitrant plantar fasciitis. Single-incision plantar fasciotomy is a relatively new technique in the surgeons’ armamentarium; however, it is not without pitfalls, specifically poor visualization. This article aims to help the foot and ankle surgeon make a smooth transition from 2-incision EPF to single-incision EPF while maintaining optimum visualization. Levels of Evidence: Level V: Expert opinion
{"title":"Technique Tip: Single-Incision Endoscopic Plantar Fasciotomy","authors":"Zachary M. Thomas, K. K. Thomas","doi":"10.1177/1938640016679707","DOIUrl":"https://doi.org/10.1177/1938640016679707","url":null,"abstract":"Two-incision endoscopic plantar fasciotomy (EPF) is an accepted surgical technique in the treatment of recalcitrant plantar fasciitis. Single-incision plantar fasciotomy is a relatively new technique in the surgeons’ armamentarium; however, it is not without pitfalls, specifically poor visualization. This article aims to help the foot and ankle surgeon make a smooth transition from 2-incision EPF to single-incision EPF while maintaining optimum visualization. Levels of Evidence: Level V: Expert opinion","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"240 - 241"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016679707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42743329","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}
We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 (P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment (P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 (P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. Levels of Evidence: Level II: Therapeutic study
{"title":"Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis","authors":"Fırat Ozan, Şemmi Koyuncu, Kaan Gürbüz, Eyyüp Sabri Öncel, T. Altay","doi":"10.1177/1938640016675408","DOIUrl":"https://doi.org/10.1177/1938640016675408","url":null,"abstract":"We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 (P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment (P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 (P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. Levels of Evidence: Level II: Therapeutic study","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"204 - 209"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016675408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43622488","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 : 2017-06-01DOI: 10.1177/1938640016685153
Kempland C. Walley, K. Hofmann, Brian T. Velasco, J. Kwon
Background. While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries. Methods. The Cochrane Library and PubMed Medline databases were explored using search terms for syndesmosis and screw removal between October 1, 2010 and June 1, 2016. Results. A total of 9 studies (1 randomized controlled trial and 8 retrospective cohort studies) were found that described the outcomes of either retained or removed syndesmotic screws. Overall, there was no difference in functional, clinical or radiographic outcomes in patients who had their syndesmotic screw removed. There was a higher likelihood of recurrent syndesmotic diastasis when screws were removed between 6 and 8 weeks. There was a higher rate of postoperative infections when syndesmotic screws were removed without administering preoperative antibiotics. Conclusion. Removal of syndesmotic screws is advisable mainly in cases of patient complaints related to the other implanted perimalleolar hardware or malreduction of the syndesmosis after at least 8 weeks postoperatively. Broken or loose screws should not be removed routinely unless causing symptoms. Antibiotic prophylaxis is recommended on removal. Radiographs should be routinely obtained immediately prior to removal and formal discussions should be had with patients prior to surgery to discuss management options if a broken screw is unexpectedly encountered intraoperatively. Radiographs and/or computed tomography imaging should be obtained after syndesmotic screw removal when indicated for known syndesmotic malreduction. Levels of Evidence: Level IV: Systematic review
{"title":"Removal of Hardware After Syndesmotic Screw Fixation: A Systematic Literature Review","authors":"Kempland C. Walley, K. Hofmann, Brian T. Velasco, J. Kwon","doi":"10.1177/1938640016685153","DOIUrl":"https://doi.org/10.1177/1938640016685153","url":null,"abstract":"Background. While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries. Methods. The Cochrane Library and PubMed Medline databases were explored using search terms for syndesmosis and screw removal between October 1, 2010 and June 1, 2016. Results. A total of 9 studies (1 randomized controlled trial and 8 retrospective cohort studies) were found that described the outcomes of either retained or removed syndesmotic screws. Overall, there was no difference in functional, clinical or radiographic outcomes in patients who had their syndesmotic screw removed. There was a higher likelihood of recurrent syndesmotic diastasis when screws were removed between 6 and 8 weeks. There was a higher rate of postoperative infections when syndesmotic screws were removed without administering preoperative antibiotics. Conclusion. Removal of syndesmotic screws is advisable mainly in cases of patient complaints related to the other implanted perimalleolar hardware or malreduction of the syndesmosis after at least 8 weeks postoperatively. Broken or loose screws should not be removed routinely unless causing symptoms. Antibiotic prophylaxis is recommended on removal. Radiographs should be routinely obtained immediately prior to removal and formal discussions should be had with patients prior to surgery to discuss management options if a broken screw is unexpectedly encountered intraoperatively. Radiographs and/or computed tomography imaging should be obtained after syndesmotic screw removal when indicated for known syndesmotic malreduction. Levels of Evidence: Level IV: Systematic review","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"252 - 257"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016685153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45137405","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 : 2017-04-01DOI: 10.1177/1938640016666924
J. Orr, J. Dunn, Kenneth A. Heida, N. Kusnezov, B. Waterman, P. Belmont
Introduction. Structural fresh osteochondral allograft transfer is an appropriate treatment option for large osteochondral lesions of the talus (OLTs), specifically lesions involving the shoulder of the talus. Sparse literature exists regarding functional outcome following this surgery in high-demand populations. Materials and Methods. Over a 2-year period, a single surgeon performed 8 structural allograft transfers for treatment of large OLTs in an active duty US military population. Lesion morphology and magnetic resonance imaging (MRI) stage were recorded. Preoperative and latest postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and pain visual analog scores were compared. Results. Eight male service members with mean age 34.4 years underwent structural allograft transfer for OLTs with mean MRI stage of 4.9 and a mean lesion volume of 2247.1 mm3. Preoperative mean AOFAS hindfoot-ankle score was 49.6, and mean pain visual analog score was 6.9. At mean follow-up of 28.5 months, postoperative mean AOFAS score was 73, and mean pain visual analog score was 4.5, representing overall improvements of 47% and 35%, respectively. Three patients were considered treatment failures secondary to continued ankle disability (2) or graft resorption requiring ankle arthrodesis. Conclusions. Despite modest improvements in short-term functional outcome scores, large osteochondral lesions requiring structural allograft transfer remain difficult to treat, particularly in high-demand patient populations. Surgeons should counsel patients preoperatively on realistic expectations for return to function following structural allograft transfer procedures. Levels of Evidence: Level IV: Retrospective study
{"title":"Results and Functional Outcomes of Structural Fresh Osteochondral Allograft Transfer for Treatment of Osteochondral Lesions of the Talus in a Highly Active Population","authors":"J. Orr, J. Dunn, Kenneth A. Heida, N. Kusnezov, B. Waterman, P. Belmont","doi":"10.1177/1938640016666924","DOIUrl":"https://doi.org/10.1177/1938640016666924","url":null,"abstract":"Introduction. Structural fresh osteochondral allograft transfer is an appropriate treatment option for large osteochondral lesions of the talus (OLTs), specifically lesions involving the shoulder of the talus. Sparse literature exists regarding functional outcome following this surgery in high-demand populations. Materials and Methods. Over a 2-year period, a single surgeon performed 8 structural allograft transfers for treatment of large OLTs in an active duty US military population. Lesion morphology and magnetic resonance imaging (MRI) stage were recorded. Preoperative and latest postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and pain visual analog scores were compared. Results. Eight male service members with mean age 34.4 years underwent structural allograft transfer for OLTs with mean MRI stage of 4.9 and a mean lesion volume of 2247.1 mm3. Preoperative mean AOFAS hindfoot-ankle score was 49.6, and mean pain visual analog score was 6.9. At mean follow-up of 28.5 months, postoperative mean AOFAS score was 73, and mean pain visual analog score was 4.5, representing overall improvements of 47% and 35%, respectively. Three patients were considered treatment failures secondary to continued ankle disability (2) or graft resorption requiring ankle arthrodesis. Conclusions. Despite modest improvements in short-term functional outcome scores, large osteochondral lesions requiring structural allograft transfer remain difficult to treat, particularly in high-demand patient populations. Surgeons should counsel patients preoperatively on realistic expectations for return to function following structural allograft transfer procedures. Levels of Evidence: Level IV: Retrospective study","PeriodicalId":39271,"journal":{"name":"Foot and Ankle Specialist","volume":"10 1","pages":"125 - 132"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1938640016666924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42417800","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}
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