Foot and Ankle Surgery最新文献_第3页

Letter to the editor to comment on “Diagnostic accuracy of 99mTc-HDP SPECT/CT and MRI for foot and ankle osteoarthritis (ProSPECT-trial): Study protocol” 致编辑评论“99mTc-HDP SPECT/CT和MRI对足部和踝关节骨关节炎的诊断准确性（前瞻性试验）：研究方案”。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-09-06 DOI: 10.1016/j.fas.2025.07.007

Parth Aphale , Himanshu Shekhar , Shashank Dokania

引用次数: 0

Acute Achilles tendon rupture and chronic tendinopathy surgery: Same tendon, with sex and ethnicity differences 急性跟腱断裂和慢性肌腱病变手术：同一肌腱，性别和种族差异。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-09-07 DOI: 10.1016/j.fas.2025.08.007

Tara Saxena , Amol Saxena , Miranda Royds , Nicola Maffulli

Background

Although differences in Achilles tendon injuries have been described based on sex and ethnicity, their impact on surgical presentation patterns and outcomes remains underreported. This study aims to compare demographics and complications between patients who underwent surgery for acute Achilles tendon rupture with those for chronic tendinopathy. All patients were operated by a single surgeon in a metropolitan region in the western United States between June 2016 and June 2022.

Methods

A retrospective review of a prospectively collected data was conducted. Data included age, sex, ethnicity, surgical indication, return to activity (RTA), and complications (re-rupture, infection, suture reaction, venous thromboembolism). Statistical analyses included Student’s t-test and Fisher’s exact/Chi-square test, with a significance set at P < .05.

Results

A total of 186 patients (121 males, 65 females; mean age: 47.5 ± 14.6 years) were included. Males were significantly more likely to undergo surgery for acute Achilles tendon repair (93 males, 5 females; P < .0001). Females were more likely to undergo surgery for chronic Achilles tendon pathology (76 %). There were no significant sex-based differences in complications or return to activity. There were variations in ethnicity, with Asian patients having a higher likelihood of acute tendon repair (87 %) whereas White patients were more likely to undergo surgical intervention for chronic tendinopathy (89 %; P < .00001).

Conclusion

Males were significantly more likely to have operative intervention for acute Achilles rupture, while females more often underwent surgery for chronic tendinopathy. There were ethnic differences in presentation patterns. Complication rate postoperatively and return to activity following surgical intervention did not vary between sex or ethnicity.

Level of evidence

III; Retrospective comparative study

背景：虽然根据性别和种族描述了跟腱损伤的差异，但其对手术表现模式和结果的影响仍未得到充分报道。本研究旨在比较急性跟腱断裂和慢性跟腱病变手术患者的人口统计学特征和并发症。所有患者在2016年6月至2022年6月期间由美国西部大都市地区的一名外科医生进行手术。方法：对前瞻性收集的资料进行回顾性分析。数据包括年龄、性别、种族、手术指征、恢复活动（RTA）和并发症（再破裂、感染、缝合反应、静脉血栓栓塞）。结果：共纳入186例患者，其中男性121例，女性65例，平均年龄47.5 ± 14.6岁。男性因急性跟腱断裂接受手术治疗的可能性显著高于女性(男性93例，女性5例；P 结论：男性因急性跟腱断裂接受手术干预的可能性显著高于女性因慢性肌腱病变接受手术治疗的可能性。呈现模式存在种族差异。术后并发症发生率和手术干预后的活动恢复率在性别和种族之间没有差异。证据等级：III；回顾性比较研究。

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引用次数: 0

Minimally invasive and open posterior calcaneal displacement osteotomy for pediatric hindfoot deformity: A comparative study 微创与开放式跟骨后移位截骨治疗小儿后足畸形的比较研究。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-19 DOI: 10.1016/j.fas.2025.08.004

Madeleine Willegger , Caroline Cristofaro , Maryse Bouchard

Background

Minimally invasive posterior displacement calcaneal osteotomy (PDCO) is often used in hindfoot deformity correction in the adult population, but there is a paucity on its use in children. The aim of this study was to compare the clinical and radiographic outcomes of open versus minimally invasive PDCO (MI-PDCO) approach in children.

Methods

This is a consecutive series of PCDOs performed as a component of a complex foot and ankle reconstruction.

Results

Twenty-nine calcaneal osteotomies in 23 patients aged 13.0 ± 3.0 years were included. Eleven osteotomies were performed open (O-PDCO) and 18 MI-PDCO. Mean follow-up was 35.4 ± 19.1 months. No delayed union, non-union, or apophyseal growth disturbance was observed. Seven nerve paresthesias were observed, two in the O-PDCO (18.1 %) and five in the MI-PDCO (27.7 %) group, all improved.

Conclusion

These results support MI-PDCO as a safe and effective alternative technique to conventional O-PDCO to correct pediatric hindfoot deformities.

Level of Clinical Evidence

Level 3 (retrospective comparative study)

背景：微创后路跟骨截骨术（PDCO）常用于成人后足畸形矫正，但在儿童中应用较少。本研究的目的是比较开放式与微创PDCO入路（MI-PDCO）在儿童中的临床和影像学结果。方法：这是一个连续的系列pcdo作为复杂的足和踝关节重建的组成部分。结果：23例患者，年龄13.0 ± 3.0岁，共29例截骨。11例为开腹截骨术（O-PDCO）， 18例为MI-PDCO。平均随访35.4 ± 19.1个月。未观察到延迟愈合、不愈合或突起生长障碍。观察到7例神经感觉异常，O-PDCO组2例（18.1 %），MI-PDCO组5例（27.7 %），均有改善。结论：这些结果支持MI-PDCO是一种安全有效的替代传统O-PDCO的方法来矫正儿童后足畸形。临床证据等级：3级（回顾性比较研究）。

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引用次数: 0

Advancing diagnostics: A systematic review and meta-analysis of conventional and weight-bearing CT in lisfranc injuries 推进诊断：常规和负重CT在lisfranc损伤中的系统回顾和荟萃分析。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-09-03 DOI: 10.1016/j.fas.2025.08.009

Alejandro Lorente Gómez , Marcela Gómez Cuenca , Carmen Victoria Rojas Moreno , Pablo Palacios Cabezas , Gonzalo Mariscal , Ibrahim Khalil , Rafael Lorente Moreno , Leire Pelaz Berdullas

Objective

This systematic review and meta-analysis evaluated the diagnostic accuracy of conventional computed tomography (CT) and weight-bearing computed tomography (WBCT) in assessing Lisfranc injuries, comparing their sensitivity, specificity, and reliability for detecting structural abnormalities between injured and uninjured cases.

Methods

A systematic search of PubMed, Scopus, WOS, and Medline databases identified 736 articles, of which 16 studies met the inclusion criteria. Seven studies were included in the meta-analysis. The analysis examined measurements such as M1-M2 and M2-C1 base distances, TMT1 and TMT2 dorsal step-offs, axial joint area and volume, and alignment parameters. Subgroup analyses compared conventional CT and WBCT methods.

Results

The injured group showed significantly greater M1-M2 and M2-C1 Base Distances than the uninjured group (M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm; p-value < 0.0001), with no significant differences between imaging modalities. The injured group had greater TMT2 dorsal step-offs (MD = 0.81 mm; p < 0.001), while TMT1 dorsal step-off differences varied between modalities. Injured joints demonstrated significantly larger Axial Joint Area and Volume (MD = 16.26 mm²) and volumes (MD = 189.1 mm³; p < 0.0001). Additionally, WBCT demonstrated high sensitivity and specificity for Lisfranc injuries, particularly for parameters like axial joint volume (AUC = 0.91). Conventional CT showed variable diagnostic performance, with sensitivity and specificity ranging from 69 % to 97.9 % and 39.3–100 %, respectively. The "Mercedes sign" (a three-pointed star appearance on axial CT indicating C1-M2 diastasis) and "Peeking cuneiform sign" (visible medial cuneiform between first and second metatarsals on AP view) showed over 92 % sensitivity and specificity.

Conclusions

Both conventional CT and WBCT effectively identify Lisfranc injuries when comparing injured and uninjured cases, with WBCT demonstrating superior sensitivity, specificity, and diagnostic accuracy in certain parameters. Conventional CT remains reliable but exhibits variability in specific assessments. Future research should focus on standardizing imaging protocols and refining diagnostic thresholds to enhance consistency and accuracy.

目的：本系统综述和荟萃分析评估了常规计算机断层扫描（CT）和负重计算机断层扫描（WBCT）在评估Lisfranc损伤中的诊断准确性，比较了它们在检测损伤和未损伤病例之间结构异常的敏感性、特异性和可靠性。方法：系统检索PubMed、Scopus、WOS和Medline数据库，共检索到736篇文献，其中16篇符合纳入标准。meta分析纳入了7项研究。分析检查了诸如M1-M2和M2-C1基距、TMT1和TMT2背侧台阶、轴向关节面积和体积以及对准参数等测量值。亚组分析比较了常规CT和WBCT方法。结果：损伤组M1-M2、M2-C1基底距离明显大于未损伤组（M1-M2: MD = 0.88 mm; M2-C1: MD = 2.61 mm； p值< 0.0001），影像学差异无统计学意义。结论：常规CT和WBCT在比较损伤和未损伤病例时均能有效识别Lisfranc损伤，WBCT在某些参数上表现出更高的敏感性、特异性和诊断准确性。常规CT仍然可靠，但在具体评估中表现出差异。未来的研究应侧重于标准化成像方案和细化诊断阈值，以提高一致性和准确性。

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引用次数: 0

Functional outcome and complications after surgical treatment of acute navicular fractures 急性舟骨骨折手术治疗后的功能结局及并发症。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-19 DOI: 10.1016/j.fas.2025.08.003

Esmee W.M. Engelmann , Jelle Posthuma , J.C. Goslings , Jens A. Halm , Tim Schepers

Background

Long-term functional outcome and complications following ORIF (Open Reduction Internal Fixation) for acute navicular fractures remain insufficiently investigated. This study aimed to evaluate functional outcome, complications, quality of life, and patient satisfaction after surgical treatment of acute navicular fractures.

Methods

This retrospective study was conducted at a level 1 trauma center, reviewing patients > 17 years with navicular fractures operated between 2010 and 2023. Functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, the Foot Function Index (FFI), and EQ-5D quality of life questionnaire. Complications, such as nonunion, infection and secondary arthrodesis were recorded. A systematic literature review of studies published between 2000 and 2024 was performed.

Results

The cohort included 24 females and 22 males with a median age of 35.9 years and mean follow-up of 69.0 (SD 42.6) months. The majority of patients (n = 44) underwent ORIF, union occurred in 43 patients, three patients had postoperative infection and five patients required secondary arthrodesis. Functional outcome was good (median AOFAS 80.0, median FFI 21.0).

Conclusions

Surgical treatment of acute navicular fractures, primarily ORIF using miniplate fixation, resulted in successful union with overall good functional outcome. Nevertheless, residual problems such as painful osteoarthritis and functional limitations, especially in type 2 and 3 injuries, could be expected.

Level of Evidence

III

背景：ORIF（切开复位内固定）治疗急性舟骨骨折的长期功能结局和并发症的研究尚不充分。本研究旨在评估急性舟骨骨折手术治疗后的功能结局、并发症、生活质量和患者满意度。方法：本回顾性研究在一家一级创伤中心进行，回顾了2010年至2023年间17例舟骨骨折患者> 。功能结局采用美国骨科足踝学会（AOFAS）足中部评分、足功能指数（FFI）和EQ-5D生活质量问卷进行评估。并发症，如不愈合，感染和继发性关节融合术被记录。对2000年至2024年间发表的研究进行了系统的文献综述。结果：该队列包括24名女性和22名男性，中位年龄35.9岁，平均随访69.0 （SD 42.6）个月。大多数患者（n = 44）接受了ORIF， 43例患者愈合，3例患者发生术后感染，5例患者需要二次关节融合术。功能结局良好（中位AOFAS为80.0，中位FFI为21.0）。结论：急性舟骨骨折的外科治疗，主要是ORIF应用微型钢板固定，成功愈合，整体功能预后良好。然而，残留的问题，如疼痛的骨关节炎和功能限制，特别是在2型和3型损伤中，是可以预期的。证据水平：III。

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引用次数: 0

Use of bony landmarks for more accurate tibiofibular syndesmotic fixation: Validity and safety analysis of the angle bisector method 使用骨标记进行更精确的胫腓联合固定：角度平分线法的有效性和安全性分析。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-08-19 DOI: 10.1016/j.fas.2025.08.005

Bedri Karaismailoglu , Julian J. Hollander , Jiyong Ahn , Matthias Peiffer , Siddhartha Sharma , Gregory R. Waryasz , Christopher W. DiGiovanni , Soheil Ashkani-Esfahani

Background and Aims

The Angle Bisector Method uses the cortices of the tibia and fibula as reference points and suggests a syndesmotic fixation trajectory through the bisector of the angle formed by two lines tangent to the anterior and posterior aspects of the tibia and fibula. This study aimed to assess whether the Angle Bisector Method can provide a patient- and level-specific syndesmotic fixation angle that is reproducible, safe, and independent of the surgeon in a cadaveric setting.

Methods

Twelve matched above-knee leg specimens from six cadavers, underwent syndesmotic fixation (using either screws or suture-buttons) at two levels—2 cm and 3.5 cm proximal to the tibial plafond. The fixations were carried out using the angle bisector method by two surgeons employing an open lateral approach. Subsequently, CT images of the cadavers were obtained. The angle between the true centroidal axis and the axis of the syndesmotic implant trajectory was measured using radiological software. Additionally, distances between fibular entry points of the centroidal axis and the implant trajectory were measured. Distances between the positioned K-wires and major neurovascular structures were measured on cadaver dissections, and any resultant damage was documented.

Results

The average angle between the centroidal axis and screw trajectory was 2.7 ± 2.9 degrees at the 2 cm level and 1.8 ± 2.5 degrees at the 3.5 cm level. The average distance between the fibular entry points of the centroidal axis and the screw was 1.7 ± 1.2 mm at the 2 cm level and 1.2 ± 1.0 mm at the 3.5 cm level. The results demonstrated low inter-surgeon variability and high intra- and inter-observer reliability (ICC>0.80). The distance between the placed K-wires and major neurovascular structures was always higher than 5 mm, affirming the safety of the technique.

Conclusion

Our data suggests that the angle bisector method can provide a reliable trajectory for syndesmotic fixation and may be safely used in surgical procedures. This approach can be applied with K-wires or a specially designed jig to facilitate syndesmotic fixation.

背景和目的：角度平分线法以胫骨和腓骨皮质为参照点，建议通过胫骨和腓骨前后切线形成的角平分线形成的关节联合固定轨迹。本研究旨在评估角平分法是否可以提供一个可重复、安全且独立于外科医生的患者和水平特异性关节联合固定角度。方法：来自6具尸体的12个匹配的膝上腿标本，在胫骨平台近端2 cm和3.5 cm两个水平进行韧带联合固定（使用螺钉或缝合按钮）。两名外科医生采用开放外侧入路，采用角平分线法进行固定。随后，获得了尸体的CT图像。使用放射学软件测量真质心轴与关节联合种植体轨迹轴线之间的夹角。此外，测量腓骨进入点的质心轴和植入物轨迹之间的距离。在尸体解剖上测量定位k针与主要神经血管结构之间的距离，并记录任何由此产生的损伤。结果：质心轴与螺钉轨迹的平均夹角在2 cm处为2.7 ± 2.9度，在3.5 cm处为1.8 ± 2.5度。在2 cm水平腓骨入路点与螺钉的平均距离为1.7 ± 1.2 mm，在3.5 cm水平处为1.2 ± 1.0 mm。结果显示低外科医生之间的可变性和高内部和观察者之间的可靠性（ICC>0.80）。放置的k线与主要神经血管结构的距离均大于5 mm，证实了该技术的安全性。结论：我们的数据表明，角平分线法可以提供可靠的关节联合固定轨迹，并且可以安全地用于外科手术。该方法可与k形针或特殊设计的夹具配合使用，以促进关节联合固定。

{"title":"Use of bony landmarks for more accurate tibiofibular syndesmotic fixation: Validity and safety analysis of the angle bisector method","authors":"Bedri Karaismailoglu , Julian J. Hollander , Jiyong Ahn , Matthias Peiffer , Siddhartha Sharma , Gregory R. Waryasz , Christopher W. DiGiovanni , Soheil Ashkani-Esfahani","doi":"10.1016/j.fas.2025.08.005","DOIUrl":"10.1016/j.fas.2025.08.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The Angle Bisector Method uses the cortices of the tibia and fibula as reference points and suggests a syndesmotic fixation trajectory through the bisector of the angle formed by two lines tangent to the anterior and posterior aspects of the tibia and fibula. This study aimed to assess whether the Angle Bisector Method can provide a patient- and level-specific syndesmotic fixation angle that is reproducible, safe, and independent of the surgeon in a cadaveric setting.</div></div><div><h3>Methods</h3><div>Twelve matched above-knee leg specimens from six cadavers, underwent syndesmotic fixation (using either screws or suture-buttons) at two levels—2 cm and 3.5 cm proximal to the tibial plafond. The fixations were carried out using the angle bisector method by two surgeons employing an open lateral approach. Subsequently, CT images of the cadavers were obtained. The angle between the true centroidal axis and the axis of the syndesmotic implant trajectory was measured using radiological software. Additionally, distances between fibular entry points of the centroidal axis and the implant trajectory were measured. Distances between the positioned K-wires and major neurovascular structures were measured on cadaver dissections, and any resultant damage was documented.</div></div><div><h3>Results</h3><div>The average angle between the centroidal axis and screw trajectory was 2.7 ± 2.9 degrees at the 2 cm level and 1.8 ± 2.5 degrees at the 3.5 cm level. The average distance between the fibular entry points of the centroidal axis and the screw was 1.7 ± 1.2 mm at the 2 cm level and 1.2 ± 1.0 mm at the 3.5 cm level. The results demonstrated low inter-surgeon variability and high intra- and inter-observer reliability (ICC>0.80). The distance between the placed K-wires and major neurovascular structures was always higher than 5 mm, affirming the safety of the technique.</div></div><div><h3>Conclusion</h3><div>Our data suggests that the angle bisector method can provide a reliable trajectory for syndesmotic fixation and may be safely used in surgical procedures. This approach can be applied with K-wires or a specially designed jig to facilitate syndesmotic fixation.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"32 2","pages":"Pages 170-175"},"PeriodicalIF":2.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Abnormal axial rotation of the Talus on weight-bearing computed tomography in patients with micro-instability of the ankle 踝关节微不稳定患者负重ct显示距骨轴向旋转异常。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-02-01 Epub Date: 2025-07-31 DOI: 10.1016/j.fas.2025.07.006

Ben Efrima , Agustin Barbero , Assaf Albsagly , Amit Benady , Cristian Indino , Camila Maccario , Federico Giuseppe Usuelli

Background

While diagnosing mechanical chronic ankle instability (CAI) is often straightforward, identifying subtle micro-instability remains challenging. A tear of the superior bundle of the lateral ligament complex has been proposed as a contributor to micro-instability, potentially causing increased anterior translation and internal talar rotation under load. Weight-bearing computed tomography (WBCT) offers valuable insight into hindfoot alignment and load-induced deformation, making it a promising tool for assessing suspected micro-instability. This study aims to compare talar axial rotation between symptomatic patients reporting subjective micro-instability and asymptomatic controls.

Methods

Forty ankles from patients with osteochondral lesions of the talus (OLT) and signs of micro-instability were compared to asymptomatic controls. WBCT and image analysis software were used to generate 3D models and perform semi-automated hindfoot alignment measurements. Inter- and intra-observer reliability was also assessed.

Results

The OLT group showed a mean axial rotation difference of −4.5 ± 4.5 degrees compared to controls (P < 0.001), indicating increased external rotation of the talus. Intra-observer reliability was good to excellent (ICC 0.88, 0.92), and inter-observer agreement was excellent (ICC 0.93, 0.90).

Conclusion

WBCT did not reveal abnormal internal rotation in OLT patients with subjective micro-instability. Instead, significant external rotation of the talus was observed. These findings suggest that external rotation may predispose patients to micro-instability. Further studies are needed to clarify its role in functional ankle instability

Level of evidence

III

背景：虽然诊断机械性慢性踝关节不稳定（CAI）通常很简单，但识别细微的微不稳定仍然具有挑战性。外侧韧带复合体上束撕裂被认为是微不稳定的一个因素，可能导致负重下前平移和距内旋转增加。负重计算机断层扫描（WBCT）提供了对后足对齐和载荷引起的变形的宝贵见解，使其成为评估可疑微不稳定的有前途的工具。本研究旨在比较主观微不稳定的有症状患者和无症状对照组的距骨轴向旋转。方法：选取距骨软骨病变（OLT）患者40例踝关节，并与无症状对照组进行比较。使用WBCT和图像分析软件生成三维模型，并进行半自动后足对准测量。还评估了观察者之间和观察者内部的可靠性。结果：与对照组相比，OLT组的平均轴向旋转差值为-4.5 ± 4.5度（P ）结论：WBCT未显示OLT患者主观微不稳定的异常内旋转。相反，观察到距骨明显外旋。这些发现表明，外旋可能使患者易发生微不稳定。需要进一步的研究来阐明其在功能性踝关节不稳定中的作用。

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引用次数: 0

Analysis of risk factors for sagittal plane malpositioning during primary ankle arthrodesis. 原发性踝关节融合术中矢状面错位的危险因素分析。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-01-29 DOI: 10.1016/j.fas.2026.01.013

Yongxing Cao, Changjun Guo, Yang Xu, Chonglin Yang, Yuan Zhu, Xiangyang Xu

Objective: This study aimed to identify specific risk factors for sagittal plane malpositioning following primary ankle arthrodesis in patients with end-stage ankle joint diseases.

Methods: A retrospective cohort analysis was conducted on 166 patients who underwent primary ankle arthrodesis between January 2010 and December 2019. Sagittal plane malpositioning was defined as postoperative talar anterior translation > 5 mm or sagittal plane angulation > 10° on lateral radiographs. Potential risk factors analyzed included age, gender, affected side, primary disease, preoperative alignment, surgical approach combined with fixation system, concomitant procedures, and surgeon experience. Binary logistic regression was used to evaluate associations with postoperative malpositioning.

Results: The incidence of sagittal plane malpositioning was 16.3 % (27/166). Preoperative pes equinus and/or anterior talar subluxation (OR = 6.887, 95 % CI: 1.375-34.50, p = 0.019) and surgery performed by mid-senior surgeons (vs. senior surgeons; OR = 3.210, 95 % CI: 1.039-9.919, p = 0.043) were significant risk factors. Compared with the anterior approach + cannulated screws, the lateral approach + lateral plate plus cannulated screws was associated with a lower risk (OR = 0.105, 95 % CI: 0.012-0.953, p = 0.045). No significant associations were found with gender, age, affected side, primary disease, preoperative anteroposterior alignment, or concomitant subtalar arthrodesis.

Conclusion: Preoperative sagittal deformities, use of the anterior approach with cannulated screws alone, and less experienced surgeons increase the risk of sagittal malpositioning after primary ankle arthrodesis. The lateral approach with lateral plate fixation may reduce this risk. Thorough preoperative planning, appropriate surgical technique selection, and surgeon training are crucial to improving outcomes.

Level of evidence: Ⅲ, Retrospective Comparative Study.

目的：本研究旨在确定终末期踝关节疾病患者原发性踝关节融合术后矢状面错位的具体危险因素。方法：对2010年1月至2019年12月接受原发性踝关节融合术的166例患者进行回顾性队列分析。矢状面错位定义为术后距前平移> 5 mm或侧位片矢状面角度> 10°。分析的潜在危险因素包括年龄、性别、患侧、原发疾病、术前对齐、手术入路联合固定系统、伴随手术和外科医生经验。使用二元逻辑回归来评估与术后错位的关系。结果：矢状面错位发生率为16.3 %（27/166）。术前马足和/或距前半脱位（or = 6.887, 95 % CI: 1.375-34.50, p = 0.019）和中高级外科医生的手术（or = 3.210, 95 % CI: 1.039-9.919, p = 0.043）是显著的危险因素。与前路入路+ 空心螺钉相比，外侧入路+ 外侧钢板+空心螺钉的风险较低（OR = 0.105, 95 % CI: 0.012-0.953, p = 0.045）。未发现与性别、年龄、受病侧、原发疾病、术前前后位对齐或伴发距下关节融合术有显著相关性。结论：术前矢状位畸形、单纯使用前路空心螺钉和经验不足的外科医生增加了原发性踝关节融合术后矢状位错位的风险。外侧入路加外侧钢板固定可降低这种风险。彻底的术前计划、适当的手术技术选择和外科医生培训是改善预后的关键。证据级别：Ⅲ，回顾性比较研究。

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引用次数: 0

Is arthroscopically-assisted reduction and internal fixation (ARIF) superior to percutaneous fixation in talar neck fractures? A proportional meta-analysis. 关节镜辅助复位内固定（ARIF）是否优于距颈骨折经皮内固定？比例荟萃分析。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-01-29 DOI: 10.1016/j.fas.2026.01.012

Antonio Izzo, Claudia Carbone, Vincenzo de Matteo, Michela Saracco, Sara Rosito, Berardino Petrocelli, Luigi Mastrogiacomo, Paolo Magliulo, Alessio Bernasconi

Introduction: Arthroscopically assisted Reduction and Internal Fixation (ARIF) to fix talar neck fractures is progressively gaining popularity. Our aim was to determine if ARIF in this setting might increase the healing rate and reduce the number of complications as compared to percutaneous fixation (PF) alone.

Methods: As per PRISMA guidelines, multiple databases (Scopus, Pubmed, Web of Science and Cochrane) were used to retrieve studies reporting on patients diagnosed with a fracture of the talar neck undergone minimally invasive surgery using screws as exclusive fixation method. Data were recorded regarding the design of the study, the cohort, the surgical technique and the outcome achieved (clinical scores and complication rate) with the longest possible follow-up. The methodological quality of studies was evaluated using the MINORS (methodological items for non-randomized studies). Results after ARIF and PF were compared.

Results: Six studies were selected (ARIF=11 cases, 2 studies; PF=51 cases, 4 studies). In the two groups, the mean sample size (p = 0.88) and the mean age of patients (p = 0.24) were comparable. Patients were mostly males in the percutaneous fixation group (M/F: 36/15) and mostly females in the ARIF group (M/F: 4/7). The mean follow-up in the ARIF group was 16 months (range, 12-18) and 31 months in the percutaneous fixation group (range, 20-48), but the difference was not significant (p = 0.09). In both groups radiographic healing was achieved in all patients. The pooled complication rate was significantly different in the ARIF group (1 %) as compared to the PF group (19 %; p = 0.04). The incidence of early (before 48 months) peri-talar osteoarthritis was significantly lower in ARIF (0 %) as compared to PF (11 %; p = 0.04). The quality of studies was poor in the ARIF group and moderate in the PF group.

Conclusions: In this review based on small-sample studies, we found a similar radiographic healing rate in talar neck fractures treated percutaneously using screws with or without arthroscopy. Arthroscopic assistance allowed to reduce the incidence of complications, and specifically of early (before 48 months) peri-talar osteoarthritis. Larger studies are needed to confirm or disprove these findings.

Level of evidence: level IV, systematic review of level I to IV studies.

关节镜下辅助复位内固定（ARIF）治疗距颈骨折越来越受欢迎。我们的目的是确定在这种情况下，与单独经皮固定（PF）相比，ARIF是否可以提高治愈率并减少并发症的数量。方法：根据PRISMA指南，使用多个数据库（Scopus、Pubmed、Web of Science和Cochrane）检索诊断为距颈骨折的患者采用螺钉作为唯一固定方法进行微创手术的研究。记录有关研究设计、队列、手术技术和获得的结果（临床评分和并发症发生率）以及尽可能长时间随访的数据。使用未成年人（非随机研究的方法学项目）评估研究的方法学质量。ARIF和PF后的结果比较。结果：共纳入6项研究（ARIF=11例，2项研究；PF=51例，4项研究）。两组患者的平均样本量（p = 0.88）和平均年龄（p = 0.24）具有可比性。经皮固定组患者多为男性（M/F: 36/15）， ARIF组患者多为女性（M/F: 4/7）。ARIF组平均随访16个月（范围12 ~ 18个月），经皮固定组平均随访31个月（范围20 ~ 48个月），差异无统计学意义（p = 0.09）。两组患者均获得x线摄影治疗。与PF组（19 %;p = 0.04）相比，ARIF组的合并并发症发生率（1 %）有显著差异。ARIF患者早期（48个月前）距骨周围骨关节炎的发生率（0 %）明显低于PF患者（11 %;p = 0.04）。ARIF组的研究质量较差，PF组的研究质量中等。结论：在这篇基于小样本研究的综述中，我们发现距颈骨折经皮螺钉伴或不伴关节镜治疗的x线片治愈率相似。关节镜辅助可以减少并发症的发生率，特别是早期（48个月前）距骨周围骨关节炎。需要更大规模的研究来证实或反驳这些发现。证据等级：四级，对一级至四级研究的系统评价。

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引用次数: 0

Branches of the tibial nerve in the foot of fetal cadavers. 胎儿尸体足部的胫神经分支。

IF 2 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2026-01-23 DOI: 10.1016/j.fas.2026.01.011

Yadigar Kastamoni, Hanife Ertürk, Kenan Öztürk, İhsan Hız, Soner Albay

Background: This study aims to investigate the course, branching, and variations of the tibial nerve from the level of the ankle.

Methods: A total of 116 feet from 58 fetal cadavers were dissected and examined.

Results: It was observed that the bifurcation of the tibial nerve was located within the tarsal tunnel in all cases. Examination of the tibial nerve bifurcations revealed that the bifurcation was most frequently located proximal to the medial malleolus-calcaneal axis. The medial calcaneal nerve was classified into six distinct types, with Type 2 representing the most prevalent pattern, observed in 39.7 % of the specimens. The anastomosis between the medial and lateral plantar nerves was categorized into four types, among which Type 1 was the most common, occurring in 81.89 % of the cases.

Conclusions: This study will provide significant information for anatomists and clinicians regarding the course and branching pattern of the tibial nerve.

Level of evidence: Level IV (case series).

背景：本研究旨在探讨胫骨神经从踝关节水平开始的过程、分支和变化。方法：对58具胎儿尸体116尺进行解剖检查。结果：所有病例胫骨神经分叉点均位于跗骨隧道内。检查胫骨神经分叉显示分叉最常位于内踝-跟骨轴近端。跟内侧神经分为六种不同的类型，以2型为最常见的类型，在39.7% %的标本中观察到。足底内侧神经与外侧神经吻合分为四种类型，其中以1型最为常见，发生率为81.89 %。结论：这项研究将为解剖学家和临床医生提供有关胫骨神经的路线和分支模式的重要信息。证据等级：四级（病例系列）。

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