Foot and Ankle Surgery最新文献

Background: The Ponseti method is the gold standard for managing congenital idiopathic clubfoot. Recent modifications, such as the accelerated Ponseti protocol, aim to shorten treatment duration without compromising outcomes. However, evidence comparing its efficacy and safety to the standard protocol remains inconclusive.

Objective: To compare the efficacy and safety of the accelerated versus standard Ponseti method in the treatment of congenital idiopathic clubfoot.

Methods: Eligible studies included randomized controlled trials and prospective comparative studies involving patients with idiopathic clubfoot treated with either accelerated or standard Ponseti methods.

Results: Sixteen studies involving 957 patients were included. There was no significant difference between groups in post-treatment Pirani score [MD = -0.03, 95 % CI (-0.24-0.17), p = 0.75], tenotomy rate [RR = 1.04, 95 % CI (0.99-1.09), p = 0.14], or relapse rate [RR = 1.11, 95 % CI (0.80-1.55), p = 0.54]. However, the accelerated group required slightly more casts [MD = 0.38, p = 0.032] but achieved significantly shorter treatment duration [MD = -20.43 days, p < 0.001]. Subgroup and sensitivity analyses confirmed the robustness of the findings. No major methodological flaws were detected, though blinding was generally lacking.

Conclusion: The accelerated Ponseti method is as effective and safe as the standard protocol, with the advantage of significantly shorter treatment duration. It may be a preferable alternative in appropriate clinical settings, though standardized implementation and long-term follow-up are recommended.

Background: Ankle fractures are highly prevalent orthopaedic injuries frequently involving the posterior malleolus, affecting ankle stability and function.

Methods: This study evaluated functional outcomes and return to sport following operative fixation of posterior malleolus fractures. The study included all consecutive patients with posterior malleolus fracture, who underwent operative fixation in a single institution in the UK. Patient demographics, fracture pattern based on Mason classification, operative details, postoperative radiographs and complications were extracted and analysed. Primary outcome was functional outcome assessed using the Olerud and Molander (OM) score and secondary outcomes were return to sport, union rates, complications and Visual Analogue Pain Score (VAS).

Results: Between May 2019 and May 2021, n = 52 patients were eligible for inclusion. Mean age was 45.2 ± 14.5 with mean follow up of 14.2 ± 4.3 months. The mean OM score was 79.3 ± 16.9 and mean VAS score was 1.2 ± 1.7. Residual symptoms were frequent: 55 % reported some level of ongoing pain, 35 % stiffness, 23 % swelling. Out of 43 patients doing sports pre-injury, 28 (65 %) returned to the same sport level, 11 (26 %) to a lower level, and 4 (9 %) were unable to return. No significant differences in outcome were observed between Mason fracture types.

Conclusions: Functional recovery was achieved in the majority of patients, with 42 % excellent and 52 % fair outcomes, though residual symptoms remained common. Residual symptoms and functional limitations must be emphasised to patients to manage postoperative expectations.

Background: The Lapidus bunionectomy has evolved with advanced fixation constructs since its first description. These new techniques have aimed to reduce complications such as non-union or hardware related symptoms. The IOFix™ system, an intramedullary device that has been designed to enhance stability and compression, may offer outcomes that are comparable to traditional medial locking plate with lag screw constructs.

Purpose: To compare outcomes of the Lapidus bunionectomy using the IOFix™ and plate construct versus a traditional medial locking plate with a plantar lag screw.

Methods: This IRB-approved retrospective case-control study reviewed 46 patients (23 per cohort) treated by a single surgeon between 2014 and 2022, with minimum 24-month follow-up. Patients underwent Lapidus bunionectomy using either an IOFix™ and dorsal plate (intervention) or a locking plate with plantar lag screw (control). Outcome measures included incidence of non-union, hardware removal, loss of correction (1st IMA >8° or HAA >20°), and AOFAS Hallux scores. Statistical analysis used two-tailed t-tests and Fisher's exact test with significance set at P < 0.05.

Results: All cases in both IOFix™ and locking plate groups achieved a union rate of 100 %. There were no reported infections, non-unions, or revision surgeries in either cohort. Hardware removal rates were not significantly different between IOFix™ (26 %) and control (13 %) groups (P = 0.46), and only the dorsal plates were removed. There were no reported cases of removal of the IOFix™ device. AOFAS scores improved significantly in both groups post-operatively (P < 0.0001), with no significant difference between groups pre- or post-operatively. There were no significant differences in demographic data, loss of correction, or complication rates between groups.

Conclusion: The IOFix™ and dorsal plate construct offers comparable outcomes to traditional locking plate with lag screw fixation in the Lapidus bunionectomy, with similar union rates, clinical outcomes, and hardware-related complications. These findings suggest that IOFix™ is an effective alternative fixation method. Further studies with larger sample sizes and long-term follow-up are warranted.

Introduction: Augmented repair is recommended in severe cases of ankle instability, but the technique remains debated. This study compared ankle and subtalar joint stability after Broström-Gould (BG) and Broström with inferior extensor retinaculum (IER) augmentation using a 3D opto-electronic protocol.

Methods: Eighteen cadaveric feet were tested in four conditions: intact, unstable (lateral ankle and subtalar ligaments disinserted), BG, and IER. Three manual tests were applied: anterior drawer (ADT), varus tilt in neutral (VTTN), and in dorsiflexion (VTTF). Ankle and subtalar rotations and ATFL/CFL elongation were recorded.

Results: Both techniques improved ankle and subtalar varus stability as well as ankle rotational stability (p < 0.05). Compared with BG, IER further reduced talus-calcaneus and tibia-calcaneus varus rotation during VTTN and VTTF (p < 0.05), and decreased tibia-talus flexion-extension during ADT (p < 0.05) CONCLUSION: IER provided greater ankle and subtalar varus stability than BG, though both limited motions compared with intact joints.

Objective: Diabetes-related foot complications could lead to amputation and death. Major amputations are known to yield higher mortality rate compared to minor amputations. In patients who already had a minor diabetic amputation, knowing the risk factors contributing to a major re-amputation is of great importance. This study aims to quantify the risk of major amputation following minor diabetic amputation and to investigate the systemic and local risk factors of the re-amputation event.

Methods: This is a retrospective comparative study among patients who had a minor amputation as a diabetic complication where one group had no subsequent amputation (Group 1) versus another group with subsequent major amputation (Group 2). The minimum follow-up period was of 24 months. The main outcomes were set as the frequency of major re-amputation and the independent systemic and the local risk factors such as wound healing complications, stump issues and the impact of using MRI-guided level for index amputation.

Results: Out of the 107 index amputations (97 patients), 70 cases (65 patients) did not present with subsequent amputations (Group 1) and 18 patients/cases (16.8 %) required a major amputation at the last follow-up (Group 2). The logistic regression analysis showed peripheral artery disease (PAD) and non MRI-guided index minor amputation as independent factors for higher subsequent major amputations (p = 0.04 and p = 0.02, respectively).

Conclusion: The risk of a major amputation following a diabetic minor amputation is not infrequent, almost 17 %. PAD was found to be the only independent systematic factor to positively correlate with the risk of major re-amputation. MRI-guided level of index amputation, at least 1 cm proximal to MRI bone infection sign, was significantly negatively correlated with re-amputation.

Background: Treatment of foot and ankle critical-sized defects (CSDs) remains a surgical challenge. Custom 3D-printed metallic implants have emerged as a promising solution, however current literature is limited. This study evaluated the incidence and associated factors of deep postoperative infection following custom cage implantation.

Methods: A retrospective cohort study was conducted on 62 patients who underwent custom cage implant arthrodesis. Pre-, peri-, and postoperative variables were collected, with deep postoperative infection as the primary outcome.

Results: Of 62 patients, 13 (21 %) developed deep postoperative infections at a median 957 days. Superficial wound breakdown was significantly associated with infection. History of ipsilateral foot and ankle infection, diabetes, smoking, and neuropathy were not significantly associated with infection.

Conclusion: Infection rates after custom cage implantation were comparable to those of traditional CSD management methods. These findings support continued evaluation of custom cage implants and emphasize the importance of reducing postoperative infection risk.

Level of evidence: III.

Background: Injuries to the tarsometatarsal joint (Lisfranc injuries) significantly affect foot biomechanics and gait. Surgical treatment is often necessary for fractures or unstable ligamentous Lisfranc injuries. However, data on midterm outcomes regarding gait and function remain limited. We hypothesized that operative treatment restores biomechanical function and gait.

Methods: We retrospectively analyzed patients treated with osteosynthesis for Lisfranc injuries at our institution. Outcomes were assessed using subjective and objective measures (AOFAS, FAAM-G). Gait analysis included joint angle measurements, EMG, and pedobarography, comparing affected feet to the unaffected side and a matched group of healthy controls.

Results: Twelve patients (4 female, 8 male; mean age 44.3 years, range 25-64) were included. Gait analysis after osteosynthesis of Lisfranc injuries showed promising outcomes, with no significant differences in key pedobarometry parameters compared to the unaffected side and healthy individuals.

Conclusions: Osteosynthesis for Lisfranc injuries enables restoration of normal gait patterns and good midterm clinical outcomes.

Level of evidence: Level III - Retrospective Comparative Study.

Background: Peroneal tendons dislocation is an infrequent and misdiagnosed pathology. The aim of this study was to establish the relevance of the anatomic characteristics of fibular groove and the superior peroneal retinaculum, and its relationship with peroneal tendon stability.

Methods: The present study was conducted on 14 lower extremities of fresh defrosted cadavers. Anatomical parameters of the fibula, peroneal tendons, superior peroneal retinaculum and minimal deep required to achieve peroneal tendon stability in the peroneal groove were done.

Results: A statistically significant difference in the minimum depth required to achieve peroneal sulcus stability was found between groups with superior peroneal retinaculum type I and V (p = 0.015).

Conclusions: Our findings provide novel anatomical and morphometric evidence supporting the relevance of superior peroneal retinaculum morphology, particularly type I, in promoting peroneal tendon groove stability.

Level of evidence: IV.

Background: Double or triple arthrodesis is a common surgical intervention for patients with rigid flatfoot deformity who have not responded to nonoperative treatment. While traditionally performed as an open surgery, minimally invasive (MIS) techniques have emerged as an alternative with benefits such as lower wound complication rates, less pain, and improved cosmesis.⁵ METHODS: Ninety-seven open and 79 MIS arthrodesis procedures were retrospectively analyzed. Primary outcomes, including Visual Analog Scale (VAS) and Foot Function Index (FFI) scores, were assessed at each preoperative and postoperative appointment.

Results: Both cohorts demonstrated significant improvements in VAS and FFI scores (p < 0.001). There were no significant differences in nonunion rates or time to union. However, the open cohort had a significantly higher incidence of wound dehiscence (8.2 % vs 0 %) (p = 0.009).

Conclusion: Both open and MIS techniques resulted in similar improvement in patient reported outcome measures. MIS techniques offered a significant advantage in reducing postoperative wound dehiscence.

Level iii evidence: