Foot and Ankle Surgery最新文献

Background: Lateral ankle sprain (LAS) is the most common traumatic injury, yet its diagnosis and management remain suboptimal. This contributes to a high prevalence of residual symptoms, negatively impacting patient quality of life and increasing healthcare costs. We hypothesized that routine ultrasonography (US) following LAS could significantly modify the treatment strategy established by a specialist. Additionally, we hypothesized that US is an efficient tool for identifying osseous injuries and associated ligamentous injuries.

Methods: Fifty-one ankles with lateral instability diagnosed in the emergency department (ED) were retrospectively included. A second evaluation by an orthopedic surgeon was conducted within the first ten days to establish the "initial treatment". All patients underwent US and MRI within the first three weeks after the initial ED assessment and were reevaluated to establish the "post-US treatment". We determined concordance between initial and post-US treatment. Additionally, we assessed the diagnostic accuracy of US for identifying osseous and associated ligament injuries, including the anteroinferior talofibular ligament (AITFL), deltoid ligament, spring ligament, calcaneocuboid ligament (CCL), dorsal talonavicular ligament (DTNL), and bifurcate ligament, MRI serving as the reference standard for assessing ligamentous and osseous injuries.

Results: Treatment for LAS was modified for 16 ankles (31.3 %) following US examination (W=97, p < 0.05). US demonstrated excellent sensitivity (0.73) and specificity (0.95) for identifying osseous injuries. Additionally, US detected injuries to the AITFL in 6 ankles (11.8 %), deltoid ligament in 16 (31.3 %), spring ligament in 1 (2 %), CCL in 1 (2 %), DTNL in 1 (2 %), and bifurcate ligament in 2 (3.9 %).

Conclusion: US examination following LAS was significantly associated with treatment modifications. It also proved high accuracy for detecting osseous injuries missed by plain X-rays and diagnosing associated ligament injuries. Given these findings, it appears relevant to update the current diagnostic algorithm for LAS, including US.

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.

Background: Total ankle arthroplasty wound healing complications are likely influenced by intraoperative retraction. The current study compared contact pressures from various retractors at multiple incision lengths in an anterior approach to the ankle. We hypothesized Gelpis created higher contact pressures and longer incisions reduced pressures.

Methods: Twelve cadaveric lower extremities were dissected using 12 cm, 15 cm and 20 cm incisions. A TekScan sensor measuring contact pressure and surface area was placed between the Gelpi, Army-Navy (short and long), and Weitlaner retractors and exposed soft tissue structures.

Results: Average contact pressures reduced with increasing incision lengths except for Weitlaners. Army-Navy Long showed significantly lower pressures at 15 cm. Gelpis exhibited highest contact pressures except at 20 cm(p < 0.05). No significant differences were observed between retractors at 12 cm(p > 0.05).

Conclusions: Army-Navy retractors produced the least contact pressure in 12 cm and 15 cm incisions and self-retainers created higher contact pressures. Contact pressures typically decreased as incision lengths increased.

Level of evidence: Level V.

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.

Introduction: The presence of a posterior malleolar (PM) fragment has a negative prognostic impact in ankle fractures. Percutaneous anterior to posterior screw fixation has been advocated for the treatment of ankle fractures involving the posterior malleolus and satisfactory results were demonstrated in several studies. The aim of this retrospective study was to evaluate the clinical effect of percutaneous anterior to posterior screw fixation via lateral malleolus incision window approach (APSF-LMA) for the treatment of posterior malleolus fracture (PMF) and present outcomes of patients with type 4 of Bartoníček-Rammelt classification in comparison to using the dorsiflexion ankle anterior posterior screw fixation (APSF-DA) and posterior plate fixation through posterolateral approach (PPF-PLA).

Methods: We retrospectively reviewed the clinical outcomes of 58 patients with ankle fractures involving Bartoníček-Rammelt type 4 PMF from January 2019 to December 2023. Comparisons were conducted between the groups regarding operative time, union time, the Olerud-Molander Ankle Score (OMAS), the EuroQol-5 Dimensions (EQ-5D), the American Orthopedic Foot and Ankle Society score (AOFAS), Kellgren-Lawrence (KL) osteoarthritis classification and clinical findings.

Results: The demographic characteristics were comparable between the groups. Fewer operative time was performed in the APSF-LMA (79(75-84.5) mins) and APSF-DA (78(70-85) mins) groups than in the PPF-PLA group (105(98-112) mins; P < 0.0001). When compared with the other two approaches, the APSF-LMA approach was associated with higher AOFAS scores (P < 0.05) and lower grade of KL (P < 0.0001) at the last follow-up. No significant intergroup differences were detected in the incidence of complications (P > 0.999), OMAS scores (P = 0.921) and EQ-5D (P = 0.806). Radiological and clinical findings demonstrated that fixation of the distal fibula (P = 0.727), the time of bony union and postoperative angulation (P = 0.846) were similar between the groups.

Conclusions: The APSF-LMA approach can serve as a safe and effective option for posterior malleolus fractures, as it offers favorable outcomes in ankle operation time and ankle functional recovery in the early postoperative period and is equivalent to the other two approaches in terms of the incidence of complications, fracture healing and postoperative angulation for patients with posterior malleolus fractures.

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).