Foot and Ankle Surgery最新文献

Background: Contemporary guidelines advocate for initial debridement and single-stage definitive fixation with immediate soft tissue reconstruction for open fractures. This study aims to evaluate the effectiveness of single-stage stabilization and immediate definitive soft tissue coverage in open ankle fractures compared to closed fractures.

Methods: We compared all isolated open ankle fractures (OF) treated between January 2017 and June 2019 to a control group of operatively managed closed ankle fractures (CF). The OF group included patients with extensive soft tissue injury loss with periosteal stripping and bone exposure (Gustilo and Anderson IIIB) requiring split skin graft, rotational flap or free flap. Clinical outcomes assessed included infection rates, amputation, revision hardware surgery, surgical reduction, non-union rates, and functional outcomes (assessed using the MOXFQ and EQ-5D-5L questionnaires). Health provider matrices were utilized to evaluate cost-benefit parameters, such as length of stay (LOS). Statistical analysis was performed with a significance level set at P < 0.05.

Results: A total of 27 OF and 35 CF cases with AO classification 44 A-C fractures were analyzed following standard treatment protocols. No amputations were reported, but deep/superficial infections occurred in 3 patients in the OF group compared to 2 in the CF group. There was a three-folds increase in mal-union (P = .11), rates of additional surgeries and discharge times in the OF group. (P < 0.05). However, return to functional weight bearing between OF (mean 10.6 weeks) and CF (mean 7.2 weeks) was similar (P = 0.06), and there were no significant differences in EQ-5D-5L and MOXFQ scores at the end of orthopaedic treatment p = 0.5 and 0.16 respectively. The mean hospital LOS was significantly longer for OF (15.6 days) compared to CF (5.4 days) (P < 0.05).

Conclusion: Definitive stabilization and immediate soft tissue reconstruction in the management of open ankle fractures result in high rates of limb salvage and achieve functional outcomes similar to those seen in matched closed ankle fractures upon completion of orthopedic treatment. Although the patient journey is extended, soft tissue and infective complications do not significantly differ. This calls for further investigation to establish the long-term cost-benefit implications of this approach.

Background: This study aimed to compare the clinical and radiologic outcomes among grades according to the arthroscopic classification of chronic ATFL lesions after arthroscopic lateral ligament repair.

Methods: We retrospectively analyzed 135 patients with chronic lateral ankle instability who underwent arthroscopic lateral ligament repair at 3 institutions between 2018 and 2020. The patients were divided into four groups according to the arthroscopic classification of the ATFL remnants. The Karlsson ankle functional score (KAFS) and foot and ankle outcome score (FAOS) were evaluated preoperatively and at the last follow-up. On stress radiographs, the talar tilt and anterior talar translation were measured preoperatively and at the last follow-up.

Results: Of the 135 included patients, 41 (30.4 %), 42 (31.1 %), 34 (25.2 %), and 18 (13.3 %) were in groups 1, 2, 3, and 4, respectively. There were no significant differences among the groups with respect to the preoperative patient characteristics, except for concomitant injuries. The mean KAFS and FAOS improved significantly at the last follow-up in all groups; however, no significant differences occurred among the groups in any scores preoperatively or at the last follow-up. The mean talar tilt and anterior talar translation decreased significantly at the last follow-up in all the groups. Group 1 exhibited significantly less preoperative talar tilt than that in the other groups (P < .001). However, no significant difference occurred in talar tilt among the groups at the last follow-up. There were no differences among the groups in the preoperative anterior talar translation or values at the last follow-up.

Conclusions: The present study demonstrated that arthroscopic lateral ligament repair showed good functional and stress radiographic outcomes regardless of the quality of ATFL remnant.

Background: Ankle osteoarthritis affects 1-3 % of all adults. Contemporary evidence is equivocal when comparing the outcomes and complications of TAA and AA. This review aims to compare the complications between TAA and AA to provide surgeons with an additional perspective when managing ESAO.

Methods: We conducted a systematic review and meta-analysis, searching four international databases from inception until 21 Jan 2024 for RCTs and score-matched studies reporting on TAA or AA for ESAO. Score-matched studies were included if matching accounted for four or more covariates related to patient demographics and comorbidities. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was complications stratified into total, major, and minor as guided by previous studies. We rated intra-study risk of bias using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. We assessed the certainty of evidence using the GRADE approach.

Results: 5 studies (2 RCTs and 3 score-matched studies) totalling 13,957 patients (6975 TAA, 6982 AA) were included in the meta-analysis. The pooled RR for total complications was 0.95 (95 %-CI: 0.85 to 1.08, p = 0.45, moderate certainty, favourable towards AA). The pooled RR for major complications was 1.18 (95 %-CI: 0.70 to 1.98; p = 0.54, low certainty, favouring TAA) and for minor complications was 0.96 (95 %-CI: 0.75 to 1.22; p = 0.73, moderate certainty, favouring AA).

Conclusion: Previous reviews have recognised TAA and AA as equivocally effective surgical options for patients with ESAO. Our review may suggest that TAA and AA have similar rates of major and minor complications. Surgeons should consider the specific complications for TAA and AA despite the similar rates of complications when counselling patients.

Protocol registration: CRD42023389626.

Introduction: There is evidence that the presence of a posterior malleolus fracture (PMF) worsens the prognosis of ankle fractures, making conservative treatment a poor choice. PMFs include a heterogeneous group of bone injury patterns that are sometimes associated to medial malleolus extensions, as well as fibula fractures or syndesmotic damage. This requires the surgeon to be well-versed in anatomy to choose the appropriate surgical approach. This study examines the relationship between the visualization of the distal posterior tibial surface through a Traditional Postero-Medial (TPM) approach in a simulated fracture pattern equivalent to Bartonícek type III fractures previously studied with axial CT images.

Methods: This is an experimental analytical cross-sectional anatomical study. Twenty fresh-frozen adult cadaveric ankle/foot specimens preserved at - 27 ºC at the University of Barcelona School of Medicine were examined. The traditional posteromedial approach was performed for each specimen, then anatomical measurements were performed. Subsequently, a Bartonícek type III fracture pattern was designed and generated for each of them. Finally, the anatomical view was correlated with axial CT images for each one and the fracture pattern was assessed. Measurements of Anatomical Visualization Surface (AVS), Total width of the Posterior M. (TWPM), Imaging Visualization Surface (IVS) and the Total Imaging Viewing Surface (TIVS) were recorded. Univariate and bivariate analysis was performed. The mean, standard deviation (SD), minimum and maximum values were calculated. The Intraclass Correlation Coefficient (ICC) was calculated.

Results: Of the 20 specimens, 9 were female and 11 male, with 8 right and 12 left specimens, aged between 65 and 95 years. The average Anatomical Visualization Surface (AVS) was 24.1 ± 7.49 mm. The average of the total width of the posterior muscle (TWPM) was 30.55 ± 7.19 mm. While the average visualization was 77 ± 11 %. The average Imaging Visualization Surface was 30.23 ± 6.1 mm. The average Total Imaging Visualization Surface was 37.53 ± 3.45 mm. While the average of visualization in CT was 80 ± 11 %. A degree of agreement (CCI) was obtained with a value of 0.667 CI 95 % (0.1773-0.8672). That is, the CCI is considered good (CCI value between 0.4 and 0.75).

Conclusion: The TPM approach is a valid alternative for surgical access and visualization of the PM, including complex Bartonícek type III fractures. The TPM approach achieves axial visualization of the distal posterior tibial plafond of 77 ± 11 %.

Background: Free chatbots powered by large language models offer lateral ankle sprains (LAS) treatment recommendations but lack scientific validation.

Methods: The chatbots-Claude, Perplexity, and ChatGPT-were evaluated by comparing their responses to a questionnaire and their treatment algorithms against current clinical guidelines. Responses were graded on accuracy, conclusiveness, supplementary information, and incompleteness, and evaluated individually and collectively, with a 60 % pass threshold.

Results: The collective analysis of the questionnaire showed Perplexity scored significantly higher than Claude and ChatGPT (p < 0.001). In the individual analysis, Perplexity provided significantly more supplementary information than the other chatbots (p < 0.001). All chatbots met the pass threshold. In the algorithm evaluation, ChatGPT scored significantly higher than the others (p = 0.023), with Perplexity below the pass threshold.

Conclusions: Chatbots' recommendations generally aligned with current guidelines but sometimes missed crucial details. While they offer useful supplementary information, they cannot yet replace professional medical consultation or established guidelines.

Background: The aim of this study was to evaluate the patient reported outcome measures (PROMS), radiological outcome and complications when performing a triple arthrodesis using the IOFIX system for the talonavicular and calcaneocuboid joints.

Methods: Data was collected prospectively. Twenty-nine consecutive patients were reviewed 1 year postoperative. Outcomes analysed were rate of fusion, American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), patient satisfaction and complications.

Results: Complete fusion was achieved in 90 %. The mean preoperative AOFAS score improved from 42 (95 % confidence interval: 22-43) to 75 (95 % confidence interval 67-82) postoperative and the mean VAS improved from 6.5 (95 % confidence interval 4.9-8.6) to 4 (95 % confidence interval 3.1-4.9), p < 0.001. There was an early complication rate of 13 %. After 1 year 86 % were satisfied and there was a complication rate of 3 %.

Conclusions: This study suggests that the IOFIX system offers a reliable and performant alternative technique for patients undergoing a triple arthrodesis.

Level of evidence: Level II, prospective cohort study.