Foot and Ankle Surgery最新文献

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.

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.

Background: The outcomes of total ankle replacements (TAR) in golfers are not known. The primary aim was to assess whether golfers experience similar improvements using the Manchester-Oxford Foot Questionnaire (MOXFQ) compared to the wider population. Secondary aims were to assess difference in demographics, health-related quality of life, and return to golf.

Methods: This was a retrospective review of prospectively collected data. Nineteen golfers and 144 non-golfers were included. Outcomes measured were MOXFQ, EQ5D3L and patient satisfaction.

Results: Golfers had significantly better MOXFQ scores preoperatively (p = 0.02) and postoperatively (p = 0.03), but there was no significant difference in mean change. Postoperative EQ5D3L scores were similar between groups. 52 % returned to golf within 6 months and 79 % within one year, similar to hip, knee and shoulder arthroplasty.

Conclusion: Golfers experience comparable improvements following TAR, with high rates of return to play. These findings may be used to counsel patients and manage expectations preoperatively.

Level of evidence: II.

Introduction: Hallux rigidus (HR) is a common degenerative condition of the first metatarsophalangeal joint (MTPJ), particularly limiting in active adults and athletes. While joint-sacrificing procedures such as arthrodesis are effective, joint-preserving techniques remain preferable in patients wishing to maintain function and mobility. The modified Youngswick osteotomy offers such an option by decompressing and realigning the joint.

Methods: This retrospective observational study included 55 physically active patients (mean age: 42.8 ± 8.5 anni years) with grade II HR who underwent modified Youngswick osteotomy between 2015 and 2022. Inclusion criteria included active engagement in sports, age under 60 years, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS), the European Foot and Ankle Society (EFAS) score, and return to sports (RTS) rates.

Results: At a mean follow-up of 79.3 months, 49 of 52 patients (94.2 %) resumed sports activities. Significant improvements were observed in VAS scores (from 5.04 to 0.9, p < .001) and EFAS general (22.7 ± 6.1-37.1 ± 5.4, p < .001) and sport-specific scores (9.3-14.3, p < .001). Postoperative dorsiflexion improved from a mean of 24.5° to 52.5° (p < .001). Complications were rare and mild, including two cases of transfer metatarsalgia and one hardware intolerance.

Conclusion: Modified Youngswick osteotomy is an effective joint-preserving surgical option for moderate HR in active adults. It provides excellent pain relief, improves function and range of motion, and allows for a high rate of return to sports. This technique represents a valid alternative to arthrodesis in patients wishing to maintain MTPJ mobility and an active lifestyle.