Pub Date : 2024-12-13DOI: 10.1016/j.fas.2024.12.004
Marije C Vink, Liza N van Steenbergen, Bas de Hartog, Wierd P Zijlstra, Tom M van Raaij, Rinne M Peters
Background: Total ankle arthroplasty (TAA) has been developed as treatment for disabling tibiotalar osteoarthritis. TAAs are divided into mobile- and fixed-bearings. The aim was to determine the incidence and trends of fixed- and mobile bearings over time and investigate the association of bearing type and risk of revision after primary TAA in the Netherlands.
Methods: Using data from the Dutch Arthroplasty Register (LROI) (2014-2023), we analyzed trends in use of bearing type, reasons for revision and implant survival (n = 1246).
Results: Fixed bearings were more often used than mobile bearings (67 % versus 33 %). Revision risk at 3, 5 and 7 years was respectively 2.8 %, 3.3 %, and 5.4 % for fixed bearings, versus 6.5 %, 10.4 %, and 11.3 % for mobile bearings. The adjusted hazard ratio was 2.5 (95 %CI 1.4-4.4) for mobile bearings.
Conclusion: Fixed bearings were associated with a lower revision risk than mobile bearings in total ankle arthroplasties based on Dutch registry data.
{"title":"Lower risk of revision in fixed-bearing compared to mobile-bearing total ankle arthroplasties: A register based evaluation of 1246 patients in the Netherlands.","authors":"Marije C Vink, Liza N van Steenbergen, Bas de Hartog, Wierd P Zijlstra, Tom M van Raaij, Rinne M Peters","doi":"10.1016/j.fas.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.fas.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty (TAA) has been developed as treatment for disabling tibiotalar osteoarthritis. TAAs are divided into mobile- and fixed-bearings. The aim was to determine the incidence and trends of fixed- and mobile bearings over time and investigate the association of bearing type and risk of revision after primary TAA in the Netherlands.</p><p><strong>Methods: </strong>Using data from the Dutch Arthroplasty Register (LROI) (2014-2023), we analyzed trends in use of bearing type, reasons for revision and implant survival (n = 1246).</p><p><strong>Results: </strong>Fixed bearings were more often used than mobile bearings (67 % versus 33 %). Revision risk at 3, 5 and 7 years was respectively 2.8 %, 3.3 %, and 5.4 % for fixed bearings, versus 6.5 %, 10.4 %, and 11.3 % for mobile bearings. The adjusted hazard ratio was 2.5 (95 %CI 1.4-4.4) for mobile bearings.</p><p><strong>Conclusion: </strong>Fixed bearings were associated with a lower revision risk than mobile bearings in total ankle arthroplasties based on Dutch registry data.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899824","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}
Background: The utility of forefoot cleaning using bristled brush has been proposed by previous studies but has not been tested in any study. The aim of the current study is to investigate the antiseptic efficacy of additional forefoot scrubbing with bristled brush after a standard 2-step preparation with alcohol and chlorhexidine in foot and ankle surgery.
Methods: One hundred patients underwent foot and ankle surgery by one orthopedic surgeon were included and categorized into one of two groups of different skin preparation procedure before surgery. Group 1 is the control group which received a standard 2-step preparation with alcohol and chlorhexidine. Group 2 is the forefoot scrubbing group which received a standard preparation with alcohol and chlorhexidine and an additional forefoot scrubbing in a sterile fashion. Positive culture results and microbe species were primary outcomes. A secondary outcome was the occurrence of any surgical site infection (SSI) 12 months following surgery.
Results: The hallux nail fold positive rate of the forefoot scrubbing group was significantly lower than that of the control group after draping (forefoot scrubbing group, 0 %; control group, 12 %; p = 0.027) and after surgery (forefoot scrubbing group, 6 %; control group, 28 %; p = 0.003). The microbe species of hallux nail fold after surgery included Staphylococcus, coagulase negative, Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus luteus, Neisseria, and Corynebacterium afermentans. There was no difference in the rate of SSI between the forefoot scrubbing group (10 %) and the control group (6 %).
Conclusion: Forefoot scrubbing with bristled brush before foot and ankle surgery reduces microbe growth rate after draping and after surgery at hallux nail fold.
Level of evidence: Level II, prospective cohort study.
{"title":"Efficacy of forefoot scrubbing with bristled brush during foot and ankle surgery.","authors":"Shengxuan Cao, Yuan Sun, Shirong Li, Xin Ma, Chen Wang, Xu Wang","doi":"10.1016/j.fas.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.fas.2024.12.001","url":null,"abstract":"<p><strong>Background: </strong>The utility of forefoot cleaning using bristled brush has been proposed by previous studies but has not been tested in any study. The aim of the current study is to investigate the antiseptic efficacy of additional forefoot scrubbing with bristled brush after a standard 2-step preparation with alcohol and chlorhexidine in foot and ankle surgery.</p><p><strong>Methods: </strong>One hundred patients underwent foot and ankle surgery by one orthopedic surgeon were included and categorized into one of two groups of different skin preparation procedure before surgery. Group 1 is the control group which received a standard 2-step preparation with alcohol and chlorhexidine. Group 2 is the forefoot scrubbing group which received a standard preparation with alcohol and chlorhexidine and an additional forefoot scrubbing in a sterile fashion. Positive culture results and microbe species were primary outcomes. A secondary outcome was the occurrence of any surgical site infection (SSI) 12 months following surgery.</p><p><strong>Results: </strong>The hallux nail fold positive rate of the forefoot scrubbing group was significantly lower than that of the control group after draping (forefoot scrubbing group, 0 %; control group, 12 %; p = 0.027) and after surgery (forefoot scrubbing group, 6 %; control group, 28 %; p = 0.003). The microbe species of hallux nail fold after surgery included Staphylococcus, coagulase negative, Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus luteus, Neisseria, and Corynebacterium afermentans. There was no difference in the rate of SSI between the forefoot scrubbing group (10 %) and the control group (6 %).</p><p><strong>Conclusion: </strong>Forefoot scrubbing with bristled brush before foot and ankle surgery reduces microbe growth rate after draping and after surgery at hallux nail fold.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848168","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.05.011
Temitope Adebayo, Zachary Koroneos, Erdi Özdemir, Alex Herrin, Sherif El Akkari, Gregory Lewis, Umur Aydogan
Background
The objective of this study was to evaluate the biomechanical stability of a medially placed nitinol staple compared to two crossed-screws in the first TMT-1 joint fusion in a cadaveric cyclic loading model.
Methods
Seven matched pairs (N = 7) of lower limb cadaveric specimens were utilized. TMT-1 joints from each donor were fixed with a medially placed nitinol staple or dorsally placed two 3.5 mm partially threaded cannulated crossed-screws. Specimens were tested in a 4-point bending setting with increasing cyclic forces.
Results
The mean plantar gapping was not significantly different between the two groups at any loading stage below 200 N. Specimens fixed with a nitinol staple failed at a mean load of 305 ± 57 N. Conversely, those fixed with crossed-screws failed at 373 ± 86 N. (P = .09).
Conclusion
There was no statistical difference between a medially placed nitinol staple and dorsally placed crossed-screws in failure loads and plantar gapping under cyclic loads at the TMT-1 joint, however, the staple fixation was much more variable.
{"title":"Cannulated screws versus nitinol staple for tarsometatarsal fusion: A cadaveric biomechanical comparison model","authors":"Temitope Adebayo, Zachary Koroneos, Erdi Özdemir, Alex Herrin, Sherif El Akkari, Gregory Lewis, Umur Aydogan","doi":"10.1016/j.fas.2024.05.011","DOIUrl":"10.1016/j.fas.2024.05.011","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to evaluate the biomechanical stability of a medially placed nitinol<span> staple compared to two crossed-screws in the first TMT-1 joint fusion in a cadaveric cyclic loading model.</span></div></div><div><h3>Methods</h3><div>Seven matched pairs (N = 7) of lower limb cadaveric specimens were utilized. TMT-1 joints from each donor were fixed with a medially placed nitinol staple or dorsally placed two 3.5 mm partially threaded cannulated crossed-screws. Specimens were tested in a 4-point bending setting with increasing cyclic forces.</div></div><div><h3>Results</h3><div>The mean plantar gapping was not significantly different between the two groups at any loading stage below 200 N. Specimens fixed with a nitinol staple failed at a mean load of 305 ± 57 N. Conversely, those fixed with crossed-screws failed at 373 ± 86 N. (<em>P</em> = .09).</div></div><div><h3>Conclusion</h3><div>There was no statistical difference between a medially placed nitinol staple and dorsally placed crossed-screws in failure loads and plantar gapping under cyclic loads at the TMT-1 joint, however, the staple fixation was much more variable.</div></div><div><h3>Level of evidence</h3><div>Level V, basic science study, biomechanics</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 656-661"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141130041","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.05.019
Mahmut Ozdemir , Baris Birinci , Bahtiyar Haberal , Ekin Kaya Simsek , Aysen Terzi , Bedi Cenk Balcık , Yuksel Ugur Yaradilmis
Purpose
Several clinical and experimental studies have revealed that L-Arginine, which has antioxidant properties, accelerates tissue healing. This study examined the in vivo effects of oral L - Arginine supplementation on tendon regeneration in Wistar rats.
Method
For each weighting of an average of 250–300 g, 24 Wistar rats were separated into three equal groups. Each rat's right hind leg Achilles tendons were tenotomized and then repaired. The first group (Control) was followed up with a regimen of standard food and water. In the second group (L-Arg Low Dose), 300 mg/kg, and in the third group (L-Arg High Dose), 600 mg/kg L-Arginine was administered in water daily with a regimen of standard food and water ad libitum. After eight weeks, the rats were sacrificed, and the tendons were histologically and biomechanically analyzed.
Results
Tendon peak strength values of the L-Arg Low Dose and L-Arg High Dose groups were similar but significantly higher than the control group. A statistically significant difference was observed between the groups in terms of ground substance, fiber arrangement, cellularity, hyalinization, and GAG properties ( p = 0.05, p = 0.002, p = 0.016, p = 0.027, p = 0.05). There was no statistically significant difference between the groups according to the histological examination of collagen properties, fiber structure, tenocyte properties, rounding of the nuclei, and collagen stainability. (p = 0.999, p = 0.061, p = 0.195, p = 0.195, p = 0.130). No mortality, wound complications, or re-ruptures were observed.
Conclusion
Compared with the control group, histologically and biomechanically distinct therapeutic effects of L-Arginine supplementation on tendon healing were determined.
Level of clinical evidence
5
一些临床和实验研究表明，具有抗氧化特性的l -精氨酸可以加速组织愈合。本研究考察了口服L -精氨酸对Wistar大鼠肌腱再生的体内影响。方法取24只Wistar大鼠，每称重250 ~ 300 g，随机分为3组。取每只大鼠右后腿跟腱断腱后修复。第一组（对照组）的随访是标准的食物和水。第二组（l -精氨酸低剂量）300 mg/kg，第三组（l -精氨酸高剂量）600 mg/kg l -精氨酸每日在水中服用，并按标准食物和水随意饮用。8周后处死大鼠，对肌腱进行组织学和生物力学分析。结果精氨酸低剂量组和精氨酸高剂量组小鼠脑电峰值强度相似，但显著高于对照组。各组间在基质、纤维排列、细胞结构、透明化和GAG特性方面差异均有统计学意义（p = 0.05, p = 0.002, p = 0.016, p = 0.027, p = 0.05）。两组间胶原蛋白性质、纤维结构、小细胞性质、细胞核圆形、胶原染色等组织学检查差异无统计学意义。(p = 0.999, p = 0.061, p = 0.195, p = 0.195, p = 0.130)。无死亡、伤口并发症或再破裂。结论与对照组相比，补充l -精氨酸对肌腱愈合的组织学和生物力学效果明显。临床证据水平
{"title":"The effect of L-Arginine therapy on achilles tendon healing: A histological and biomechanical investigation in an animal model","authors":"Mahmut Ozdemir , Baris Birinci , Bahtiyar Haberal , Ekin Kaya Simsek , Aysen Terzi , Bedi Cenk Balcık , Yuksel Ugur Yaradilmis","doi":"10.1016/j.fas.2024.05.019","DOIUrl":"10.1016/j.fas.2024.05.019","url":null,"abstract":"<div><h3>Purpose</h3><div>Several clinical and experimental studies have revealed that L-Arginine, which has antioxidant properties, accelerates tissue healing. This study examined the in vivo effects of oral L - Arginine supplementation on tendon regeneration in Wistar rats.</div></div><div><h3>Method</h3><div><span>For each weighting of an average of 250–300 g, 24 Wistar rats were separated into three equal groups. Each rat's right hind leg </span>Achilles tendons were tenotomized and then repaired. The first group (Control) was followed up with a regimen of standard food and water. In the second group (L-Arg Low Dose), 300 mg/kg, and in the third group (L-Arg High Dose), 600 mg/kg L-Arginine was administered in water daily with a regimen of standard food and water ad libitum. After eight weeks, the rats were sacrificed, and the tendons were histologically and biomechanically analyzed.</div></div><div><h3>Results</h3><div><span><span>Tendon peak strength values of the L-Arg Low Dose and L-Arg High Dose groups were similar but significantly higher than the control group. A statistically significant difference was observed between the groups in terms of </span>ground substance<span>, fiber arrangement, cellularity, hyalinization, and </span></span>GAG<span> properties ( p = 0.05, p = 0.002, p = 0.016, p = 0.027, p = 0.05). There was no statistically significant difference between the groups according to the histological examination of collagen properties, fiber structure, tenocyte properties, rounding of the nuclei, and collagen stainability. (p = 0.999, p = 0.061, p = 0.195, p = 0.195, p = 0.130). No mortality, wound complications, or re-ruptures were observed.</span></div></div><div><h3>Conclusion</h3><div>Compared with the control group, histologically and biomechanically distinct therapeutic effects of L-Arginine supplementation on tendon healing were determined.</div></div><div><h3>Level of clinical evidence</h3><div>5</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 700-705"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406417","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.05.012
Gustavo Araujo Nunes , Kepler Alencar Mendes de Carvalho , Eli Schmidt , Ki Chun Kim , Tommaso Forin Valvecchi , Nacime Salomão Barbachan Mansur , Roberto Zambelli , Cesar de Cesar Netto
Background
The Zadek osteotomy modified by Taylor (ZO) is a surgical technique used to treat insertional Achilles tendinopathy (IAT) by reducing the heel's prominence and elevating the Achilles tendon insertion. This study aims to analyze the biomechanical consequences of IAT after ZO using a virtual surgical simulation with a specific software.
Methods
A retrospective analysis of 20 wtbearing computed tomography (WBCT) scans of IAT patients was conducted. Using Disior's BonelogicTM software, 3D models were created from WBCT images. Virtual ZO was performed on these models, and various biomechanical parameters were measured before and after the virtual osteotomy.
Results
The virtual ZO showed significant statistical differences in the average of the calcaneal length (p < 0.001), Fowler Philips angle (p < 0.001), calcaneal pitch (p < 0.001), and the sagittal talocalcaneal angle (p < 0.001).
Conclusions
The virtual ZO analysis suggests that this procedure can decrease the Fowler Philips angle, shorten the calcaneus, modifying specifically the sagittal alignment.
{"title":"Biomechanical consequences of Zadek osteotomy in insertional achilles tendinopathy: A virtual surgical simulation study","authors":"Gustavo Araujo Nunes , Kepler Alencar Mendes de Carvalho , Eli Schmidt , Ki Chun Kim , Tommaso Forin Valvecchi , Nacime Salomão Barbachan Mansur , Roberto Zambelli , Cesar de Cesar Netto","doi":"10.1016/j.fas.2024.05.012","DOIUrl":"10.1016/j.fas.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><div>The Zadek osteotomy<span><span> modified by Taylor (ZO) is a surgical technique used to treat insertional Achilles tendinopathy (IAT) by reducing the heel's prominence and elevating the </span>Achilles tendon insertion. This study aims to analyze the biomechanical consequences of IAT after ZO using a virtual surgical simulation with a specific software.</span></div></div><div><h3>Methods</h3><div>A retrospective analysis of 20 wtbearing computed tomography (WBCT) scans of IAT patients was conducted. Using Disior's BonelogicTM software, 3D models were created from WBCT images. Virtual ZO was performed on these models, and various biomechanical parameters were measured before and after the virtual osteotomy.</div></div><div><h3>Results</h3><div>The virtual ZO showed significant statistical differences in the average of the calcaneal length (p < 0.001), Fowler Philips angle (p < 0.001), calcaneal pitch (p < 0.001), and the sagittal talocalcaneal angle (p < 0.001).</div></div><div><h3>Conclusions</h3><div>The virtual ZO analysis suggests that this procedure can decrease the Fowler Philips angle, shorten the calcaneus, modifying specifically the sagittal alignment.</div></div><div><h3>Level of evidence</h3><div>IV; case series.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 662-666"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262270","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}
In suspected Ankle Instability, the parameters that can be defined in the X-ray have their limitation owing to their variability in positioning and rotation of the tibiofibular joint. This inaccuracy further increases due to variability in morphometric parameters of distal tibiofibular syndesmosis among different populations based on race and sex. This research aims to study morphometry of normal distal tibiofibular syndesmosis based on computed tomography imaging in the Indian population.
Methods
An Prospective observational study was performed from December 2020 to October 2022 on normal ankle CT scans of 100 Indian population using axial, sagittal, and coronal CT images. Anterior and posterior tibiofibular distance, Morphology of the incisura fibularis based on depth, Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO), Transverse and longitudinal length of the fibula, and Relationship between the center of the talus and the center of a line joining the outer aspect of malleoli in the coronal plane were measured and analyzed by two different observers.
Results
Out of the 100 participants, 77 (77 %) were male, and 23 (23 %) were female. The overall mean age of participants was 34.69 ± 9.7 years. The incisura fibularis was concave in 54 %, and shallow in 46 %. Anterior tibiofibular distance, Posterior tibiofibular distance, and Tibiofibular overlap were significantly different in comparison to the male with female populations (p-value < 0.05).
Conclusion
This study gives the indices that describe normal variations in the anatomical relationship between the fibula and fibular incisure in the Indian population, which will be helpful for improving the diagnostic accuracy of distal tibiofibular syndesmoses and providing optimal treatment in order to improve functional outcomes and reduce the risk of complications.
{"title":"Computed tomography-based morphometric analysis of normal distal tibiofibular syndesmosis in the Indian population","authors":"Saroj Kumar Bhagat, Anil Regmi , Bishwa Bandhu Niraula, Saroj Prasad Sah, Bom Bahadur Kunwar, Robin Yadav, Vikas Maheshwari, Pradeep Kumar Meena","doi":"10.1016/j.fas.2024.05.015","DOIUrl":"10.1016/j.fas.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><div><span>In suspected Ankle Instability, the parameters that can be defined in the X-ray have their limitation owing to their variability in positioning and rotation of the tibiofibular joint. This inaccuracy further increases due to variability in morphometric parameters of distal tibiofibular syndesmosis among different populations based on race and sex. This research aims to study morphometry of normal distal tibiofibular syndesmosis based on </span>computed tomography imaging in the Indian population.</div></div><div><h3>Methods</h3><div>An Prospective observational study was performed from December 2020 to October 2022 on normal ankle CT scans of 100 Indian population using axial, sagittal, and coronal CT images. Anterior and posterior tibiofibular distance, Morphology of the incisura fibularis based on depth, Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO), Transverse and longitudinal length of the fibula, and Relationship between the center of the talus and the center of a line joining the outer aspect of malleoli in the coronal plane were measured and analyzed by two different observers.</div></div><div><h3>Results</h3><div>Out of the 100 participants, 77 (77 %) were male, and 23 (23 %) were female. The overall mean age of participants was 34.69 ± 9.7 years. The incisura fibularis was concave in 54 %, and shallow in 46 %. Anterior tibiofibular distance, Posterior tibiofibular distance, and Tibiofibular overlap were significantly different in comparison to the male with female populations (p-value < 0.05).</div></div><div><h3>Conclusion</h3><div>This study gives the indices that describe normal variations in the anatomical relationship between the fibula and fibular incisure in the Indian population, which will be helpful for improving the diagnostic accuracy of distal tibiofibular syndesmoses and providing optimal treatment in order to improve functional outcomes and reduce the risk of complications.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 681-687"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293851","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.06.001
Paulo Carvalho , Holly Johnson , Gabriel Ferreira , João Santos , Miki Dalmau-Pastor
Purpose
The main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second toe correction utilizing a novel distal and bicortical proximal phalanx osteotomy (DBPPO).
Methods
A minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic CHT deformities of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS).
Results
Between January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001).
Conclusion
Percutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up.Level of evidence: Level II – Prospective cohort study
{"title":"Percutaneous distal bicortical proximal phalanx osteotomy for second toe deformities – A two-year prospective cohort study","authors":"Paulo Carvalho , Holly Johnson , Gabriel Ferreira , João Santos , Miki Dalmau-Pastor","doi":"10.1016/j.fas.2024.06.001","DOIUrl":"10.1016/j.fas.2024.06.001","url":null,"abstract":"<div><h3>Purpose</h3><div><span><span>The main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second </span>toe<span> correction utilizing a novel distal and bicortical proximal phalanx </span></span>osteotomy (DBPPO).</div></div><div><h3>Methods</h3><div><span>A minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic </span>CHT deformities<span> of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS).</span></div></div><div><h3>Results</h3><div>Between January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001).</div></div><div><h3>Conclusion</h3><div>Percutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up.Level of evidence: Level II – Prospective cohort study</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 706-712"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141409320","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.05.018
Wonyong Lee , John McDonald , Mohammad Azam , Andrew D. Lachance
Background
Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's neuroma. This systematic review and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton's neuroma, focusing on the differences between the plantar and dorsal approach.
Methods
Our comprehensive literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing.
Results
Total eight studies were included in this study. In aggregate, 237 neuromas underwent excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64–0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28–4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98–1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group.
Conclusions
We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.
{"title":"The comparison of postoperative outcomes in Morton's neuroma excision between plantar versus dorsal approach: A systematic review and meta-analysis","authors":"Wonyong Lee , John McDonald , Mohammad Azam , Andrew D. Lachance","doi":"10.1016/j.fas.2024.05.018","DOIUrl":"10.1016/j.fas.2024.05.018","url":null,"abstract":"<div><h3>Background</h3><div><span>Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's neuroma. This </span>systematic review<span> and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton's neuroma, focusing on the differences between the plantar and dorsal approach.</span></div></div><div><h3>Methods</h3><div>Our comprehensive literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation<span>, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing.</span></div></div><div><h3>Results</h3><div>Total eight studies were included in this study. In aggregate, 237 neuromas underwent excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64–0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28–4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98–1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group.</div></div><div><h3>Conclusions</h3><div>We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 621-629"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332250","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}
Pub Date : 2024-12-01DOI: 10.1016/j.fas.2024.05.010
Soheil Ashkani-Esfahani , Olivia Lucchese , Rohan Bhimani , Atta Taseh , Gregory Waryasz , Gino M.M. Kerkhoffs , Mario Maas , Christopher W. DiGiovanni , Daniel Guss
Background
Weight-bearing CT (WBCT) 3D volumetric measurement has shown promising accuracy for the diagnosis of syndesmotic instability. However, these measurements are rather complex and time-consuming, rendering them a clinically unfavorable option. We hypothesized that automatized measurements would be more accurate and time-efficient than manual ones.
Methods
Thirty cases of intraoperatively confirmed syndesmotic instability along with thirty individuals with no injuries to the ankle joint were recruited as cases and controls, retrospectively. Two observers conducted the manual volumetric measurements two times, at a one-week interval. An automated algorithm for 3D WBCT measurements was developed to conduct the measurements on the axial images. The time spent on each method was recorded. Mann-Whitney U test was used to compare the values between human raters and computers. Inter- and intra-class reliability were calculated.
Results
The intra-class correlation coefficient was found to be “excellent” for the automated measurements (0.97) and “good” for the observers (0.75). Similarly, the Cronbach’s alpha was shown to be higher for the computer (0.88) than the observers (0.60 and 0.62). The mean time spent on the measurements was different between human raters and the computer-assisted method (p < 0.001).
Conclusion
Automated volumetric assessment of syndesmosis seems to be a faster and more reliable option than the manual one. We suggest future larger-scale prospective studies conducted under actual clinical circumstances for more definitive conclusions.
{"title":"Automation improves the efficiency of weightbearing CT scan 3D volumetric assessments of the syndesmosis","authors":"Soheil Ashkani-Esfahani , Olivia Lucchese , Rohan Bhimani , Atta Taseh , Gregory Waryasz , Gino M.M. Kerkhoffs , Mario Maas , Christopher W. DiGiovanni , Daniel Guss","doi":"10.1016/j.fas.2024.05.010","DOIUrl":"10.1016/j.fas.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><div>Weight-bearing CT (WBCT) 3D volumetric measurement has shown promising accuracy for the diagnosis of syndesmotic instability. However, these measurements are rather complex and time-consuming, rendering them a clinically unfavorable option. We hypothesized that automatized measurements would be more accurate and time-efficient than manual ones.</div></div><div><h3>Methods</h3><div>Thirty cases of intraoperatively confirmed syndesmotic instability along with thirty individuals with no injuries to the ankle joint were recruited as cases and controls, retrospectively. Two observers conducted the manual volumetric measurements two times, at a one-week interval. An automated algorithm for 3D WBCT measurements was developed to conduct the measurements on the axial images. The time spent on each method was recorded. Mann-Whitney U test was used to compare the values between human raters and computers. Inter- and intra-class reliability were calculated.</div></div><div><h3>Results</h3><div>The intra-class correlation coefficient was found to be “excellent” for the automated measurements (0.97) and “good” for the observers (0.75). Similarly, the Cronbach’s alpha was shown to be higher for the computer (0.88) than the observers (0.60 and 0.62). The mean time spent on the measurements was different between human raters and the computer-assisted method (p < 0.001).</div></div><div><h3>Conclusion</h3><div>Automated volumetric assessment of syndesmosis seems to be a faster and more reliable option than the manual one. We suggest future larger-scale prospective studies conducted under actual clinical circumstances for more definitive conclusions.</div></div><div><h3>Level of evidence</h3><div>Retrospective case-control study - Level 3</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 8","pages":"Pages 652-655"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092266","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}
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