Journal of Foot & Ankle Surgery最新文献

The study aimed to provide a comprehensive analysis of radiological and anatomical measurements in patients with medial osteochondral lesions of the talus (OLT), particularly those without a history of trauma. The retrospective cross sectional study evaluated 23 medial OLT individuals aged 18-45 with no history of trauma who were identified by magnetic resonance imaging (MRI) between 2016 and 2020. The control group consisted of 27 individuals between the ages of 18 and 45 who did not have OLT and applied for other reasons. Measurements were performed with 16 parameters from anteroposterior (AP) and lateral weight-bearing ankle conventional radiographs (CR). All individuals' demographic data were assessed. A total of 50 patients aged 18-45 years, including 26 males and 24 females with a mean age of 30.28±4.46 years, were evaluated in the study. No significant differences in age or gender were found between the groups (P>0.05). Analysis of both the OLT and control groups revealed a significant association of decreased talar declination angle (P<0.001) and Meary-Tomeno's angle (P = 0.003) with medial OLT. There was no relationship between other radiological parameters and medial OLT development. In conclusion, a decreased talar declination angle and a decreased Meary-Tomeno's angle appear to have significant relationship with development of medial OLT in individuals without a history of trauma. These findings also indicate that a possible cause of medial OLT is a lower-angled positioning of the talus relative to the ground and the first metatarsus in the sagittal plane. Level of Clinical Evidence: Level 3 cross sectional study.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the main treatment, but surgical intervention has gained interest to improve poor long-term outcomes. Few long-term outcome studies exist on operative management of CN. A retrospective chart review was performed to analyze demographics, comorbidities, complications, and outcomes of operative management of CN. Patients were divided into two cohorts for analysis: limited surgical intervention (LSI) and reconstructive surgery (RS). Fifty-eight patients with CN treated surgically over 11 years were identified. Average follow-up was 46 months (range, 1 to 173 months). The mean age was 60.2 (range, 29 to 81) years, and the average body mass index was 34.3. Diabetes caused CN in 72.4 % (42/58) of patients. The LSI cohort (n = 32) had significantly higher rates of presenting infection (59.4 %; 19/32) and ulceration (87.5 %; 28/32) compared with the RS cohort (n = 26; 23.1 % [6/26] and 50 % [13/26], respectively). Rates of postoperative infection and ulceration were lower in the LSI group (25 % [8/32] and 34.4 % [11/32], respectively) than the RS group (42.3 % [11/26] and 42.3 % [11/26], respectively). The amputation rate for the LSI cohort was 21.9 % (7/32) compared with 23.1 % (6/26) for RS. This large, single-center study of operatively treated CN patients showed no significant difference between LSI and RS. This study provides data to help surgeons counsel patients on expected outcomes.

The management of acute distal tibiofibular syndesmotic injuries has evolved over time and therefore, the aim of this study was to evaluate the use of different methods and the changes regarding management of distal tibiofibular syndesmotic injury among Dutch trauma- and orthopedic surgeons. A digital survey based on a previous survey conducted in 2012 was sent to (orthopedic) trauma surgeons from all different hospitals in the Netherlands. Sixty out of the 68 invited hospitals completed at least one survey (88.2 %). For Weber B or low Weber C fractures, there was a preference for the use of a single syndesmotic screw (SS)(73.6 %), while two screws were mainly used in Maisonneuve fractures (89.3 %). Furthermore, there was a clear preference for 3.5-mm screws, engaging three cortices, 2 to 4-cm above the tibiotalar joint. There is a significant decrease in routine removal of SSs (23.2 % compared to 87.0 % in 2012, p < 0.01). The percentage of hospitals in this survey that used the suture button (SB) was relatively low: 8.3 % for low fibular fractures and 5.0 % in high fibular fractures. In conclusion, the most striking difference compared to 2012 is the large decline in routine removal of the SS, which is in line with current literature. The SS is mainly implanted engaging three cortices, placed 2-4 cm above the tibiotalar joint and 3.5 mm in size and for the treatment of Maisonneuve fractures, two screws are preferred over a single SS. LEVEL OF EVIDENCE: Level III.

Ankle fractures are a common intra-articular trauma. The gold standard treatment for unstable ankle fractures has been Open Reduction Internal Fixation with plating and lag screw(s). Advocates for intramedullary nailing of the fibula note decreased wound complications and greater biomechanical strength. We hypothesized that time to union and time to weight bearing would be decreased with a fibular intramedullary nail compared to prior ankle ORIF literature. A retrospective cohort study was conducted of 65 consecutive ankle fracture patients treated with a fibular nail. The median follow-up time was 18.3 months (IQR: 55.4 - 97.6 days). All patients (100%) achieved clinical and radiographic union at a median of 9.6 (IQR: 54 - 78 days) and 10.8 weeks (IQR: 58 - 95 days), respectively. Post-operatively patients bore weight in walking boot and athletic shoe at a median 6.1 and 9.4 weeks, respectively. Fifteen patients suffered complications (23.1%). Patients with history of prior or active smoking were significantly correlated to longer time to union (p=0.016). Time to union also took 0.43 days longer for each additional year of age (t-value 2.13, p-value = 0.038). Nineteen out of 65 patients (29.2%) participated in the Olerud-Molander Ankle Scoring and the median functional outcome score was 71 (IQR: 56 - 93). While fibular nailing has advanced passive range of motion and weight bearing in our institution, time to weight bearing is clouded by surgeon comfort. Further study comparing fibular fracture healing and weight bearing status in regards to intramedullary and plate fixation in needed. LEVEL OF EVIDENCE: IV.

Treatment of end-stage ankle conditions is a complex challenge in foot and ankle surgery. The talus is prone to issues such as osteoarthritis (OA) and avascular necrosis (AVN). Patient-specific total ankle and total talus replacement (TATTR) procedures have emerged as potential solutions, but the decision to include subtalar arthrodesis in these surgeries is multifaceted. In this study, we aimed to understand the relationship between past surgeon decisions for fusion with TATTR and three-dimensional joint health assessments using preoperative CT data. Twenty-seven TATTR with subtalar fusion and 19 TATTR without subtalar fusion were analyzed. Each patient underwent a bilateral computed tomography scan, which was segmented prior to surgery. Distance mapping of various subtalar regions was performed, and average distance was reported. For better analysis, the sinus tarsi was divided into four sectors and the calcaneus posterior facet into nine sectors. Statistical analysis involved calculating the difference in means between the fused and unfused cases. The fusion group exhibited significant joint space narrowing in the posterolateral aspect of the sinus tarsi (p = 0.021). Conversely, on the posterior facet of the subtalar joint, the fusion group showed significant joint space widening in both the anteromedial (p = 0.025) and middle/medial (p = 0.032) sections. Surgeons' decision to perform subtalar arthrodesis in TATTR procedures often aligns with clinical signs of sinus tarsi impingement, as evidenced by significant changes in joint space measurements. While joint health assessments play a pivotal role, other factors, such as surgeon preference and patient-specific considerations, also influence decision-making.

CPL-01 (ropivacaine extended-release injection) is formulated to safely provide postoperative analgesia and reduce opioid use. Participants undergoing unilateral distal first metatarsal bunionectomy with osteotomy were randomized to receive either CPL-01 (200 mg in Cohort 1, 300 mg in Cohort 2), ropivacaine HCl (50 mg in Cohort 1, 75 mg in Cohort 2), or volume-matched placebo into the surgical site prior to closure. Participants remained in an inpatient setting for 72 h to assess efficacy (Numeric Rating Scale [NRS] scores for pain with activity adjusted for opioid usage, and rescue medication usage), safety and pharmacokinetics. Seventy-three participants were randomized and treated, and 71 participants completed the study. Participants who received 300 mg CPL-01 had a mean (SD) area under the curve from 0 to 72 h (AUC_0-72) of the NRS score with activity of 356.9 (132.82), which was lower than placebo, indicating less pain. Participants who received CPL-01 300 mg also had numerically lower mean total opioid consumption. CPL-01 was safe and well-tolerated, with no evidence of increased AEs in one group versus another. Infiltration of CPL-01 had no impact on wound or bone healing. CPL-01 showed predictable and consistent extended-release pharmacokinetics, with no indication of "dose-dumping." Ropivacaine HCl delivered 94.3-99.7 % of its ropivacaine dose in the first 24 h; the 300 mg CPL-01 dose delivered 38.5 %. While this Phase 2b study was small, results demonstrated the safety, efficacy, and extended-release characteristics of this long-acting ropivacaine formulation in this surgical model, supporting further development of CPL-01 in Phase 3 clinical studies. LEVEL OF CLINICAL EVIDENCE: 1.

Although preoperative antibiotics are used routinely in ankle fracture surgery, there is considerable variability in postoperative antibiotic dosing regimens amongst surgeons. The aim of this study is to compare the rate of surgical site infection (SSI) in patients receiving one dose of preoperative antibiotics to patients who received more than one dose of antibiotics. A single-center Level I Trauma Center retrospective review of patients with isolated closed ankle fractures who underwent open reduction internal fixation over a 10-year period was performed. Demographics data and risk factors were obtained from the electronic medical record. SSI was detected using a text-mining algorithm on all postoperative clinic notes. Factors associated with the development of SSI or increased antibiotic dosing were evaluated. Eight-hundred and twenty-six patients were included in the analysis. There was no correlation between infection rate and any of the potential risk factors evaluated. Two-hundred and ninety-two patients received only one dose of antibiotics preoperatively and 534 patients received more than one antibiotic dose. The rate of SSI was not significantly different between the single-dose cohort (5.8 %) and the multi-dose cohort (3.9 %) (p=0.215). Routine use of postoperative antibiotics in open reduction internal fixation of closed ankle fractures did not decrease the rate of SSI, regardless of associated comorbidities. LEVEL OF EVIDENCE: : Level III (therapeutic retrospective cohort study).

The objective of this study is to conduct a prospective trial comparing the therapeutic efficacy of Omega toenail correction and the Winograd procedure in treating stage II-III paronychia. From August 2018 to August 2023, ninety cases from eighty-three patients were randomly divided into two groups, one receiving Omega toenail correction (experimental group) and the other receiving the Winograd procedure (control group). The clinical therapeutic effects of both treatments were evaluated based on time to resume movement, treatment cycle, one-year recurrence rate, and visual analogue scale (VAS) scores before and after treatment. The clinical efficacy was compared between Omega toenail correction and Winograd procedure treating paronychia of stage Ⅱ-Ⅲ. It has been demonstrated that the time to resume movement in the experimental group is obviously shorter than that in the control group (P = 0.024), while the treatment cycle is longer (P = 0.009) with no significant difference (P = 0.734) in the aspect of one-year recurrence rate. However, the VAS after the correction in the experimental group is significantly lower than that in the control group (P = 0.019). It has been suggested that Omega toenail correction characterized by easy operation, sure efficacy and lower recurrence rate can be widely applied in clinic work.

Percutaneous hallux valgus correction is gaining popularity with foot and ankle surgeons. Various studies have found that the percutaneous approach has increased patient satisfaction and outcomes. The technique of the procedure has some variability with the geometry of the distal osteotomy being the most scrutinized. As of this publication, there has been no comparative studies on the geometry of the distal metatarsal osteotomy. This is a retrospective study of 50 patients who underwent percutaneous correction of a hallux valgus deformity with either a percutaneous transverse or modified chevron osteotomy. The two groups were compared radiographically, preoperatively, and postoperatively using both the intermetatarsal and hallux valgus angles. There is no difference in radiographic outcomes when comparing pre and post-operative IM and HAV angles, and it is the surgeon's comfort levels with a particular geometry of the osteotomy that should determine the approach.

Little is known regarding outcomes of talus fracture management among patients with diabetes mellitus. This study aimed to compare post-operative outcomes after open reduction and internal fixation for talus fracture in patients with complicated diabetes, uncomplicated diabetes, and patients without diabetes. We used the PearlDiver database to identify patients who underwent operative repair of talus fractures from 2009 to 2021. Complications were evaluated at 30-days, 90-days, and 1 year of surgery. As we performed multiple separate analyses, to minimize the risk of type 1 error we employed the Bonferroni correction for statistical significance (p< 0.017). The PearlDiver identified 5,232 patients with talus fracture that underwent open reduction internal fixation. Stratified by diabetes status, the "complicated diabetes," "uncomplicated diabetes," and "no diabetes" groups contained 223, 418, and 4591 patients, respectively. Reoperation, acute kidney injury, and myocardial infarction were increased among diabetes patients compared to non-diabetes patients, irrespective of diabetes severity within 3 months of surgery. Furthermore, patients with complicated diabetes were more likely to develop sepsis and wound disruption compared to their non-diabetes counterparts within 3 months. While not statistically significant, complicated diabetes patients were diagnosed with talar non-union at higher rates compared with non-diabetes patients. Further analysis may reveal a clinically significant discrepancy in non-union between these groups. Complicated diabetes is associated with significantly higher risk of multiple adverse events following talus fracture repair. LEVEL OF CLINICAL EVIDENCE: 3.