Journal of Foot & Ankle Surgery最新文献_第4页

Relationship between ATFL-CFL-PTFL angle and subtalar instability ATFL-CFL-PTFL角度与距下不稳定性的关系。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-09 DOI: 10.1053/j.jfas.2025.10.002

Jun Zhou , Wei Wang , Ying He , Jinshan Xing , Yanyuan Zhang , Lei Zhang

Background

Ankle stability depends on lateral ligaments, yet research on Anterior Talofibular Ligament (ATFL), Calcaneofibular Ligament (CFL), and Posterior Talofibular Ligament (PTFL) angle variations in patients with subtalar joint instability (STJI) remains limited.

Purpose

The aim of this study was to investigate the correlation between the ATFL-CFL-PTFL angles and STJI, which could provide a new idea for effective evaluation of STJI.

Study Design

Retrospective case series.

Method

This retrospective study compared 220 subjects from 2010 to 2023: 110 patients with STJI and 110 control group subjects. The two groups of participants were positioned in a neutral supine orientation, and measurements using Magnetic Resonance Imaging (MRI) of the ankle region were conducted. Upon obtaining a detailed MRI scan, the ATFL-CFL-PTFL angle was utilized as a benchmark for comparison between individuals with STJI and those who are healthy.

Results

In the STJI group, the ATFL-PTFL angle was 86.3° ± 3.6°, the ATFL-CFL angle was 131.4° ± 4.7°, and the PTFL-CFL angle was 96.5° ± 4.0°. In the control group (non-STJI group), the ATFL-PTFL angle was 79.5° ± 3.8°, the ATFL-CFL angle was 126.8° ± 3.5°, and the PTFL-CFL angle was 86.3° ± 2.9°. There were significant differences (p < 0.01) in the ATFL-PTFL, ATFL-CFL, and PTFL-CFL angles between the STJI group and the control group.

Conclusion

Although ATFL-PTFL-CFL angle distribution overlapped between STJI and control groups, most STJI patients had significantly higher values, supporting its use as a secondary diagnostic index for STJI.

背景：踝关节的稳定性依赖于外侧韧带，但距下关节不稳（STJI）患者距腓骨前韧带（ATFL）、跟腓骨韧带（CFL）和距腓骨后韧带（PTFL）角度变化的研究仍然有限。目的：探讨ATFL-CFL-PTFL角度与STJI的相关性，为有效评价STJI提供新的思路。方法：本回顾性研究比较了2010年至2023年的220例患者，其中110例为STJI患者，110例为对照组。两组参与者均处于中性仰卧位，并使用磁共振成像（MRI）对踝关节区域进行测量。在获得详细的MRI扫描后，ATFL-CFL-PTFL角度被用作STJI患者与健康人群之间比较的基准。结果：STJI组ATFL-PTFL角为86.3°±3.6°，ATFL-CFL角为131.4°±4.7°，PTFL-CFL角为96.5°±4.0°。对照组（非stji组）ATFL-PTFL角为79.5°±3.8°，ATFL-CFL角为126.8°±3.5°，PTFL-CFL角为86.3°±2.9°。STJI组与对照组在ATFL-PTFL、ATFL-CFL、PTFL-CFL角度上差异有统计学意义（p < 0.01）。结论：虽然ATFL-PTFL-CFL角分布在STJI组和对照组之间有重叠，但大多数STJI患者的值明显更高，支持其作为STJI的二级诊断指标。

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引用次数: 0

Evaluating nutritional and clinical correlates of ponseti technique success in pediatric clubfoot 评价小儿内翻足Ponseti技术成功的营养和临床相关因素。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-12 DOI: 10.1053/j.jfas.2025.11.003

Muhammad Muzzammil , Syed Ghulam Mujtaba Shah , Abdul Qadir , Syed Jahanzeb , Muhammad Owais Minhas , Amna Jamil

Objective

Malnutrition is a very critical health problem, especially among developing countries. It is considered one of the major risk factors for diseases and mortality in children. Clubfoot or congenital talipes equinovarus (CTEV) is the most common form of congenital orthopedic abnormality, and the Ponseti method has become the gold standard of treatment for clubfoot over the last two decades. This research study aimed at identifying the malnutrition prevalence in clubfoot patients and its relation with the Ponseti technique's outcome for the patients coming to the Orthopedic Clinic of a tertiary care hospital in Karachi, Pakistan. We further attempted to investigate the relationship of the clinical tests between CBC, serum albumin level, serum electrolytes, and nutritional status.

Methods

This was a cross-sectional study carried out from January to December 2022 with a total of 105 clubfoot patients. The WHO classification of weight-for-age index was used to assess the nutritional status of patients, and clinical tests were also conducted to evaluate the correlation between malnutrition and the outcome of the Ponseti technique. Statistical analysis was performed with a P value ≤ 0.05 deemed significant.

Results

Among 105 patients, 84 (80%) had good nutritional status and 21 (20%) had malnutrition. The average number of casts per patient and the percentage of patients requiring 6 or more casts were higher in the malnourished group at 45.5% compared to 21.42%. The number of Achilles tenotomy procedures performed was higher in the malnourished group at 76.4% compared to 51.8%. Clinical tests proved a straight correlation of nutritional status and results after the Ponseti technique.

Conclusion

Malnutrition remains a critical determinant of Ponseti technique outcomes in clubfoot patients. Addressing nutritional deficits through early interventions and incorporating clinical tests into routine evaluations can significantly improve treatment efficacy. These findings highlight a strong correlation between malnutrition and increased treatment complexity, but causality cannot be concluded from this study. Further longitudinal or interventional research is warranted to explore these relationships more definitively.

目的：营养不良是一个非常严重的健康问题，特别是在发展中国家。它被认为是儿童患病和死亡的主要危险因素之一。内翻足或先天性马蹄内翻（CTEV）是最常见的先天性矫形畸形，在过去的二十年里，Ponseti方法已成为治疗内翻足的金标准。本研究旨在确定在巴基斯坦卡拉奇一家三级医院骨科诊所就诊的内翻足患者中营养不良的发生率及其与Ponseti手术结果的关系。我们进一步尝试探讨临床试验与CBC、血清白蛋白水平、血清电解质和营养状况之间的关系。方法：这是一项横断面研究，于2022年1月至12月进行，共105例内翻足患者。采用WHO年龄体重指数分类来评估患者的营养状况，并进行临床试验来评估营养不良与Ponseti技术结果之间的相关性。以P值≤0.05为显著性进行统计学分析。结果：105例患者中营养状况良好84例（80%），营养不良21例（20%）。营养不良组每名患者的平均石膏次数和需要6次或更多石膏的患者比例为45.5%，高于21.42%。营养不良组进行跟腱切开术的次数为76.4%，高于51.8%。临床试验证明，营养状况与Ponseti技术后的结果直接相关。结论：营养不良是影响内翻足患者Ponseti技术治疗效果的关键因素。通过早期干预和将临床试验纳入常规评估来解决营养不足问题，可显著提高治疗效果。这些发现强调了营养不良与治疗复杂性增加之间的强烈相关性，但不能从本研究中得出因果关系。进一步的纵向或介入研究是必要的，以更明确地探索这些关系。

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引用次数: 0

Open reduction of metatarsal fractures is associated with a safer risk profile than percutaneous fixation 跖骨骨折切开复位比经皮固定具有更安全的风险。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-18 DOI: 10.1053/j.jfas.2025.11.014

Christian F. Zirbes BS , Nicholas R. Kiritsis BS , Conor N. O'Neill MD , Albert T. Anastasio MD

Background

Despite open reduction internal fixation (ORIF) and percutaneous fixation being commonly used for the treatment of metatarsal fractures, the relative complication profiles are unclear.

Purpose

To compare short– and medium–term complications between ORIF and percutaneous fixation of metatarsal fractures using a large multi–center database.

Study Design

We used the TriNetX research network to identify two patient cohorts with metatarsal fractures: those who underwent ORIF, and those that underwent percutaneous fixation.

Methods

Two propensity–matched cohorts of 846 patients each who underwent percutaneous fixation or internal fixation between 2010 and 2024. We compared complication rates at 30 days, 90 days, and 1 year by calculating rates, odds ratios, and p–values.

Results

At 30 and 90–days, ORIF was associated with lower rates of ED visits and inpatient admission, with no differences in revision procedures at 1 year. Subgroup analysis by fracture location demonstrated that ORIF of 1st metatarsal fractures was associated with higher short–term complication rates than central metatarsal fractures, while patients who underwent ORIF of a 5th metatarsal fracture had lower rates of early adverse events and revision surgery within 1 year.

Conclusions

Despite greater surgical exposure, open reduction internal fixation was associated with fewer short–term ED presentations and inpatient admissions. These findings challenge assumptions about the relative safety of percutaneous fixation and suggest that open techniques for metatarsal fracture fixation may offer a favorable risk profile, especially when considering hospital utilization. Further prospective trials are warranted to validate these results and explore whether patient– or injury–specific factors meaningfully impact complication risk.

背景：尽管切开复位内固定（ORIF）和经皮内固定是治疗跖骨骨折的常用方法，但相关的并发症情况尚不清楚。目的：通过一个大型的多中心数据库，比较ORIF和经皮内固定治疗跖骨骨折的中短期并发症。研究设计：我们使用TriNetX研究网络来确定两个跖骨骨折患者队列：接受ORIF的患者和接受经皮固定的患者。方法：2010年至2024年间，两个倾向匹配的846例患者均接受了经皮固定或内固定。我们通过计算发生率、优势比和p值来比较30天、90天和1年的并发症发生率。结果：在第30天和第90天，ORIF与较低的急诊科就诊率和住院率相关，1年的翻修程序没有差异。骨折部位亚组分析显示，第1跖骨骨折的ORIF短期并发症发生率高于中央跖骨骨折，而第5跖骨骨折的ORIF患者1年内早期不良事件发生率和翻修手术发生率较低。结论：尽管更多的手术暴露，切开复位内固定与更少的短期ED表现和住院有关。这些研究结果挑战了关于经皮固定相对安全性的假设，并表明开放技术用于跖骨骨折固定可能具有良好的风险，特别是在考虑到医院使用时。需要进一步的前瞻性试验来验证这些结果，并探讨患者或损伤特异性因素是否有意义地影响并发症风险。

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引用次数: 0

Evaluation of K-wires splinting of first and second metatarsals following proximal open wedge osteotomy for hallux valgus correction 近端开楔截骨后第一、第二跖骨k线夹板矫正拇外翻的疗效评价。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-26 DOI: 10.1053/j.jfas.2025.09.009

Abou Bakr zein Mohammed MD , Ahmed Mahmoud Kholeif MD , Ali Mohammed Reda MD , Hosam El-Din Amin MD , Sayed Naser Abdallah Naser MD

Background

Hallux valgus is a prevalent foot deformity affecting a significant portion of the population and often managed through various surgical techniques. Proximal opening wedge osteotomy of the first metatarsal bone is a popular and effective management modality, yet there remains no consensus on the optimal fixation method

Purpose

Evaluating the outcomes of K-wires fixation versus plate and screws fixation following proximal opening wedge osteotomy of the first metatarsal bone for managing moderate to severe hallux valgus

Study design

Retrospective multicenter cohort study.

Methods

Forty patients were evenly divided into two groups; Group A (K-wires fixation to the second metatarsal) and Group B (plate and screws fixation). Patients were followed up for at least 1 year.

Results

Both groups showed significant improvements in hallux valgus angle, inter-metatarsal angle, and American Orthopedic Foot and Ankle Society scores, with no significant differences between them. However, K-wires fixation was associated with lower implant costs (P = 0.01), and fewer subsequent surgeries (P = 0.01). Complications such as complex regional pain syndrome and wound issues were more frequent in the plate group, with six cases requiring plate removal due to prominence

Conclusion

K-wire fixation is a cost-effective and reliable alternative to plate and screws fixation, offering similar clinical outcomes while reducing secondary surgical intervention rates

背景：拇外翻是一种常见的足部畸形，影响了很大一部分人群，通常通过各种手术技术来治疗。第一跖骨近端开口楔形截骨术是一种流行且有效的治疗方式，但关于最佳固定方法仍未达成共识目的：评估k针固定与钢板螺钉固定在第一跖骨近端开口楔形截骨术后治疗中度至重度拇外翻的效果研究设计：回顾性多中心队列研究。方法：40例患者平均分为两组；A组（克氏针固定第二跖骨）和B组（钢板螺钉固定）。患者随访至少1年。结果：两组拇外翻角、跖间角、American orthopical Foot and Ankle Society评分均有明显改善，两组间差异无统计学意义。然而，k针固定与较低的种植成本（P = 0.01）和较少的后续手术（P = 0.01）相关。并发症如复杂的局部疼痛综合征和伤口问题在钢板组中更常见，有6例病例因突出而需要取出钢板。结论：k线固定是一种经济可靠的替代钢板和螺钉固定，提供相似的临床结果，同时降低了二次手术干预率。

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引用次数: 0

Central sensitization and pain phenotypes in symptomatic pes planus: A multicenter cross-sectional study 症状性扁平足的中枢致敏和疼痛表型：一项多中心横断面研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-27 DOI: 10.1053/j.jfas.2025.09.008

Gülseren Demir Karakılıç , Melek Aykut Selçuk , Esra Mert

Background

Pes planus (PP) is a common foot disorder often associated with persistent pain despite treatment. Central sensitization (CS) and nociplastic pain (NcP) are potential contributors but remain underexplored in PP.

Purpose

To investigate the prevalence of CS and nociplastic-like features in patients with symptomatic PP and examine their associations with pain, disability, psychological distress, and quality of life.

Study Design

Multicenter cross-sectional study.

Methods

A total of 107 patients with diagnosed PP and 107 age- and sex-matched healthy controls were enrolled. Participants completed Turkish versions of Visual Analog Scale (VAS), Foot Function Index (FFI), Pain-DETECT, Central Sensitization Inventory (CSI), Hospital Anxiety and Depression Scale (HADS), and Short Form-12 (SF-12). Group comparisons, correlation analyses, and regression models were performed to identify predictors of nociplastic-like features and CS.

Results

Compared with controls, PP patients reported greater pain (VAS mean difference 3.9, 95 % CI 3.1–4.7) and disability (FFI mean difference 45.8, 95 % CI 41.2–50.4). Probable nociplastic-like features were identified in 48.6 % of PP versus 3.7 % of controls, and CSI ≥40 in 61.7 % versus 43.9 %. Anxiety and depression scores were higher in PP, while SF-12 physical and mental scores were lower. In regression models, pain duration, intensity, disability, and CS predicted nociplastic-like features, while CS was predicted by pain severity, disability, nociplastic-like features, and psychological distress.

Conclusion

Symptomatic PP is not solely a structural condition but involves central and psychosocial mechanisms. Recognition of CS and nociplastic processes supports multidisciplinary management strategies that address biomechanical, central, and psychological contributors to persistent pain.

背景：扁平足（PP）是一种常见的足部疾病，尽管治疗，但常伴有持续疼痛。中枢致敏（CS）和致伤性疼痛（NcP）是PP的潜在诱因，但在PP中尚未得到充分研究。目的：调查有症状的PP患者中CS和致伤性样特征的患病率，并研究它们与疼痛、残疾、心理困扰和生活质量的关系。研究设计：多中心横断面研究。方法：共纳入107例诊断为PP的患者和107例年龄和性别匹配的健康对照。参与者完成了土耳其版本的视觉模拟量表（VAS）、足部功能指数（FFI）、疼痛检测、中枢致化量表（CSI）、医院焦虑和抑郁量表（HADS）和简短表格-12 （SF-12）。通过组间比较、相关分析和回归模型来确定肿瘤样特征和CS的预测因子。结果：与对照组相比，PP患者报告更大的疼痛（VAS平均差值3.9,95% CI 3.1-4.7）和残疾（FFI平均差值45.8,95% CI 41.2-50.4）。48.6%的PP和3.7%的对照组确定了可能的致伤样特征，CSI≥40的患者分别为61.7%和43.9%。焦虑和抑郁得分较高的PP，而SF-12生理和心理得分较低。在回归模型中，疼痛持续时间、强度、残疾和CS可预测致伤样特征，而CS可通过疼痛严重程度、残疾、致伤样特征和心理困扰来预测。结论：症状性PP不仅是一种结构性疾病，而且涉及中枢和社会心理机制。对CS和伤害过程的认识支持多学科管理策略，以解决造成持续性疼痛的生物力学、中枢和心理因素。证据等级：III级，横断面研究。

{"title":"Central sensitization and pain phenotypes in symptomatic pes planus: A multicenter cross-sectional study","authors":"Gülseren Demir Karakılıç , Melek Aykut Selçuk , Esra Mert","doi":"10.1053/j.jfas.2025.09.008","DOIUrl":"10.1053/j.jfas.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Pes planus (PP) is a common foot disorder often associated with persistent pain despite treatment. Central sensitization (CS) and nociplastic pain (NcP) are potential contributors but remain underexplored in PP.</div></div><div><h3>Purpose</h3><div>To investigate the prevalence of CS and nociplastic-like features in patients with symptomatic PP and examine their associations with pain, disability, psychological distress, and quality of life.</div></div><div><h3>Study Design</h3><div>Multicenter cross-sectional study.</div></div><div><h3>Methods</h3><div>A total of 107 patients with diagnosed PP and 107 age- and sex-matched healthy controls were enrolled. Participants completed Turkish versions of Visual Analog Scale (VAS), Foot Function Index (FFI), Pain-DETECT, Central Sensitization Inventory (CSI), Hospital Anxiety and Depression Scale (HADS), and Short Form-12 (SF-12). Group comparisons, correlation analyses, and regression models were performed to identify predictors of nociplastic-like features and CS.</div></div><div><h3>Results</h3><div>Compared with controls, PP patients reported greater pain (VAS mean difference 3.9, 95 % CI 3.1–4.7) and disability (FFI mean difference 45.8, 95 % CI 41.2–50.4). Probable nociplastic-like features were identified in 48.6 % of PP versus 3.7 % of controls, and CSI ≥40 in 61.7 % versus 43.9 %. Anxiety and depression scores were higher in PP, while SF-12 physical and mental scores were lower. In regression models, pain duration, intensity, disability, and CS predicted nociplastic-like features, while CS was predicted by pain severity, disability, nociplastic-like features, and psychological distress.</div></div><div><h3>Conclusion</h3><div>Symptomatic PP is not solely a structural condition but involves central and psychosocial mechanisms. Recognition of CS and nociplastic processes supports multidisciplinary management strategies that address biomechanical, central, and psychological contributors to persistent pain.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"65 2","pages":"Pages 39.e1-39.e7"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of fibular fixation in the treatment of adolescent displaced distal tibial physeal fractures to fix or not to fix? 腓骨固定在青少年胫骨远端移位性骨骺骨折治疗中的作用是固定还是不固定？

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-15 DOI: 10.1053/j.jfas.2025.10.005

Zhaoqiang Chen MD , Xinwei Li BS , Taotao Hui MD , Jun Wang MD , Zhongli Zhang MD , Weifeng Lin BS

Background

In treating adolescent displaced distal tibial physeal/fibula fractures, the role of fibular fixation is not clearly defined.

Purpose

This study aimed to assess the role of fibular fixation in adolescent displaced distal tibial physeal/fibula fractures and its significance with functional outcomes.

Study design

Retrospective cohort study.

Methods

50 patients with adolescent displaced distal tibial physeal/fibula fractures were enrolled into the study and divided into two groups based on whether the fibula was fixed (group A) or not (group B). The two groups were compared for differences in demographic data, operative time, intraoperative fluoroscopy times, weight-bearing time, union time, and complications. Clinical and functional outcomes were regularly assessed using the premature epiphyseal closure (PPC) rate and the American Orthopaedic Foot and Ankle Score (AOFAS) ankle-hindfoot foot scoring system.

Results

There were significant differences in operative time (p < 0.001), intraoperative fluoroscopy times (p < 0.001), fibula healing time (p < 0.001) and weight-bearing time (p < 0.001) between the two groups. In contrast, fibular fixation did not affect the outcome of the clinical ankle score (p = 0.484).

Conclusion

For adolescent patients with distal tibial physeal fractures and concurrent fibula fractures, fibular fixation can significantly shorten fibular healing time and enable earlier weight-bearing. This fixation may also improve the ability to achieve and maintain the reduction in complex distal tibial physeal fractures. However, routine fibular fixation is not recommended and should be considered based on fracture characteristics such as syndesmotic instability, severe fibular displacement/shortening, or challenges in maintaining tibial reduction.

背景：在治疗青少年移位的胫骨远端骨骺/腓骨骨折时，腓骨固定的作用尚未明确定义。目的：本研究旨在评估腓骨固定在青少年移位的胫骨远端骨骺/腓骨骨折中的作用及其对功能预后的意义。研究设计：回顾性队列研究。方法：选取50例青少年胫骨远端骨骺/腓骨骨折移位患者，根据腓骨是否固定分为两组（A组）和未固定组（B组）。比较两组在人口学资料、手术时间、术中透视次数、负重时间、愈合时间和并发症方面的差异。使用骨骺过早闭合（PPC）率和美国骨科足踝评分（AOFAS）踝关节-后足足评分系统定期评估临床和功能结果。结果：两组患者手术时间（p < 0.001）、术中透视次数（p < 0.001）、腓骨愈合时间（p < 0.001）、负重时间（p < 0.001）差异均有统计学意义。相比之下，腓骨固定不影响临床踝关节评分（p = 0.484）。结论：对于青少年胫骨远端骨骺骨折并发腓骨骨折患者，采用腓骨固定可显著缩短腓骨愈合时间，使患者更早负重。这种固定也可以提高复杂的胫骨远端骨骺骨折实现和维持复位的能力。然而，常规腓骨固定不推荐，应根据骨折特征，如关节联合不稳定，严重腓骨移位/短缩，或维持胫骨复位的挑战来考虑。证据等级：III级，回顾性队列研究。

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引用次数: 0

Association between isolated fibular fracture displacement and deep deltoid injury: A comparative analysis of arthroscopic and radiographic assessments 孤立腓骨骨折移位与深三角肌损伤之间的关系：关节镜和影像学评估的比较分析。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-19 DOI: 10.1053/j.jfas.2025.11.013

Fernando Ramierez DPM, FACFAS , David R. Collman DPM, FACFAS , Sheng-Fang Jiang MS , John Schuberth DPM

Background

Isolated distal fibular fractures can often be successfully treated without surgery. Fracture stability is largely dependent on an intact deep deltoid ligament, yet methods of determining ligament integrity remain a clinical challenge. Recently, fibular fracture displacement on radiographs has been used to predict deep deltoid disruption. Purpose: To determine whether distal fibular fracture displacement is a reliable indicator of fracture stability based on arthroscopic assessment of deep deltoid ligament integrity. Study Design: This retrospective study evaluated isolated fibular fracture displacement on radiographs in 85 patients at a single medical center. All patients underwent surgical repair of the fracture and arthroscopic evaluation of the deep deltoid.

Methods

Anterior to posterior fibular fracture displacement (APD) and lateral fracture displacement (LFD) were measured and correlated with deep deltoid integrity at each millimeter (mm) of displacement.

Results

Fifty-seven (67 %) patients had an intact deep deltoid, with a median APD of 0.8 mm (range 0.0 – 3.7 mm). Twenty-eight (33 %) patients had a ruptured deep deltoid, with a median APD displacement of 1.85 mm (range 1.05 – 2.7 mm). The deep deltoid was intact over a wide range of fracture gap measurements. The APD was significantly greater in patients with a ruptured deep deltoid (p < 0.001).

Conclusion

Although there was a significant increase in fracture displacement when the deep deltoid was compromised, large APD gap distances did not consistently correlate with a deep deltoid rupture. Anterior to posterior fracture gap distance is not a reliable indicator of deltoid ligament integrity in isolated distal fibula fractures.

背景：孤立性腓骨远端骨折通常无需手术即可成功治疗。骨折稳定性在很大程度上依赖于完整的深三角韧带，然而确定韧带完整性的方法仍然是一个临床挑战。最近，x线片上腓骨骨折移位已被用来预测深三角肌断裂。目的：通过关节镜评估深三角韧带完整性，确定腓骨远端骨折移位是否是骨折稳定性的可靠指标。研究设计：本回顾性研究评估了同一医疗中心85例孤立腓骨骨折移位患者的x线片表现。所有患者都接受了骨折的手术修复和关节镜对深三角肌的评估。方法：测量腓骨前后骨折位移（APD）和外侧骨折位移（LFD），并与每毫米位移（mm）的深三角肌完整性相关。结果：57例（67%）患者有完整的深三角肌，中位APD为0.8 mm（范围0.0 - 3.7 mm）。28例（33%）患者深三角肌破裂，APD中位位移1.85 mm（范围1.05 - 2.7 mm）。在大范围的骨折间隙测量中，深三角肌是完整的。深三角肌破裂患者APD显著增高（p < 0.001）。结论：虽然当深三角肌受损时骨折位移显著增加，但APD间隙距离大并不总是与深三角肌破裂相关。在孤立性腓骨远端骨折中，前后骨折间隙距离并不是三角韧带完整性的可靠指标。证据等级：3级，回顾性队列。

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引用次数: 0

Comparison of popliteal nerve block and combined spinal-local infiltration anesthesia in Hallux Valgus Surgery: A randomized clinical trial 腘神经阻滞与脊髓-局部联合浸润麻醉在拇外翻手术中的比较：一项随机临床试验。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-09-26 DOI: 10.1053/j.jfas.2025.08.016

Leonieke N. Palmen MD , Myrthe P.F. van de Ven MSc , Elcke Karthaus MSc , Martin Hagenaars MD, PhD , Sander Koëter MD, PhD , Justus H.W. Jansen MD, PhD

Background

Early mobilization and adequate pain relief are important in hallux valgus surgery. The effect of anesthesia technique on post-operative mobility has not been well studied.

Purpose

In search for the anesthesia technique that allows best for early mobility, a prospective clinical trial was conducted to compare popliteal nerve block anesthesia with combined local infiltration anesthesia (LIA) and spinal anesthesia.

Study Design

Randomized clinical trial

Methods

Thirty-three patients eligible for hallux valgus surgery were prospectively randomized to receive either LIA/spinal anesthesia (n=14) or popliteal nerve block anesthesia (n=17). Hallux valgus surgery was performed in a short stay clinical setting, facilitating data collection during an overnight stay. Patients were postoperatively mobilized both on the day of surgery, and the next day. The primary outcome was early postoperative mobility. Intra- and postoperative pain relief, and patient satisfaction were secondary outcomes.

Results

On the day of surgery, independent mobilization and weight-bearing ability of patients who received LIA/spinal anesthesia were significantly better (p=0.022, p=0.010), compared to patients receiving the popliteal nerve block. The next day, independent mobilization did not differ between the 2 groups, although the weight bearing ability was better in patients who received LIA/spinal anesthesia. No significant between-group differences were observed in intra- and postoperative pain. High satisfaction with the anesthetic technique was achieved in both groups.

Conclusion

LIA/spinal anesthesia was associated with earlier independent ambulation and weight-bearing, suggesting potential benefits for outpatient hallux valgus surgery. However, both popliteal nerve block anesthesia and LIA/spinal anesthesia are suitable for hallux valgus surgery, with adequate pain relief and high patient satisfaction.

背景：在拇外翻手术中，早期活动和充分缓解疼痛是很重要的。麻醉技术对术后活动能力的影响尚未得到很好的研究。目的：为了寻找最有利于早期活动的麻醉技术，我们进行了一项前瞻性临床试验，比较腘神经阻滞麻醉与局部浸润麻醉（LIA）和脊髓联合麻醉。研究设计：随机临床试验方法：33例符合拇外翻手术条件的患者前瞻性随机接受LIA/脊髓麻醉（n=14）或腘神经阻滞麻醉（n=17）。拇外翻手术是在短期住院的临床环境中进行的，便于过夜住院期间的数据收集。术后患者在手术当天和第二天均可活动。主要结果是术后早期活动能力。术后疼痛缓解和患者满意度是次要结果。结果：手术当日，与腘神经阻滞组相比，LIA/脊髓麻醉组患者的独立活动能力和负重能力明显更好（p=0.022, p=0.010）。第二天，两组之间的独立活动没有差异，尽管接受LIA/脊髓麻醉的患者的负重能力更好。组内、术后疼痛无明显差异。两组患者对麻醉技术均有较高的满意度。结论：LIA/脊髓麻醉与早期独立行走和负重有关，提示门诊拇外翻手术的潜在益处。但腘神经阻滞麻醉和LIA/脊髓麻醉均适用于拇外翻手术，疼痛缓解效果好，患者满意度高。临床证据等级：2级。

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引用次数: 0

Fusion rates in tibiotalocalcaneal arthrodesis with tantalum-coated metal cone augmentation 钽涂层金属锥体增强胫距跟关节融合术的融合率。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-16 DOI: 10.1053/j.jfas.2025.10.007

Aine M. Gallahue MD, MEng, BS , Adel Mahjoub MD , Nicholas D’Antonio MD , Vineeth Romiyo BS , Pietro M. Gentile BS , Erik Freeland DO

Background

Tantalum-coated metal spacers (TCMS) have been increasingly utilized to fill and provide structure to large bony defects in the hindfoot. There is a paucity of literature assessing the outcomes of tantalum-coated metal spacers in foot and ankle surgery. Purpose: This study serves to assess clinical outcomes and fusion rates of patients who underwent tibiotalocalcaneal arthrodesis with tantalum augmentation.

Study Design

This is a retrospective cohort study (N = 65) of patients who underwent tibiotalocalcaneal arthrodesis with and without TCMS at a tertiary care center between 2015 and 2021.

Methods

Computed tomography scans at the six-month postoperative point were reviewed to determine fusion status. Patient-reported outcomes measures were collected after at least 1 year postoperatively. A multivariate logistic regression model was used to measure the likelihood of achieving fusion with tantalum augmentation.

Results

There was a statistically significant lower rate of hardware failure in the TCMS group (4.76 % vs. 34.09 %, p = 0.021). TCMS-augmentation was a nonsignificant predictor of increased odds of fusion at the six-month postoperative point (OR = 4.84, p = 0.124).

Conclusion

This study is the largest to date to present 6-month postoperative CT scans demonstrating successful tibiotalocalcaneal arthrodesis fusion with tantalum augmentation, contributing to our understanding of its utility. Further studies are needed to evaluate the efficacy of TCMS-augmented fusions as a viable substitute to custom printed cages.

背景：钽涂层金属垫片（TCMS）已越来越多地用于填补和提供结构的大骨缺损后脚。评估钽涂层金属垫片在足部和踝关节手术中的效果的文献很少。目的：本研究旨在评估经钽增强的胫距跟关节融合术患者的临床结果和融合率。研究设计：这是一项回顾性队列研究（N = 65），研究对象是2015-2021年间在三级保健中心接受胫距-跟骨关节融合术的患者，有和没有中西医结合。方法：回顾术后6个月的计算机断层扫描以确定融合状态。术后至少1年后收集患者报告的结果测量。使用多元逻辑回归模型来测量与钽增强实现融合的可能性。结果：TCMS组硬体失败率明显低于对照组（4.76% vs. 34.09%, p = 0.021）。tcms增强是术后6个月融合几率增加的无显著性预测因子（OR = 4.84,p = 0.124）。结论：本研究是迄今为止最大的一项6个月术后CT扫描，显示钽增强成功的胫距跟骨关节融合术，有助于我们了解其实用性。需要进一步的研究来评估tcms增强融合作为定制打印笼的可行替代品的有效性。临床证据等级：3级。

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引用次数: 0

Deltoid ligament insufficiency in hindfoot arthrodesis for progressive collapsing foot deformity: A retrospective analysis 后足关节融合术治疗进行性塌陷足畸形时三角韧带功能不全的回顾性分析。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-28 DOI: 10.1053/j.jfas.2025.10.010

Arina Litarov DPM , Jacob G. Gross DPM, AACFAS , Isaac M. Kline DPM, AACFAS , Alan R. Catanzariti DPM, FACFAS , Brandon M. Schooley MD

Background

In advanced stages of progressive collapsing foot deformity, attenuation of the deltoid ligament can contribute to valgus tilt of the talus within the ankle mortise. Hindfoot arthrodesis is the standard treatment for late-stage progressive collapsing foot deformity; however, unrecognized deltoid ligament insufficiency may predispose patients to postoperative tibiotalar valgus.

Purpose

To evaluate the accuracy of preoperative MRI in detecting deltoid ligament insufficiency in patients undergoing hindfoot arthrodesis for late-stage PCFD.

Study Design/Methods

37 feet from 35 patients undergoing arthrodesis for advanced PCFD were reviewed. Preoperative MRI findings were compared to intraoperative valgus stress radiographs. Sensitivity, specificity, and odds ratio for MRI detecting deltoid incompetence were calculated.

Results

Deltoid ligament disruption occurred in 18.9% (7/37) of cases as confirmed by both MRI and intraoperative stress testing. 35.1% (13/37) had a negative MRI but a positive stress exam. An additional 10.8% (4/37) had MRI-positive findings unconfirmed by stress test. Overall, 54.1% (20/37) demonstrated deltoid ligament insufficiency in intraoperative stress examination. MRI identified deltoid tears in 29.7% (11/37) of cases, yielding a sensitivity of 63.6% and specificity of 50.0%. The odds ratio of a positive MRI predicting actual deltoid ligament insufficiency was 1.75.

Conclusion

MRI as a standalone modality demonstrated limited accuracy in detecting functionally significant deltoid laxity. Functional deltoid incompetence should be considered in surgical planning, and adjunctive intraoperative assessments should be performed to confirm deltoid instability. Prospective studies are needed to determine the best method of reducing the incidence of postoperative tibiotalar valgus.

背景：在进行性塌陷足畸形的晚期，三角韧带的衰减可导致踝骨内距骨外翻倾斜。后足关节融合术是晚期进行性塌陷足畸形的标准治疗方法；然而，未被认识到的三角韧带功能不全可能使患者易发生术后胫距外翻。目的：评价晚期PCFD后足融合术患者术前MRI检查三角韧带功能不全的准确性。研究设计/方法：回顾了35例晚期PCFD患者的37英尺关节融合术。术前MRI检查结果与术中外翻应力x线片进行比较。计算MRI检测三角肌功能不全的敏感性、特异性和优势比。结果：经MRI及术中应激试验证实，三角韧带断裂发生率为18.9%（7/37）。35.1% (13/37) MRI阴性，应激检查阳性。另外10.8%（4/37）的mri阳性结果未经压力测试证实。总的来说，54.1%（20/37）的患者在术中应力检查中表现为三角韧带功能不全。在29.7%（11/37）的病例中，MRI诊断出三角肌撕裂，敏感性为63.6%，特异性为50.0%。MRI阳性预测三角韧带功能不全的比值比为1.75。结论：MRI作为一种独立的方式在检测功能上显著的三角肌松弛时显示出有限的准确性。手术计划时应考虑功能性三角肌功能不全，术中应进行辅助评估以确认三角肌不稳定。需要前瞻性研究来确定减少术后胫距外翻发生率的最佳方法。临床证据等级：III级证据。

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引用次数: 0