Journal of Foot & Ankle Surgery最新文献_第5页

Mortality rate of geriatric patients with open ankle fractures 老年开放性踝关节骨折患者的死亡率。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-11 DOI: 10.1053/j.jfas.2025.11.009

Sarah Mansager DPM, AACFAS , Youngjae Lee PhD , Jessica Katzer DPM , Isabella Saley DPM , David Calderwood DPM, AACFAS , Garret Burks PhD , Kelly Kugach DPM, AACFAS

Background

Open ankle fractures can pose a threat to life in the geriatric population, aged 65 years and older. These patients are susceptible to postoperative complications, often related to poor bone mineral density and soft tissue quality. While the mortality rate associated with open ankle fractures in the elderly has been explored, there is a lack of studies addressing mortality outcomes beyond one year. Furthermore, there is an absence of comparison to the general population. Without that comparison, it is difficult to determine whether open ankle fractures are independently associated with an increased mortality risk.

Purpose

This study aimed to determine the mortality rate of open ankle fractures in geriatric patients and to compare that to the mortality rate of a general geriatric population. Additionally, we aimed to identify potential risk factors associated with increased mortality.

Study Design

A retrospective review of 115 patients who sustained open ankle fractures at our institution between 2012 and 2024 was performed.

Results

Of these, 41 patients had a documented date of death, and our analysis revealed a 12.0 % mortality rate at 1-year and a 29.2 % mortality rate at 5-years post-surgery. The standardized mortality ratio was calculated to contextualize the observed mortality relative to the expected mortality in the general population after age and sex matching, which showed a higher 1-year mortality rate in our geriatric patients with open ankle fractures compared to the general population.

Conclusion

These findings offer valuable insights for clinicians and highlight the risk faced by this population.

背景：在65岁及以上的老年人群中，开放性踝关节骨折可能对生命构成威胁。这些患者易发生术后并发症，通常与骨密度和软组织质量差有关。虽然已经探讨了老年人开放性踝关节骨折的死亡率，但缺乏针对一年以上死亡率结果的研究。此外，没有与一般人群进行比较。没有这种比较，很难确定开放性踝关节骨折是否与死亡风险增加独立相关。目的：本研究旨在确定老年患者开放性踝关节骨折的死亡率，并将其与普通老年人群的死亡率进行比较。此外，我们旨在确定与死亡率增加相关的潜在危险因素。研究设计：对我院2012年至2024年间115例开放性踝关节骨折患者进行回顾性分析。结果：其中41例患者有死亡日期记录，我们的分析显示，术后1年死亡率为12.0%，5年死亡率为29.2%。计算标准化死亡率是为了将观察到的死亡率与年龄和性别匹配后的普通人群的预期死亡率联系起来，结果显示，与普通人群相比，我们的老年开放性踝关节骨折患者的1年死亡率更高。结论：这些发现为临床医生提供了有价值的见解，并突出了这一人群面临的风险。

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引用次数: 0

Team approach to short versus below-knee amputation yields equivalent patient-reported outcomes in both groups 在两组患者报告的结果中，短距离截肢和膝下截肢的团队方法相同。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-10 DOI: 10.1053/j.jfas.2025.11.008

Christopher M. Ply BS , Hannah Soltani BS , Craig J. Verdin DPM , Christian X. Lava MS , John R. DiBello MS , Richard C. Youn MD , Karen K. Evans MD , John S. Steinberg DPM, FACFAS , Jayson N. Atves DPM, FACFAS , Christopher E. Attinger MD

Background

The choice between limb salvage with the controversial midfoot amputation or below-knee amputation (BKA) is largely subjective.

Purpose

We seek to compare patient-reported outcome measures (PROMs) and complication rates of the Chopart and Lisfranc midfoot amputations to BKA.

Study Design

A single-center retrospective cohort study was performed from October 2017 to September 2023 of adult patients undergoing Lisfranc, Chopart, or BKA. Lisfranc and Chopart amputations were grouped as midfoot amputations and compared to BKA.

Methods

Patient demographics, comorbidities, adverse outcomes, and PROMs were compared. The Lower Extremity Functional Scale (LEFS), PROM Information System Pain Intensity (PROMIS-3a), Self-Reporting Questionnaire-20 (SRQ-20), and Connor-Davidson Resilience Scale (CD-RISC) were collected from ambulatory patients at least 6 months after surgery.

Results: A total of 73 patients were included

18 underwent midfoot amputation (6 Lisfranc and 12 Chopart), and 55 BKA. The average age was 62.5 ± 12.0 years with an average Charlson Comorbidity Index of 5.0 [IQR: 4.0] and a median follow-up duration of 40.6 [27.8] months. Midfoot amputees had insignificantly higher rates of postoperative complication (16.7% vs 3.6%, p = 0.092) and significantly higher rates of recurrence requiring revision surgery (44.4% vs 18.2%, p = 0.025). PROMs were similar between groups. Multivariate regression analysis revealed that function was independently associated with peripheral vascular disease (B = -10.1, p = 0.047) and psychological distress (B = -2.4, p = 0.002), but not amputation type (p = 0.978).

Conclusion

With a team-based approach that prioritizes function and patient preference, patient-reported function is impacted by comorbidity and mental health, not by amputation level.

背景：肢体保留与有争议的足中部截肢或膝下截肢（BKA）之间的选择很大程度上是主观的。目的：我们试图比较Chopart和Lisfranc足中截肢与BKA患者报告的预后指标（PROMs）和并发症发生率。研究设计：2017年10月至2023年9月，对接受Lisfranc、Chopart或BKA手术的成年患者进行单中心回顾性队列研究。将Lisfranc和Chopart截肢归为中足截肢，并与BKA进行比较。方法：比较患者人口统计学、合并症、不良结局和PROMs。收集门诊患者术后至少6个月的下肢功能量表（LEFS）、PROM信息系统疼痛强度量表（promisa -3a）、自我报告问卷-20 （SRQ-20）和Connor-Davidson弹性量表（CD-RISC）。结果：共纳入73例患者：18例行足中截肢（6例Lisfranc， 12例Chopart）， 55例行BKA。平均年龄62.5±12.0岁，平均Charlson合并症指数5.0 [IQR: 4.0]，中位随访时间40.6[27.8]个月。中足截肢者术后并发症发生率（16.7% vs 3.6%, p=0.092）和复发率（44.4% vs 18.2%, p=0.025）均显著高于中足截肢者。两组之间的prom相似。多因素回归分析显示，功能与周围血管疾病（B=-10.1, p=0.047）和心理困扰（B=-2.4, p=0.002）独立相关，与截肢类型无关（p=0.978）。结论：采用以团队为基础的方法，优先考虑功能和患者的偏好，患者报告的功能受合并症和心理健康的影响，而不是截肢水平。

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引用次数: 0

Midterm outcomes of first metatarsophalangeal joint arthrodesis using memory staples 第一跖趾关节融合术使用记忆钉的中期结果。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-25 DOI: 10.1053/j.jfas.2025.11.017

Jun Min Leow , Michael Pearce , Wei Hao Lee , Hisham Shalaby , John McKinley , Colin Thomson

Introduction

There is limited evidence investigating the use of memory staples for first metatarsophalangeal joint (MTPJ) arthrodesis. This study reports the midterm clinical and functional outcomes of patients who underwent the procedure.

Methods

A retrospective review of 78 first MTPJ arthrodeses carried out between 2016 and 2018 in the study centre was performed. Patients were followed up via telephone call to complete the Manchester-Oxford Foot Questionnaire (MOXFQ) and service review questionnaire.

Results

The mean follow-up period was 6.6 ± 0.9 years. The asymptomatic nonunion rate was 2.6 %. The post-operative MOXFQ-index was 12.9 ± 19.5, MOXFQ-pain 12.3 ± 22.6, MOXFQ-walking 16.3 ± 23.8 and MOXFQ-social 9.7 ± 17.3. Eighty-seven percent of patients responded to their toe being better postoperatively. Eighty-four percent of patients were satisfied with the operation. Ninety-five percent of patients felt the operation met their expectations.

Conclusion

This study has shown that first MTPJ arthrodesis with memory staples is associated with low complication rates and good patient-reported outcomes at midterm follow-up.

关于第一跖趾关节（MTPJ）融合术使用记忆钉的研究证据有限。本研究报告了接受该手术的患者的中期临床和功能结果。方法：回顾性分析2016-2018年在研究中心进行的78例首次MTPJ关节病。通过电话随访患者，填写曼彻斯特-牛津足部问卷（MOXFQ）和服务评价问卷。结果：平均随访6.6±0.9年。无症状骨不连率为2.6%。术后moxfq指数为12.9±19.5，moxfq疼痛指数为12.3±22.6，moxfq行走指数为16.3±23.8，moxfq社交指数为9.7±17.3。87%的患者术后脚趾好转。84%的患者对手术满意。95%的患者认为手术达到了他们的预期。结论：本研究表明，首次MTPJ关节融合术合并记忆钉在中期随访中并发症发生率低，患者报告的结果良好。证据等级：四级。

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引用次数: 0

Comparison of hindfoot arthrodesis nail and humeral intramedullary nail for tibiotalocalcaneal arthrodesis 后足关节融合术钉与肱骨髓内钉在胫距跟骨关节融合术中的比较

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-25 DOI: 10.1053/j.jfas.2025.10.009

Ali Can Çiçek, M. Fatih Aksay

Background

Tibiotalocalcaneal (TTC) arthrodesis is a standard procedure for severe hindfoot deformities. While both hindfoot arthrodesis nails (HAN) and repurposed humeral intramedullary nails (HIN) are used for fixation, direct comparisons of their outcomes are scarce.

Purpose

This study aimed to directly compare the surgical, clinical, and functional outcomes of HAN and HIN fixation in TTC arthrodesis.

Study Design

Retrospective comparative cohort study.

Methods

This retrospective cohort study included 55 patients who received TTC arthrodesis from 2019 to 2023. Based on the implant used, patients were divided into a HAN group (n=26) and a HIN group (n=29). We compared the groups for demographic data, intraoperative variables (operative time, blood loss, radiographic alignment), fusion time, and functional outcomes (VAS pain and AOFAS scores).

Results

Patient demographics were similar at baseline. Our analysis revealed that the HIN technique resulted in a shorter operation, but the HAN approach allowed for significantly better intraoperative alignment and implant placement (p<0.001). For functional outcomes, the HIN group reported significantly higher AOFAS scores (p=0.028). Fusion times and post-operative pain levels were equivalent between the two groups.

Conclusion

Both the HAN and HIN systems proved to be effective and safe for TTC arthrodesis. The choice between them involves a key trade-off: while HAN implants provide greater intraoperative control over alignment, HIN fixation is associated with superior postoperative functional outcomes. The optimal implant should therefore be selected on a case-by-case basis, considering individual patient anatomy and surgeon experience.

背景：胫距跟骨（TTC）关节融合术是治疗严重后足畸形的标准手术。虽然后足关节融合术（HAN）和肱骨髓内钉（HIN）都被用于固定，但对其结果的直接比较很少。目的本研究旨在直接比较TTC关节融合术中HAN和HIN固定的手术、临床和功能结果。研究设计：回顾性比较队列研究。方法本回顾性队列研究纳入了2019 - 2023年接受TTC关节融合术的55例患者。根据所使用的种植体将患者分为HAN组（n=26）和HIN组（n=29）。我们比较了两组的人口学数据、术中变量（手术时间、出血量、影像学对齐）、融合时间和功能结果（VAS疼痛和AOFAS评分）。结果基线时患者人口统计学相似。我们的分析显示，HIN技术的手术时间较短，而HAN入路的术中对齐和植入效果明显更好（p<0.001）。在功能结局方面，HIN组的AOFAS评分显著高于对照组（p=0.028）。两组融合时间和术后疼痛水平相当。结论HAN和HIN系统在TTC关节融合术中均是安全有效的。两者之间的选择涉及到一个关键的权衡：虽然HAN植入物提供了更好的术中对齐控制，但HIN固定具有更好的术后功能结果。因此，最佳的植入物应根据具体情况选择，考虑到个体患者的解剖结构和外科医生的经验。

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引用次数: 0

Postoperative foot and ankle axis parameters and their relationship to functional outcomes after tibial pilon fracture surgery 胫骨Pilon骨折术后足、踝轴参数及其与功能预后的关系。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-02 DOI: 10.1053/j.jfas.2025.09.010

Fatih Palıt , Ahmet Demirel , Turan Bilge Kızkapan

Background

Tibial pilon fractures are challenging intra-articular distal tibial fractures that compromise foot–ankle biomechanics. Restoration of anatomical radiological axis parameters has been reported as a predictor of clinical outcomes.

Purpose

To investigate the relationship between postoperative foot and ankle axis parameters and functional outcomes.

Study Design

Retrospective cohort study.

Methods

This single-center retrospective study included 60 surgically managed tibial pilon fractures between February 2021 and June 2023. Postoperative radiological parameters (ADTA, LDTA, MAD, MDA, plantigrade angle) were measured. AOFAS, FADI, VAS, and SF-36 were used to determine functional outcomes. Correlation and multiple regression analyses were performed.

Results

Mean age was 40.3 ± 8.6 years, and 61.7 % of patients were male. Anatomical reduction was achieved in 78.3 % of patients. Those with anatomical reduction had significantly higher AOFAS, FADI, and SF-36 scores (p < 0.05). Plantigrade angle correlated positively with AOFAS and FADI and negatively with VAS. Greater MDA was associated with poorer functional outcomes.

Conclusion

Postoperative radiological axis parameters, particularly the plantigrade angle and metatarsal declination angle, showed significant correlation with early functional outcomes after tibial pilon fracture surgery. Precise radiological measurements are essential for predicting recovery and guiding treatment strategies.

背景：胫骨pilon骨折是胫骨远端关节内骨折的挑战，它损害了足踝生物力学。解剖放射轴参数的恢复已被报道为临床结果的预测指标。目的：探讨术后足、踝轴参数与功能预后的关系。研究设计：回顾性队列研究。方法：这项单中心回顾性研究纳入了2021年2月至2023年6月间60例手术治疗的胫骨pilon骨折。测量术后放射学参数（ADTA、LDTA、MAD、MDA、跖底角）。使用AOFAS、FADI、VAS和SF-36来确定功能结局。进行相关分析和多元回归分析。结果：患者平均年龄40.3±8.6岁，男性占61.7%。78.3%的患者实现解剖复位。解剖复位组AOFAS、FADI、SF-36评分均显著增高（p < 0.05）。跖底角与AOFAS、FADI呈正相关，与VAS呈负相关。MDA越大，功能预后越差。结论：术后放射轴参数，尤其是跖骨角和跖骨倾角与胫骨pilon骨折术后早期功能预后有显著相关性。精确的放射测量对于预测恢复和指导治疗策略至关重要。证据等级：III级，回顾性队列研究。

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引用次数: 0

Determinants of implant removal in isolated Weber type B and C ankle fractures: A retrospective cohort study 孤立性Weber B型和C型踝关节骨折中植入物移除的决定因素：一项回顾性队列研究。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-12 DOI: 10.1053/j.jfas.2025.10.004

Bekir Karagoz , Mustafa Erdem , Hunkar Cagdas Bayrak , Murat Bakir , Ismail Agir

This retrospective cohort study aimed to identify demographic, clinical, and functional factors influencing the decision to remove implants in patients who underwent surgical treatment for isolated Weber type B and C lateral malleolar fractures. A total of 211 patients who underwent open reduction and internal fixation between 2014 and 2022 and had at least one year of follow-up were included. Patients were divided into two groups: those who underwent implant removal (n = 67) and those who did not (n = 144). Functional status was assessed using the physical functioning and mental health subscales of the Short Form-36 (SF-36), and multivariate logistic regression was used to identify independent predictors of implant removal. Patients in the implant removal group were significantly younger, had a higher proportion of males, and longer follow-up periods. Postoperative SF-36 scores were significantly and clinically higher in the non-removal group. Multivariate analysis revealed that male sex, younger age, and lower postoperative physical and mental health scores were independently associated with implant removal. The most common reason for removal was peri-implant pain (40.3 %). These findings suggest that implant removal decisions are influenced not only by physical symptoms but also by demographic and functional health factors, underscoring the importance of a patient-centered approach in orthopedic decision-making.

本回顾性队列研究旨在确定人口统计学、临床和功能因素对孤立性Weber B型和C型外踝骨折手术治疗患者移除植入物的影响。共有211例患者在2014年至2024年间接受了切开复位和内固定，随访时间至少为1年。患者分为两组：接受种植体移除的患者（n = 67）和未接受种植体移除的患者（n = 144）。使用SF-36 （Short Form-36）的身体功能和心理健康亚量表评估功能状态，并使用多变量逻辑回归来确定植入物移除的独立预测因素。植体移除组患者明显年轻化，男性比例较高，随访时间较长。未切除组术后SF-36评分明显高于对照组。多变量分析显示，男性、年龄较小、术后生理和心理健康评分较低与植入物移除独立相关。拔牙最常见的原因是种植体周围疼痛（40.3%）。这些研究结果表明，植入物移除的决定不仅受到身体症状的影响，还受到人口统计学和功能健康因素的影响，强调了以患者为中心的骨科决策方法的重要性。

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引用次数: 0

Preserving native distal tibial angles in total ankle replacement does not negatively affect implant survival 在全踝关节置换术中保留原始胫骨远端角对植入物存活没有负面影响。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-10 DOI: 10.1053/j.jfas.2025.10.013

Laurian J.M. van Es , Matthijs J.J. van Dam , Bart W.K. de Wit , Juri F.A. Aaftink , Joyce L. Benner , Gino M.M.J. Kerkhoffs , Bart J. Burger , Anika I. Tsuchida

Background

In total ankle replacement (TAR), the tibial component is positioned at 90° to the tibial axis, although distal tibia angles (DTAs) of healthy ankle joints vary. This study investigated DTA changes during TAR and their impact on prosthesis survival.

Methods

In this retrospective case series of 152 consecutive third-generation TARs (142 patients), pre- and postoperative lateral and anterior distal tibia angles (LDTA, ADTA) and changes (ΔLDTA, ΔADTA) were measured. Prosthesis survival (all causes) was compared using Hazard ratios (HRs) between patients with and without alterations of native DTAs. Secondly, associations between postoperative alignment and revision, as well as consistency of LDTA measurements between Mortise and Whole Limb views, were evaluated.

Results

Mean follow-up was 6.7 ± 4.5 (0.01-18.4) years. Twenty (13.2%) TARs were revised after an average of 5.4 ± 4.7 years (5-year survival of 86.8%). No correlation was found between DTA alteration and revision for either LDTA (HRs 1.03-2.29, p=0.18-0.98) or ADTA (HRs 1.06-2.28, p=0.23-0.91). No significant differences were observed among change-in-alignment groups. However, in the sagittal plane, a trend was observed favoring maintenance of non-neutral alignment (>3°) over altering ADTAs >3° to neutral. LDTAs measured on the different views appeared comparable (p=0.16).

Conclusion

Non-neutral postoperative alignment appeared to have less direct influence on revision rates than previously described. Although no significant association was found between changes in native tibial anatomy and TAR revision rates, this study highlights that surgeons may want to consider native anatomy more closely, rather than adhering to a rigid, neutral manufacturer’s approach.

背景：在全踝关节置换术（TAR）中，尽管健康踝关节的胫骨远端角度（DTAs）不同，但胫骨组件的位置与胫骨轴呈90°。本研究探讨了TAR期间DTA的变化及其对假体存活的影响。方法：回顾性分析152例连续第三代TARs患者（142例），测量术前和术后胫骨外侧角和前胫骨远端角（LDTA， ADTA）及其变化（ΔLDTA， ΔADTA）。使用风险比（hr）比较有和没有原生dta改变的患者的假体生存率（所有原因）。其次，评估术后对齐和翻修之间的关系，以及Mortise和Whole Limb视图之间LDTA测量的一致性。结果：平均随访时间6.7±4.5（0.01 ~ 18.4）年。20例（13.2%）TARs在平均5.4±4.7年（5年生存率为86.8%）后进行了修订。无论是LDTA （HRs 1.03-2.29, p=0.18-0.98）还是ADTA (HRs 1.06-2.28, p=0.23-0.91)， DTA改变与修订之间均无相关性。在对齐改变组之间没有观察到显著差异。然而，在矢状面，观察到倾向于维持非中性排列（bbbb3°）而不是改变ADTAs bbbb3°至中性。不同视角测量的ldta具有可比性（p=0.16）。结论：非中性术后对准对翻修率的直接影响似乎比先前描述的要小。虽然未发现胫骨原解剖结构的改变与TAR翻修率之间存在显著关联，但本研究强调，外科医生可能希望更密切地考虑胫骨原解剖结构，而不是坚持采用刚性、中性的制造商入路。证据级别：IV病例系列。

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引用次数: 0

Assessment of three-dimensional hallux valgus deformity utilizing full weightbearing computed tomography scans 利用全负重CT扫描评估三维拇外翻畸形：全负重CT扫描三维拇外翻畸形。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-10 DOI: 10.1053/j.jfas.2025.11.002

Derek A. McLister DPM, FACFAS , Sarah O’Brien DPM , Nathan J. Fischer DPM , Brandon S. Nagel DPM , Alexander CM. Chong MSAE MSME

Background

Hallux valgus (HV) is a complex triplanar deformity.

Purpose

To utilize preoperative weightbearing computed tomography (WBCT) of patients with HV deformity to characterize the true triplanar nature of the deformity, as well as to assess first metatarsophalangeal joint pathology.

Study design

Retrospective case series.

Methods

A retrospective study of adult patients with HV deformity treated between 1/2020 and 7/2024.

Results

Sixty-four patients were included. Inter-rater reliability for all radiographic measurements demonstrated good to excellent agreement. WBCT findings demonstrated that 38 patients (59 %) exhibited both first metatarsal pronate and tibial sesamoid subluxation, while 7 patients (11 %) showed neither deformity. 51 patients (80 %) presented true sesamoid subluxation. The rate of pseudo-sesamoid subluxation was 9 % (6/64 patients). WBXR findings showed that 42 patients (66 %) had moderate HV deformity with 37 patients (58 %) demonstrating an abnormal HVA, 20 patients (31 %) with mild HV, and 2 patients (3 %) with severe HV. 37 patients (58 %) observed with first metatarsal joint degeneration and 30 patients (47 %) exhibited erosion of the intersesamoid crista. The tibial sesamoid subluxation grade demonstrated a statistically significant and meaningful moderate correlation with HVA, degeneration of the first metatarsal joint and erosion of the intersesamoidal crista, but a slightly less meaningful moderate correlation with HV deformity.

Conclusion

WBCT provides a reproducible, three-dimensional assessment of HV deformity, offering more accurate evaluation of first metatarsal pronation, sesamoid subluxation, and degenerative of both the first metatarsophalangeal joint and the intersesamoidal crista compared to conventional radiographs.

背景：拇外翻是一种复杂的三面畸形。目的：利用HV畸形患者术前负重计算机断层扫描（WBCT）表征畸形的真正三面性，并评估第一跖趾关节病理。研究设计：回顾性病例系列方法：对2020年1月至2024年7月期间接受治疗的成年HV畸形患者进行回顾性研究。结果：共纳入64例患者。所有放射照相测量的内部可靠性显示出良好到极好的一致性。WBCT结果显示，38例患者（59%）表现为第一跖骨前旋和胫骨籽骨半脱位，而7例患者（11%）未表现为畸形。51例（80%）出现真籽突半脱位。假性籽骨半脱位率为9%（6/64例）。WBXR结果显示，42例（66%）患者为中度HV畸形，37例（58%）HVA异常，20例（31%）为轻度HV， 2例（3%）为重度HV。37例（58%）患者出现第一跖关节退变，30例（47%）患者出现椎间嵴糜烂。胫骨籽骨半脱位等级与HVA、第一跖关节退变和骨间嵴糜烂有统计学意义的中度相关性，但与HV畸形的中度相关性略低。结论：与常规x线片相比，WBCT提供了一种可重复的、三维的HV畸形评估，可以更准确地评估第一跖骨前旋、第一跖趾关节和第一跖骨间嵴半脱位和退变。临床证据等级：4级。

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引用次数: 0

Evaluation of incisional negative pressure wound therapy with anterior approach total ankle arthroplasty 切口负压创面治疗前路全踝关节置换术的疗效评价。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-14 DOI: 10.1053/j.jfas.2025.11.010

James M. Cottom DPM, FACFAS , Tyler J. Verdoni DPM, AACFAS

Background

Total ankle replacement continues to find significantly increased utilization as the technology advances. While there are different systems on the market, most are implanted through an anterior incisional approach just lateral to the tibialis anterior tendon. This incision is prone to decreased wound healing, increased time to healing, and postoperative dehiscence and infection risk. When patient comorbid medical conditions are taken into consideration as well, the chance of complications increases significantly. To date, multiple articles have been published discussing how to decrease complication rate associated with this higher risk incision, such as different suturing patterns, utilization of a postoperative drain, and incisional wound vac application (iNPWT). Purpose: The purpose of this study is to present our results with iNPWT utilization for anterior approach total ankle arthroplasty. Methods: Thirty one (31) patient’s consecutive total ankle replacement (TARs) were retrospectively reviewed. Eleven [11] patients underwent TAR with iNPWT (Group 1) application and 20 patients underwent TAR without iNPWT (Group 2) application. Results: In group 1, wound complications were 1/11 (9 %) and in group 2 wound complications were 4/20 (20 %); with an overall 5/31 (16 %) wound complication rate (p value 0.429). Conclusion: In our present study, we identified a reduction of wound healing complications by 11 % when comparing the two groups, although failed to reach statistical significance. While future studies are needed with more patient enrollment, iNPWT application is a quick and safe method to help reduce complications associated with the anterior approach for total ankle replacement.

背景：随着技术的进步，全踝关节置换术的使用率继续显著增加。虽然市场上有不同的系统，但大多数是通过胫骨前肌腱外侧的前切口入路植入的。这种切口容易减少伤口愈合，增加愈合时间，增加术后裂开和感染的风险。当患者合并症的医疗条件也考虑在内，并发症的机会显着增加。迄今为止，已经发表了多篇文章讨论如何降低与这种高风险切口相关的并发症发生率，例如不同的缝合方式，术后引流的利用以及切口伤口真空应用（iNPWT）。目的：本研究的目的是介绍我们在前路全踝关节置换术中应用iNPWT的结果。方法：回顾性分析31例连续全踝置换术（TARs）患者的临床资料。11例患者行合并iNPWT的TAR（第1组），20例患者行未应用iNPWT的TAR（第2组）。结果：1组创面并发症发生率为1/11(9%)，2组创面并发症发生率为4/20 (20%)；总体5/31（16%）的伤口并发症发生率（p值0.429）。结论：在我们目前的研究中，我们发现两组比较伤口愈合并发症减少了11%，尽管没有达到统计学意义。虽然未来的研究需要更多的患者加入，但iNPWT应用是一种快速安全的方法，有助于减少前路全踝关节置换术相关的并发症。临床证据水平：3。

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引用次数: 0

Radiographic foot morphology and its association with Sinus Tarsi syndrome 足部影像学形态及其与跗窦综合征的关系。

IF 1.3 4区医学 Q2 Medicine

Journal of Foot & Ankle Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-25 DOI: 10.1053/j.jfas.2025.11.018

Muhammed Furkan Küçükşen MD , Haluk Yaka MD , Mustafa Özer MD

Background

Sinus tarsi syndrome is a clinical condition characterized by diffuse lateral foot pain, with underlying causes that remain incompletely understood. Radiographic parameters reflecting sagittal foot morphology and load distribution may be related to this condition.

Purpose

To investigate the relationship between sinus tarsi syndrome and radiographic parameters that may influence load distribution and reflect sagittal foot morphology.

Study Design

Retrospective comparative study.

Methods

Between 2018 and 2022, 61 patients with chronic nontraumatic lateral foot pain and magnetic resonance imaging findings consistent with sinus tarsi syndrome were evaluated. A control group of 61 patients with similar demographics, no specific foot pathology on examination, and no MRI findings suggestive of sinus tarsi syndrome was selected. On weightbearing lateral radiographs, calcaneal inclination angle, lateral talocalcaneal angle, Böhler’s angle, Gissane angle, sinus tarsi length, and sinus tarsi depth were measured. The sinus tarsi steepness index was calculated by dividing depth by length.

Results

Patients with sinus tarsi syndrome showed smaller Gissane and lateral talocalcaneal angles and shorter sinus tarsi length, but greater depth and steepness index compared with controls. In multivariable analysis, sinus tarsi depth, length, and steepness index were independently associated with sinus tarsi syndrome.These findings indicate a steeper sinus tarsi configuration that may underlie the condition’s pathomechanics.

Conclusion

A steeper sinus tarsi morphology is associated with sinus tarsi syndrome, likely due to altered ligament tension and increased intra-sinus pressure. Recognizing this morphology may help identify high-risk patients and guide surgical planning when conservative treatment fails.

背景：跗骨窦综合征是一种以弥漫性外侧足部疼痛为特征的临床症状，其根本原因尚不完全清楚。反映矢状足形态和负荷分布的x线摄影参数可能与这种情况有关。目的：探讨跗窦综合征与影响负荷分布和反映矢状足形态的影像学参数之间的关系。研究设计：回顾性比较研究。方法：对2018年至2022年间61例慢性非外伤性外侧足痛患者的磁共振成像结果与跗窦综合征一致进行评估。选择61例具有相似人口统计学特征、检查时无特殊足部病理、无提示跗骨窦综合征MRI表现的患者作为对照组。负重侧位片测量跟骨倾斜角、距骨外侧角、Böhler’s角、Gissane角、跗骨窦长度、跗骨窦深度。鼻窦斜度指数由深度除以长度计算。结果：与对照组相比，跗骨窦综合征患者的距骨和距骨外侧角较小，跗骨窦长度较短，但深度和陡峭度指数较大。在多变量分析中，跗骨窦深度、长度和陡峭度指数与跗骨窦综合征独立相关。这些发现表明，更陡峭的鼻窦结构可能是这种疾病的病理力学基础。结论：跗骨窦形态较陡与跗骨窦综合征有关，可能是由于韧带张力改变和窦内压力增加所致。认识到这种形态可以帮助识别高危患者，并在保守治疗失败时指导手术计划。临床证据水平：3回顾性比较研究。

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引用次数: 0