Journal of Foot & Ankle Surgery最新文献

Fixation methods for posterior malleolar fracture (PMF) are a source of great controversy. This study aims to compare complications, clinical, and radiological outcomes between PA screws and posterior plate in PMF using current literature. A systematic search strategy was conducted following the PRISMA protocol. Medline (PubMed), Embase (Elsevier), and Lilacs databases were used to identify complication rates (infection, nonunion, loss of reduction, osteoarthrosis, and sural nerve injury) and to compare reported functional outcomes. The level of evidence in the articles was assessed using the GRADE tool. The studies eligible for meta-analysis were processed using The Review Manager version 5.4.1 software. Twelve articles met the inclusion criteria; 5 articles were included for subgroup meta-analysis. Overall infection rate, loss of reduction and sural nerve injury were each 2%. Osteoarthritis rate was 10%. There was no difference in risk reduction for infection rate (RD = 0.01; 95% CI: -0.03 to 0.06; p = .50), loss of reduction (RD = -0.00; 95% CI: -0.03 to 0.03; p = .88), sural nerve injury (RD = 0.01; 95% CI: -0.03 to 0.04; p = .70), osteoarthrosis (RD = -0.00; 95% CI: -0.09 to 0.09; p = .97), functional (MD = 0.70; 95% CI: -1.06 to 2.45; p = .44) or pain scores (MD = 0.12; 95% CI: -0.31 to 0.55; p = .58), nor deficit in dorsiflexion (MD= -0.26; 95% CI: -1.64 to 1.12; p = .71). There were no clinical nor radiological significant differences when comparing fixation of PMF with plates or PA screws. With current literature it is not possible to establish the superiority of either fixation.

Persistent toe walking is associated with autism spectrum disorder. The true prevalence of persistent toe walking and odds of progression to surgery in children with and without autism remains unclear. This retrospective descriptive study identified patients ages 3 to 17 years who were enrolled in our healthcare system over a 2-year period. Using international classification of disease codes, we identified all children with autism and persistent toe walking, and excluded children with conditions that may independently cause toe walking. Data on Achilles lengthening surgeries, sex, race and body mass index was gathered. The toe walking prevalence amongst children with and without autism was calculated. Multivariable logistic regression analysis controlling for sex, race and body mass index was used to determine independent risk factors for persistent toe walking and surgery. Of the children who met inclusion criteria (N = 284,925), 4622 (1.6%) had persistent toe walking. Prevalence of persistent toe walking was higher amongst children with autism (6.3% vs 1.5%, p < .01), as were odds of persistent toe walking (OR 4.13, 95% CI 3.74 to 4.56, p < .01). Males and White patients had higher odds of persistent toe walking compared to females and patients of any other race, respectively (p < .01 for all). Although children with autism and toe walking had higher rates of surgery than their counterparts without autism (4.3% vs 2.6%, p = .04), this difference was not significant after controlling for sex, race and BMI (OR 1.59, 95% CI 0.95 to 2.69, p > .05).

In 2011, the Council of Podiatric Medical Education, the accrediting body of the American Podiatric Medical Association, approved the conversion of all Podiatric Residencies to 3-year surgical programs. In 2012, there were 12 podiatric fellowships recognized by the American College of Foot and Ankle Surgeons. To date, there are 53 programs listed under the college's website. As podiatric fellowships expand, further research is needed to identify advantages and pitfalls of fellowship training. Our primary aim was to obtain current fellow survey data to enhance our understanding of podiatric reconstructive foot and ankle surgery fellowship training programs. In doing so, we decided to use one of the most salient topics in fellowship training- Total Ankle Replacement. Invitation was administered by email and 73.6% of active reconstructive 2023-24 American College of Foot and Ankle Surgeons postgraduate fellows responded. Fellowship total ankle replacement case volume was significantly greater than residency (p = 0.037). Completion of 0-5 total ankle replacement(s) was 30.8%, and greater than 30 in 17.9% of fellows. Fifty nine percent reported feeling "comfortable" or "very comfortable" with total ankle arthroplasty. Patient specific instrumentation was used in a majority of cases (66.7%). Over three fourths (79.8%) of fellows stated they planned on performing TAR as an attending surgeon after their fellowship. Despite its limitations, we hope our survey data can aid graduating and previous fellows and add to the body of knowledge for future TAR educational programs and industry involvement. As podiatric fellowships continue to transform, so too must our research efforts to track progress.