Journal of Foot & Ankle Surgery最新文献

Objective: Talocalcaneal (TC) coalition is an abnormal connection between the talus and calcaneus, causing painful, restricted subtalar motion, recurrent ankle sprains, and rigid flatfoot. The purpose of this study was to compare 3D-navigation to traditional open techniques in resection of TC coalitions.

Patient and methods: Patients who underwent TC coalition resection with the assistance of intra-operative 3-D navigation (study cohort = 12 patients, 14 feet) or the traditional non-navigated approach (control group = 4 patients, 5 feet) at a single tertiary referral center were reviewed. Operative time (OT), anesthesia time (AT), tourniquet time (TT), blood loss (EBL), length of hospital stay (LOS), complications, duration of immobilization postoperatively, and average effective dose of radiation in millisieverts (mSv) were reviewed.

Results: OT (p = 0.97), EBL (p = 0.75), LOS (p = 0.58), AT (p = 0.46), and TT (p = 0.76) did not differ between groups. Mean duration of postoperative immobilization was 2 weeks shorter for the navigated group but not statistically significant (p = 0.11). Two complications occurred in the navigated group; one obese patient (BMI=34 kg/m²) had delayed wound healing, and another patient had a superficial skin infection. The average effective dose of radiation for all patients (n = 12) in the navigated group was 0.0081 mSv. The average dose for patients undergoing only one intraoperative CT spin (n = 9) was 0.0052 mSv.

Conclusions: Navigated TC coalition excision had comparable OT, EBL, LOS, AT, and TT to traditional non-navigated approach patients. The addition of intraoperative 3D navigation provides precise resection guidance without significantly increased surgical time with comparable total effective radiation dose to the traditional use of intra-operative fluoroscopy.

Background: Hallux valgus is a multiplanar deformity often involving first metatarsal pronation. Weightbearing computed tomography may improve assessment compared to standard radiographs, which are limited to two-dimensional views.

Methods: A systematic review was conducted according to PRISMA guidelines. PubMed and Cochrane databases were searched for studies evaluating weightbearing computed tomography in assessing HV components, including metatarsal pronation and sesamoid position. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: Fourteen studies (706 feet) were included. Weightbearing computed tomography consistently outperformed Weightbearing radiographs in detecting first metatarsal pronation and allowed more accurate differentiation between intrinsic torsion and joint malalignment. Pronation and sesamoid displacement were correlated, though thresholds and clinical significance varied. Nine studies were low risk of bias.

Conclusions: Weightbearing computed tomography provides a more accurate and reproducible assessment of metatarsal pronation and sesamoid alignment than weightbearing radiographs. However, its clinical impact remains uncertain. Future studies should standardize measurements and assess whether pronation correction improves surgical outcomes.

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.

Background: Surgical stabilization is crucial for managing syndesmosis injuries following ankle trauma. While syndesmosis screws provide anatomical stability, they are associated with issues such as potential loosening or the need for removal. Screw breakage, although frequently reported, may not represent a true complication in asymptomatic patients. The suture-button technique aims to preserve physiological mobility and enhance functional outcomes.

Purpose: To compare the clinical and radiological outcomes of screw fixation and suture-button fixation in syndesmosis injuries with isolated lateral malleolus fractures.

Study design: Retrospective comparative study.

Methods: This study included 73 patients treated between 2018 and 2022. Patients were divided into two groups: suture-button fixation (n = 41) and syndesmosis screw fixation (n = 32). Clinical outcomes were assessed using AOFAS and OMAS scores, while MCS, TFCS, and TFO were used for radiological evaluation. The MCID was applied to determine the clinical relevance of score differences.

Results: Both groups showed significant improvements in AOFAS and OMAS scores (p < 0.05). At final follow-up, the suture-button group demonstrated significantly higher AOFAS (95.9 ± 6.1 vs. 89.4 ± 12.6, p = 0.005) and OMAS (94.2 ± 8.1 vs. 88.9 ± 11.7, p = 0.025) scores, exceeding MCID thresholds. Although complication rates were lower in the suture-button group (p = 0.022), this difference became insignificant after excluding screw breakage (p = 0.951). Range of motion was also significantly better in the suture-button group (p = 0.033).

Conclusion: The suture-button technique provided superior clinical outcomes and joint mobility, while both methods offered comparable radiographic stability.

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.

Background: Total ankle arthroplasty and arthrodesis utilization has significantly increased in recent years with limited current studies examining physician reimbursement rates.

Purpose: This study provides an analysis of physician fee reimbursement from 2007 to 2025 and utilization trends from 2007 to 2022 for foot and ankle arthrodesis and arthroplasty procedures.

Study design: Retrospective analysis METHODS: Physician reimbursement data were extracted from the CMS Physician Fee Schedule Look-Up Tool using CPT codes between 2007 and 2025. National payment amounts were inflation-adjusted using the Consumer Price Index (January 2025 values) and reported in 2025 USD. For each CPT code, nominal and inflation-adjusted reimbursement trends were analyzed. Medicare Part B Summary Data File was used to collect utilization trends per CPT code from 2007 to 2022.

Results: From 2007 to 2025, nominal reimbursement rates changed for most CPT codes: 27702 (-1.21 %), 27815 (- 0.38 %), 27870 (- 0.44 %), 28725 (- 1.52 %), and 29899 (-1.71 %). The procedures that showed nominal increases were 27871 (+3.41 %) and 28740 (+1.46 %). When adjusted for inflation, all procedures experienced declines: 27702 (-37.05 %), 27815 (-36.52 %), 27870 (-36.56 %), 27871 (-34.11 %), 28725 (-37.25 %), 28740 (-35.35 %), and 29899 (-37.37 %). The total percentage change from 2007 to 2022 showed increased utilization for CPT codes 27702 (+502.54 %), 27870 (+8.06 %), 28725 (+69.78 %), and 28740 (+156.98 %) and reductions for CPT codes 27871 (-32.88 %), 28715 (-9.52 %), and 29899 (-17.35 %).

Conclusion: Between 2007 and 2025, inflation-adjusted reimbursement reductions ranged from 34.11 % to 37.25 %, while utilization rates varied for foot and ankle arthroplasty and arthrodesis procedures.

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.

Open arthrodesis remains the gold standard for management of end stage subtalar joint arthritis. Rate of isolated subtalar fusion complicated by nonunion has been documented between 4-22.8 %. However, little is known about success of subtalar joint fusion when performed underneath a previously constructed ankle arthrodesis. The aim of this systematic review was to assess the cases of nonunion in patients who underwent a subtalar joint fusion with documented history of previous ipsilateral ankle fusion. A broad literature search was performed through PubMed, Google Scholar, and Cochrane Database using the following search terms: "Time to fusion, ankle fusion complication, outcomes ankle fusion." Meta-regression was performed to assess the effects of study sample size and publication year on the non-union rate. Three studies met inclusion and exclusion criteria. The non-union rates of subtalar joint arthrodesis following ankle fusion in the included studies ranged from 20 % to 55.6 %. The pooled rate was 38 % (95 % CI: 18.2 % to 59.8 %). Our series included a larger number of cases, allowing statistical analysis that clearly demonstrated a markedly lower subtalar fusion rate in patients with previous ipsilateral ankle fusion when compared to what has been documented in the literature.

Background: Acute Achilles tendon rupture is a common injury. The optimal management of acute Achilles tendon rupture remains controversial.

Purpose: Compare the efficacy and complications of minimally invasive repair with improved oval forceps suture-guiding method and open repair with modified Kessler method.

Study design: A clinical measurement.

Methods: We enrolled 60 patients from Jan 2017 to Jun 2019. Patients were randomly divided into Group Mini (30 cases) and Group Open (30 cases). The operation duration and length of incision were compared. The functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society score, Achilles tendon total rupture score, range of motion of the ankle and plantarflexion strength ratio. The time from surgery to return to work and sports were recorded and the complications were also assessed.

Results: The operation duration and length of incision in Group Mini were significantly less than that in Group Open, which reduced wound complications and improved cosmesis. However, there were no significant differences between the two groups in term of the functional outcomes. The time from surgery to return to work and sports in Group Mini were significantly shorter than that in Group Open. As for complications, the postoperative complication rate in Group Mini were significantly lower than that in Group Open.

Conclusions: There may be benefits to the minimally invasive approach in the treatment of acute Achilles tendon rupture compared to open.