Journal of Foot & Ankle Surgery最新文献

Fillet of toe flap (FTF) leverages the "spare parts" algorithm in reconstructive surgery-utilizing tissue from amputated or otherwise non-salvageable body parts, thus avoiding donor-site morbidity. This study assesses the efficacy of FTF coverage in non-traumatic foot amputations. A retrospective review of patients undergoing foot amputation with FTF coverage between January 2013 to August 2023 was conducted. Patient characteristics, operative details, and outcomes were collected. Primary outcome was FTF survival (no necrosis ≤7 days postoperatively). Secondary outcome was acute complications (≤42 days postoperatively). A total of 70 patients were included. Mean age was 65.0±13.7 years. Median Charlson Comorbidity Index was 6.0 (interquartile range [IQR]: 4.0-7.0). The most common wound location was the hallux (n=34). In 45 (64.2 %) patients with preoperative angiography, the patency rates were: first dorsal metatarsal artery (n=10, 22.2 %), lateral plantar artery (n=7, 15.6 %), medial plantar artery (n=6, 13.3 %), and dorsalis pedis artery (n=4, 8.9 %). Mean follow-up duration was 9.0 (IQR: 32) months. Fifteen (21.4 %) patients experienced at least one acute complication: deep surgical site infection (SSI; i.e., abscess, gangrenous necrosis; n=13, 18.6 %) and cellulitis (n=7, 10.0 %). Eleven (15.7 %) patients required reoperation for debridement (n=4, 5.7 %), wound closure (n=4, 5.7 %), flap necrosis (n=3, 4.3 %), incision and drainage (n=1, 1.4 %), split-thickness skin grafting (n=1, 1.4 %), and foreign body exploration (n=1, 1.4 %). FTF survival was 94.2 % (n=66). FTF facilitates reconstruction in complex cases and should be integrated into each chronic LE wound algorithm to avoid additional donor-site morbidity, and to facilitate stump-length preservation or limb salvage.

Tibiotalocalcaneal (TTC) fusion with an intramedullary nail (IMN) has been utilized for a myriad of indications in hindfoot and ankle reconstruction. However, some controversies remain on the optimal position of the hindfoot. Previous studies have reported on the potential medialization of the rearfoot during insertion of the IMN, but few studies have examined the potential affect on the subtalar joint. We performed the present cadaveric study in order to assess the involvement of a 12-mm IMN with the posterior facet of the calcaneus. A 3-mm guide wire (for a standard TTC IMN) was inserted in an anterograde fashion beginning within the central aspect of the tibial canal in 10 fresh-frozen below knee cadaver specimens. The subtalar joint of each specimen was exposed and images of the posterior facet were collected. Utilizing an open source Java image processing program (ImageJ/Fiji), we calculated a mean native calcaneal posterior facet of 4.6 cm² with a post ream surface area of 3.6 cm², resulting in a mean of 21.4% of the posterior facet occupied by an IMN in an anterograde fashion. In conclusion, a TTC IMN placed in optimal position within the ankle and tibia is likely to occupy, on average, a fifth of the calcaneal posterior facet. Though this does leave some possibility of a medial shift of the rearfoot complex, care must be taken to not violate the lateral calcaneal or talar wall. LEVEL OF CLINICAL EVIDENCE: 5.

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society-lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score. Level of Evidence: Level 3.

The literature has established that the first metatarsal-phalangeal joint arthrodesis procedure will provide some correction of the first intermetatarsal and hallux valgus angles. But while this has previously primarily been investigated as a simple association (i.e. comparison of pre-operative to post-operative values), the objective of this investigation was to consider angular change as a continuous variable and to specifically correlate it with pre-operative values. Radiographs from 100 consecutive first metatarsal-phalangeal joint arthrodeses meeting selection criteria were evaluated. A negative Pearson correlation coefficient was observed between the pre-operative first intermetatarsal angle and intraoperative change in the first intermetatarsal angle (Pearson -0.547; p<0.001). In other words, with progressively increased levels of pre-operative intermetatarsal angle deformity, one should expect greater intermetatarsal angle correction. The relationship is described by the equation Y = 2.82 - 0.38X indicating that for every one degree of pre-operative intermetatarsal deformity over approximately 7 degrees, 0.38 degrees of post-operative correction might be expected. A negative Pearson correlation was observed between the pre-operative hallux valgus angle and the intraoperative change in the first hallux valgus angle (Pearson -0.806; p<0.001). In other words, with progressively increased levels of pre-operative hallux valgus angle deformity, one should expect greater hallux valgus correction. The relationship is described by the equation Y = 5.5 - 0.63X indicating that for every one degree of pre-operative hallux valgus angle deformity over approximately 9 degrees, 0.63 degrees of hallux valgus angle post-operative correction might be expected. Results of this investigation demonstrate a statistical correlation between pre-operative radiographic deformity and intermetatarsal angle and hallux valgus angle post-operative correction, and might provide foot and ankle surgeons with a degree pre-operative prediction of expected angular correction following the procedure. LEVEL OF EVIDENCE: 3.