Journal of Foot & Ankle Surgery最新文献

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.

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.

Introduction: Fracture healing remains a complex and multifactorial biological process, influenced by mechanical stability, vascular supply, and biological environment. The aim of this study was to assess whether statistically significant prognostic differences in fracture healing exist between ORIF and MIPO after teriparatide therapy, using the RUST scores.

Materials and methods: Twenty seven patients with tibial plafond fractures were divided into two groups: 14 treated with ORIF and 13 with MIPO. All patients received postoperative teriparatide injections. Functional outcomes were assessed using the AOFAS score, and quality of life was evaluated with SF-12 and VAS. Continuous data were analyzed using Student's t-test, with statistical significance set at p < .05.

Results: VAS and RUST scores showed moderate correlation (.001 < p < .034). Postoperative AOFAS scores initially declined, with significant difference favoring MIPO (p = .024), but converged by 6 months. At 6 months, ORIF demonstrated higher RUST all cortices (p = .035) and medial-lateral (p = .001), with no difference in anterior-posterior. ORIF may achieve superior cortical consolidation and alignment versus MIPO.

Discussion: The ORIF group demonstrated superior bone consolidation, as indicated by higher RUST in cortical 4 and medial-lateral (M-L) views (P = .035 and P = .001). Despite these differences, clinical outcomes depend on fracture type, patient health, and surgical timing. ORIF should be considered the preferred approach for complex tibial plafond fractures.

Conclusion: ORIF may offer advantages in anatomical reduction and bone healing over MIPO in tibial plafond fractures, with comparable clinical outcomes. The authors believe that teriparatide was a useful adjuvant in the healing of pilon fractures.

Background: Bone morphological change intramedullary screw fixation, characterized by gap widening at the plantar side of the fifth metatarsal shaft, is considered a factor contributing to delayed union and pseudoarthrosis. However, the reduction in bowing of the fifth metatarsal, which occurs alongside the plantar gap, has not been reported. A reduction in bowing height, concurrent with plantar gap widening, may protect against refracture.

Purpose: This study aimed to investigate the effects of surgery for Jones fractures on morphological changes associated with refractures.

Methods: From 2008 to 2019, 222 patients underwent headless intramedullary screw fixation for Jones fractures. Of these, 19 feet had postoperative refractures, which were matched to 57 feet with normal bony union (1:3 ratio) based on bone graft, screw diameter, and metatarsal screw ratio.

Results: X-ray analysis compared the height of bowing of the fifth metatarsal between group R (refracture patients) and group U (normal union patients).In Group R, the bowing height remained at 4.5 mm before and after surgery. In Group U, the bowing height decreased from 4.5 mm preoperatively to 4.3 mm postoperatively (P < 0.01).

Conclusion: The reduction in bowing height of the fifth metatarsal was significantly greater in the normal union group than in the refracture group after intramedullary screw fixation. This suggests that the alignment change post-surgery may help prevent refracture.

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.