Journal of Foot & Ankle Surgery最新文献

Background: Metatarsophalangeal (MTP) joint instability may cause forefoot sensory disturbances, often misattributed to Morton's neuroma. This study investigated the association between MTP joint instability and sensory disturbances.

Methods: Thirty-three patients were enrolled, including 58 feet in total. All patients underwent surgery for moderate to severe hallux valgus, and in unilateral cases, the contralateral foot was also included when eligible. MTP instability was classified as stable, subluxed, or dislocated using the drawer test under fluoroscopy. Sensory disturbances in the 2nd-4th web spaces were evaluated with the Semmes-Weinstein monofilament test.

Results: Instability was most frequent in the 2nd (69.0%) and 3rd (65.5%) toes. Sensory disturbance rates in the 2nd and 3rd web spaces were significantly higher in feet with instability in both the 2nd and 3rd MTP joints compared to stable feet (P = .02, P = .03), while no significant difference was found for the 4th web space (P = .42).

Conclusions: MTP joint instability may cause sensory disturbances by affecting adjacent plantar digital nerves and should be considered in clinical evaluations.

Background: Total ankle arthroplasty (TAA) and ankle arthrodesis (AAD) are the established surgical options for end-stage ankle arthritis.

Purpose: This study aimed to compare the two procedures and to investigate factors associated with postoperative outcomes, including ankle range of motion (ROM) measured on lateral radiographs. ROM was assessed as the motion of the foot relative to the lower leg and was defined as the apparent ankle ROM (AROM).

Methods: We retrospectively analyzed data from 38 patients who underwent TAA (n=18) or AAD (n=20) between 2015 and 2023. Patients with a minimum of 1-year follow-up were included in this study. Preoperative and postoperative evaluations included the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and AROM. Comparisons between groups were made using non-parametric tests.

Results: Both groups showed significant postoperative improvements in the JSSF scores (p<0.001). The TAA group showed no significant change in AROM (p=0.093), whereas the AAD group showed a significant decrease in AROM (p=0.011). Postoperative AROM differed significantly between the groups. In the TAA group, postoperative JSSF scores correlated with age, and postoperative AROM correlated with preoperative AROM. In the AAD group, postoperative JSSF scores correlated with preoperative JSSF score and postoperative AROM.

Conclusion: Both TAA and AAD yielded favorable outcomes. The JSSF score following TAA was associated with age, whereas outcomes after AAD were more closely linked to the preoperative clinical status and postoperative AROM, highlighting the importance of adjacent joint mobility after surgery. The timing of surgery and rehabilitation strategies are essential for optimizing results.

Background: Surgical site infections are estimated to occur in 1.4 % - 5.5 % of all patients who undergo ankle fracture open reduction with internal fixation.

Purpose: While other studies only report on infection rates after ankle ORIF, this study evaluated the association between infection rates and operative factors.

Study design: We performed a retrospective cohort study of adults at Kaiser Permanente Northern California who underwent ankle fracture ORIF between January 1, 2010 and September 30, 2022.

Methods: Patients were followed up to 6 weeks after initial surgery for return to the operating room, and charts were reviewed for deep SSI. We utilized 6 weeks return to the operating room to identify patients with acute and subacute deep SSI.

Results: Among the 9,749 eligible patients who underwent ankle fracture ORIF, 33 (0.3 %) returned to the operating room within 6 weeks, 3 of whom returned within 2 weeks. The rate of return to operating room was higher in patients with incision time greater than 120 min (OR 5.16, 95 % CI 2.59-10.26; p < 0.001), with tourniquet time of 90-150 minutes (OR 4.30, 95 % CI 1.909.71; p < 0.0001), with immunocompromised status (OR 14.19, 95 % CI 3.3061.12; p < 0.0001), and with hemoglobin A1c greater than 8.0 %(OR 4.12, 95 % CI 1.40-12.12; p = 0.01).

Conclusion: We concluded that decreasing operative time and tourniquet time are important modifiable variables in the prevention of deep SSI in ankle fracture patients. Body mass index, Ioban use, and antibiotic powder use were not associated with the development of deep SSI.

Level of clinical evidence: Level 3: This retrospective cohort study holds a designation based on the analysis of patients who underwent ankle fracture ORIF.

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.

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.

Background: When performing arthrodesis of the first metatarsophalangeal joint (MTPJ), reported fixation options have been vast with high success rates and a low complication profile. Immediate postoperative weightbearing status typically varies by surgeon irrespective of fixation construct.

Purpose: There has been a paucity of literature regarding the effect postoperative weight bearing status has on the nonunion rate following first MTPJ arthrodesis.

Study design/methods: We performed a systematic review and identified a total of 40 studies and 3,222 feet that underwent first MTPJ arthrodesis with a cohort of patients that were made heel weightbearing as tolerated (HWB), non weightbearing (NWB), and full weightbearing (FWB).

Results: Nonunion rate was found to be lowest in the FWB cohort at 4.34% compared to 8.20% for that of the HWB group, and 9.27% for NWB (p < 0.001). Time to union was found to be fastest in the NWB group at 8.8 weeks, compared to 10.42 weeks for immediate full weight bearing and 12.18 weeks for immediate heel weight bearing (p < 0.001).

Conclusion: While time to union varied, immediate full weightbearing was associated with the lowest nonunion rate, with no adverse effect on fusion success compared to delayed protocols.

Level of clinical evidence: 4-Retrospective.

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.