Pub Date : 2024-08-08DOI: 10.1097/btf.0000000000000430
Joseph A S McCahon, Tiffany N. Bridges, Selene G Parekh
Peritendinous adhesions is one of the most common complications following tendon injuries, resulting in limited joint motion and function. Interventions to optimize tendon gliding have been proposed—particularly the use of biological adjuncts such as hyaluronic acid. Several clinical and biomechanical studies have demonstrated improved tendon gliding and decreased excursion resistance with the use of a hyaluronic adjunct. We present a surgical technique using a hyaluronic acid/alginate sheet following acute repair of an Achilles tendon rupture to aid in tendon healing and prevent peritendinous adhesions. Diagnostic level IV.
{"title":"Application of Hyaluronic Acid/Alginate Sheet to Achilles Tendon Injuries to Prevent Peritendinous Adhesions","authors":"Joseph A S McCahon, Tiffany N. Bridges, Selene G Parekh","doi":"10.1097/btf.0000000000000430","DOIUrl":"https://doi.org/10.1097/btf.0000000000000430","url":null,"abstract":"\u0000 \u0000 Peritendinous adhesions is one of the most common complications following tendon injuries, resulting in limited joint motion and function. Interventions to optimize tendon gliding have been proposed—particularly the use of biological adjuncts such as hyaluronic acid. Several clinical and biomechanical studies have demonstrated improved tendon gliding and decreased excursion resistance with the use of a hyaluronic adjunct. We present a surgical technique using a hyaluronic acid/alginate sheet following acute repair of an Achilles tendon rupture to aid in tendon healing and prevent peritendinous adhesions.\u0000 \u0000 \u0000 \u0000 Diagnostic level IV.\u0000","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1097/btf.0000000000000426
Sarang Desai
Chronic insertional Achilles tendinosis is a common source of posterior heel pain. When nonoperative treatment fails, surgical procedures include debridement of unhealthy tissue, enthesophytes, and Haglund’s deformity. This surgical procedure often entails detaching the Achilles tendon from its insertion, followed by a reconstructive procedure to re-attach the Achilles tendon to the bone. Most common double-row repairs involve 2 proximal and 2 distal anchors with crossing sutures. This technique may have several limitations, including the proximal portion of the tendon not being compressed to bone and the lack of complete coverage of the distal Achilles insertion. This paper describes a new double-row technique to address these potential shortcomings, aiming for a more biomechanically favorable repair with a quicker functional recovery. The method and 1-year outcomes from a series of 33 patients are described. Level of Evidence: Level IV.
{"title":"Diamondback Double-Row Reconstruction with Proximal Modification for the Treatment of Chronic Insertional Achilles Tendinosis","authors":"Sarang Desai","doi":"10.1097/btf.0000000000000426","DOIUrl":"https://doi.org/10.1097/btf.0000000000000426","url":null,"abstract":"Chronic insertional Achilles tendinosis is a common source of posterior heel pain. When nonoperative treatment fails, surgical procedures include debridement of unhealthy tissue, enthesophytes, and Haglund’s deformity. This surgical procedure often entails detaching the Achilles tendon from its insertion, followed by a reconstructive procedure to re-attach the Achilles tendon to the bone. Most common double-row repairs involve 2 proximal and 2 distal anchors with crossing sutures. This technique may have several limitations, including the proximal portion of the tendon not being compressed to bone and the lack of complete coverage of the distal Achilles insertion. This paper describes a new double-row technique to address these potential shortcomings, aiming for a more biomechanically favorable repair with a quicker functional recovery. The method and 1-year outcomes from a series of 33 patients are described.\u0000 \u0000 Level of Evidence: Level IV.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141824320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1097/btf.0000000000000424
Stephanie R. Washburn, Emily Pilc, H. R. Tuten
To present the clinical and radiographic data, emphasize our surgical technique and how it was used, and the outcome measures in a case series of patients with chronic symptomatic peroneal sheath pain. A retrospective chart and radiograph review was conducted involving 36 adolescent patients (ages 8 to 20 y) treated surgically for chronic symptomatic peroneal sheath pain from 2010 to 2020. Findings that include chief complaint, magnetic resonance imaging findings, and surgical measures were documented. The patients’ postoperative and clinic visit notes were analyzed and outcome scores (FAOS Foot & Ankle Survey, AOFAS Ankle-Hindfoot Scale, and Kaikkonen Functional Scale) were calculated to determine the long-term results of the procedure. In our case series of 36 patients undergoing surgical treatment for chronic symptomatic peroneal sheath pain the procedures performed were as follows: 35 peroneal sheath repairs (97.22%), 34 ankle arthroscopies (94.44%), 27 resections of anomalous peroneus brevis muscle belly (75.00%), 2 resections of accessory peroneus quartus muscle (5.56%), 7 partial synovectomies (19.44%), 29 debridements (80.56%), and 6 Brostrom repairs (16.67%). magnetic resonance imaging findings showed 50% of our patient population had low-lying peroneus brevis muscles, and on examination during surgery, 61.11% of peroneus brevis muscles extended past the fibular tip. The average time in the cast post-operatively was 4.33 weeks. The average time from surgery to return to activity was 9.03 weeks. Twenty-two of the 36 patients (61.11%) were athletes and 100% were able to return to their sport. Outcome scores were retrospectively determined to be 99.27 for the FAOS Foot and Ankle Survey, 98.72 for the AOFAS Ankle-Hindfoot Scale, and 99.31 for the Kaikkonen Functional Scale. Complications were minimal and included 1 postoperative infection, 3 cast impingements, and 2 reported instances of post-operative pain. In our retrospective case series of 36 patients, the outcomes of surgical intervention for peroneal tendon pathology unresponsive to nonsurgical management in pediatric patients were evaluated. Our surgical method utilizes debridement, synovectomy, excision of low lying peroneus brevis muscle belly, excision of peroneus quartus if present, repair of split-tears of the tendons, and repair of the peroneal tendon sheath using “pants over vest” sutures to tighten the sheath. Our chart review shows all 36 patients were satisfied with the outcome, demonstrated improvement in relevant patient-reported outcome measures, and would elect to undergo the procedure again. Therefore, the novel surgical techniques outlined in this study appear to be viable options to treat chronic symptomatic peroneal tendon sheath pain resistant to conservative methods. Level of Evidence: Retrospective Case Series, Level IV.
{"title":"Surgical Technique For Chronic Symptomatic Peroneal Sheath Pain in Young Patients","authors":"Stephanie R. Washburn, Emily Pilc, H. R. Tuten","doi":"10.1097/btf.0000000000000424","DOIUrl":"https://doi.org/10.1097/btf.0000000000000424","url":null,"abstract":"To present the clinical and radiographic data, emphasize our surgical technique and how it was used, and the outcome measures in a case series of patients with chronic symptomatic peroneal sheath pain. A retrospective chart and radiograph review was conducted involving 36 adolescent patients (ages 8 to 20 y) treated surgically for chronic symptomatic peroneal sheath pain from 2010 to 2020. Findings that include chief complaint, magnetic resonance imaging findings, and surgical measures were documented. The patients’ postoperative and clinic visit notes were analyzed and outcome scores (FAOS Foot & Ankle Survey, AOFAS Ankle-Hindfoot Scale, and Kaikkonen Functional Scale) were calculated to determine the long-term results of the procedure. In our case series of 36 patients undergoing surgical treatment for chronic symptomatic peroneal sheath pain the procedures performed were as follows: 35 peroneal sheath repairs (97.22%), 34 ankle arthroscopies (94.44%), 27 resections of anomalous peroneus brevis muscle belly (75.00%), 2 resections of accessory peroneus quartus muscle (5.56%), 7 partial synovectomies (19.44%), 29 debridements (80.56%), and 6 Brostrom repairs (16.67%). magnetic resonance imaging findings showed 50% of our patient population had low-lying peroneus brevis muscles, and on examination during surgery, 61.11% of peroneus brevis muscles extended past the fibular tip. The average time in the cast post-operatively was 4.33 weeks. The average time from surgery to return to activity was 9.03 weeks. Twenty-two of the 36 patients (61.11%) were athletes and 100% were able to return to their sport. Outcome scores were retrospectively determined to be 99.27 for the FAOS Foot and Ankle Survey, 98.72 for the AOFAS Ankle-Hindfoot Scale, and 99.31 for the Kaikkonen Functional Scale. Complications were minimal and included 1 postoperative infection, 3 cast impingements, and 2 reported instances of post-operative pain. In our retrospective case series of 36 patients, the outcomes of surgical intervention for peroneal tendon pathology unresponsive to nonsurgical management in pediatric patients were evaluated. Our surgical method utilizes debridement, synovectomy, excision of low lying peroneus brevis muscle belly, excision of peroneus quartus if present, repair of split-tears of the tendons, and repair of the peroneal tendon sheath using “pants over vest” sutures to tighten the sheath. Our chart review shows all 36 patients were satisfied with the outcome, demonstrated improvement in relevant patient-reported outcome measures, and would elect to undergo the procedure again. Therefore, the novel surgical techniques outlined in this study appear to be viable options to treat chronic symptomatic peroneal tendon sheath pain resistant to conservative methods.\u0000 \u0000 Level of Evidence: Retrospective Case Series, Level IV.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141682190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-13DOI: 10.1097/btf.0000000000000423
Garrett Wireman, Taylor Hale, Thomas Poynter, David Seligson, Nicholas Laco
The current guide describes a technique that has been in place at the University of Louisville for several years and has been utilized to create structural antibiotic hindfoot nails. This has the intention of creating a stable construct that can be utilized in the setting of previous osteomyelitis, or that is at high risk of developing infections in the postoperative state. This technique guide provides a reproducible way to apply an antibiotic delivery system to a tibiotalocalcaneal nail at the time of definitive surgical intervention. It described our method at rural state level one trauma hospital of utilizing antibiotic-impregnated polymethylmethacrylate around a nail for both antibiotic properties as well as structural properties. Antibiotic delivery systems are a well-researched surgical tool, combining this with a hindfoot nail offers definitive surgical management of otherwise complicated surgical cases. Although this technique has been in use at the University of Louisville for many years, additional research should be done to determine long-term outcomes. Diagnostic Level 7. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Structural Antibiotic-Coated Hindfoot Nail Preparation: A Technique Guide","authors":"Garrett Wireman, Taylor Hale, Thomas Poynter, David Seligson, Nicholas Laco","doi":"10.1097/btf.0000000000000423","DOIUrl":"https://doi.org/10.1097/btf.0000000000000423","url":null,"abstract":"The current guide describes a technique that has been in place at the University of Louisville for several years and has been utilized to create structural antibiotic hindfoot nails. This has the intention of creating a stable construct that can be utilized in the setting of previous osteomyelitis, or that is at high risk of developing infections in the postoperative state. This technique guide provides a reproducible way to apply an antibiotic delivery system to a tibiotalocalcaneal nail at the time of definitive surgical intervention. It described our method at rural state level one trauma hospital of utilizing antibiotic-impregnated polymethylmethacrylate around a nail for both antibiotic properties as well as structural properties. Antibiotic delivery systems are a well-researched surgical tool, combining this with a hindfoot nail offers definitive surgical management of otherwise complicated surgical cases. Although this technique has been in use at the University of Louisville for many years, additional research should be done to determine long-term outcomes.\u0000 \u0000 \u0000 Diagnostic Level 7. See Instructions for Authors for a complete description of levels of evidence.\u0000","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141349747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1097/btf.0000000000000413
Hayden L. Hoffler, Bryan Raymond, Brian D. Neerings
Calcaneal exostectomy with Achilles tendon reattachment and repair is a common procedure used to treat insertional Achilles tendonitis and Haglund deformity. This was first described by Haglund in the early 1900s. Calcaneal exostectomy with Achilles tendon reattachment and repair reduces pain by removing the spur on the back of the heel. We describe a less common operative technique utilizing a Krackow suture technique to create another failure point during the repair of the Achilles tendon. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Secondary Achilles Tendon Repair After Calcaneal Exostectomy for Haglund Deformity Using a Unique Surgical Technique","authors":"Hayden L. Hoffler, Bryan Raymond, Brian D. Neerings","doi":"10.1097/btf.0000000000000413","DOIUrl":"https://doi.org/10.1097/btf.0000000000000413","url":null,"abstract":"Calcaneal exostectomy with Achilles tendon reattachment and repair is a common procedure used to treat insertional Achilles tendonitis and Haglund deformity. This was first described by Haglund in the early 1900s. Calcaneal exostectomy with Achilles tendon reattachment and repair reduces pain by removing the spur on the back of the heel. We describe a less common operative technique utilizing a Krackow suture technique to create another failure point during the repair of the Achilles tendon.\u0000 \u0000 Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1097/btf.0000000000000416
Erroll J. Bailey
{"title":"MIS and The First Ray","authors":"Erroll J. Bailey","doi":"10.1097/btf.0000000000000416","DOIUrl":"https://doi.org/10.1097/btf.0000000000000416","url":null,"abstract":"","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1097/btf.0000000000000420
Alexander Lerner, R. Jakušonoka, A. Jumtins, D. Rothem
Management of high-energy injuries with extensive soft tissue damage and massive distal tibial loss is challenging and often lead to severe dysfunction. In these complex situations ankle fusion procedure is the most commonly performed surgery. Publications devoted to treatment options and outcomes in these surgical challenging conditions are relatively rare. The purpose of this work is to present our clinical experience in using staged external fixation protocol in the treatment of six patients who suffered from complex open fractures of the distal tibial segment with severe bone and soft tissue loss due to high-energy trauma. The retrospective analysis of six patients (Gustilo-Anderson III B and III C fractures) with massive distal tibial loss and treated using a staged protocol of external fixation between 1998 and 2010, was carried out. Mean bone loss was 11.5 cm (range, 9 – 15 cm). All patients had reconstructive surgery using circular external fixation frames. The outcome in three of them was solid ankle fusion – two patients had acute distal shortening and proximal tibial elongation by distraction osteogenesis and one had acute fibular transfer to replace distal tibial loss with fixation using Ilizarov circular frame. In other three patients, the functional and the radiological outcome was pain-free ankle joint pseudoarthrosis – one had proximal tibial elongation, one had a combination of bone transport with distal fibular transfer and one had acute limb shortening without tibial elongation. All six patients were pain-free and satisfied with functional outcomes, regardless of the final solid bone fusion or pseudoarthrosis. The method of circular external fixation combined with proximal tibial elongation by distraction histogenesis is recommended for limb reconstruction in high-energy injuries with massive distal tibial loss including articular surface. Diagnostic Level Ⅳ.
处理具有广泛软组织损伤和大量胫骨远端缺失的高能量损伤具有挑战性，通常会导致严重的功能障碍。在这些复杂情况下，踝关节融合术是最常用的手术。有关这些手术难题的治疗方案和结果的出版物相对较少。 本文旨在介绍我们采用分期外固定方案治疗六名因高能量创伤导致骨和软组织严重缺损的胫骨远端复杂开放性骨折患者的临床经验。 该研究对 1998 年至 2010 年间采用分期外固定方案治疗的六名胫骨远端大量缺损的患者（Gustilo-Anderson III B 型和 III C 型骨折）进行了回顾性分析。平均骨量损失为 11.5 厘米（9 - 15 厘米）。 所有患者均使用圆形外固定架进行了重建手术。其中三名患者的手术结果为踝关节实体融合--两名患者通过牵引成骨术进行了急性远端缩短和胫骨近端拉长，一名患者进行了急性腓骨转移以替代胫骨远端缺损，并使用Ilizarov圆形外固定架进行固定。其他三名患者的功能和放射学结果均为无痛性踝关节假关节--一名患者进行了胫骨近端拉长，一名患者进行了骨转运与腓骨远端转移相结合的治疗，一名患者进行了急性肢体缩短，但未进行胫骨拉长。无论最终采用的是实骨融合还是假关节，所有六名患者均无疼痛，并对功能结果感到满意。 对于胫骨远端（包括关节面）大量缺损的高能量损伤的肢体重建，推荐采用环形外固定结合牵引组织生成法进行胫骨近端拉长的方法。 诊断级别Ⅳ。
{"title":"Is the Ankle Fusion the Single Salvage Procedure and the Best Result for the Massive Distal Tibial Loss: Surgical Techniques and Clinical Results","authors":"Alexander Lerner, R. Jakušonoka, A. Jumtins, D. Rothem","doi":"10.1097/btf.0000000000000420","DOIUrl":"https://doi.org/10.1097/btf.0000000000000420","url":null,"abstract":"\u0000 \u0000 Management of high-energy injuries with extensive soft tissue damage and massive distal tibial loss is challenging and often lead to severe dysfunction. In these complex situations ankle fusion procedure is the most commonly performed surgery. Publications devoted to treatment options and outcomes in these surgical challenging conditions are relatively rare.\u0000 \u0000 \u0000 \u0000 The purpose of this work is to present our clinical experience in using staged external fixation protocol in the treatment of six patients who suffered from complex open fractures of the distal tibial segment with severe bone and soft tissue loss due to high-energy trauma.\u0000 \u0000 \u0000 \u0000 The retrospective analysis of six patients (Gustilo-Anderson III B and III C fractures) with massive distal tibial loss and treated using a staged protocol of external fixation between 1998 and 2010, was carried out. Mean bone loss was 11.5 cm (range, 9 – 15 cm).\u0000 \u0000 \u0000 \u0000 All patients had reconstructive surgery using circular external fixation frames. The outcome in three of them was solid ankle fusion – two patients had acute distal shortening and proximal tibial elongation by distraction osteogenesis and one had acute fibular transfer to replace distal tibial loss with fixation using Ilizarov circular frame. In other three patients, the functional and the radiological outcome was pain-free ankle joint pseudoarthrosis – one had proximal tibial elongation, one had a combination of bone transport with distal fibular transfer and one had acute limb shortening without tibial elongation. All six patients were pain-free and satisfied with functional outcomes, regardless of the final solid bone fusion or pseudoarthrosis.\u0000 \u0000 \u0000 \u0000 The method of circular external fixation combined with proximal tibial elongation by distraction histogenesis is recommended for limb reconstruction in high-energy injuries with massive distal tibial loss including articular surface.\u0000 \u0000 \u0000 \u0000 Diagnostic Level Ⅳ.\u0000","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1097/btf.0000000000000419
Luis Beraún-Coronel, José Beraún-Coronel, Fredy Chamorro-Robles
Injuries of the midfoot are rare and they usually occur as a result of high-energy trauma. The navicular and cuboid, bones that belong to the midfoot, are fundamental structures in stabilizing the medial and lateral columns of the foot respectively, so they require an adequate treatment. We present a 26-year-old man with a complete tarsal navicular bone dislocation without associated navicular fracture, and a complete cuboid dislocation after sustaining a 4 meters fall, it was also accompanied by fracture of the lateral cuneiform and the base of the fourth metatarsal. The patient was treated successfully with open reduction and fixation with screw and Kirschner wires. At 18 months follow-up, we considered the patient’s outcome was good obtaining 90 (90/100) points in American Orthopedic Foot and Ankle Society Midfoot Score. Diagnostic Level V.
{"title":"A Rare Midfoot Injury Case Report: Complete Dislocation of the Navicular With Dislocation of the Cuboid","authors":"Luis Beraún-Coronel, José Beraún-Coronel, Fredy Chamorro-Robles","doi":"10.1097/btf.0000000000000419","DOIUrl":"https://doi.org/10.1097/btf.0000000000000419","url":null,"abstract":"\u0000 \u0000 Injuries of the midfoot are rare and they usually occur as a result of high-energy trauma. The navicular and cuboid, bones that belong to the midfoot, are fundamental structures in stabilizing the medial and lateral columns of the foot respectively, so they require an adequate treatment. We present a 26-year-old man with a complete tarsal navicular bone dislocation without associated navicular fracture, and a complete cuboid dislocation after sustaining a 4 meters fall, it was also accompanied by fracture of the lateral cuneiform and the base of the fourth metatarsal. The patient was treated successfully with open reduction and fixation with screw and Kirschner wires. At 18 months follow-up, we considered the patient’s outcome was good obtaining 90 (90/100) points in American Orthopedic Foot and Ankle Society Midfoot Score.\u0000 \u0000 \u0000 \u0000 Diagnostic Level V.\u0000","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140258339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.1097/btf.0000000000000418
K. Yammine, J. Mouawad, Youssef Jamaleddine
Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.
{"title":"The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes","authors":"K. Yammine, J. Mouawad, Youssef Jamaleddine","doi":"10.1097/btf.0000000000000418","DOIUrl":"https://doi.org/10.1097/btf.0000000000000418","url":null,"abstract":"Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes.\u0000 Levels of Evidence: Level V, expert opinion.","PeriodicalId":507475,"journal":{"name":"Techniques in Foot & Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140265170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-19DOI: 10.1097/btf.0000000000000401
Sand Mastrangelo, Caroline B. Granruth, Viviana Serra-Lopez, A. Headen, Anthony Ndu
Osteomyelitis of the foot and ankle is an unfortunate, albeit pervasive, complication faced by orthopedic surgeons and their patients. Chronic osteomyelitis confers a great risk of amputation and protracted hospital admission in patients with diabetes, existing orthopedic hardware, and/or compromised tissue perfusion. The current standard of practice in the treatment of osteomyelitis is the initiation of broad antibiotic coverage followed by subsequent narrowing informed by culture data and sensitivities. While mild to moderate infections are treated with oral antibiotics, more severe infections are often treated using intravenous (IV) antibiotics. Vancomycin, in its IV form, is frequently administered intraoperatively for patients with osteomyelitis as it confers adequate coverage of common causative organisms, including staphylococcus aureus. However, given the diminished blood flow to distal extremities commonly seen in patients experiencing this complication, inadequate distribution of oral or IV antibiotics may occur. This is especially problematic, as it leads to an increased risk of recurrent infection and the ultimate need for amputation. Here, we present an alternate method of intraoperative vancomycin administration for patients with chronic osteomyelitis in the form of paste, powder, and injectable slurry. Postoperatively, oral or IV antibiotics are continued based on OR culture susceptibility. We found this to be an effective way to administer intraoperative antibiotics to ensure adequate osseous and soft tissue penetration in patients with complicated osteomyelitis of the foot and ankle. Level of Evidence: III.
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