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Radiographic and Patient-Reported Outcomes for First Tarsometatarsal Arthrodesis Using an Intramedullary Nail for Hallux Valgus Deformity A Consecutive Case Series.
Pub Date : 2024-12-17 DOI: 10.1177/19386400241301822
Connor C Ott, Ayush D Shah, Kayla J Seiffert, Rebecca Stone McGaver, Paul M Cammack, Scott M Holthusen, Jeffrey D Seybold, John C Tanner, William M Engasser

Background: First tarsometatarsal (TMT) arthrodesis is one of the most common procedures performed each year for the correction of hallux valgus deformity, and nonunion rates for first TMT arthrodesis are commonly reported to be between 4% and 15%. The purpose of this study was to evaluate the effectiveness of an intramedullary nail system in patients requiring first TMT arthrodesis.

Methods: An ambispective, multisurgeon, consecutive case series was conducted, in which retrospective and prospective collection of patient-reported outcome measure (PROM) and radiologic data were conducted. Patients who underwent first TMT arthrodesis from July 2019 to July 2022 for hallux valgus deformity with an intramedullary nail system and had adequate records for a minimum of 3 months postoperation (±4 weeks) were included.

Results: Seventy patients were included in the final analysis, with a median prospective PROM follow-up of 1.6 years. There was an overall union rate of 91.4% (64/70 patients). Nine patients required secondary procedures: 4 hardware removals and 5 nonunion revisions. Collected PROMs and radiologic data showed significant improved from preoperative to prospective follow-up (P < .01).

Conclusion: First TMT arthrodesis using an intramedullary nail system result in nonunion rates and PROMs comparable to other techniques currently being used.

Levels of evidence: Level IV: Retrospective Case Series.

背景:第一跗跖(TMT)关节置换术是每年为矫正拇指外翻畸形而实施的最常见手术之一,据报道,第一跗跖(TMT)关节置换术的不愈合率通常在 4% 到 15% 之间。本研究的目的是评估髓内钉系统对首次TMT关节置换术患者的有效性:方法:该研究是一项由多名外科医师参与的连续性病例系列研究,通过回顾性和前瞻性收集患者报告结果(PROM)和放射学数据。研究对象包括在2019年7月至2022年7月期间首次接受髓内钉系统TMT关节置换术治疗拇指外翻畸形的患者,这些患者在术后至少有3个月(±4周)的充足记录:最终分析纳入了 70 名患者,前瞻性 PROM 随访时间中位数为 1.6 年。总体吻合率为 91.4%(64/70 名患者)。九名患者需要进行二次手术:4例硬件移除,5例非愈合翻修。收集的PROMs和放射学数据显示,从术前随访到前瞻性随访,患者的病情有了显著改善(P < .01):结论:首次使用髓内钉系统进行TMT关节置换术的不愈合率和PROM与目前使用的其他技术相当:IV级:回顾性病例系列
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引用次数: 0
Survey of Utilization of Weightbearing Computed Tomography Within AOFAS Membership. 关于 AOFAS 会员使用负重计算机断层扫描的调查。
Pub Date : 2024-12-14 DOI: 10.1177/19386400241297605
Sudheer C Reddy, Cesar de Cesar Netto

Background: Weightbearing computed tomography (WBCT) has been increasingly employed to evaluate and treat patients with varied pathologies such as progressive collapsing foot deformity (PCFD), posttraumatic deformity, hallux valgus, ankle arthritis, Charcot arthropathy, lisfranc, and syndesmosis injuries. However, little is known regarding its overall availability to foot and ankle providers and how it is being used in clinical practice. The goal of this study is to assess the utilization of WBCT among AOFAS members, identify the indications for use in clinical practice and potential barriers for implementation.

Methods: A survey was emailed to AOFAS members inquiring about the use WBCT in clinical practice. Practice and demographic information were also collected. A total of 220 responses were collected over a 2-month period. Respondents were queried with respect to the availability of WBCT in practice, indications for use, frequency of use, ownership of the scanner, and barriers to implementation.

Results: 58% of respondents did not have access to WBCT. Most respondents were in practice 10 years or more (69%). Single-specialty private practice was the most common practice type (39%). Of those with access to WBCT, 5 or fewer scans were ordered per week (57% of respondents). Evaluation of hindfoot/ankle deformity was the most common indication (69% of respondents) with it being used as a preoperative evaluation tool approximately 25% of the time (57% of respondents). Radiology department owned WBCT in most institutions (34%). 75% of respondents with WBCT use it postoperatively less than 25% of the time. Of those without WBCT, 94% stated they would like to have it with cost being the most significant barrier to implementation.

Conclusion: Most respondents surveyed did not have access to WBCT, with cost being the greatest barrier. However, 94% of those without it would like to have access to it. For those with access, it is used 5 or fewer times per week with evaluation of hindfoot/ankle deformity being the most common indication.

Level of evidence: Level IV (Observational Study).

背景:负重计算机断层扫描(WBCT)越来越多地被用于评估和治疗各种病症的患者,如进行性塌足畸形(PCFD)、创伤后畸形、足外翻、踝关节炎、Charcot 关节病、lisfranc 和巩膜损伤。然而,人们对其在足踝医疗机构的总体可用性以及在临床实践中的使用情况知之甚少。本研究的目的是评估 AOFAS 会员对 WBCT 的使用情况,确定其在临床实践中的使用适应症以及潜在的实施障碍:方法:通过电子邮件向 AOFAS 会员发送调查问卷,询问 WBCT 在临床实践中的使用情况。同时还收集了实践和人口统计信息。在两个月的时间里,共收集到 220 份回复。调查询问了受访者在临床实践中是否使用 WBCT、使用适应症、使用频率、扫描仪的所有权以及实施障碍:结果:58%的受访者没有使用 WBCT。大多数受访者从业时间在 10 年或以上(69%)。单一专科私人诊所是最常见的诊所类型(39%)。在可以使用 WBCT 的受访者中,每周订购的扫描次数为 5 次或更少(57% 的受访者)。评估后足/踝关节畸形是最常见的适应症(69% 的受访者),约有 25% 的时间将其用作术前评估工具(57% 的受访者)。大多数机构的放射科都拥有 WBCT(34%)。在拥有 WBCT 的受访者中,75% 的受访者在术后使用 WBCT 的比例低于 25%。在没有 WBCT 的受访者中,94% 的人表示他们希望拥有 WBCT,而成本是实施 WBCT 的最大障碍:结论:大多数受访者无法使用 WBCT,费用是最大的障碍。然而,94% 的受访者表示希望能够使用。对于那些有条件的受访者来说,每周使用 5 次或更少,评估后足/踝关节畸形是最常见的适应症:证据级别:IV 级(观察性研究)。
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引用次数: 0
Distal Fibula Fractures-Intramedullary Fixation Versus Plating: A Systematic Review and Meta-analysis of Randomized Control Trials. 腓骨远端骨折-髓内固定与钢板固定:随机对照试验的系统回顾和元分析》。
Pub Date : 2024-12-01 Epub Date: 2022-08-24 DOI: 10.1177/19386400221118470
Vikash Raj, Sitanshu Barik, Richa

Purpose: The aim of the present study is to compare the functional scores and complications of intramedullary fixation versus plate osteosynthesis of distal fibular fractures in adults.

Methods: Study was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses format from MEDLINE, Embase, Ovid, and Cochrane databases. The included articles were assessed according to the risk of bias assessment tool by Cochrane collaboration.

Results: A total of 5 randomized control trials were included for quantitative review. Random sequence generation and allocation concealment of the study subjects were the strengths of all the included studies. There was high heterogeneity among the included studies (I2 > 75%). There was no significant difference between the Olerud-Molander scores in both the groups but the trend favored the intramedullary nailing of distal fibula (mean difference of 3.42, 95% confidence interval [CI] of 8.90). Complications were significantly lesser in the intramedullary group across the studies (odds ratio 0.26, 95% CI of 0.81).

Conclusion: Intramedullary nailing of fibula with the use of modern locking fibular nails is an alternative to fibular plating for unstable distal fibular fractures in properly selected cases. There remains the need for standardizing the method of operative treatment of distal fibular fractures which can be done by a well-planned large-scale prospective study design.

Level of evidence: Level 1.

目的:本研究旨在比较成人腓骨远端骨折髓内固定与钢板骨结合的功能评分和并发症:研究按照系统综述和Meta分析首选报告项目的格式进行,数据来源于MEDLINE、Embase、Ovid和Cochrane数据库。根据 Cochrane 协作组织的偏倚风险评估工具对纳入的文章进行了评估:结果:共纳入 5 项随机对照试验进行定量审查。随机序列生成和研究对象的分配隐藏是所有纳入研究的优点。纳入的研究之间存在高度异质性(I2>75%)。两组患者的 Olerud-Molander 评分无明显差异,但趋势倾向于腓骨远端髓内钉(平均差异为 3.42,95% 置信区间 [CI] 为 8.90)。在所有研究中,髓内组的并发症明显较少(几率比0.26,95% CI为0.81):结论:对于经过适当选择的不稳定腓骨远端骨折病例,使用现代锁定腓骨钉进行腓骨髓内置钉是一种替代腓骨钢板固定的方法。目前仍需对腓骨远端骨折的手术治疗方法进行标准化,可通过精心策划的大规模前瞻性研究设计来实现:证据等级:1 级。
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引用次数: 0
Correlation Between Statin Use and Symptomatic Venous Thromboembolism Incidence in Patients With Ankle Fracture: A Machine Learning Approach. 踝关节骨折患者使用他汀类药物与症状性静脉血栓栓塞发生率的相关性:机器学习方法。
Pub Date : 2024-12-01 Epub Date: 2023-10-31 DOI: 10.1177/19386400231207692
Nour Nassour, Bardiya Akhbari, Noopur Ranganathan, Ahmed Tawakol, Rachel P Rosovsky, Daniel Guss, Christopher W DiGiovanni, Soheil Ashkani-Esfahani

Background: Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture.

Methods: In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex.

Results: Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P < .001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02).

Conclusion: Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture.

Levels of evidence: 3.

背景:识别与静脉血栓栓塞症(VTE)发生率相关的因素有可能改善VTE的预防,并积极影响预防决策。在这项研究中,我们旨在调查踝关节骨折患者服用他汀类药物与VTE发生率之间的相关性。方法:在这项回顾性病例对照研究中,病例为发生VTE的患者,对照组为未发生VTE患者,比例为1:4。获得患者的人口统计学、高脂血症史和他汀类药物使用报告。使用随机森林分类器(RFC)模型,根据他汀类药物的消耗量、体重指数(BMI)、年龄和生物性别,预测他汀类药物消费者在脚踝骨折后是否有VTE的风险,而不考虑VTE预防用药。结果:1175例踝关节骨折患者中,238例确诊为VTE(病例组),937例无症状VTE(对照组;比例1:4)。50例(21%)病例和407例(43%)对照组服用他汀类药物。他汀类药物使用者踝关节骨折后VTE的发生率显著降低,比值比(OR)=0.35,95%CI:0.25,0.49,P<.001。我们的模型显示,在预测VTE风险方面,受试者曲线下面积(AUROC)为78%,敏感性为73%,特异性为83%。除了他汀类药物的使用(模型重要性=0.1)外,VTE的预测因素的重要性是年龄(模型重要性0.72)、BMI(模型重要性0.24)和生理性别(模型重要性0.02)。结论:在我们的踝关节骨折患者群体中,他汀类药物与较低的VTE发生率显著相关。证据级别:3。
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引用次数: 0
Effect of Fibular Malrotation on Tibiotalar Joint Contact Mechanics in a Weber B Ankle Fracture Model. 韦伯 B 型踝关节骨折模型中腓骨旋转对胫腓关节接触力学的影响
Pub Date : 2024-12-01 Epub Date: 2022-10-08 DOI: 10.1177/19386400221127835
Alfonso E Ayala, Ansab Khwaja, Brianna C Goodison, Simeon L Smith, Samuel Y Kim, Jared T Irwin, L Daniel Latt

Background: In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics.

Methods: Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion.

Results: In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions.

Conclusion: The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment.

Levels of evidence: Level V: Bench testing.

背景:在微移位韦伯 B 型踝关节骨折中,腓骨远端骨折片可能发生外旋。这种旋转不良在X光片上很难发现,如果通过非手术治疗使旋转不良减轻,可能会导致关节力学改变,容易引发创伤后骨关节炎。本研究评估了腓骨旋转不良对胫腓关节接触力学的影响:方法:使用材料测试系统(MTS)机器对六个尸体脚踝进行测试。胫骨关节传感器记录接触面积和压力。样本在完好、中性旋转和旋转不良状态下进行了测试。每次试验都在中立位、背屈 15° 和跖屈 15° 时施加 686N 的轴向负荷和 147N 的跟腱负荷:在比较畸形踝关节和完好踝关节时发现,接触压力峰值在中立位屈曲时显著增大(完好踝关节为 5.56 MPa ± 1.39,畸形踝关节为 7.21 MPa ± 1.07,P = .03),在背屈时无显著差异,在跖屈时显著减小(完好踝关节为 11.2 MPa ± 3.04,畸形踝关节为 9.01 MPa ± 1.84,P = .01)。不同情况下的接触面积没有明显差异:研究结果表明,腓骨旋转不良会导致胫腓关节接触压力发生显著变化,这可能会导致创伤后骨关节炎的发生。如果在X光平片上怀疑腓骨旋转不良,应进行计算机断层扫描(CT)以评估其程度,并进一步考虑手术治疗:证据等级:第五级:台架试验。
{"title":"Effect of Fibular Malrotation on Tibiotalar Joint Contact Mechanics in a Weber B Ankle Fracture Model.","authors":"Alfonso E Ayala, Ansab Khwaja, Brianna C Goodison, Simeon L Smith, Samuel Y Kim, Jared T Irwin, L Daniel Latt","doi":"10.1177/19386400221127835","DOIUrl":"10.1177/19386400221127835","url":null,"abstract":"<p><strong>Background: </strong>In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics.</p><p><strong>Methods: </strong>Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion.</p><p><strong>Results: </strong>In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions.</p><p><strong>Conclusion: </strong>The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment.</p><p><strong>Levels of evidence: </strong>Level V: Bench testing.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"577-584"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494971","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}
引用次数: 0
Management of Open Ankle Fractures in Elderly Patients With a Fibula Nail is a Safe and Reliable Technique. 用腓骨钉治疗老年开放性踝关节骨折是一种安全可靠的技术。
Pub Date : 2024-12-01 Epub Date: 2022-06-29 DOI: 10.1177/19386400221099660
Abdulrahman Odeh, James Archer, Basil Budair, Alastair Marsh, Paul Fenton

Background: Ankle fractures are becoming more common in the elderly and their management is frequently challenging. There is increasing evidence of good outcomes following fibula nail fixation in the management of ankle fractures. The use of a fibula nail in open fractures comes with potential advantages such as minimal soft tissue dissection, early rehabilitation, and decreased wound complications. We aimed to assess their use in the management of open ankle fractures in the elderly.

Methods: A review of patients aged 60 years or older with an open ankle fracture treated with a fibular nail at a major trauma center was conducted. All patients were managed with joint Orthopaedic and Plastic Surgical input to determine their optimal management. Functional outcome scores, postoperative complications, and re-operation rates were determined.

Results: Fifteen patients were identified with a mean age of 76 years. Patient-reported outcomes (Olerud and Molander Score) were calculated in 73% of patients. Our results demonstrated excellent outcome scores (>91) in 1 patient, good outcome scores (61-90) in 7 patients, and fair outcome scores (31-60) in 3 patients. There were no postoperative complications or re-operations within our study group.

Conclusion: This article is the largest series presenting the outcomes of fibula nails in the management of open ankle fractures in elderly patients. We conclude that it can be used as a treatment option to safely manage open ankle fractures in the elderly. It provides a stable fixation, early weight-bearing, low risk of postoperative complications while maintaining good patient-reported functional outcomes.

Level of evidence: Level 4.

背景:踝关节骨折在老年人中越来越常见,其治疗往往具有挑战性。越来越多的证据表明,腓骨钉固定治疗踝关节骨折效果良好。在开放性骨折中使用腓骨钉具有潜在的优势,如最小化软组织剥离、早期康复和减少伤口并发症。我们旨在评估腓骨钉在老年开放性踝关节骨折治疗中的应用情况:我们对一家大型创伤中心使用腓骨钉治疗的 60 岁及以上开放性踝关节骨折患者进行了回顾性研究。所有患者均接受了骨科和整形外科的联合治疗,以确定最佳治疗方案。确定了功能结果评分、术后并发症和再次手术率:结果:15 名患者的平均年龄为 76 岁。对 73% 的患者进行了患者报告结果(Olerud 和 Molander 评分)计算。结果显示,1 名患者的疗效极佳(大于 91 分),7 名患者的疗效良好(61-90 分),3 名患者的疗效一般(31-60 分)。我们的研究小组中没有术后并发症或再次手术:本文是对腓骨钉治疗老年开放性踝关节骨折疗效的最大系列报道。我们的结论是,腓骨钉可作为一种治疗方法,安全地治疗老年开放性踝关节骨折。它能提供稳定的固定、早期负重、术后并发症风险低,同时保持良好的患者功能报告结果:证据等级:4 级。
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引用次数: 0
Association Between Pronation External Rotation IV Fracture Pattern and Regional Bone Density. 俯仰外旋 IV 型骨折模式与区域骨密度之间的关系
Pub Date : 2024-12-01 Epub Date: 2023-05-17 DOI: 10.1177/19386400231173163
Dominick Casciato, Daniel T DeGenova, Zachary Hill, Jia Bao Lin, Tucker Peabody, Nolan Schmitz, Benjamin Taylor

Introduction: Throughout the musculoskeletal system, fracture patterns and subsequent healing rely partly on bone density. In the foot and ankle, bone density has been shown to play a role in supination and external rotation fracture patterns. Adding to previous research, this investigation examines the association between bone density and trimalleolar versus trimalleolar equivalent fracture patterns following pronation and external rotation injuries using computed tomography (CT)-derived Hounsfield units (HU).

Methods: A retrospective chart review was conducted among patients without a history of fracture or osteoporosis who sustained a PER IV fracture. Demographic data were collected. Fractures were separated between PER IV equivalent and fracture groups. CT-derived HU was assessed at the distal tibia and fibula. Density was compared between PER IV equivalent and fracture groups and among posterior malleolar fracture patterns.

Results: Seventy-five patients met the selection criteria, with 17 comprising the equivalent group and 58 in the fracture group. There were 38 type 1, 9 type 2, and 11 type 3 posterior malleolus fractures. The ankle bone density of the PER fracture equivalent group (331.98 ± 65.71HU) was greater than the PER fracture group (281.61 ± 76.99HU; P = .008). A statistically significant difference in tibial bone densities among equivalent and all PER fracture types (P = .01) with the equivalent group (331.98 ± 65.71HU) maintaining a greater tibial bone density than the type 2 posterior malleolus fracture group (252.35 ± 57.33HU; P = .009).

Conclusion: Higher bone density was associated with PER IV equivalent fractures; however, there was no density difference among posterior malleolus fracture types. When presented with PER IV fractures, consider fixation that addresses a lower bone density.

Level of evidence: III.

导言:在整个肌肉骨骼系统中,骨折模式和随后的愈合部分取决于骨密度。在足部和踝部,骨密度已被证明在上翻和外旋骨折模式中发挥作用。在以往研究的基础上,本研究使用计算机断层扫描(CT)得出的胡恩斯菲尔德单位(HU),对骨密度与代偿和外旋损伤后的三极与三极等效骨折模式之间的关系进行了研究:方法:对无骨折史或骨质疏松症史的 PER IV 骨折患者进行了回顾性病历审查。收集了人口统计学数据。将骨折分为 PER IV 等效组和骨折组。评估胫骨远端和腓骨的 CT 导出 HU。比较了PER IV等效组和骨折组之间以及后臼壁骨折形态之间的密度:75名患者符合选择标准,其中17名患者为等效组,58名患者为骨折组。后踝臼骨骨折类型为 1 型 38 例、2 型 9 例、3 型 11 例。PER骨折等效组的踝关节骨密度(331.98 ± 65.71HU)高于PER骨折组(281.61 ± 76.99HU;P = .008)。同等骨折和所有 PER 骨折类型的胫骨骨密度差异有统计学意义(P = .01),同等骨折组(331.98 ± 65.71HU)的胫骨骨密度高于 2 型后踝骨骨折组(252.35 ± 57.33HU;P = .009):结论:较高的骨密度与 PER IV 型等效骨折有关;但后踝骨骨折类型之间不存在密度差异。当出现 PER IV 骨折时,应考虑针对骨密度较低的骨折进行固定:证据等级:III。
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引用次数: 0
Unstable Rotational Ankle Fractures Treated With Anatomic Mortise Repair and Direct Posterior Malleolus Fixation. 用解剖臼修复和直接后踝骨固定治疗不稳定的旋转性踝关节骨折。
Pub Date : 2024-12-01 Epub Date: 2022-07-21 DOI: 10.1177/19386400221110087
Connor P Littlefield, Jack H Drake, Kenneth A Egol

Introduction: The purpose of this study was to evaluate patient outcomes following a standardized algorithmic approach to ankle mortise stabilization, following rotational fracture, utilizing direct repair of the posterior malleolus in the prone position. Methods: Eighty consecutive patients with unstable rotational ankle fractures that involved the posterior malleolus were analyzed. All underwent direct repair of the posterior malleolus regardless of size through a posterolateral approach. Electronic records were retrospectively reviewed for demographic information, initial injury and operation details, healing status, and complications. Preoperative and postoperative radiographs were obtained to assess the initial injury and healing was determined both by radiographic and clinical progress at follow-up visits. Results: Average posterior malleolus fragment width was 8.1 ± 3.7 mm (range = 2.1-19.9 mm) and percentage of the articular surface was 23.6% (range = 7.1%-56.7%) on the lateral radiograph. Overall, 80/80 (100%) patients healed their ankle fractures by a mean 2.9 ± 1.1 months. Only 1 (1.3%) patient required transsyndesmotic fixation following posterior malleolus repair. Mean range of ankle motion was as follows: dorsiflexion 20° ± 10°, plantarflexion 34° ± 10°, inversion 8° ± 4°, and eversion 7° ± 4°. Seventy-nine patients (98.8%) had an anatomic mortise reduction. Nine patients (11.3%) had a superficial wound complication, 3 patients (3.8%) had dysesthesia in the sural nerve distribution, and 1 patient (1.3%) lost reduction of the medial malleolus. Conclusion: Patients who undergo direct repair of the posterior malleolus in the prone position can expect a high rate of healing with superficial wound breakdown being the biggest problem, which was associated with an ankle fracture dislocation. Posterior malleolus fixation may obviate the need of transsyndesmotic stabilization.Levels of Evidence: Retrospective Level IV.

简介:本研究的目的是评估患者在旋转性骨折后,利用俯卧位直接修复后踝骨臼的标准化算法稳定踝关节后的效果。研究方法研究分析了连续 80 例不稳定旋转性踝关节骨折并累及后踝骨的患者。所有患者均通过后外侧入路直接修复了后踝骨,而不考虑其大小。研究人员对电子记录进行了回顾性审查,以了解人口统计学信息、初始损伤和手术细节、愈合状况以及并发症。术前和术后均拍摄了X光片,以评估最初的损伤情况,而愈合情况则通过随访时的X光片和临床进展来确定。结果在侧位X光片上,后踝骨碎片的平均宽度为8.1 ± 3.7 mm(范围=2.1-19.9 mm),关节面的百分比为23.6%(范围=7.1%-56.7%)。总体而言,80/80(100%)名患者的踝关节骨折平均在 2.9 ± 1.1 个月后愈合。只有 1 名(1.3%)患者在后踝骨修复后需要经髁固定。踝关节的平均活动范围如下:背屈 20°±10°,跖屈 34°±10°,内翻 8°±4°,外翻 7°±4°。79名患者(98.8%)的解剖臼缩小。9名患者(11.3%)出现了表皮伤口并发症,3名患者(3.8%)出现了腓肠神经分布区疼痛,1名患者(1.3%)失去了内侧踝骨的缩窄。结论在俯卧位直接修复后踝骨的患者可期待较高的愈合率,最大的问题是浅表伤口破损,这与踝关节骨折脱位有关。后踝骨固定术可避免经胫骨稳定的需要:回顾性IV级
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引用次数: 0
Defining Operative Indications in Lisfranc Injuries: A Systematic Review. 确定 Lisfranc 损伤的手术指征:系统回顾
Pub Date : 2024-12-01 Epub Date: 2023-06-06 DOI: 10.1177/19386400231175376
Christian Pearsall, Emily Arciero, Puneet Gupta, Henrik Bäcker, Direk Tantigate, David P Trofa, J Turner Vosseller

Objective: The aim of this review was to determine operative indications for Lisfranc injuries.

Methods: A systematic review using a MEDLINE literature search was performed using the index "Lisfranc Injury" from 1980 onward using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines where applicable. Inclusion criteria were all clinical studies reporting on the management of Lisfranc injuries obtained via the search index, including case reports, review articles, cohort studies, and randomized trials. Non-English-language articles, inaccessible articles, those not relevant to the management of Lisfranc injuries (biomechanical, cadaveric, and technique articles), and those that did not explicitly state operative indications (vague or absent indications) were excluded.

Results: After identifying 737 studies, the full text of 391 studies was reviewed, and 58 reports providing explicit operative indications were included in the final analysis. Fifty-one (81.1%) studies provided diastasis cutoffs varying ≥2 mm (35/58; 60.4%), ≥1 mm (13; 22.4%), and ≥3 mm (3; 5.2%); the diastasis location was most commonly unspecified (31/58; 53.5%) or varied between combinations of metatarsal, tarsal, cuboid, and cuneiform bones (20/58; 27.6%). Specific imaging criteria for surgery included an avulsion fracture or fleck sign (3/58; 5.2%), arch height loss (3/58; 5.2%), and a tear on magnetic resonance imaging (5; 8.6%). The 11 (19%) studies defining operative indications in terms of classification schemes used the Nunley and Vertullo (8/58; 13.8%), Myerson (2; 3.5%), and Buehren (1; 1.7%) systems. Twenty-one (36.2%) studies provided multiple operative indications.

Conclusion: The most common Lisfranc operative indications among the limited reporting studies varied from a 1- to 3-mm diastasis across several locations. It is imperative for operative indications to be reported with an increased frequency and in a homogenous fashion to guide the clinical management of these subtle injuries.

Levels of evidence: Level IV; systematic Review.

目的:本综述旨在确定 Lisfranc 损伤的手术适应症:本综述旨在确定 Lisfranc 损伤的手术适应症:在适用的情况下,采用 PRISMA(系统性综述和 Meta 分析的首选报告项目)指南,使用 MEDLINE 文献检索索引 "Lisfranc 损伤 "对 1980 年以来的文献进行了系统性综述。纳入标准是通过搜索索引获得的所有报告 Lisfranc 损伤治疗的临床研究,包括病例报告、综述文章、队列研究和随机试验。非英语文章、无法访问的文章、与Lisfranc损伤治疗无关的文章(生物力学、尸体和技术文章)以及未明确说明手术适应症的文章(适应症模糊或不存在)均被排除在外:结果:在确定了 737 项研究后,对 391 项研究的全文进行了审查,最终分析纳入了 58 篇提供明确手术适应症的报告。51项(81.1%)研究提供了≥2毫米(35/58;60.4%)、≥1毫米(13;22.4%)和≥3毫米(3;5.2%)的裂隙分界线;裂隙位置最常见的是未指定(31/58;53.5%),或在跖骨、跗骨、立方体骨和楔骨组合之间变化(20/58;27.6%)。手术的具体成像标准包括撕脱骨折或斑点征(3/58;5.2%)、足弓高度下降(3/58;5.2%)以及磁共振成像显示撕裂(5;8.6%)。有 11 项(19%)研究使用 Nunley 和 Vertullo 系统(8/58;13.8%)、Myerson 系统(2;3.5%)和 Buehren 系统(1;1.7%)对手术适应症进行了分类。21项(36.2%)研究提供了多种手术适应症:结论:在有限的报告研究中,最常见的 Lisfranc 手术适应症从 1 毫米到 3 毫米不等,涉及多个部位。当务之急是提高手术适应症的报告频率和一致性,以指导这些微小损伤的临床治疗:证据等级:IV 级;系统性综述。
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引用次数: 0
The Wait Time for Surgery Following Injury Affects Functional Outcomes and Complications After an Ankle Fracture: A Propensity Score-Matched Multicenter Study, the TRON Study. 受伤后等待手术的时间影响踝关节骨折后的功能结果和并发症:倾向评分匹配多中心研究--TRON研究》。
Pub Date : 2024-12-01 Epub Date: 2023-04-15 DOI: 10.1177/19386400231164211
Takayuki Sugino, Yasuhiko Takegami, Kosuke Bando, Toshifumi Sato, Tomoki Fujita, Yoshiharu Oka, Shiro Imagama

Background: The present study aimed to evaluate the hypothesis that a 1-week extension of the waiting period to perform surgery for ankle fracture might affect postoperative results and complications.

Methods: We used our multicenter database named TRON (Trauma Research Group of Nagoya). In all, 779 patients who underwent surgery for ankle fracture, who had no comorbidities were eligible. After exclusion, we analyzed 596 patients. We divided the patients into 2 groups according to whether they were operated on within 7 days after the injury with propensity score matching.

Results: The operative time of the delayed operation group (DO group) was significantly longer than that of the early operation group (EO group) (115.87 ± 56.59 vs 85.93 ± 34.58 minutes; P < .001). The rate of infection in the DO group was significantly higher than that of the EO group (16 patients [6.5%] vs 4 patients [1.6%]; P = .016).

Conclusion: Waiting for more than a week to perform ankle surgery may lead to longer operative times and increased infection rates.

Levels of evidence: III.

研究背景本研究旨在评估踝关节骨折手术等待期延长一周可能会影响术后效果和并发症的假设:我们使用了名为 TRON(名古屋创伤研究小组)的多中心数据库。共有 779 名无合并症的踝关节骨折手术患者符合条件。经过排除,我们对 596 名患者进行了分析。我们根据患者是否在受伤后 7 天内进行手术,将其分为两组,并进行倾向评分匹配:结果:延迟手术组(DO 组)的手术时间明显长于早期手术组(EO 组)(115.87 ± 56.59 vs 85.93 ± 34.58 分钟;P < .001)。DO组的感染率明显高于EO组(16例患者[6.5%] vs 4例患者[1.6%];P = .016):结论:等待一周以上再进行踝关节手术可能会导致手术时间延长和感染率增加:证据等级:III.
{"title":"The Wait Time for Surgery Following Injury Affects Functional Outcomes and Complications After an Ankle Fracture: A Propensity Score-Matched Multicenter Study, the TRON Study.","authors":"Takayuki Sugino, Yasuhiko Takegami, Kosuke Bando, Toshifumi Sato, Tomoki Fujita, Yoshiharu Oka, Shiro Imagama","doi":"10.1177/19386400231164211","DOIUrl":"10.1177/19386400231164211","url":null,"abstract":"<p><strong>Background: </strong>The present study aimed to evaluate the hypothesis that a 1-week extension of the waiting period to perform surgery for ankle fracture might affect postoperative results and complications.</p><p><strong>Methods: </strong>We used our multicenter database named TRON (Trauma Research Group of Nagoya). In all, 779 patients who underwent surgery for ankle fracture, who had no comorbidities were eligible. After exclusion, we analyzed 596 patients. We divided the patients into 2 groups according to whether they were operated on within 7 days after the injury with propensity score matching.</p><p><strong>Results: </strong>The operative time of the delayed operation group (DO group) was significantly longer than that of the early operation group (EO group) (115.87 ± 56.59 vs 85.93 ± 34.58 minutes; P < .001). The rate of infection in the DO group was significantly higher than that of the EO group (16 patients [6.5%] vs 4 patients [1.6%]; P = .016).</p><p><strong>Conclusion: </strong>Waiting for more than a week to perform ankle surgery may lead to longer operative times and increased infection rates.</p><p><strong>Levels of evidence: </strong>III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"592-597"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675380","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}
引用次数: 0
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Foot & ankle specialist
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