Foot & ankle specialist最新文献

Background: Syndesmotic ankle fractures occur when damage to the syndesmosis complex is combined with a malleolar fracture. This can result in severe pain, weakness, and instability. Surgical interventions include syndesmotic screw fixation (SS), suture button fixation (SB), and tibiotalocalcaneal nail (TTC). This meta-analysis aims to compare the outcomes of these treatment methods for syndesmotic ankle fractures.

Methods: A literature search was conducted on PubMed and Embase for comparison studies that included at least 2 surgical interventions and at least one of the relevant functional outcomes and/or complication metrics until June 2024. The Olerud-Molander Ankle Score (OMAS) was used to compare functional outcomes, and it is a self-reported outcome measure that evaluates the symptoms and function of those with ankle fractures, while infections and reoperations were reported to compare complication outcomes. Statistical analyses were performed using Review Manager 5.4. A P-value ≤ .05 was considered statistically significant. The risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale.

Results: A total of 18 studies with a total of 1,040 patients were ultimately included in this study. The SS had a significantly higher OMAS 2-year follow-up compared to TTC. The TTC had a significantly lower infection rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than SS. The SB had a significantly lower reoperation rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than TTC. The SB had a significantly lower infection rate compared to TTC.

Conclusion: The SB emerges as the preferred treatment method for syndesmotic ankle fractures, while TTC stands as a viable alternative. The SB is recommended as the primary surgical intervention for patients with syndesmotic ankle fractures due to its superior clinical benefits when compared to TTC and SS.

Levels of evidence: 3.

Syndactyly-polydactyly-ear lobe (SPEL) syndrome is a rare, genetic, congenital limb malformation syndrome that can be characterized by 6 different human phenotypes. We report a rare case of SPEL syndrome in a young woman with right earlobe malformations and asymptomatic preaxial polydactyly with partial duplication of the right hallucal distal phalanx without a supernumerary toe. Unique aspects of our patient's clinical presentation include lack of a supernumerary digit with a bifurcated distal phalanx, associated earlobe malformations, adult age, and no reported familial history of SPEL syndrome. Syndactyly-polydactyly-ear lobe syndrome has not been reported in the literature since 1976, making the present case particularly noteworthy.Level of Evidence: Level 5, Case Report.

Hallux valgus deformity frequently presents with an increased distal metatarsal articular angle (DMAA) which may require additional correction. Minimally invasive hallux valgus surgery is often used in patients with increased DMAA. We hypothesized that the triplanar correction with the minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) would improve the DMAA, in addition to the hallux valgus angle (HVA), intermetatarsal angle (IMA), and patient-reported outcomes. A retrospective chart review was performed on patients who underwent an META procedure for hallux valgus correction. The DMAA, HVA, IMA were measured on preoperative, 2-week postoperative, and final follow-up radiographs. Patient demographics, complications, and Patient-Reported Outcomes Measure Information System (PROMIS) pain, function, and mobility scores were recorded. Univariate analysis and t-test were used to describe measurements between DMAA, HVA, and IMA. Twenty-seven META osteotomies were performed on 25 patients. At the final follow-up, mean DMAA, HVA, IMA decreased from 9.73 ± 1.96 to 4.35 ± 0.85 degrees, 30.45 ± 7.91 to 6.59 ± 2.75 degrees, and 15.37 ± 3.67 to 3.72 ± 1.84 degrees, respectively (P < .001). The PROMIS pain scores significantly improved from 58.96 ± 6.00 to 49.69 ± 9.35 at the final follow-up (P < .001). These observations imply successful resolution of hallux valgus, with a single META procedure. This approach may be an alternative to open or multiple corrections of hallux valgus, while preserving improvement in functional outcomes.Level of Evidence: Level IV.

Introduction: As artificial intelligence (AI) becomes increasingly integrated into medicine and surgery, its applications are expanding rapidly-from aiding clinical documentation to providing patient information. However, its role in medical decision-making remains uncertain. This study evaluates an AI language model's alignment with clinical consensus statements in foot and ankle surgery.

Methods: Clinical consensus statements from the American College of Foot and Ankle Surgeons (ACFAS; 2015-2022) were collected and rated by ChatGPT-o1 as being inappropriate, neither appropriate nor inappropriate, and appropriate. Ten repetitions of the statements were entered into ChatGPT-o1 in a random order, and the model was prompted to assign a corresponding rating. The AI-generated scores were compared to the expert panel's ratings, and intra-rater analysis was performed.

Results: The analysis of 9 clinical consensus documents and 129 statements revealed an overall Cohen's kappa of 0.29 (95% CI: 0.12, 0.46), indicating fair alignment between expert panelists and ChatGPT. Overall, ankle arthritis and heel pain showed the highest concordance at 100%, while flatfoot exhibited the lowest agreement at 25%, reflecting variability between ChatGPT and expert panelists. Among the ChatGPT ratings, Cohen's kappa values ranged from 0.41 to 0.92, highlighting variability in internal reliability across topics.

Conclusion: ChatGPT achieved overall fair agreement and demonstrated variable consistency when repetitively rating ACFAS expert panel clinical practice guidelines representing a variety of topics. These data reflect the need for further study of the causes, impacts, and solutions for this disparity between intelligence and human intelligence.

Level of evidence: Level IV: Retrospective cohort study.

Primary tumors of the calcaneus present a reconstructive challenge. Their relatively low incidence leads to limited evidence, clinical experience, and ongoing discussion regarding the optimal surgical strategy. In this report, we present a case of a 19-year-old male diagnosed with an aggressive osteoblastoma who underwent subtotal calcanectomy. A custom 3D-printed titanium endoprosthesis was designed for limb-salvage reconstruction. Trabecular porous structure and screws were used to achieve subtalar and calcaneo-cuboid fusion and to compensate for the deficient ligamentous apparatus following resection. An innovative system for reattachment of the calcaneal tuberosity with spared of the Achilles tendon was also utilized. At 3 months, the implant was completely incorporated, allowing full weight bearing. At the 18-month follow-up, the implant showed no signs of loosening, the patient had no signs of recurrence, had excellent function, and successfully returned to all his pretreatment activities, underscoring the effectiveness of this reconstructive approach in the management of calcaneal tumors.Level of Evidence: IV, Case report.

Background: The combined effect of fixation type and preoperative deformity together might influence the union rate after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to compare the nonunion and failure rate of dorsal locking plate versus cross-screws for the first MTP arthrodesis considering the preoperative deformity, including hallux valgus versus rigidus. We secondarily aimed to compare the observed nonunion rate with the rate in the systematic reviews.

Methods: This was a retrospective cohort study including 372 patients and 378 feet. The surgical technique was identical except for the use of a dorsal locking plate in 181 (49%) and cross-screws in 191 (51%) MTP joints. The radiographic union was assessed at 3 months postoperative. Those who did not heal by the 3-month follow-up were categorized as a "symptomatic" versus "asymptomatic" nonunion. Those categorized as nonunion after 3 months were followed until union occurred.

Results: The results demonstrated that dorsal locking plate fixation (OR = 10.1, 95% CI: 1.3-80) and hallux valgus deformity (OR = 4.7, 95% CI: 1.2-18) were significantly associated with a higher nonunion rate. At 3-month follow-up, a total of 19 (5%) patients showed nonunion. Of the total nonunions, 15 (79%) were fixed by the locking plate, and 4 (21%) were fixed by cross-screws. Of the 15 nonunions with plate fixation, 6 (40%) underwent a second surgery due to device failure, while none of the cross-screws required a second surgery. Out of the 6 secondary surgeries, 5 (83%) demonstrated a nonunion with valgus deformity and 1 required removal of hardware due to prominent hardware.

Conclusion: Our results support that a dorsal locking plate for the fusion of a hallux valgus deformity is associated with a significantly higher risk of symptomatic nonunion and a secondary surgery compared to cross-screws, possibly due to the failure of the plate in neutralizing the medio-lateral deforming forces.

Levels of evidence: Level IV, Retrospective Cohort.

Background: Surgical management of ankle osteoarthritis (AOA) includes Ankle Arthrodesis (AA) or Total Ankle Arthroplasty (TAA). The purpose of this study was to analyze data from the National Surgical Quality Improvement Project (NSQIP) to elucidate differences in outcomes between TAA and AA.

Methods: Patients who underwent TAA or AA from January 2010 to December 2020 were included in this analysis. Matched cohorts were created using 1:1 propensity score matching to match patients according to patient demographics. Independent sample t-tests and chi-square tests were used to determine whether there was a difference between groups. A binary logistic regression was performed to determine the odds ratio (OR) and 95% confidence intervals for any adverse event as related to patient demographics and comorbidities.

Results: There were 2,053 TAA and 359 AA in the unmatched cohorts. The matched cohorts included 359 patients in each group. In the matched cohorts, there was an increase in transfusions, urinary tract infection (UTI), and return to the operating room in the arthrodesis group compared with the arthroplasty group (1.95%, 0.28%, P = .038; 1.11%, 0.00%, P = .045, 3.90%, 1.11%, P = .017). The logistic regression revealed that length of hospital stay (OR = 1.157) and insulin-dependent diabetes (OR = 6.043) had an increased risk of any adverse event for TAA or AA.

Conclusion: Identification of complication rates and patient risk factors for adverse events after TAA and AA can assist surgeons and patients in their choice of treatment for AOA.

Levels of evidence: III (retrospective cohort study).

Introduction: Open pilon fractures represent a challenging injury for both patients and physicians. Patients must contend with prolonged non-weightbearing, wound complications, and the possibility of post-traumatic arthritis. Surgeons also deal with a fracture which is difficult to treat and that is prone to poor outcomes. To better understand these challenging injuries and identify details that may portend better patient outcomes, we performed a retrospective review of open pilon fractures treated at a level 1 trauma county hospital by orthopedic trauma-trained surgeons.

Materials and methods: A search was performed for patients treated for open pilon fractures at our institution. Demographics and fracture information for each patient, as well as pre and postoperative details for each patient, were collected. We also identified complications such as infection, nonunion, and the need for additional surgeries in patients. Patients were then compared to one another, and they were also stratified according to their Gustilo-Anderson classification of open fracture to identify differences.

Results: Patients in our study who sustained type 3 open injuries were older, more often required additional surgeries, sustained nonunion of their fracture, became infected or underwent amputation than patients with type 1 and 2 injuries. 20% of all patients with type 3 open injuries underwent 4 or more additional procedures, while only 13% did not require additional surgery. In contrast, over half of all patients with type 1 and 2 open injuries did not require any additional surgeries.

Conclusions: Despite following currently recommended guidelines for the treatment of open pilon fractures, these injuries are still prone to complications. Elderly patients and those with type 3 injuries are especially at high risk for negative postoperative outcomes due to the increased severity of soft-tissue damage. Further research is necessary to identify optimal protocols for these devastating injuries, especially in vulnerable populations.

Levels of evidence: Level III.

Background: The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery.

Methods: Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed.

Results: A total of 54 patients were included. A body mass index (BMI) of 30 kg/m² or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores.

Conclusion: This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction.

Level of evidence: Level III: Retrospective case control.