Foot & ankle specialist最新文献

BackgroundThe purpose of this study is to determine whether patients with a history of preoperative opioid use will have an increased likelihood of postoperative opioid use and complications after undergoing forefoot, hindfoot, or ankle surgery.MethodsA retrospective review was conducted on forefoot, hindfoot, and ankle surgeries between 2015 and 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. A total of 326 patients (356 feet) were included with a mean follow-up up of 2.12 (range, 1.00-4.98) years. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (eg, Foot and Ankle Outcome Score), and opioid exposure.ResultsThere were significantly more complications among opioid exposed patients than opioid naïve ones (exposed = 29.41%, naïve = 9.62%; P = .044). Preoperative opioid exposure significantly correlated with postoperative opioid exposure (90-day: r = .903, p < .001; 180-day: r = .805, p < .001), and increased hospital length of stay (r = .263, p = .029). Furthermore, body mass index was a significant predictor of postoperative opioid exposure (90-day: r = .262, p = .013; 180-day: r = .217, p = .021), as was concomitant mental illness (90-day: r = .225, p = .035).ConclusionPatients with preoperative opioid exposure have significantly more complications and increased postoperative opioid exposure after foot and ankle surgery.Levels of Evidence:Level III: Retrospective cohort study.

Background: As total talus replacement (TTR) grows in popularity as a salvage option for talar collapse, a critical evaluation of the complications associated with this procedure is indicated.

Methods: In this review of the literature, we present a patient report and provide a review of several complications seen after TTR, including ligamentous instability, infection, and adjacent joint osteoarthritis, which we have encountered in our practice.

Results: Total talus replacement has the potential to reduce pain and preserve range of motion. However, the treating surgeon must be cognizant of the variety of adverse outcomes. We have presented cases of potential devastating complications from our own clinical experience and the literature.

Conclusions: In conclusion, TTR may have utility in the properly selected patient with end-stage talar collapse, but implant composition, indications, and patient demographic variables complicate the interpretation of the literature.Levels of Evidence: Level III.

BackgroundThis study evaluates the effect of surgical construct on postoperative outcomes in patients undergoing isolated talonavicular (TN) or double (TN and subtalar ST) arthrodesis. TN constructs included plate and screw, screw and staple, and isolated staple constructs. Subtalar constructs included 1- and 2-screw constructs.MethodsRetrospective chart review identified 52 patients who underwent double or isolated TN arthrodesis between 2016 and 2021 by a single fellowship-trained foot and ankle surgeon with minimum 6 months of follow-up (mean = 1.62 years, range = 0.50-4.39 years). Data collected included demographics, medical history, surgical indication, surgical constructs used, complications, reoperations, patient-reported outcome measures, and radiographic measures.ResultsOverall complication and reoperation rates were 26.3% and 12.3%, respectively. Among TN constructs, time to ST (P = .026) and TN (P = .018) fusion was significantly slower among patients receiving a plate and screw construct. Complication rate did not differ, but reoperation rate was significantly higher for plate and screw TN constructs (P = .039). Postoperative Foot and Ankle Outcome Score (FAOS) Quality of Life (P = .028) and Total (P = .016) scores were significantly better among plate and screw TN constructs.ConclusionUtilization of screw and staple or isolated staple construct have significantly quicker time to fusion and lower reoperation rates than plate and screw constructs for the TN joint.Level of Evidence:Level III: Retrospective cohort study.

BackgroundThere is a paucity of literature assessing 2 of the commonly used static Patient-Reported Outcomes Measurement Information System (PROMIS) forms (PROMIS Global-10 and PROMIS Physical Function Short Form 10a [PF SF 10a]) and the Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL).MethodsThe PROMIS Global-10, PROMIS PF SF 10a, and FAAM ADL were compared among new foot and ankle patients. Spearman rho (ρ) correlations were calculated, and ceiling and floor effects were determined.ResultsThe FAAM ADL demonstrated strong correlations with PROMIS PF SF 10a, P = .88, 95% confidence interval (CI): 0.86-0.90, P < .001, and PROMIS Global-10 Physical Health (P = .75, 95% CI: 0.71-0.78, p < .001). The FAAM ADL and PROMIS Global-10 Mental Health demonstrated a moderate correlation (P = .41, 95% CI: 0.34-0.47, P < .001). No PROM demonstrated an appreciable floor effect. The PROMIS Global-10 Physical Health demonstrated the lowest ceiling effect (n=11 [1.6%]).ConclusionBecause the PROMIS Global-10 captures physical health adequately, provides mental health insight, and performs as well (if not better), we recommend the PROMIS Global-10 among the PROMs studied.Level of Evidence: Level III.

Background: To decrease postoperative opioid consumption, nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are considered a proper substitute with few side effects. Our null hypothesis is that a standard-dose, short-term ketorolac exposure does not increase the nonunion rate of a first metatarsophalangeal joint (MTPJ) arthrodesis.

Methods: In a retrospective cohort study, we included 181 primary first MTPJ arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. A 30 mg intravenous dose of ketorolac was administered perioperatively, followed by a post-operative oral course of 10 mg oral ketorolac every 6 hours for 5 consecutive days. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at 3 months postoperative. Radiographic nonunion was also categorized clinically as symptomatic versus asymptomatic.

Results: At 3 months postoperative, a nonunion occurred in 15 (8.3%) patients. Of the 15 radiographic nonunions, 7 (45%) were clinically asymptomatic, while the other 8 (55%) were symptomatic. Six (75%) of the 8 symptomatic nonunions ultimately underwent revision surgery. The nonunion rate in our study compared to that described in the literature (5.4%) was similar and showed no significant difference (P = .067).

Conclusion: The use of a short course of oral ketorolac (40 mg/day or less for a maximum of 5 days) does not seem to affect the union rate after first MTPJ arthrodesis and can be used safely and effectively in the management of post-operative pain to decrease opioid consumption following this procedure.

Levels of evidence: Level 4.

BackgroundThe purpose of this study was to evaluate opioid usage and prescribing trends among workers' compensation (WC) patients who underwent foot or ankle operative procedures compared with a control group.MethodsA retrospective review was conducted for WC and non-WC patients who underwent foot or ankle procedures in a single academic orthopaedic surgery practice. Outcome measures were total morphine milligram equivalents (MME) and number of opioid prescriptions.ResultsA total of 118 patients were identified, including 51 patients in the WC group and 67 in the non-WC group. After index surgery, 67% (34 of 51) of WC patients had 2 or more additional opioid prescriptions compared to 39% (26 of 67) of non-WC patients (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.4-6.7; P = .003). Collectively, there were greater prescriptions of oxycodone MME (P = .002) and hydrocodone MME (P = .07) in the WC cohort.ConclusionsWorkers' compensation patients seem to be prescribed and consume opioids at a higher rate postoperatively. It is important for treating physicians to be aware of these trends, and discussions with patients regarding expected opioid use when planning surgical intervention may be beneficial. Physicians may need to set expectations preoperatively and suggest there are limits on the amount of opioids that can safely be prescribed.Level of Evidence:Level III, Retrospective cohort study, Prognostic.

Posterior ankle impingement syndrome (PAIS) is a clinical disorder with pain elicited when the foot is placed into a forced plantarflexion position, resulting in compression of bony and/or soft tissue structures located within the posterior ankle region. Numerous soft tissue structures exist in close proximity to the posterior ankle joint which can also result in impingement, with flexor hallucis tendinitis being associated in 63% to 85% of cases. The purpose of this study is to present 3 cases of both open and endoscopic surgical approaches for the treatment of PAIS caused by a hypertrophied and low-lying flexor hallucis longus (FHL) muscle. While there remains a paucity of high-level research with regards to treatment outcomes for PAIS, our report demonstrates that surgical excision can lead to significant improvements in patient symptomatology and function. We hope that this report will shed light on the importance of identifying alternative and uncommon causes of PAIS as well as aid in the workup and treatment of such cases.Level of Evidence: Level 4.

BackgroundThis study aims to quantify how well midfoot and transverse tarsal joint arthritis can be treated nonoperatively with fluoroscopic-guided injections.

Methods: We reviewed the records of 132 patients (155 feet) diagnosed with midfoot arthritis between 2015 and 2019, who received conservative management via periodic fluoroscopic-guided steroid injections. Patients were told to follow-up as needed after the injection.

Results: There was a 94.2% success rate of treating midfoot and transverse tarsal joint osteoarthritis via fluoroscopic-guided corticosteroid injections. On average, each foot received 3.1 (range, 1-21) injections, which did not differ between cohorts (operative = 3.9, nonoperative = 3.0; P = .147). Patients with higher pretreatment Pain Catastrophizing Scale (PCS) scores in Magnification (P = .046), Helplessness (P = .002), and Total (P = .003) subsections were more likely to undergo surgery. Patients diagnosed with depression were more likely to receive more total injections (depression = 4.3, nondepression = 2.9, P = .046) over a greater injection duration (depression = 22.2 months, nondepression = 11.4 months, P = .046).

Conclusions: Overall, fluoroscopic-guided injections are effective nonoperative treatment of midfoot and transverse tarsal joint arthritis.

Level of evidence: Level III, Retrospective cohort study.

IntroductionThe involvement of the posterior malleolus (PM) in dislocated bimalleolar ankle fractures is associated with inferior clinical outcomes. There is no consensus on whether and when a computed tomography (CT) scan should be performed in the case of an inconspicuous X-ray of the PM. How high is the risk of missing a posterior malleolus fracture (PMF) without a CT scan? The aim of this study was hence to analyze the rate of correctly performed assessments of the PM in bimalleolar ankle fractures based on X-rays and to correlate this with surgical therapy.Materials and MethodsIn total, 100 bimalleolar ankle fractures, 50% with and 50% without PMF visible on the basis of a CT scan, were analyzed by 4 observers at 2 different time points 30 days apart (d1 and d2). The observers had to decide on the basis of X-rays whether a PMF was present or not. This was followed by a correlation with the operative treatment.ResultsAnalyzing each observer independently, the correct diagnoses of a present PMF were made in an average of 83% of cases, with no significant difference between seniors and residents. In 22 of 50 cases (44%) with a PMF confirmed on a CT scan, it was missed by at least one of the observers based on plain radiographs. For those PMF that required fixation (24 of the 50 PMF), in 25% of cases, at least 2 observers missed the diagnosis of a PMF.ConclusionsBased on our results, there are deficits in the detection of PMF in bimalleolar ankle fractures only on the basis of X-rays, even in PMF that were later fixed surgically. This study aids the awareness that PMF can be easily missed on X-rays and raises the question of whether a CT scan might become mandatory in distal fibula fractures that involve the upper ankle joint.Levels of Evidence:Level III: Retrospective study.