Foot & ankle surgery (New York, N.Y.)最新文献

英文中文

Functional and radiographic outcomes following percutaneous fixation of intra-articular calcaneal fractures: a systematic review 跟骨关节内骨折经皮内固定后的功能和影像学结果：系统回顾

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2026-01-13 DOI: 10.1016/j.fastrc.2026.100602

Marcel Brzeszczyński , Filip Brzeszczyński , Oktawiusz Bończak

The management of displaced intra-articular fractures of the calcaneus remains controversial due to the soft tissue complications associated with the traditional extensile lateral surgical approach. Minimally invasive percutaneous techniques have been developed with the aim of restoring calcaneal shape while reducing wound complications. This review evaluated functional and radiographic outcomes following percutaneous fixation of displaced intra-articular fractures of the calcaneus. A systematic search of MEDLINE and EMBASE databases identified studies that reported functional outcomes or radiographic measurements after percutaneous fixation. Data on patient demographics, fracture classification, operative technique, outcomes, complications, and study quality were extracted. Eight studies comprising 295 patients and 309 fractures met inclusion criteria. All studies included fractures of Sanders type three, seven included fractures of Sanders type two, and two reported fractures of Sanders type four. The average follow-up period across all studies was 29.2 months. Functional outcomes were favourable, with a pooled average score on the American Orthopaedic Foot and Ankle Society hindfoot scale of 85.6 across all studies and an average Maryland foot score of 88.9 across two studies. Radiographic correction was maintained at final follow-up, with improvements in both Böhler and Gissane angles reported in five studies. Five studies were assessed as high quality and three as low quality. Percutaneous fixation of displaced intra-articular fractures of the calcaneus provides reliable functional improvement, satisfactory restoration of radiographic parameters, and a lower rate of wound complications compared with open reduction and internal fixation. Larger, high-quality prospective studies are required to define the optimal minimally invasive method.

Level of clinical evidence: 2

由于传统的可伸展外侧手术入路会导致软组织并发症，因此对跟骨关节内移位骨折的治疗仍存在争议。微创经皮技术的目的是恢复跟骨形状，同时减少伤口并发症。这篇综述评估了跟骨移位性关节内骨折经皮内固定治疗后的功能和影像学结果。对MEDLINE和EMBASE数据库进行系统搜索，确定了报告经皮固定后功能结果或放射学测量的研究。提取患者人口统计学、骨折分类、手术技术、结局、并发症和研究质量的数据。8项研究包括295名患者和309例骨折符合纳入标准。所有研究均包括Sanders 3型骨折，7例包括Sanders 2型骨折，2例报道的Sanders 4型骨折。所有研究的平均随访期为29.2个月。功能结果是有利的，在所有研究中，美国矫形足和踝关节协会后足量表的综合平均得分为85.6分，在两项研究中，马里兰足的平均得分为88.9分。在最后的随访中，影像学矫正得以维持，五项研究报告Böhler和Gissane角度均有改善。5项研究被评为高质量，3项为低质量。与切开复位和内固定相比，经皮内固定移位的跟骨关节内骨折提供可靠的功能改善，令人满意的影像学参数恢复，伤口并发症发生率较低。需要更大规模、高质量的前瞻性研究来确定最佳的微创方法。临床证据等级：2

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引用次数: 0

Surgical management of intraosseous lipoma of the calcaneus with pathological fracture and subsequent treatment of complications: A case report and literature review 跟骨骨内脂肪瘤伴病理性骨折的手术治疗及并发症的治疗：1例报告并文献复习

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2026-01-10 DOI: 10.1016/j.fastrc.2026.100601

Levi Smith , Scott Carrington , Andrew Elliott

Intraosseous lipoma is a very rare finding, which can occur in the calcaneus with unknown etiology. Up to 33% of these lesions are asymptomatic, with between 25–40% of lesions found incidentally. Patients often present with pain, tenderness and swelling, and in severe cases pathological fracture at initial presentation. The aim is to review a multi-faceted case involving evaluation and surgical management of a pathologic fracture of a large intraosseous lipoma of the calcaneus, and subsequent management of complications over a course of 9 months. An overview of the literature detailing intraosseous lipoma is also presented. 49-year-old male presents after a fall from four feet, immediate onset of pain to the right rearfoot, unable to ambulate. Physical exam revealed ecchymosis to medial instep, edema. Radiographs and CT initially obtained, and MRI later revealed intraosseous lipoma involving 80% of the body of the calcaneus with pathological intraarticular fracture. The patient underwent excision via curettage, void fill with bone cement, and plate and screw fixation. Patient later developed osteomyelitis of the calcaneus, requiring removal of hardware and bone cement, and later replacement with an antibiotic spacer. Patient has since required no further surgical intervention. This case presentation seeks to further the literature in understanding of intraosseous lipoma, in addition to the complicating pathologic fracture to the calcaneus.

骨内脂肪瘤是一种非常罕见的发现，它可以发生在跟骨不明病因。高达33%的此类病变无症状，25-40%的病变是偶然发现的。患者通常表现为疼痛、压痛和肿胀，严重者在初次就诊时出现病理性骨折。目的是回顾一个多方面的病例，包括对一个巨大的跟骨骨内脂肪瘤的病理性骨折的评估和手术处理，以及随后9个月的并发症处理。文献概述详细骨内脂肪瘤也提出。49岁男性从四英尺高处摔下，右后脚立即疼痛，无法行走。体检发现内侧脚背淤斑，水肿。最初获得的x线片和CT，后来的MRI显示骨内脂肪瘤累及跟骨体的80%，并伴有病理性关节内骨折。患者行刮除术，骨水泥填充空隙，钢板螺钉固定。患者后来发展为跟骨骨髓炎，需要移除硬体和骨水泥，随后用抗生素间隔器替代。此后，患者不再需要进一步的手术干预。本病例报告旨在进一步了解骨内脂肪瘤的文献，以及跟骨的复杂病理性骨折。

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引用次数: 0

Primarily misdiagnosed bosworth lesion in a pilon fracture with soft-tissue problems-a case report 主要误诊的博斯沃思病变在头枕骨折与软组织问题- 1例报告

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2026-01-05 DOI: 10.1016/j.fastrc.2026.100599

Dr Marie Serilas , Dr Fergus Bonnevie

This case report highlights two critical aspects of a complex ankle injury. It first presents a specific and rare injury pattern: a Bosworth fracture-dislocation occurring in conjunction with a tibial pilon fracture. Most consequentially, the key lesion was not identified initially and, therefore, was not treated promptly. This diagnostic failure directly led to severe soft-tissue complications, which compromised the surgical plan, delayed definitive treatment, and increased the risk of a poor outcome.

本病例报告强调了复杂踝关节损伤的两个关键方面。它首先提出了一个特殊的和罕见的损伤模式：博斯沃思骨折脱位并发胫骨pilon骨折。最重要的是，关键病变最初没有被发现，因此没有及时治疗。这种诊断失败直接导致严重的软组织并发症，危及手术计划，延迟最终治疗，并增加预后不良的风险。

引用次数: 0

From crisis to closure: Early aggressive debridement and use of skin grafting in limb threatening necrotizing fasciitis 从危象到愈合：肢体坏死性筋膜炎的早期积极清创和植皮术

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-23 DOI: 10.1016/j.fastrc.2025.100598

Hayley Collins DPM, William Lopez DPM, Michael Cooper MD

Necrotizing fasciitis (NF) in the setting of diabetic ketoacidosis (DKA) and septic shock presents a formidable challenge to limb preservation. This case describes a 64-year-old female with longstanding uncontrolled diabetes who presented in profound metabolic and septic compromise, with extensive soft tissue gas and polymicrobial infection of the right foot and leg. Emergent radical debridement and partial foot amputation were performed within hours of arrival, with vascular surgery consulted for below-knee amputation (BKA) due to concern for non-salvageability. This case highlights the impact of early aggressive debridement, serial washouts, and strategic wound optimization, culminating in successful split-thickness skin grafting. Despite the severity of infection and systemic compromise, amputation was limited to the first ray and second digit. At 2.5 months postoperatively, the patient regained ambulatory function and expressed high satisfaction with limb preservation. The graft healed fully, and no further surgical intervention was required. This outcome underscores the critical role of interdisciplinary coordination, surgical persistence, and timely decision-making in complex NF cases.

Level of evidence

坏死性筋膜炎（NF）在糖尿病酮症酸中毒（DKA）和感染性休克的设置提出了一个巨大的挑战肢体保存。该病例描述了一名64岁女性，患有长期不受控制的糖尿病，表现为严重的代谢和脓毒性损害，右脚和腿部有广泛的软组织气体和多微生物感染。急诊根治性清创和部分足部截肢在到达后数小时内进行，由于担心无法修复，血管外科咨询了膝下截肢（BKA）。本病例强调了早期积极清创、连续冲洗和策略性伤口优化的影响，最终成功地进行了分厚皮肤移植。尽管感染严重，全身受损，截肢仅限于第一根和第二根手指。术后2.5个月，患者恢复了行走功能，并对肢体保留表示高度满意。移植物完全愈合，不需要进一步的手术干预。这一结果强调了在复杂的NF病例中跨学科协调、手术坚持和及时决策的关键作用。证据水平

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引用次数: 0

Second metatarsal reconstruction after segmental bone loss using a custom 3D-printed implant: A case report 使用定制3d打印植入物重建节段性骨丢失后的第二次跖骨：1例报告

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-04 DOI: 10.1016/j.fastrc.2025.100595

Mustafa Al-Tameemi , Lawrence M. Fallat

Reconstructing extensive bone loss in the foot after trauma poses a significant surgical challenge. The challenge becomes even greater when the injury involves weight-bearing structures. This case report presents the use of a custom 3D-printed implant to reconstruct the second metatarsal following loss of its distal portion. This injury was further complicated by dislocations of the third to fifth metatarsophalangeal joints with plantar protrusion of the third and fourth metatarsal heads through the foot. Additionally, a dislocation of the first tarsometatarsal joint was also present. A staged surgical approach was employed consisting of (1) irrigation and debridement of the open wound, reduction of the dislocated joints and placement of a temporary antibiotic spacer into the distal second metatarsal space (2) insertion of a fibular strut allograft into the distal second metatarsal space while the custom 3D implant was being designed and internal fixation of the first tarsometatarsal joint using a bridge plate and (3) definitive reconstruction of the second metatarsal using a patient-specific 3D-printed implant.

Our surgical procedure restored foot anatomy and enabled our patient to return to full weight bearing. Postoperative radiographs confirmed excellent alignment, stability, and integration of the implant. This case highlights the transformative potential of 3D printing technology in addressing critical bone loss and restoring function in complex foot trauma. Custom implants offer significant advantages over traditional bone grafting techniques providing a promising solution for complex orthopedic reconstructions.

创伤后重建足部大面积骨丢失是一项重大的外科挑战。当损伤涉及承重结构时，挑战就更大了。本病例报告介绍了使用定制的3d打印植入物重建第二跖骨远端部分缺失后的重建。第三至第五跖指关节脱位，伴有第三和第四跖头穿过足部的足底突出，进一步加重了该损伤。此外，第一跗跖关节脱位也存在。采用分阶段手术方法，包括：(1)冲洗和清创开放性伤口；将脱位关节复位，并将临时抗生素垫片置入第二跖骨远端间隙(2)在设计定制3D植入物的同时，将异体腓骨支撑移植物置入第二跖骨远端间隙，并使用桥板对第一跖骨关节进行内固定；(3)使用患者特异性3D打印植入物对第二跖骨进行最终重建。我们的外科手术恢复了足部解剖结构，使患者恢复了完全的负重。术后x线片证实植入物排列、稳定性和整合良好。这个案例强调了3D打印技术在解决严重骨质流失和恢复复杂足部创伤功能方面的变革潜力。与传统的骨移植技术相比，定制植入物具有显著的优势，为复杂的骨科重建提供了一个有前途的解决方案。

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引用次数: 0

Surgical management of functional hallux limitus using cotton osteotomy/posterior muscle group lengthening and its effect on cuneiform articular angle, Medial Arch Sag Angle, and Meary's angle 棉截骨/后肌群延长术治疗功能性拇极限及其对楔形关节角、内弓凹陷角和Meary's角的影响

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-04 DOI: 10.1016/j.fastrc.2025.100594

William Stallings DPM , Julia Reczek DPM , Léthicia K. Paul DPM, MPH, MS , Holly Zucchero DPM , Samuel Adegboyega DPM

Introduction

Functional hallux limitus (FnHL) can arise from medial column instability caused by pathological compensation within the closed kinetic chain. This report presents a surgical case of FnHL attributed to instability at the naviculocuneiform joint (NCJ) following failed conservative management.

Methods

Medial column stability was addressed with a Cotton osteotomy, using the cuneiform articular angle (CAA) to determine appropriate graft size. An Austin osteotomy and proximal Akin were performed to correct a bunion deformity, while posterior muscle group lengthening was added to reduce rearfoot-driven strain on the medial column. Medial column integrity was evaluated preoperatively and at one year postoperatively via weight-bearing lateral radiographs, assessing the medial arch sag angle (MASA), CAA, medial cuneiform height (MCH), and Meary’s angle. Confirmation bias was reduced by using radiographic angles to support subjective outcomes of procedure.

Results

Postoperative imaging demonstrated notable improvement in CAA, Meary’s angle, and MCH, confirming correction of medial column instability. MASA remained unchanged. The bunion deformity was also corrected radiographically. Clinically, the patient showed improved 1st metatarsophalangeal joint (MPJ) function, with the metatarsophalangeal-interphalangeal (MTP-IP) score increasing from 62 to 90 at one year.

Conclusion

This appears to be the first report describing the combined use of a first metatarsal distal shaft osteotomy, Cotton osteotomy, and posterior muscle group lengthening to improve both 1st MPJ function and medial column stability during gait. A novel NC fault classification system is introduced to guide preoperative planning for medial column instability.

功能性拇受限症（FnHL）可由封闭动力链内病理性代偿引起的内侧柱不稳定引起。本报告报告一例保守治疗失败后，因船盂关节不稳定而手术治疗的FnHL病例。方法采用棉花截骨术解决内侧柱稳定性问题，使用楔形关节角（CAA）确定合适的移植物大小。行Austin截骨术和近端Akin术矫正拇囊炎畸形，同时增加后肌群延长术以减少后脚驱动的内侧柱劳损。术前和术后1年通过负重侧位片评估内侧柱完整性，评估内侧弓凹陷角（MASA）、CAA、内侧楔形体高度（MCH）和Meary’s角。通过使用放射角度来支持手术的主观结果，减少了确认偏倚。结果术后影像学显示CAA、Meary’s角、MCH均有明显改善，证实内侧柱不稳定得到了矫正。MASA保持不变。拇囊炎畸形也进行了影像学矫正。临床表现为第一跖趾关节（MPJ）功能改善，一年后跖趾趾间关节（MTP-IP）评分由62分提高至90分。结论：这是第一跖骨远端截骨术、棉花截骨术和后肌群延长术联合应用来改善第一MPJ功能和步态时内侧柱稳定性的首次报道。介绍了一种新的NC故障分类系统，用于指导中枢柱失稳的术前规划。

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引用次数: 0

Minimally invasive cheilectomy with first metatarsal plantarflexory osteotomy fixated via intramedullary plating device - A novel technique for the management of hallux limitus and concomitant metatarsus primus elevatus: A case report with 3-year follow-up and surgical technique guide 微创颧骨切除经髓内钢板固定第一跖趾跖屈骨切开术-一种治疗拇趾局限性及伴发跖前突的新技术：3年随访1例及手术技术指导

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-01 DOI: 10.1016/j.fastrc.2025.100588

Benjamin Wehrli DPM, FACFAS , Jonathan Fisher DPM, FACFAS , G. Parker Peresko DPM, FACFAS

Background

Hallux Limitus/Rigidus is a well-described pathologic spectrum, although the surgical management, especially when observed with concomitant metatarsus primus elevatus, can present less-than-desirable outcomes. While there is an abundance of available literature on the surgical management of these pathologies, more recent findings potentiate a continued need for a more encompassing approach.

Study Design

Case Report with Technique Guide.

Methods

We report the case of a 79-year-old male with painful symptomatic late-stage hallux limitus. Conservative measures were attempted and failed. Upon electing surgical intervention, a minimally invasive cheilectomy and 1st metatarsal plantarflexory osteotomy was conducted to address the hallux limitus and elevatus components simultaneously.

Results

The implementation of this novel surgical technique improved clinical factors, allowed for restoration of 1st metatarsal positioning, satisfactory exposure to address periarticular osteophytosis secondary to hallux limitus, while allowing for a minimal degree of soft tissue dissection. Postoperative course was uneventful with marked improvement in 1st metatarsophalangeal joint motion and patient’s pain and symptom generators, even when compared at 3-year follow-up. No recurrence of the resected exostoses or metatarsal malalignment was noted.

Conclusion

Recent literature has suggested the need for a more comprehensive approach when surgically addressing hallux limitus with associated metatarsus primus elevatus. The novel technique described in the report today of a minimally invasive cheilectomy coupled with plantarflexory osteotomy fixated via intramedullary plating appears to be a safe and effective surgical option. The advantageous minimal incisional window allowed for increased soft tissue protection without detracting from the correction of the root pathologies intraoperatively.

Level of Evidence

IV. Case-Report

背景：局限性足/僵直是一种描述良好的病理谱系，尽管手术治疗，特别是当观察到伴有第一跖增高时，可能会出现不太理想的结果。虽然有大量关于这些病理的外科治疗的可用文献，但最近的研究结果表明，需要一种更全面的方法。研究设计案例报告与技术指南。方法我们报告一位79岁男性，有疼痛症状的晚期拇趾限制症。人们尝试了一些保守的措施，但都失败了。在选择手术干预后，微创颧骨切除术和第一跖跖跖骨切开术同时解决拇趾局限性和抬高性成分。结果该新手术技术的实施改善了临床因素，允许第一跖骨定位的恢复，满意的暴露以解决继发于拇趾受限的关节周骨赘病，同时允许最小程度的软组织剥离。术后过程平稳，即使与3年随访相比，第一跖趾关节运动、患者疼痛和症状产生也有明显改善。未发现切除的外植骨复发或跖骨畸形。结论：最近的文献表明，需要更全面的方法，手术治疗拇趾限制与相关的跖前突。在今天的报告中描述的微创颧骨切除术联合经髓内钢板固定的跖屈截骨术的新技术似乎是一种安全有效的手术选择。有利的最小切口窗口允许增加软组织保护，而不会影响术中对牙根病理的纠正。证据水平病例报告

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引用次数: 0

About the Journal 关于华尔街日报

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-01 DOI: 10.1016/S2667-3967(25)00127-2

引用次数: 0

Erratum to “Open anterior Ankle cheilectomy as salvage procedure for anterior ankle impingement, a case report” [Foot & Ankle Surgery: Techniques, Reports & Cases 4 (2024) 100432] “开放式踝关节前骨切除术作为踝关节前撞击的抢救手术1例报告”的勘误[足踝外科：技术、报告与病例4 (2024)100432]

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-12-01 DOI: 10.1016/j.fastrc.2025.100581

Francisco Bouhon Chilao, Laurent Mustaki, Jean-François Fischer, Ceyran Hamoudi

引用次数: 0

Vascular tumor of the lower extremity: A case report and review of the literature 下肢血管肿瘤一例报告及文献复习

Foot & ankle surgery (New York, N.Y.)

Pub Date : 2025-11-24 DOI: 10.1016/j.fastrc.2025.100590

Gianna M. Tuitele B.S. , Isabel Bathke B.A. , Layla Galavotti B.S. , Evelyn Heigh-Rosen D.P.M.

We report a suspected case of epithelioid hemangioendothelioma tumor located on the plantar aspect of the foot. A 27-year-old female presented with a painful mass on the plantar aspect of her left foot. The pain was worsened by poorly fitting shoes. Upon further evaluation, a vascular tumor was found via a punch biopsy of the plantar lesion. Histopathologic features suggestive of a hemangioendothelioma with suspected low-grade malignancy were present. Staging PET CT scan was performed prior to surgical excision. The lesion was then fully excised with surgical pathology revealing only intravascular papillary endothelial hyperplasia. Fortunately, no malignancy was identified. After 6 months of follow-up, the patient had no surgical complications or recurrence. Malignant tumors of the foot and ankle are rare. Raised lesions presenting on the foot and ankle should be promptly addressed to optimize diagnosis and definitive treatment.

我们报告一个疑似病例上皮样血管内皮瘤肿瘤位于足底方面。一个27岁的女性提出了一个痛苦的肿块在她的左脚足底方面。不合脚的鞋子加重了疼痛。经进一步评估，通过足底病变的穿刺活检发现血管肿瘤。组织病理特征提示血管内皮瘤疑似低级别恶性肿瘤。手术切除前进行PET CT扫描。病变完全切除，手术病理仅显示血管内乳头状内皮增生。幸运的是，未发现恶性肿瘤。随访6个月，无手术并发症及复发。脚和脚踝的恶性肿瘤是罕见的。出现在足部和踝关节的凸起病变应及时处理，以优化诊断和最终治疗。

引用次数: 0

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