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

英文中文

Influence of selective versus nonselective joint preparation in first metatarsophalangeal arthrodesis: A systematic review and meta-analysis 选择性与非选择性关节准备对第一跖趾关节融合术的影响：一项系统回顾和荟萃分析

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

Pub Date : 2025-03-24 DOI: 10.1016/j.fastrc.2025.100496

Mark J. Bullock DPM, FACFAS , Kyleigh Pierson DPM , Shivam U. Desai MS , Rebecca Hill Renirie MA, MLIS , Chin-I Cheng PhD , Marisa Samani BS , Nhan Tran DPM

First metatarsophalangeal (MPJ) arthrodesis is a common and effective procedure for hallux rigidus and select patients with hallux valgus. Non selective joint preparation with conical reamers is the most common method for joint preparation in the literature. This meta-analysis compares patients who underwent 1st MPJ arthrodesis with reamer versus patients who underwent selective joint preparation with rongeurs and/or burrs. A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, Cochrane, and Scopus databases were used to identify recent studies based on inclusion and exclusion criteria, and only patients with locking plate fixation were included. Twenty three studies with reamers and 5 studies with selective joint preparation met criteria. Many of the included studies in both treatment groups had low quality data with inadequate radiographic follow-up. A random effects model was utilized to compare union rates between the treatment groups. The estimated union rate was significantly higher (p = 0.03) for selective joint preparation, 99 % (95 % CI 98–100), compared with reamers, 93 % (95 % CI 91–96). Current data suggests selective debridement with rongeurs and/or burrs has superior union rates when 1st MPJ arthrodesis is performed with locking plate fixation.

Level of Clinical Evidence: 3

第一跖趾（MPJ）关节融合术是治疗拇趾僵硬和拇外翻的一种常见而有效的方法。用锥形铰刀进行非选择性关节制备是文献中最常用的关节制备方法。这项荟萃分析比较了使用铰刀进行第一次MPJ关节融合术的患者与使用咬合钳和/或刺进行选择性关节准备的患者。根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行系统评价。PubMed、CINAHL、Cochrane和Scopus数据库根据纳入和排除标准识别近期的研究，仅纳入锁定钢板固定的患者。23项铰刀研究和5项选择性关节准备研究符合标准。两个治疗组纳入的许多研究数据质量较低，影像学随访不足。采用随机效应模型比较治疗组间愈合率。选择性关节预备的预估愈合率为99% (95% CI 98-100)，显著高于铰刀的93% (95% CI 91-96) （p = 0.03）。目前的数据表明，当首次MPJ关节融合术采用锁定钢板固定时，使用牙钳和/或毛刺进行选择性清创具有更高的愈合率。临床证据等级：3

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引用次数: 0

Angioleiomyoma in the ankle mimicking a schwannoma: A case report and review of literature 模拟神经鞘瘤的踝关节血管平滑肌瘤：1例报告及文献复习

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

Pub Date : 2025-03-18 DOI: 10.1016/j.fastrc.2025.100495

Junaid Akbar DPM (Podiatric Resident) , Jonathan Gabor MD (Orthopedic Resident) , Stuart Katchis MD (Section Chief)

A wide range of differentials arise when a soft tissue mass is encountered. Soft tissue masses of the foot and ankle are difficult to diagnose preoperatively due to delays in presentation and non-specific clinical findings. Further imaging and histological examination are needed for a definitive diagnosis. We present a case of interest of a patient who presented to clinic with a symptomatic solitary mobile mass of the ankle, which initially presented as a schwannoma clinically and on advanced imaging. Histological examination, after surgical excision, confirmed the diagnosis of benign angioleiomyoma. Angioleiomyoma is a rare benign tumor of the tunica media of vasculature smooth muscle. This case report adds to the sparse published literature on angioleiomyomas of the foot and ankle and may aid in the diagnosis of this rare condition.

当遇到软组织肿块时，会出现大范围的差异。由于延迟的表现和非特异性的临床表现，术前很难诊断足部和踝关节软组织肿块。需要进一步的影像学和组织学检查才能确诊。我们提出了一个病例的兴趣病人谁提出了临床症状孤立移动肿块的踝关节，最初表现为神经鞘瘤临床和先进的影像。手术切除后的组织学检查证实为良性血管平滑肌瘤。摘要血管平滑肌瘤是一种罕见的血管平滑肌中膜良性肿瘤。本病例报告增加了稀疏的已发表的关于足部和踝关节血管平滑肌瘤的文献，可能有助于这种罕见疾病的诊断。

引用次数: 0

Not your father's palliative care 不是你父亲的姑息治疗

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

Pub Date : 2025-03-10 DOI: 10.1016/j.fastrc.2025.100494

Susan M. Walsh DPM, MBA

The specialty and prevalence of palliative care has substantially grown in the past two decades, such that multiple professional organizations are addressing the topic as it uniquely influences their providers and patient populations. A 66 year old female with a bimalleolar ankle fracture in the setting of multiple comorbid conditions provides an example of the need for including the principles of palliative medicine in the care of those patients with foot and ankle pathology.

在过去的二十年中，姑息治疗的专业和流行程度有了实质性的增长，因此许多专业组织都在解决这个问题，因为它对他们的提供者和患者群体产生了独特的影响。一个66岁的女性双踝骨折，在多重合并症的情况下，提供了一个需要包括姑息医学原则的例子，在这些足部和踝关节病理患者的护理。

引用次数: 0

Re-injury after arthroscopic anatomical reconstruction by allograft tendon of the lateral ankle ligaments treated by a new arthroscopic anatomical allograft reconstruction: A case report 关节镜下同种异体解剖重建治疗踝关节外侧韧带肌腱重建后再损伤1例

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

Pub Date : 2025-03-07 DOI: 10.1016/j.fastrc.2025.100489

Julien Paquot MD, David Ancelin MD,Ph

Revision surgery after ligamentoplasty with anatomical reconstruction presents a complex challenge that remains underreported. This case report highlights a unique arthroscopic revision approach using a novel allograft technique, which has not been previously documented in the surgical literature. A 22-year-old female sustained trauma to her left ankle following a prior anatomical ligamentoplasty reconstruction of the anterior talofibular and calcaneofibular ligaments using an allograft. Persistent instability despite conservative management necessitated revision surgery. Clinical examination and MRI confirmed graft rupture and malposition of the talar tunnel. Arthroscopic revision ligamentoplasty was performed using a non-irradiated allograft with tunnel correction. A new blind talar tunnel (5 mm × 20 mm) was meticulously positioned in the "bare zone" of the talus, ensuring optimal biomechanical alignment. Postoperatively, the patient regained stability and resumed professional activities without recurrent instability episodes.

Relevance and Impact:

•
Correcting the improper placement of bone tunnels during revision surgery is critical for successful outcomes.
•
Arthroscopic approaches allow for comprehensive joint inspection while minimizing surgical morbidity.
•
The use of allografts in revision procedures avoids donor site morbidity while ensuring optimal functional recovery.

韧带成形术与解剖重建后的翻修手术是一个复杂的挑战，但仍未被充分报道。本病例报告强调了一种独特的关节镜翻修方法，使用一种新颖的同种异体移植技术，这在以前的外科文献中没有记载。一位22岁的女性在先前使用同种异体移植对距腓骨前韧带和跟腓骨韧带进行解剖性韧带成形术重建后，左脚踝持续受伤。尽管保守治疗，但持续不稳定需要翻修手术。临床检查和MRI证实植骨破裂和距骨隧道错位。关节镜下翻修韧带成形术采用非辐照同种异体移植物进行隧道矫正。一个新的距骨盲隧道（5mm × 20mm）被精心定位在距骨的“裸露区”，确保最佳的生物力学对齐。术后，患者恢复稳定并恢复职业活动，无复发性不稳定发作。相关性和影响：•在翻修手术中纠正不正确的骨隧道放置对成功的结果至关重要。•关节镜入路允许全面的关节检查，同时最大限度地减少手术发病率。•在翻修手术中使用同种异体移植物避免了供体部位的发病率，同时确保了最佳的功能恢复。

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引用次数: 0

Minimally invasive zadek osteotomy: A cadaveric study of structures at risk 微创zadek截骨术：一项危险结构的尸体研究

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

Pub Date : 2025-03-04 DOI: 10.1016/j.fastrc.2025.100491

Anthony Schwab DPM, MS , Corine L. Creech DPM, FACFAS

Minimally invasive surgery (MIS) has continued to expand with respect to applications throughout the forefoot and into the hindfoot. Our center has performed the minimally invasive Zadek osteotomy in ten fresh frozen cadaver limbs through a single percutaneous incision. Distances in millimeters (mm) were measured from the anterior and posterior arm of the osteotomy to identify nearby anatomical structures. We documented the position of the peroneal sheath and sural nerve relative to the lateral portal, and the position of the tibialis posterior tendon (TP), flexor digitorum longus tendon (FDL), posterior tibial artery (PTA), posterior tibial vein (PTV), and flexor hallucis longus (FHL). The average distance of the sural nerve and the peroneal sheath from the anterior and posterior aspect of the osteotomy about the lateral portal was 6.65, 11.21 and 21.84, 23.26 mm, respectively. No medial neurovascular or tendinous structure was damaged as a result of the osteotomy, and the closest medial structure at risk was the tibial nerve at an average of 24.51 mm from the anterior arm of the osteotomy and 18.21 mm from the posterior arm of the osteotomy. While several technique guides have been discussed, to our knowledge this is the first study looking into structures at risk for this specific procedure with previously established anatomic portals.

Level of clinical evidence: Level V Cadaveric Study

微创手术（MIS）在整个前足和后足的应用方面不断扩大。本中心对10例新鲜冷冻尸体肢体进行了经皮单切口微创Zadek截骨术。以毫米（mm）为单位测量截骨前后臂的距离，以确定附近的解剖结构。我们记录了腓骨鞘和腓肠神经相对于外侧门静脉的位置，以及胫后腱（TP）、趾长屈肌腱（FDL）、胫后动脉（PTA）、胫后静脉（PTV）和拇长屈肌（FHL）的位置。腓肠神经和腓骨鞘距门静脉外侧截骨前后面的平均距离分别为6.65、11.21和21.84、23.26 mm。截骨术未损伤内侧神经血管或肌腱结构，最接近的内侧结构是胫骨神经，平均距截骨前臂24.51 mm，距截骨后臂18.21 mm。虽然已经讨论了一些技术指南，但据我们所知，这是第一次研究这种特定手术有风险的结构，并且已经建立了解剖入口。临床证据等级：V级尸体研究

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引用次数: 0

Revisional total ankle arthroplasty for a unique case of late periprosthetic joint infection 翻修全踝关节置换术治疗晚期假体周围关节感染一例

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

Pub Date : 2025-03-02 DOI: 10.1016/j.fastrc.2025.100488

Yashkumar Bhalala DPM , Lawrence Fallat DPM FACFAS

We present a rare case of an infection seeding from a sinus infection in a patient who had previously undergone total ankle arthroplasty (TAA). Instances of sinus infections leading to periprosthetic joint infection (PJI) are uncommon. Effective diagnosis, management, and treatment are crucial. The surgical approach for these cases includes the removal of the loosened and painful tibial and talar components, eradication of the infection, and reconstruction. Once the infection has been resolved, the final procedure involves implanting a stemmed tibial and talar component. This technique offers an alternative to post-TAA ankle arthrodesis.

我们提出一个罕见的病例感染播种从窦感染的病人谁曾接受过全踝关节置换术（TAA）。鼻窦感染导致假体周围关节感染（PJI）的情况并不常见。有效的诊断、管理和治疗至关重要。这些病例的手术方法包括去除松动和疼痛的胫骨和距骨部件，根除感染和重建。一旦感染得到解决，最后的手术包括植入胫骨和距骨的有柄假体。该技术为taa后踝关节融合术提供了另一种选择。

引用次数: 0

Recalcitrant calcaneal intraosseous lipoma treated with a cadaveric femoral head allograft plug and internal fixation in a 22-year-old military veteran: A case report 顽固性跟骨内脂肪瘤22岁退伍军人用尸体同种异体股骨头内固定治疗1例

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

Pub Date : 2025-03-01 DOI: 10.1016/j.fastrc.2025.100469

Miranda G. Montion M.A. , Quinn Schroeder D.P.M. , Danielle Brewer D.P.M. , Rujul Patel B.S. , Maryam Ameen B.A. , Aneesha N. Usman M.S. , Kyle McKray Smith D.P.M.

Introduction

Intraosseous lipomas (IOL's) are rare benign tumors of mature adipose tissue within the bone, most commonly found in the calcaneus, femur, tibia, and humerus. These lesions are typically asymptomatic and often discovered incidentally in imaging studies. Calcaneal IOL's pose unique challenges due to their location and potential for significant structural compromise.

Body

Here we describe a young male with a recalcitrant calcaneal IOL's without remission of symptoms from previous treatments. Surgery consisted of aggressive lesion debridement with remodeling and interpositional packing of a cadaveric femoral head allograft and tibial autograft Additionally, the construct was secured with a lag screw and supported by an anatomic lateral wall plate. The patient at two years post-operation has returned to normal weight-bearing, comfortable ambulation, and increased quality of life working as a full-time mail carrier.

Conclusion

To the authors’ knowledge, this is the first report of an IOL's in the foot and ankle literature treated with a cadaveric femoral head allograft and internal fixation. Our approach underscores the efficacy of combining aggressive tumor resection with structural allografts and non-structural autografts protected with internal fixation, offering a promising alternative in managing benign calcaneal neoplasms refractory to conventional therapies.

骨内脂肪瘤（IOL’s）是骨内成熟脂肪组织的罕见良性肿瘤，最常见于跟骨、股骨、胫骨和肱骨。这些病变通常无症状，经常在影像学检查中偶然发现。跟骨人工晶状体由于其位置和潜在的重大结构损害而带来了独特的挑战。在这里，我们描述了一个年轻的男性顽固性跟骨人工晶状体，没有从以前的治疗症状缓解。手术包括积极的病变清创，重建和对尸体同种异体股骨头移植物和自体胫骨移植物进行间位填塞。此外，该结构用一根螺钉固定，并由解剖外侧壁板支撑。术后两年，患者已恢复正常负重，行走舒适，生活质量提高，成为一名全职邮递员。结论：据作者所知，这是文献中首次报道用尸体异体股骨头移植和内固定治疗足部和踝关节人工晶状体。我们的方法强调了侵袭性肿瘤切除联合结构性同种异体移植物和非结构性自体移植物内固定保护的有效性，为治疗常规治疗难治的良性跟骨肿瘤提供了一个有希望的选择。

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引用次数: 0

Intramedullary use of an antibiotic synthetic bone filler in diabetics undergoing metatarsal amputation(s) 抗生素合成骨填充物在糖尿病患者跖骨截肢术中的髓内应用

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

Pub Date : 2025-03-01 DOI: 10.1016/j.fastrc.2025.100484

Thomas Poynter DPM , Kaitlyn J. Loesel DPM , Michael Sweeney DPM , Alden Simmons DPM , Brandon Kitchens DPM , Timothy Ford DPM , Nicholas Laco DPM

The use of intramedullary devices to treat osteomyelitis has been documented as being effective and safe. Technology has limited the use of this technique to long bones with application on an intramedullary nail or rod. In this paper, we describe a novel technique using antibiotic synthetic bone void filler (ASBVF) applied into the medullary canal of a transmetatarsal amputation. This backfills a necrotic void and creates a bioabsorbable, antibiotic impregnated filler to resist and treat further advancement or recurrence of osteomyelitis after resection.

使用髓内装置治疗骨髓炎已被证明是有效和安全的。技术限制了这种技术在长骨上的应用，并在髓内钉或棒上应用。在本文中，我们描述了一种应用抗生素合成骨空洞填充物（ASBVF）进入经跖骨截肢髓管内的新技术。这种方法可以填充坏死的空洞，形成生物可吸收的、浸透抗生素的填充物，以抵抗和治疗切除后骨髓炎的进一步进展或复发。

引用次数: 0

About the Journal 关于华尔街日报

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

Pub Date : 2025-03-01 DOI: 10.1016/S2667-3967(25)00027-8

引用次数: 0

New Transveron™ osteotomy and single dual-zone screw fixation: Sixth generation minimally invasive bunion surgery 新Transveron™截骨和单双区螺钉固定：第六代微创拇外翻手术

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

Pub Date : 2025-03-01 DOI: 10.1016/j.fastrc.2025.100477

Neal M. Blitz DPM, FACFAS

Minimally invasive bunion surgery continues to experience generation evolution with the development of newer techniques and as advanced technology emerges. Having a common vernacular and universally accepted terms, the ideal construct/technique will materialize as we compare and contrast the generations through scientific literature. This paper outlines sixth generation MIBS that combines new never-been disclosed proprietary Transveron™ osteotomy techniques and technological implant advancements that make a single screw construct structurally feasible. This generational variational update, as outlined in the article, provides a stable construct while allowing for unrestricted lateral metatarsal head translation, frontal plane sesamoid positioning, rotational-control, lateral wall real estate preservation and increased bone healing potential.

随着新技术的发展和先进技术的出现，微创拇囊炎手术继续经历世代演变。有了共同的白话和普遍接受的术语，通过科学文献的比较和对比，理想的结构/技术就会具体化。本文概述了第六代MIBS，它结合了新的从未公开的专有Transveron™截骨技术和技术种植体的进步，使单螺钉结构在结构上可行。正如文章中概述的那样，这种代际变分更新提供了稳定的结构，同时允许不受限制的外侧跖骨头平移，额平面籽骨定位，旋转控制，外侧壁空间保存和增加骨愈合潜力。

引用次数: 0

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

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