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

英文中文

Calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by Masquelet technique combined with vascularized free fibula flap: Two case reports

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

Pub Date : 2024-11-30 DOI: 10.1016/j.fastrc.2024.100446

Goki Ohashi M.D. , Takashi Nuri M.D. Ph.D. , Akinori Asaka M.D. , Shunji Miyamae M.D. , Koichi Ueda M.D. Ph.D. , Hiroaki Shima M.D. Ph.D. , Emi Yasuda M.D. Ph.D.

The treatment of calcaneal osteomyelitis is challenging, and no effective treatment has been confirmed. In particular, Pseudomonas aeruginosa is resistant to many treatments and is associated with a high risk of amputation. The induced membrane technique has recently shown efficacy in treating osteomyelitis. In this paper, we present two cases of calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by the Masquelet technique combined with a fibular free flap. Case 1 involved a 25-year-old woman who developed calcaneal osteomyelitis following a calcaneal open fracture. Case 2 involved a 46-year-old man with paraplegia who developed calcaneal osteomyelitis secondary to a chronic skin ulcer. In the first stage of surgery, the necrotic bone and soft tissue were debrided, and a polymethylmethacrylate cement spacer was implanted into the bone defect. In the second stage of surgery, a free fibula flap was transplanted to the bone defect, and the peroneal artery and vein were anastomosed to the dorsal artery and saphenous vein. In Cases 1 and 2, the C-reactive protein concentration had decreased to normal by 21 and 36 days after surgery, respectively. Both patients showed no recurrence of osteomyelitis for >3 years of follow-up. The Masquelet technique involves the use of an induced membrane with neovascularization around the cement spacer. Drug delivery to the calcaneal region is considered to increase through this membrane, contributing to the suppression of Pseudomonas aeruginosa. The blood circulation in the free fibular flap is stable, contributing to wound healing.

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引用次数: 0

Erratum regarding missing Declaration of Competing Interest statements in previously published articles

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

Pub Date : 2024-11-29 DOI: 10.1016/j.fastrc.2024.100450

引用次数: 0

Erratum regarding missing Informed patient consent statements in previously published articles

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

Pub Date : 2024-11-29 DOI: 10.1016/j.fastrc.2024.100451

引用次数: 0

Surgical outcomes of forefoot amputations on 122 patients and the role of random fasciocutaneous flaps in forefoot infections and revision surgery: A retrospective analysis

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

Pub Date : 2024-11-28 DOI: 10.1016/j.fastrc.2024.100444

Efthymios Gkotsoulias DPM, FACFAS

Deep tissue coverage in the management of high-risk limb salvage cases poses a challenge to surgeons. Local fasciocutaneous flaps are utilized for coverage of forefoot amputations when the soft tissue equilibrium does not permit primary closure. The aim of this study is to report the mid-term safety and efficacy outcomes of patients who underwent fasciocutaneous flap for limb salvage and analyze the base procedures recruited for partial ray and transmetatarsal amputations.

A review of 122 consecutive patients who underwent forefoot amputation between May 2016 and December 2021 with a minimum of 12 months follow-up was performed. Fasciocutaneous flap closure was recruited in 21 patients (17%), all of whom demonstrated successful wound closure with a mean follow-up period > 3 years (range 19 to 67 months). The Incidence of recurrent breakdown following transmetatarsal amputation (TMA) was 11 limbs (15.4%), and below-the-knee (BKA) incidence was 7 limbs (9.8%), with a 90% limb salvage rate. In this cohort, the risk of breakdown is 112.3% higher when comparing a partial ray amputation to a TMA.

At a mean follow-up greater than 3 years, the incidence of recurrent breakdown resulting in higher-level amputation was no different between closure via random fasciocutaneous flap (9.5%) and traditional closure methods (9.8%). These outcomes justify using fasciocutaneous flaps for closure and the procedures they're indicated for, such as a TMA. They provide a reliable option while maintaining the integrity of local tissue needs, with minimal morbidity, from an expendable donor site while attaining primary wound closure.

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引用次数: 0

Integrating domain-specific resources: Advancing AI for foot and ankle surgery

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

Pub Date : 2024-11-28 DOI: 10.1016/j.fastrc.2024.100445

Steven R. Cooperman DPM, MBA, AACFAS , Roberto A. Brandão DPM, FACFAS

Large language models like ChatGPT offer significant potential for applications in medicine, including patient education and clinical support. This study evaluates the performance of ChatGPT-4, ChatGPT-4 enhanced with retrieval-augmented generation (RAG), and Gemini AI in responding to clinical vignette questions regarding Hallux Rigidus, a condition requiring specialized knowledge in foot and ankle surgery. The ChatGPT-4 + RAG model, enhanced with the 2024 ACFAS clinical consensus statements, demonstrated the highest agreement with surveyor majority responses (83.26 %) compared to ChatGPT-4 (59.54 %) and Gemini AI (53.02 %). All models provided clinically appropriate responses to most questions, with the ChatGPT-4 + RAG model excelling in accuracy, despite the rationale for answers being deemed most difficult to read. These findings highlight the limitations of generic AI models, which may propagate misinformation if used by patients seeking health information. By incorporating domain-specific resources, the RAG-augmented model showed enhanced reliability and contextual accuracy, suggesting their potential as tools for both clinical decision-making and patient education. This study emphasizes the importance of integrating verified medical resources to advance AI in healthcare, addressing critical gaps in existing capabilities while minimizing risks of misinformation.

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引用次数: 0

Isolated Osteochondral defect of the first metatarsal head: A review of surgical treatment options & case report 第一跖骨头孤立性骨软骨缺损：手术治疗方案回顾及病例报告

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

Pub Date : 2024-11-23 DOI: 10.1016/j.fastrc.2024.100443

James Craven FRCPodS, MSc, Andy Naismith FRCPodS, BSc

Osteochondral defects (OCD) are a focal pathology affecting the sub-chondral bone and overlying cartilage. The presence of Osteochondral defects (OCD) within the foot and ankle are well established. Despite this, they are often regarded as an insidious finding, prone to misdiagnosis which can result in significant debilitation to the affected individual. The mechanisms underlying the formation of these lesions remain disputed. Moreover, the incidence of isolated Osteochondral defects affecting the first Metatarsophalangeal joint in the absence of any additional pathology is unknown.

There are a range of surgical treatment modalities described to treat Osteochondral defects. Strategies typically involve cartilage regeneration or replacement of the articular surface: however there are no consensus guidelines regarding the optimum surgical management when applied to the first Metatarsophalangeal joint. The following concepts review aims to explore the literature pertaining to the surgical management of Osteochondral defects including an innovative approach case study employing subchondral drilling technique.

Osteochondral defects are managed with a variety of surgical procedures. Surgical outcomes are often derived from literature relating to the knee and hindfoot with little or no study on the forefoot. The included case study demonstrates positive patient satisfaction (PSQ-10) score, improved foot function (MOXFQ) and pain reduction with a novel antegraded Osteochondral drilling technique when applied to the first metatarsal. Further study into the application of contemporary cartilage regeneration and replacement strategies in this location is warranted.

骨软骨缺损（OCD）是一种影响软骨下骨和上覆软骨的局灶性病理。骨软骨缺损（OCD）在足部和踝关节的存在是公认的。尽管如此，他们往往被认为是一个阴险的发现，容易误诊，这可能导致显着的衰弱受影响的个人。这些病变形成的机制仍有争议。此外，在没有任何其他病理的情况下，影响第一跖趾关节的孤立性骨软骨缺损的发生率尚不清楚。有一系列的外科治疗方式描述治疗骨软骨缺损。策略通常包括软骨再生或关节面置换：然而，对于应用于第一跖趾关节的最佳手术处理尚无一致的指导方针。下面的概念综述旨在探讨与骨软骨缺损的外科治疗有关的文献，包括采用软骨下钻孔技术的创新方法的案例研究。骨软骨缺损的治疗方法有多种。手术结果通常来源于与膝关节和后足有关的文献，很少或没有关于前足的研究。纳入的病例研究表明，采用新型超前骨软骨钻孔技术治疗第一跖骨时，患者满意度（PSQ-10）评分为阳性，足部功能（MOXFQ）得到改善，疼痛减轻。进一步研究当代软骨再生和替代策略在该部位的应用是必要的。

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引用次数: 0

A case of erenumab, a new migraine medication, and delayed wound and bone healing after foot and ankle surgery 偏头痛新药艾伦单抗与足踝手术后伤口和骨愈合延迟的一个案例

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

Pub Date : 2024-11-16 DOI: 10.1016/j.fastrc.2024.100442

Timothy Cheung DPM, PhD, CPT , Zachary Korwek DPM , Arij Rashid DPM, AACFAS , Rumzah Paracha MD , Ashley Bruno DPM, FACFAS

Patient selection and optimization are crucial components of successful surgery outcomes. Erenumab is a Calcitonin Gene-Related Peptide (CGRP) antagonist that was recently approved by the FDA for the treatment of migraines. CGRP is a neuropeptide implicated in migraines, but is also essential in osteotomy healing. This case reports a pathologic fracture suspected secondary to an elusive side effect of a migraine medication with subsequent delayed wound and osteotomy healing in a healthy patient that underwent an index midfoot arthrodesis and revision. The delayed wound healing lasted approximately 9 months, but once erenumab was identified as the cause of nonunion and delayed wound healing, the medication was stopped and the wound healed 2 weeks later at the next appointment. After withholding of erenumab, there were no significant changes to the foot from serial radiographs. The joint surfaces were stable with manual manipulation and the patient did not have pain with direct palpation to the surgical sites, suggesting fibrous union. This case substantiates the need for considering erenumab, a specific migraine medication, in the preoperative planning and optimization in elective foot and ankle surgery.

Level of evidence: IV, case study

患者的选择和优化是手术取得成功的关键因素。艾伦单抗是一种降钙素基因相关肽（CGRP）拮抗剂，最近获得美国食品药品管理局批准用于治疗偏头痛。CGRP 是一种与偏头痛有关的神经肽，但对截骨愈合也至关重要。本病例报告了一名健康患者在接受指数中足关节置换术和翻修术后，怀疑因偏头痛药物的副作用导致病理性骨折，随后伤口和截骨愈合延迟。伤口延迟愈合持续了约 9 个月，但一旦确定艾伦单抗是导致骨折不愈合和伤口延迟愈合的原因，就立即停药，2 周后伤口在下次就诊时愈合。停用艾伦单抗后，连续拍片显示足部没有明显变化。手动操作时关节表面稳定，直接触诊手术部位时患者没有疼痛感，这表明伤口已经纤维化。本病例证明，在选择性足踝手术的术前计划和优化中，有必要考虑使用偏头痛特效药艾伦单抗：IV级，病例研究

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引用次数: 0

Open and closed pantalar dislocations: A systematic review 开放性和闭合性髋臼脱位：系统回顾

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

Pub Date : 2024-11-13 DOI: 10.1016/j.fastrc.2024.100435

Joseph R Brown DPM , Zachary P Hill DPM , Tucker Peabody DO , Benjamin C Taylor MD

Pantalar dislocations are a relatively rare traumatic condition of the foot and ankle, and outcomes are overall unknown for these patients. A systematic review was performed to identify articles evaluating outcomes following treatment of pantalar dislocations. Studies with a minimum of 1 year follow-up, with mention of patient reported outcome measures (PROMs) and complications were included. The mean complication rate, secondary operation rate, and PROM scores were calculated based on the included articles. 203 articles were initially identified. 15 articles met the inclusion criteria, for a total of 62 pantalar dislocations. All studies were level 4 evidence (i.e., case study or series). Open dislocations (40/62; 65%) were more common than closed dislocations (22/62; 35%). The most common form of treatment of open reduction with external fixation (n = 12). The average follow-up was 43.02 months for the entire cohort. The mean age was 37.3 (19-81) years and most patients were male (n = 43). Complication rates were relatively high, with 30.6% (19/62) having osteonecrosis, 17.7% (11/62) having arthritis, and 11.3% (7/62) experiencing an infection. 19.4% (12/62) of patients required a secondary operation. At a minimum 1 year follow up, the pooled mean AOFAS and FFI scores were 75.8 and 37.5, respectively. High complication rates can be expected with relatively poor functional outcomes at short term follow up with pantalar dislocations secondary to the traumatic nature of these injuries. Surgeons managing lower extremity trauma should be aware of this pathology and treatment strategies.

Level of Evidence: Level 3 Systematic Review

踝关节脱位是一种相对罕见的足踝创伤性疾病，这些患者的治疗效果总体上并不乐观。我们进行了一项系统性回顾，以确定对治疗跖骨脱位后的疗效进行评估的文章。研究纳入了随访至少 1 年、提及患者报告结果指标 (PROM) 和并发症的文章。根据纳入的文章计算平均并发症发生率、二次手术率和 PROM 评分。初步确定了 203 篇文章。有 15 篇文章符合纳入标准，共计 62 例枕骨脱位。所有研究均为 4 级证据（即病例研究或系列研究）。开放性脱位（40/62；65%）比闭合性脱位（22/62；35%）更常见。最常见的治疗方式是开放复位加外固定（12 例）。整个组群的平均随访时间为 43.02 个月。平均年龄为 37.3 (19-81)岁，大多数患者为男性（43 人）。并发症发生率相对较高，30.6%（19/62）的患者出现骨坏死，17.7%（11/62）的患者出现关节炎，11.3%（7/62）的患者出现感染。19.4%的患者（12/62）需要进行二次手术。在至少一年的随访中，AOFAS 和 FFI 的综合平均得分分别为 75.8 分和 37.5 分。由于踝关节脱位具有创伤性，因此预计并发症发生率较高，短期随访的功能效果相对较差。处理下肢创伤的外科医生应了解这种病理变化和治疗策略：3 级系统综述

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引用次数: 0

Cerebrotendinous Xanthomatosis in the achilles tendon: A Case study 跟腱脑膜黄瘤病：病例研究

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

Pub Date : 2024-11-12 DOI: 10.1016/j.fastrc.2024.100441

Rahul Mishra DPM, PGY-3 , John T. Marcoux DPM, FACFAS

引用次数: 0

The modified Boyd fusion: An uncommon limb salvage procedure 改良博伊德融合术：不常见的肢体挽救术

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

Pub Date : 2024-11-08 DOI: 10.1016/j.fastrc.2024.100437

Zachary J Washburn DPM , Adena Mahadai DPM , James Hayes DPM , Lahari Madulapally DPM , Stephen J Frania DPM, FACFAS

This study reports on four patients who underwent a Modified Boyd Fusion, which consists of a Chopart amputation with a subtalar and ankle joint arthrodesis utilizing an intramedullary nail. This technique affords the patient a rigid platform for ambulation by controlling the rearfoot and provides maximal limb length preservation. This technique also helps prevent the complications associated with a Chopart amputation alone, which consist of an equinovarus deformity and associated increased plantar pressures of the distal stump with high risk of subsequent wound development and failure.

这项研究报告了四名接受 "改良博伊德融合术 "的患者的情况。"改良博伊德融合术 "包括利用髓内钉进行Chopart截肢和踝关节关节固定术。这种技术通过控制后足为患者提供了一个坚硬的行走平台，并最大限度地保留了肢体长度。这种技术还有助于防止单纯 Chopart 截肢术带来的并发症，包括马蹄内翻足畸形和相关的远端残端足底压力增加，以及随后伤口发展和失败的高风险。

引用次数: 0

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