Pub Date : 2024-11-07DOI: 10.1016/j.fastrc.2024.100439
Brian Burgess DPM, FACFAS , Amber Kavanagh DPM, AACFAS , Paul DeFrino MD , David Garras MD
Arthrodesis of joints in the foot and ankle is a common treatment for end-stage arthritis, however the risk of nonunion remains apparent. The use of various orthobiologic agents to aid in bony union has shown to be beneficial due to ease of use, wide availability, and lack of autograft-associated donor site morbidity. The purpose of this study was to evaluate the use of bone graft combined with supplemental allograft-derived proteins in subjects who underwent surgical treatment for nonunion. A retrospective chart review of three surgeons was completed and found 16 patients undergoing revision fusion procedures for confirmed nonunion at 29 total articulation sites in the foot and ankle with an average follow up time of 12.7 months. Fusion across each joint was assessed using serial radiographs independently reviewed by a single, independent radiologist. Successful fusion was demonstrated in 28 out of 29 articulations (96.6 %) by six months, with an average time of 2.9 months to full fusion. No adverse events related to the graft, procedure, or hardware were reported. Supplemental allograft-derived proteins may be a safe and effective additive to support bony remodeling in arthrodesis procedures in the foot and ankle.
{"title":"Treatment of foot and ankle nonunions using supplemental allograft-derived proteins: A case series","authors":"Brian Burgess DPM, FACFAS , Amber Kavanagh DPM, AACFAS , Paul DeFrino MD , David Garras MD","doi":"10.1016/j.fastrc.2024.100439","DOIUrl":"10.1016/j.fastrc.2024.100439","url":null,"abstract":"<div><div>Arthrodesis of joints in the foot and ankle is a common treatment for end-stage arthritis, however the risk of nonunion remains apparent. The use of various orthobiologic agents to aid in bony union has shown to be beneficial due to ease of use, wide availability, and lack of autograft-associated donor site morbidity. The purpose of this study was to evaluate the use of bone graft combined with supplemental allograft-derived proteins in subjects who underwent surgical treatment for nonunion. A retrospective chart review of three surgeons was completed and found 16 patients undergoing revision fusion procedures for confirmed nonunion at 29 total articulation sites in the foot and ankle with an average follow up time of 12.7 months. Fusion across each joint was assessed using serial radiographs independently reviewed by a single, independent radiologist. Successful fusion was demonstrated in 28 out of 29 articulations (96.6 %) by six months, with an average time of 2.9 months to full fusion. No adverse events related to the graft, procedure, or hardware were reported. Supplemental allograft-derived proteins may be a safe and effective additive to support bony remodeling in arthrodesis procedures in the foot and ankle.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100439"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.fastrc.2024.100438
Lily Nguyen DPM , Brian B. Nielsen MD
Ankle varus can occur after a distal tibial fracture or a physis injury in the pediatric population, can be debilitating for these children as the deformity progresses. Severe ankle varus deformities in pediatric patients pose significant challenges in orthopedic and podiatric surgery. These deformities often impair ambulatory function, lead to pain, and increase the risk of joint degeneration if left untreated. There are a few literature reports on the surgical treatment for ankle varus in children, but none on a single-stage correction with double osteotomies with iliac crest graft and fibular autograft. This case report presents on a 13-year-old patient who underwent double osteotomie with the use of an iliac crest bone allograft and distal fibular autograft to correct a severe acquired ankle varus deformity. The patient sustained a Salter-Harris type III at the age of 8, underwent percutaneous reduction internal fixation for medial malleolar fracture, and went on to develop varus deformity with a premature asymmetrical growth plate. On plain radiography, the Tibial-Ankle Surface (TAS) angle was at 57°. He was elected for a single-stage closing wedge fibular osteotomy, opening wedge tibial osteotomy with bone grafts and internal fixation, and Achilles tendon lengthening as an adjunct procedure to correct the equinus which presented after the double osteotomies. After the correction, the mechanical axis deviation improved by 34.3 mm and the post-op TAS measured 89°.
小儿胫骨远端骨折或腓骨损伤后会出现踝关节内翻，随着畸形的发展，会使这些儿童的身体变得虚弱。儿童患者严重的踝关节内翻畸形给矫形外科和足病外科带来了巨大挑战。如果不及时治疗，这些畸形通常会影响活动功能，导致疼痛，并增加关节退化的风险。关于儿童踝关节内翻的手术治疗有一些文献报道，但没有一篇是关于使用髂嵴移植和腓骨自体移植双截骨进行单阶段矫正的。本病例报告介绍了一名 13 岁患者接受髂嵴骨异体移植和远端腓骨自体移植的双截骨手术，以矫正严重的后天性踝关节内翻畸形。患者在 8 岁时发生 Salter-Harris III 型骨折，接受了内侧踝骨骨折经皮复位内固定术，随后出现踝关节屈曲畸形和过早的不对称生长板。X光平片显示，胫踝面（TAS）角度为57°。他选择了单阶段闭合性楔形腓骨截骨术、开放性楔形胫骨截骨术（植骨和内固定）以及跟腱延长术作为辅助手术，以矫正双截骨术后出现的马蹄内翻足畸形。矫正后，机械轴偏差改善了 34.3 毫米，术后 TAS 测量值为 89°。
{"title":"Double osteotomies with iliac crest bone allograft and distal fibular autograft to correct a severe pediatric ankle varus deformity: A case report","authors":"Lily Nguyen DPM , Brian B. Nielsen MD","doi":"10.1016/j.fastrc.2024.100438","DOIUrl":"10.1016/j.fastrc.2024.100438","url":null,"abstract":"<div><div>Ankle varus can occur after a distal tibial fracture or a physis injury in the pediatric population, can be debilitating for these children as the deformity progresses. Severe ankle varus deformities in pediatric patients pose significant challenges in orthopedic and podiatric surgery. These deformities often impair ambulatory function, lead to pain, and increase the risk of joint degeneration if left untreated. There are a few literature reports on the surgical treatment for ankle varus in children, but none on a single-stage correction with double osteotomies with iliac crest graft and fibular autograft. This case report presents on a 13-year-old patient who underwent double osteotomie with the use of an iliac crest bone allograft and distal fibular autograft to correct a severe acquired ankle varus deformity. The patient sustained a Salter-Harris type III at the age of 8, underwent percutaneous reduction internal fixation for medial malleolar fracture, and went on to develop varus deformity with a premature asymmetrical growth plate. On plain radiography, the Tibial-Ankle Surface (TAS) angle was at 57°. He was elected for a single-stage closing wedge fibular osteotomy, opening wedge tibial osteotomy with bone grafts and internal fixation, and Achilles tendon lengthening as an adjunct procedure to correct the equinus which presented after the double osteotomies. After the correction, the mechanical axis deviation improved by 34.3 mm and the post-op TAS measured 89°.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.fastrc.2024.100440
Ramez Sakkab DPM, AACFAS , Michael Radcliffe DPM , Marta L. Riniker DPM, FACFAS , Jeffrey E. McAlister DPM, FACFAS
Gold standard treatment for a malunited collapsed calcaneal fracture is distraction subtalar joint arthrodesis with structural graft. Various grafts are have been reported in the literature with femoral head or iliac crest allograft being most common. The present case report demonstrates a case of a 64-year-old female who presented two years after attempted subtalar joint fusion. The patient had pain recalcitrant to conservative care with clear bony collapse on weight bearing radiography and complete non-union on computed tomography. A novel technique is presented wherein a dorsally based posterior calcaneal osteotomy is performed and the removed bone wedge placed into the subtalar fusion to serve as structural autograft. The patient remained non-weight-bearing for 8 weeks post-operatively. Computed tomography was obtained at 6 months after surgery noting greater than 40% osseous bridging. The patient had improvement in all symptomatology and had complete return to activity from her baseline before the index surgery. Technique is illustrated along with description of details.
{"title":"Subtalar distraction arthrodesis with autograft from simultaneous calcaneal wedge osteotomy: A novel technique","authors":"Ramez Sakkab DPM, AACFAS , Michael Radcliffe DPM , Marta L. Riniker DPM, FACFAS , Jeffrey E. McAlister DPM, FACFAS","doi":"10.1016/j.fastrc.2024.100440","DOIUrl":"10.1016/j.fastrc.2024.100440","url":null,"abstract":"<div><div>Gold standard treatment for a malunited collapsed calcaneal fracture is distraction subtalar joint arthrodesis with structural graft. Various grafts are have been reported in the literature with femoral head or iliac crest allograft being most common. The present case report demonstrates a case of a 64-year-old female who presented two years after attempted subtalar joint fusion. The patient had pain recalcitrant to conservative care with clear bony collapse on weight bearing radiography and complete non-union on computed tomography. A novel technique is presented wherein a dorsally based posterior calcaneal osteotomy is performed and the removed bone wedge placed into the subtalar fusion to serve as structural autograft. The patient remained non-weight-bearing for 8 weeks post-operatively. Computed tomography was obtained at 6 months after surgery noting greater than 40% osseous bridging. The patient had improvement in all symptomatology and had complete return to activity from her baseline before the index surgery. Technique is illustrated along with description of details.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the incidence of TB on the rise, despite rare involvement in the feet, TB can be difficult to diagnose in the feet leading to delayed treatment and severe complications. A 67 year old women presented at our outpatient clinic with a spontaneously occurring abscess and pain of the right foot. Initially, she was treated for a gout attack. However, after four months, X-ray and MRI imaging revealed extensive osteomyelitis and bony destruction of the midfoot. Diagnosis was established through tissue biopsy. She was treated with anti-tubercular therapy for 10 months during which the foot was immobilized in a total contact cast. Stabilization of the foot was achieved by two-stage operation utilizing fusion beams commonly used in het treatment of Charcot arthropathy. Tuberculosis of the foot can be difficult to diagnose, therefore a high level of suspicion is recommended for cases not responding to conventional therapy, even in the Western world. Early recognition and treatment with anti-tubercular therapy, the cornerstone in TB treatment, can prevent permanent damage. Surgical reconstruction is reserved for the most severe cases to correct deformity and prevent disability.
{"title":"Tuberculosis of the midfoot: A rare case report","authors":"Marijn Stelwagen MD , Wouter Brekelmans MD , Fanny Lauw MD, PhD , Menno Bénard MD, PhD , Wilbert van Laar MD","doi":"10.1016/j.fastrc.2024.100436","DOIUrl":"10.1016/j.fastrc.2024.100436","url":null,"abstract":"<div><div>With the incidence of TB on the rise, despite rare involvement in the feet, TB can be difficult to diagnose in the feet leading to delayed treatment and severe complications. A 67 year old women presented at our outpatient clinic with a spontaneously occurring abscess and pain of the right foot. Initially, she was treated for a gout attack. However, after four months, X-ray and MRI imaging revealed extensive osteomyelitis and bony destruction of the midfoot. Diagnosis was established through tissue biopsy. She was treated with anti-tubercular therapy for 10 months during which the foot was immobilized in a total contact cast. Stabilization of the foot was achieved by two-stage operation utilizing fusion beams commonly used in het treatment of Charcot arthropathy. Tuberculosis of the foot can be difficult to diagnose, therefore a high level of suspicion is recommended for cases not responding to conventional therapy, even in the Western world. Early recognition and treatment with anti-tubercular therapy, the cornerstone in TB treatment, can prevent permanent damage. Surgical reconstruction is reserved for the most severe cases to correct deformity and prevent disability.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1016/j.fastrc.2024.100434
Drishti Dhawan DPM, MPH, PGY-2 , Shadi Mattar DPM, PGY-2 , John T. Marcoux DPM, FACFAS
SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare and often misdiagnosed autoinflammatory condition characterized by an assortment of osteoarticular and dermatological manifestations. We report a case of a 27-year-old female who presented with undiagnosed SAPHO syndrome that mimicked acute osteomyelitis of the 5th digit. The patient had a one-month history of a painful erythematous and edematous 5th digit with intermittent fevers that were recalcitrant to both oral and intravenous antibiotics. Radiographic and advanced imaging displayed inflammatory osteitis, which is commonly seen in cases of osteomyelitis. The patient was referred to rheumatology and diagnosed with SAPHO syndrome. This diagnosis stemmed from the emergence of concurrent symptoms, including anterior chest pain, pustular acne, knee joint pain, and aphthous ulcerations, accompanied by intermittent low-grade fevers. The patient exhibited a notable response to the initiation of Humira, Methotrexate, and Plaquenil therapy. Although she has not fully reached her baseline, there has been a significant improvement in her condition. Our case report underscores the significance of considering atypical rheumatological diseases as potential differential diagnoses in the assessment of patients presenting with symptoms suggestive of chronic, recurrent osteomyelitis, particularly in instances where conventional treatments for infectious causes have proven ineffective.
{"title":"SAPHO syndrome mimicking acute osteomyelitis in the lower extremity: A case report","authors":"Drishti Dhawan DPM, MPH, PGY-2 , Shadi Mattar DPM, PGY-2 , John T. Marcoux DPM, FACFAS","doi":"10.1016/j.fastrc.2024.100434","DOIUrl":"10.1016/j.fastrc.2024.100434","url":null,"abstract":"<div><div>SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome is a rare and often misdiagnosed autoinflammatory condition characterized by an assortment of osteoarticular and dermatological manifestations. We report a case of a 27-year-old female who presented with undiagnosed SAPHO syndrome that mimicked acute osteomyelitis of the 5th digit. The patient had a one-month history of a painful erythematous and edematous 5th digit with intermittent fevers that were recalcitrant to both oral and intravenous antibiotics. Radiographic and advanced imaging displayed inflammatory osteitis, which is commonly seen in cases of osteomyelitis. The patient was referred to rheumatology and diagnosed with SAPHO syndrome. This diagnosis stemmed from the emergence of concurrent symptoms, including anterior chest pain, pustular acne, knee joint pain, and aphthous ulcerations, accompanied by intermittent low-grade fevers. The patient exhibited a notable response to the initiation of Humira, Methotrexate, and Plaquenil therapy. Although she has not fully reached her baseline, there has been a significant improvement in her condition. Our case report underscores the significance of considering atypical rheumatological diseases as potential differential diagnoses in the assessment of patients presenting with symptoms suggestive of chronic, recurrent osteomyelitis, particularly in instances where conventional treatments for infectious causes have proven ineffective.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100434"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/j.fastrc.2024.100433
Ramez Sakkab DPM, AACFAS , Michael J. Radcliffe DPM, AACFAS , Divya Paramasivam DPM , Jeffrey E. McAlister DPM, FACFAS
Modern advancements in total ankle arthroplasty techniques and implants have increased their popularity as treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision. However, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38 %. Minor dehiscence occurred in 6.00 % of cases, while major wounds or infections occurred in 3.62 %. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03 % before 2013 to 4.75 % after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing.
{"title":"Total ankle arthroplasty incision management: What Matters? A systematic review","authors":"Ramez Sakkab DPM, AACFAS , Michael J. Radcliffe DPM, AACFAS , Divya Paramasivam DPM , Jeffrey E. McAlister DPM, FACFAS","doi":"10.1016/j.fastrc.2024.100433","DOIUrl":"10.1016/j.fastrc.2024.100433","url":null,"abstract":"<div><div>Modern advancements in total ankle arthroplasty techniques and implants have increased their popularity as treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision. However, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38 %. Minor dehiscence occurred in 6.00 % of cases, while major wounds or infections occurred in 3.62 %. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03 % before 2013 to 4.75 % after 2013 (<em>p</em> = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (<em>p</em> > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing.</div></div><div><h3>Level of Clinical Evidence</h3><div>3</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100433"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.fastrc.2024.100432
Francisco Bouhon Chilao, Laurent Mustaki, Jean-François Fischer, Ceyran Hamoudi
Anterior ankle impingement, defined by pain with restricted dorsiflexion due to tibiotalar osteophytes and soft tissue impingement, commonly affects athletic patients with repetitive motions and those with prior ankle fractures. In chronic cases, conservative treatment is unlikely to be successful. Joint-sparing surgical options such as arthroscopic debridement or open arthrotomy with cheilectomy are recommended to alleviate symptoms and restore function.
This case report details a rare instance of anterior ankle impingement associated with substantial exostosis and concurrent ankle arthritis, necessitating an aggressive open anterior ankle cheilectomy. At last follow-up, the patient was able to resume normal activities and maintain satisfactory ankle joint range of motion, without requiring further revisional procedures.
{"title":"Open anterior Ankle cheilectomy as salvage procedure for anterior ankle impingement, a case report","authors":"Francisco Bouhon Chilao, Laurent Mustaki, Jean-François Fischer, Ceyran Hamoudi","doi":"10.1016/j.fastrc.2024.100432","DOIUrl":"10.1016/j.fastrc.2024.100432","url":null,"abstract":"<div><div>Anterior ankle impingement, defined by pain with restricted dorsiflexion due to tibiotalar osteophytes and soft tissue impingement, commonly affects athletic patients with repetitive motions and those with prior ankle fractures. In chronic cases, conservative treatment is unlikely to be successful. Joint-sparing surgical options such as arthroscopic debridement or open arthrotomy with cheilectomy are recommended to alleviate symptoms and restore function.</div><div>This case report details a rare instance of anterior ankle impingement associated with substantial exostosis and concurrent ankle arthritis, necessitating an aggressive open anterior ankle cheilectomy. At last follow-up, the patient was able to resume normal activities and maintain satisfactory ankle joint range of motion, without requiring further revisional procedures.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.fastrc.2024.100431
Thomas Milisits DPM, MPH , John Ellis Marshall IV DPM , Michael Siciliano DPM , Justin Garvin DPM , Jason Miller DPM, FACFAS
Total ankle total talus replacement (TATTR) is gaining popularity in the foot and ankle surgery world in patients with end-stage ankle arthritis with concomitant pathology to the talus. What we typically do not consider is metal hypersensitivity when it comes to these complex reconstructive procedures with a substantial amount of hardware. Future research should aim to gain a greater understanding of metal components in varying company materials to determine compatibility. We report a case of a healthy 62-year-old female who underwent TAR with numerous complications and revisions ultimately leading to a TATTR and suspected hypersensitivity reaction.
全踝关节距骨置换术（TATTR）在足踝外科领域越来越受欢迎，适用于患有终末期踝关节炎并伴有距骨病变的患者。我们通常没有考虑到的是，在进行这些复杂的、使用大量硬件的重建手术时，会出现金属过敏现象。未来的研究应着眼于进一步了解金属部件与不同公司材料的兼容性。我们报告了一例 62 岁健康女性的病例，她接受了 TAR 手术，出现了许多并发症和翻修，最终导致 TATTR 和疑似超敏反应。
{"title":"Total talus metallosis with ankle arthroplasty","authors":"Thomas Milisits DPM, MPH , John Ellis Marshall IV DPM , Michael Siciliano DPM , Justin Garvin DPM , Jason Miller DPM, FACFAS","doi":"10.1016/j.fastrc.2024.100431","DOIUrl":"10.1016/j.fastrc.2024.100431","url":null,"abstract":"<div><div>Total ankle total talus replacement (TATTR) is gaining popularity in the foot and ankle surgery world in patients with end-stage ankle arthritis with concomitant pathology to the talus. What we typically do not consider is metal hypersensitivity when it comes to these complex reconstructive procedures with a substantial amount of hardware. Future research should aim to gain a greater understanding of metal components in varying company materials to determine compatibility. We report a case of a healthy 62-year-old female who underwent TAR with numerous complications and revisions ultimately leading to a TATTR and suspected hypersensitivity reaction.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.fastrc.2024.100430
Timothy P. Cheung DPM, PhD, CPT , Khanh Phuong S. Tong DPM , Shanay Fischer DPM , Kayla Obradovic DPM, MS , Norman Wortzman DPM, FACPM, DABPM , Adam S. Landsman DPM, PhD, FACFAS
In the presence of hallux limitus/rigidus and an elevated 1–2 intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) arthrodesis (FUSION) is often chosen to simultaneously correct both issues; however, this procedure obliterates the first MTPJ function and can often shorten the first ray. Alternatively, the first MTPJ implant arthroplasty (IMPLANT) has the ability to preserve some motion at the joint and does not result in shortening. Despite its surgical utility in clinical restoration, there is a paucity of understanding surrounding the first MTPJ arthroplasty's effect on the IMA. To this end, we performed a retrospective cohort study comparing the changes in IMA in patients that received either a first MTPJ IMPLANT or first MTPJ FUSION at our institution between January 1, 2017 through December 31, 2021. Weightbearing AP films preoperatively and during the immediate (i.e., 4–8 weeks) postoperative period were used to evaluate changes in IMA. We identified 49 patients (20 IMPLANT, 29 FUSION). The IMA was reduced in patients that received FUSION (P < 0.0001) or IMPLANT (P < 0.0001). Surprisingly, we found that the amount of IMA reduction was similar in both groups. Therefore, we conclude that IMPLANT procedures reduce the IMA comparable to FUSION procedures during the immediate postoperative period. Moreover, the results of our work challenges the previous notions of adductor hallucis tendon involvement in IMA reduction in FUSION procedures.
Level of Clinical Evidence: IV, retrospective case series
在存在拇指外翻/内翻和1-2跖骨间角（IMA）增高的情况下，通常会选择第一跖趾关节（MTPJ）关节固定术（FUSION）来同时矫正这两个问题。另外，第一 MTPJ 植入关节成形术（IMPLANT）能够保留关节的部分运动，并且不会导致缩短。尽管第一 MTPJ 关节成形术在临床修复中非常有用，但人们对其对 IMA 的影响了解甚少。为此，我们进行了一项回顾性队列研究，比较了 2017 年 1 月 1 日至 2021 年 12 月 31 日期间在我院接受首次 MTPJ IMPLANT 或首次 MTPJ FUSION 的患者的 IMA 变化情况。术前和术后近期（即 4-8 周）的负重 AP 片用于评估 IMA 的变化。我们确定了 49 例患者（20 例植入式，29 例融合式）。接受 FUSION（P < 0.0001）或 IMPLANT（P < 0.0001）治疗的患者 IMA 有所减少。令人惊讶的是，我们发现两组患者的 IMA 减少量相似。因此，我们得出结论：在术后初期，IMPLANT 手术与 FUSION 手术相比可减少 IMA。此外，我们的研究结果还对以往认为 FUSION 手术中 IMA 的缩小涉及内收肌腱的观点提出了质疑：IV，回顾性病例系列
{"title":"First metatarsophalangeal joint implant arthroplasty reduces the first intermetatarsal angle similar to first metatarsophalangeal joint arthrodesis in short-term follow up","authors":"Timothy P. Cheung DPM, PhD, CPT , Khanh Phuong S. Tong DPM , Shanay Fischer DPM , Kayla Obradovic DPM, MS , Norman Wortzman DPM, FACPM, DABPM , Adam S. Landsman DPM, PhD, FACFAS","doi":"10.1016/j.fastrc.2024.100430","DOIUrl":"10.1016/j.fastrc.2024.100430","url":null,"abstract":"<div><div>In the presence of hallux limitus/rigidus and an elevated 1–2 intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) arthrodesis (FUSION) is often chosen to simultaneously correct both issues; however, this procedure obliterates the first MTPJ function and can often shorten the first ray. Alternatively, the first MTPJ implant arthroplasty (IMPLANT) has the ability to preserve some motion at the joint and does not result in shortening. Despite its surgical utility in clinical restoration, there is a paucity of understanding surrounding the first MTPJ arthroplasty's effect on the IMA. To this end, we performed a retrospective cohort study comparing the changes in IMA in patients that received either a first MTPJ IMPLANT or first MTPJ FUSION at our institution between January 1, 2017 through December 31, 2021. Weightbearing AP films preoperatively and during the immediate (i.e., 4–8 weeks) postoperative period were used to evaluate changes in IMA. We identified 49 patients (20 IMPLANT, 29 FUSION). The IMA was reduced in patients that received FUSION (<em>P</em> < 0.0001) or IMPLANT (<em>P</em> < 0.0001). Surprisingly, we found that the amount of IMA reduction was similar in both groups. Therefore, we conclude that IMPLANT procedures reduce the IMA comparable to FUSION procedures during the immediate postoperative period. Moreover, the results of our work challenges the previous notions of adductor hallucis tendon involvement in IMA reduction in FUSION procedures.</div><div><strong>Level of Clinical Evidence:</strong> IV, retrospective case series</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.fastrc.2024.100429
Nikita Grama DPM, AACFAS , Amber M. Kavanagh DPM, AACFAS , Brian J. Burgess DPM, FACFAS
First metatarsal comminuted fractures are rare and debilitating injuries. They can lead to a host of complications including infection, deformity, malalignment, transfer pressure, and early onset first metatarsophalangeal joint arthritis. They are not well reported in the literature and rarely involve the first metatarsal head. We present a case report of a 17 year-old patient who sustained an open comminuted fracture of the first metatarsal head after dropping a weight on his foot. This was treated with staged procedures, resulting in open reduction and reconstruction of the metatarsal head with placement of external fixator device. He went on to full bony union with resolution of pain, full return to activity, and salvage of the first metatarsophalangeal joint. This is an uncommon case that can lead to disastrous outcomes. The goal of this paper is to outline the steps for surgical reconstruction of the first metatarsal head in order to achieve a functional first ray while avoiding a first metatarsophalangeal joint arthrodesis in a young, active patient.
{"title":"Surgical management of an open, comminuted, intra-articular crush injury to the first metatarsal head: A unique case study","authors":"Nikita Grama DPM, AACFAS , Amber M. Kavanagh DPM, AACFAS , Brian J. Burgess DPM, FACFAS","doi":"10.1016/j.fastrc.2024.100429","DOIUrl":"10.1016/j.fastrc.2024.100429","url":null,"abstract":"<div><div>First metatarsal comminuted fractures are rare and debilitating injuries. They can lead to a host of complications including infection, deformity, malalignment, transfer pressure, and early onset first metatarsophalangeal joint arthritis. They are not well reported in the literature and rarely involve the first metatarsal head. We present a case report of a 17 year-old patient who sustained an open comminuted fracture of the first metatarsal head after dropping a weight on his foot. This was treated with staged procedures, resulting in open reduction and reconstruction of the metatarsal head with placement of external fixator device. He went on to full bony union with resolution of pain, full return to activity, and salvage of the first metatarsophalangeal joint. This is an uncommon case that can lead to disastrous outcomes. The goal of this paper is to outline the steps for surgical reconstruction of the first metatarsal head in order to achieve a functional first ray while avoiding a first metatarsophalangeal joint arthrodesis in a young, active patient.</div></div>","PeriodicalId":73047,"journal":{"name":"Foot & ankle surgery (New York, N.Y.)","volume":"4 4","pages":"Article 100429"},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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